Asociación entre Glucemia inestable, tiempo de estancia y mortalidad de pacientes en estado críticos: Estudio de cohorte / Associação Entre Glicemia Instável, Tempo de Permanência e Mortalidade de Pacientes Críticos: Estudo de Coorte / Relationships between unstable Glycemia, Hospital Length Of Stay, and mortality In Critically Ill patients: A cohort study

Resumen Introducción: El control y la evaluación de los niveles glucémicos de pacientes en estado críticos es un desafío y una competencia del equipo de enfermería. Por lo que, determinar las consecuencias de esta durante la hospitalización es clave para evidenciar la importancia del oportuno manejo. Objetivo: Determinar la asociación entre la glucemia inestable (hiperglucemia e hipoglucemia), el resultado de la hospitalización y la duración de la estancia de los pacientes en una unidad de cuidados intensivos. Metodología: Estudio de cohorte prospectivo realizado con 62 pacientes a conveniencia en estado crítico entre marzo y julio de 2017. Se recogieron muestras diarias de sangre para medir la glucemia. Se evaluó la asociación de la glucemia inestable con la duración de la estancia y el resultado de la hospitalización mediante ji al cuadrado de Pearson. El valor de p<0.05 fue considerado significativo. Resultados: De las 62 personas participantes, 50 % eran hombres y 50 % mujeres. La edad media fue de 63.3 años (±21.4 años). La incidencia de glucemia inestable fue del 45.2 % y se asoció con una mayor duración de la estancia en la UCI (p<0.001) y una progresión a la muerte como resultado de la hospitalización (p=0.03). Conclusión: Entre quienes participaron, la glucemia inestable se asoció con una mayor duración de la estancia más prolongada y con progresión hacia la muerte, lo que refuerza la importancia de la actuación de enfermería para prevenir su aparición.

Resumo Introdução: O controle e avaliação dos níveis glicêmicos em pacientes críticos é um desafio e uma competência da equipe de enfermagem. Portanto, determinar as consequências da glicemia instável durante a hospitalização é chave para evidenciar a importância da gestão oportuna. Objetivo: Determinar a associação entre glicemia instável (hiperglicemia e hipoglicemia), os desfechos hospitalares e o tempo de permanência dos pacientes em uma unidade de terapia intensiva. Métodos: Um estudo de coorte prospectivo realizado com 62 pacientes a conveniência em estado crítico entre março e julho de 2017. Foram coletadas amostras diariamente de sangue para medir a glicemia. A associação entre a glicemia instável com o tempo de permanência e o desfecho da hospitalização foi avaliada pelo teste qui-quadrado de Pearson. O valor de p <0,05 foi considerado significativo. Resultados: Das 62 pessoas participantes, 50% eram homens e 50% mulheres. A idade média foi de 63,3 anos (±21,4 anos). A incidência de glicemia instável foi de 45,2% e se associou a um tempo de permanência mais prolongado na UTI (p <0,001) e uma progressão para óbito como desfecho da hospitalização (p = 0,03). Conclusão: Entre os participantes, a glicemia instável se associou a um tempo mais longo de permanência e com progressão para óbito, enfatizando a importância da actuação da equipe de enfermagem para prevenir sua ocorrência.

Abstract Introduction: The control and evaluation of glycemic levels in critically ill patients is a challenge and a responsibility of the nursing team; therefore, determining the consequences of this during hospitalization is key to demonstrate the importance of timely management. Objective: To determine the relationship between unstable glycemia (hyperglycemia and hypoglycemia), hospital length of stay, and the hospitalization outcome of patients in an Intensive Care Unit (ICU). Methods: A prospective cohort study conducted with 62 critically ill patients by convenience sampling between March and July 2017. Daily blood samples were collected to measure glycemia. The correlation of unstable glycemia with the hospital length of stay and the hospitalization outcome was assessed using Pearson's chi-square. A p-value <0.05 was considered significant. Results: Among the 62 patients, 50% were male and 50% were female. The mean age was 63.3 years (±21.4 years). The incidence of unstable glycemia was 45.2% and was associated with a longer ICU stay (p<0.001) and a progression to death as a hospitalization outcome (p=0.03). Conclusion: Among critically ill patients, unstable glycemia was associated with an extended hospital length of stay and a progression to death, emphasizing the importance of nursing intervention to prevent its occurrence.

Prevenção do pé diabético: práticas de cuidados de usuários de uma unidade saúde da família / Prevención del pie diabético: prácticas de cuidados de usuarios de una unidad de salud de la familia / Prevention of diabetic foot: care practices among users of a family health unit

RESUMO Objetivo conhecer as práticas de cuidados com os pés realizadas por usuários com Diabetes Mellitus atendidos em uma Unidade de Saúde da Família. Método estudo descritivo, com abordagem qualitativa. Foram entrevistados 12 usuários com diagnóstico de Diabetes Mellitus atendidos por uma Unidade Saúde da Família de um município do interior do Estado do Rio Grande do Sul (RS). Resultados dentre os participantes predominaram mulheres, com ensino fundamental incompleto e baixa renda. Identificou-se cuidados importantes para a prevenção de lesão nos pés, que a maioria dos usuários não realizava, ou realizava incorretamente. Conclusão Os usuários têm dificuldade em realizar os cuidados com os pés de forma correta e de associar que cuidados básicos são importantes para a prevenção de lesão nos pés.

RESUMEN Objetivo conocer las prácticas de cuidados de los pies que realizan los pacientes con Diabetes Mellitus atendidos en una Unidad de Salud de la Familia. Método estudio descriptivo con enfoque cualitativo. Se entrevistaron a doce usuarios diagnosticados de Diabetes Mellitus, atendidos por una Unidad de Salud de la Familia en una ciudad del interior del Estado de Rio Grande do Sul (RS). Resultados entre los participantes predominaron las mujeres, con educación primaria incompleta y bajos ingresos. Se percibió que la mayoría de los usuarios no realizó, o realizó incorrectamente, cuidados importantes para prevenir lesiones en los pies. Conclusión los usuarios tienen dificultades para realizar correctamente los cuidados de los pies y para entender que los cuidados básicos son importantes para la prevención de lesiones en los pies.

ABSTRACT Objective to learn the foot care measures taken by users with Diabetes Mellitus treated at a Family Health Unit. Method for this qualitative, descriptive study, twelve users with a diagnosis of Diabetes Mellitus attending a Family Health Unit in a town in Rio Grande do Sul State (RS) were interviewed. Results the participants were predominantly women, had not completed lower secondary school and had little income. Important care for preventing foot injuries was identified, but was not performed or performed incorrectly by most users. Conclusion users found it difficult to perform foot care correctly and to make the association that basic care is important to prevent foot injury.

Protocolo de admisión del paciente diabetico. Un enfoque desde los factores básicos condicionantes y la agencia de autocuidado / Diabetic patient admission protocol. An approach from the basic conditioning factors and the self-care agency

El Consejo Internacional de Enfermeras (CIE) define a la Enfermería como los cuidados, autónomos y en colaboración, que se prestan a las personas de todas las edades, familias, grupos y comunidades, enfermos o sanos, en todos los contextos. Incluye la promoción de la salud, la prevención de la enfermedad y los cuidados de los enfermos, discapacitados y personas moribundas. A su vez Berbiglia y Banfield citan a Orem, ésta plantea que la práctica de la Enfermería en relación con los individuos se institucionaliza alrededor del proceso de una persona, la/el enfermera/o, que proporciona ayuda directa a otra persona, cuando ésta persona es total o parcialmente incapaz de ayudarse a sí misma en el cumplimiento de los cuidados diarios relacionados con la salud, a causa de la situación de salud existente. La misma autora define al estado de salud que indica la necesidad de asistencia enfermera como "la incapacidad de las personas de proporcionarse por sí mismas y continuamente el autocuidado (AC) de calidad y cantidad necesarios según las situaciones de la salud personal". Expresa también que los factores básicos condicionantes son "los factores internos o externos a los individuos que afectan sus habilidades para involucrarse en el autocuidado o afectan el tipo y cantidad de autocuidado requeridos". El objetivo, Sistematizar y acordar las intervenciones y cuidados de enfermería en la admisión del paciente con diabetes, con un enfoque desde los factores básicos condicionantes del autocuidado y la capacidad de la agencia de Autocuidado, que ingresan al servicio de urgencias de adultos, de un Hospital público, 2020. En este sentido el profesional de Enfermería cumple un rol fundamental dentro del equipo de salud para identificar el déficit de autocuidado y promover, gestionar e impulsar diversas estrategias para la promoción de la salud, la prevención de la enfermedad y su tratamiento[AU]

O Conselho Internacional de Enfermeiras (ICN) define Enfermagem como cuidado autônomo e colaborativo, prestado a pessoas de todas as idades, famílias, grupos e comunidades, doentes ou saudáveis, em todos os contextos. Inclui a promoção da saúde, a prevenção de doenças e o atendimento de doentes, deficientes e moribundos. Berbiglia e Banfield, por sua vez, citam Orem, que afirma que a prática de enfermagem em relação aos indivíduos é institucionalizada em torno do processo de uma pessoa, a enfermeira, que fornece ajuda direta a outra pessoa, quando essa pessoa é total ou parcialmente incapaz de ajudar a si mesma na realização dos cuidados diários relacionados à saúde, devido à situação de saúde existente. O mesmo autor define o estado de saúde que indica a necessidade de assistência de enfermagem como "a incapacidade das pessoas de proverem a si mesmas e continuamente o autocuidado (CA) de qualidade e quantidade necessárias de acordo com as situações de saúde pessoal". Também expressa que os fatores condicionantes básicos são "fatores internos ou externos aos indivíduos que afetam suas habilidades para se envolver em autocuidado ou afetam o tipo e a quantidade de autocuidado necessária". O objetivo sistematizar e acordar intervenções e cuidados de enfermagem na admissão do paciente com diabetes, com foco nos fatores condicionantes básicos do autocuidado e na capacidade da agência de Autocuidado, que entra no pronto-socorro de adultos, de um hospital público, 2020. Nesse sentido, o profissional de enfermagem desempenha papel fundamental dentro da equipe de saúde para identificar o déficit de autocuidado e promover, gerenciar e promover diversas estratégias de promoção da saúde, prevenção e tratamento de doenças[AU]

The International Nurses Council (INC ­ 2015) defines Nursery as the independent and accompanied care given to people of all ages, ethnicity, gender, rather family, group and communities, ill or heathy in all sort of contexts. Including Heath`s promotion, sickness prevention and different cares of patients, disable and dying people. In turn, Berbiglia and Banfield cite Orem, which states that the practice Nursing practice as the relationship individuals, which is institutionalized around the process of one person the Nurse, the one who helps directly to the other person, when this one is not fully or partially capable on their own means to help themselves to take charge of their daily health care, caused by the actual health situation remaining. The same author defines the state of health that indicates the Nurses assistance as "The non-capacity of people to assure by themselves the continued self-care, nor in quality and quantity necessary according to the situation of personal health". On the other hand, the author, also states that the basic conditioning factors are "internal or external factors handled by individuals who affect their abilities to engage in self-care or affect the type and amount of self-care required ". The objective is to systematize and agree on interventions and nursing care in the admission of the patient with diabetes, with an approach from the basic conditioning factors of self-care and the capacity of the Self-care agency, who enter the emergency department of adults, of a public hospital, 2020 In this sense, the nursing professional plays a fundamental role within the health team to identify the deficit of self-care and promote, manage and promote various strategies for health promotion, disease prevention and treatment[AU]

Cuidado multiprofissional em saúde de crianças e adolescentes com diabetes: estudo da literatura / Multiprofessional caution in health of children andteenagers with diabetes: literature study

Objetivo: descrever o cuidado multiprofissional em saúde para as crianças e adolescentes com Diabetes Mellitus. Método: revisão integrativa, de caráter descritivo e qualitativo. Realizado na Scientific Electronic Library Online (SciELO) e Google acadêmico, com a coleta de dados em junho de 2021. Mediante critérios de inclusão e exclusão e cruzamento dos descritores, foram selecionadas 8 publicações sobre o tema. Os resultados foram expostos em dois quadros. Resultados e discussões: Prevaleceram artigos dos anos de 2020 sobre o tema. A maioria das revistas publicadas são da área da enfermagem. Educar em saúde, torna-se essencial no acompanhamento e manutenção da diabetes. O adoecimento das crianças e adolescentes com DM, repercute em toda a família. Conclusão: A abordagem multiprofissional é extremamente importante, por cuidar da criança/adolescente, mas de todos os envolvidos, orientando as intervenções e potencializando o cuidado no domicílio.(AU)

Objective: to describe the multidisciplinary health care for children and adolescents with Diabetes Mellitus. Method: integrative review, descriptive and qualitative. Carried out at: Scientific Electronic Library Online (SciELO) and academic Google, with data collection in June 2021. Through inclusion and exclusion criteria and crossing of descriptors, 8 publications on the subject were selected. The results were displayed in two tables. Results and discussions: Articles from the 2020s on the subject prevailed. Most journals published are in the field of nursing. Health education becomes essential in monitoring and maintaining diabetes. The illness of children and adolescents with DM affects the whole family. Conclusion: The multidisciplinary approach is extremely important, as it takes care of the child/adolescent, but of all those involved, guiding interventions and enhancing home care.(AU)

Objetivo: describir la atención de salud multidisciplinaria para niños y adolescentes con Diabetes Mellitus. Método: revisión integradora, descriptiva y cualitativa. Realizado en: Scientific Electronic Library Online (SciELO) y Google académico, con recolección de datos en junio de 2021. Mediante criterios de inclusión y exclusión y cruce de descriptores, se seleccionaron 8 publicaciones sobre el tema. Los resultados se muestran en dos tablas. Resultados y discusiones: prevalecieron los artículos de la década de 2020 sobre el tema. La mayoría de las revistas publicadas pertenecen al campo de la enfermería. La educación sanitaria se vuelve fundamental para controlar y mantener la diabetes. La enfermedad de los niños y adolescentes con DM afecta a toda la familia. Conclusión: El abordaje multidisciplinario es de suma importancia, ya que se ocupa del niño / adolescente, pero de todos los involucrados, orientando las intervenciones y potenciando la atención domiciliaria.(AU)

Addressing Hospital-Acquired Hypoglycemia.

BACKGROUND: Hospitalized patients who have diabetes often experience hospital-acquired hypoglycemia, a potentially serious adverse event; as a result, management of this condition has become an important quality of care indicator in the inpatient environment. A growing body of research and evidence-based clinical guidelines support proper timing of point of care (POC) blood glucose (BG) measurements, mealtime insulin administration, and meal delivery to reduce the incidence of both hypoglycemic and hyperglycemic events. Monitoring and improving the timing of these three patient care interventions are recognized as a crucial step in the safe and effective care of patients with diabetes. PURPOSE: The objective of the QI project was to improve the timing of mealtime insulin administration related to bedside BG monitoring and meal delivery for patients with diabetes who receive mealtime insulin; a secondary goal was to decrease the number of episodes of recurrent hypoglycemia. The overall strategy was to change staff members' approach to mealtime insulin management from a series of individual tasks to a process-oriented collaborative approach. METHODS: Nurses on the medical-surgical unit at one hospital within a large health system formed a QI team with staff members in information technology and food and nutrition services. The team implemented an eight-week QI pilot project (July 3 to August 26, 2017) using a multidisciplinary approach to coordinate between POC BG measurement, mealtime insulin administration, and meal delivery. RESULTS: More than two years after the hospital-wide rollout of the practice change, follow-up analysis has shown that, on both noncritical and critical care units, recurrent hypoglycemia has decreased. For example, comparing data obtained in a six-month period before the pilot project (November 2016 through April 2017) with the same six-month period in 2018 and 2019, more than a year after the pilot project, the percentage of patient stays (admissions) on noncritical care units in which there was a recurrence of hypoglycemia fell from 41.8% (of 1,162 total hospital admissions) to 35.1% (of 792 total hospital admissions); similarly, the percentage of patient stays on critical care units in which recurrent hypoglycemia occurred decreased from 36.8% to 22.8%. CONCLUSIONS: Findings suggest that ensuring a consistent 30-minute window between POC BG measurement and meal delivery enabled nursing staff to perform timely POC BG measurements and administer a more optimal mealtime insulin dose. Increasing interdisciplinary communication, collaboration, and awareness of best practice guidelines relating to proper mealtime insulin administration resulted in a sustained improvement in timing between POC BG measurements and mealtime insulin administration and between mealtime insulin administration and meal delivery.

Diabetes Mellitus Self-Management to Decrease the Risk for Chronic Kidney Disease.

Diabetes mellitus is the leading cause of chronic kidney disease (CKD). Managing diabetes mellitus is challenging. and patients have difficulty understanding self-management of the disease. The existing literature on self-management and patient-to-nurse relationships offers a deeper understanding of the challenges for patients with diabetes mellitus, their risk of CKD, how self-management impacts that risk, and how nurses can enhance self-management. Improving self-management of diabetes mellitus can decrease the risk for CKD. Essential self-management strategies to improve the quality of life of patients with diabetes mellitus include self-care behaviors, monitoring biological measures, and medication adherence.

Impact of diabetes specialist nurses on inpatient care: A systematic review.

BACKGROUND: People with diabetes have longer hospital stays and poorer clinical outcomes. Diabetes inpatient specialist nurses have been introduced to improve care. AIMS: To assess the evidence for the benefit of diabetes specialist nurses in the inpatient setting. METHODS: A systematic search of MEDLINE (ovid), Embase (ovid), CINAHL (EBSCO) and Web of Science core collection from January 1998 to September 2019 was performed using key terms for diabetes specialist nurses and hospital setting. Studies measuring patient care using any standardised or validated outcome measures after introduction of a dedicated diabetes specialist nurse or nursing team were eligible for inclusion and findings reported by narrative synthesis. RESULTS: There were 10 studies which met the inclusion criteria. One was a randomised controlled study and the remaining nine studies were before and after studies with three of them using a time series analysis methodology. The majority reported length of stay (LOS) and showed a reduction in median LOS by between 0.5 and 3 days. Reductions in bed occupancy ranged from 39% to 47%. There was a paucity of evidence for outcomes related to patient care with some measures limited to single studies. These included a 52% reduction in total drug errors, improved patient knowledge, higher patient satisfaction and improved glycaemic control post-discharge. There was no reduction of mortality observed. CONCLUSIONS: These studies suggest a reduction in LOS and improved clinical care for patients with diabetes after the introduction of diabetes inpatient specialist nurses. Future research should examine a range of benefits associated with diabetes inpatient specialist nurse delivered services, including reduction of inpatient complications such as infections and cardiovascular events.

Diabetes Mellitus: estratégias de educação em saúde para o autocuidado / Diabetes Mellitus: health education strategies for self-care / Diabetes Mellitus: estrategias de educación en salud para el cuidado personal

Objetivo: descrever as principais estratégias realizadas ao longo dos quatro anos da ação de extensão Agir e Educar (em) frente o Diabetes Mellitus. Método: trata-se de um estudo qualitativo, descritivo, tipo relato de experiência, desenvolvido a partir de relatórios anuais e arquivos diversos da ação de extensão Agir e Educar (em) frente o Diabetes Mellitus. Resultados: elencaram-se os resultados a partir de três categorias: Grupo Agir e Educar; Atenção individual como estratégia do cuidado e Educação em saúde nas redes sociais ou redes sociais como estratégia viável para a educação em saúde. Conclusão: nota-se que o grupo Agir e Educar (em) frente o Diabetes Mellitus desenvolveu diferentes ações educativas no intuito de proporcionar estratégias para a melhoria da qualidade de vida da pessoa com Diabetes Mellitus, a partir da ótica do conceito ampliado de saúde, que preza pela autonomia e pelo empoderamento dos indivíduos. Ressalta-se, como contribuição para a área da Saúde, a utilização das mídias sociais para se alcançar um maior número de pessoas e disseminar conhecimento.(AU)

Objective: to describe the main strategies carried out over the four years of the extension action Act and Educate in the Face of Diabetes Mellitus. Method: it is a qualitative, descriptive, experience report type study, developed from annual reports and various files of the extension action Act and Educate in the face of Diabetes Mellitus. Results: The results were listed from three categories: Act and Educate Group; Individual Care as a Care Strategy and Health Education in Social Networks or Social Networks as a viable strategy for Health Education. Conclusion: It is noted that the group Act and Educate in the face of Diabetes Mellitus developed different educational actions in order to provide strategies for improving the quality of life of the person with Diabetes Mellitus, from the perspective of the expanded concept of health, which values the autonomy and empowerment of individuals. As a contribution to the Health area, the use of social media to reach a greater number of people and spread knowledge is highlighted.

Objetivo: describir las principales estrategias llevadas a cabo durante los cuatro años de la acción de extensión Actuar y Educar contra la Diabetes Mellitus. Método: se trata de un estudio cualitativo, descriptivo, tipo informe de experiencia, desarrollado en base a informes anuales y diferentes archivos de la acción de extensión Actuar y Educar (en) contra la Diabetes Mellitus. Resultados: se enumeraron los resultados mediante tres categorías: Grupo Agir e Educar; La atención individual como estrategia de atención y la Educación para la salud en redes sociales o redes sociales como estrategia viable para la educación en salud. Conclusión: se observa que el grupo Agir y Educar (en) contra a la Diabetes Mellitus desarrolló diferentes acciones educativas con el fin de brindar estrategias para mejorar la calidad de vida de las personas con Diabetes Mellitus, desde la perspectiva del concepto ampliado de salud, que valora la autonomía y el empoderamiento de las personas. Como aporte al área de Salud, se destaca el uso de las redes sociales para llegar a un mayor número de personas y difundir el conocimiento.(AU)

Development of the professional role of diabetes nurses in specialised diabetes and primary care in Catalonia / Desarrollo del rol profesional de la enfermera en diabetes en Cataluña en atención especializada y en atención primaria

OBJECTIVES: The aim of this study was to describe therapeutic education programmes in diabetes in Catalonia and the differences according to the healthcare setting in which the patients are attended (primary care [PC] and specialised diabetes care [SDC]). METHOD: We performed a descriptive, cross-sectional, comparative study of diabetes nurses (DN) in SDC and PC in Catalonia. The sample was obtained from all the DN in SDC and a randomised cluster sample of DN in PC. The questionnaire of the Study of European Nurses in Diabetes (SEND) validated in Spanish was used. RESULTS: A total of 287 questionnaires were analysed (24.3% SDC and 75.6% PC). More training in diabetes through masters, postgraduate courses and continuing education was observed in SDC (p < 0.001) as well as structured, written, education programmes and the combination of individual and group education strategies (p < 0.05). The roles of educator, consultant, researcher, manager, liaison or collaborator and innovator and the telematic follow-up of patients was also more developed in SDC (p < 0.05). The grade of work satisfaction was elevated in both groups. CONCLUSIONS: (1) Nursing professionals in SDC assume more roles of specialised clinical nursing and also have more training in diabetes and therapeutic education than PC professionals. (2) Professionals in SDC work with a greater proportion of structured diabetes therapeutic education programmes although this should improve in both settings. According to the results obtained and the scientific evidence currently available, the training of DN working in the care of people with diabetes should be accredited in order to increase the use of structured programmes and investigation by DNs in both healthcare settings

OBJETIVOS: Describir la educación terapéutica en diabetes en Cataluña y las diferencias según el ámbito asistencial donde esta se imparte (asistencia primaria [AP] y asistencia especializada [AE]). MÉTODO: Estudio descriptivo, transversal y comparativo en PE de AE y de AP en Cataluña. La muestra se obtuvo a partir de todos los PE de AE y una muestra aleatoria por conglomerados de PE de AP. Se utilizó el cuestionario del Study of European Nurses in Diabetes validado al español. RESULTADOS: Se analizaron 287 cuestionarios (24,3% AE y 75,6% AP). Se observó más formación en diabetes a nivel de máster, posgrado y formación continuada en AE (p < 0,001). Más programas de educación estructurada, escritos y que combinan las estrategias de educación individual y grupal en AE (p < 0,05). Los roles educador, asesor, investigador, director, colaborador e innovador así como el seguimiento de pacientes vía telemática están más desarrollados en AE (p < 0,05). En ambos grupos el grado de satisfacción laboral es elevado. CONCLUSIONES: 1) Los profesionales de enfermería de AE asumen más roles de enfermera clínica especialista, además de tener más formación en diabetes y educación terapéutica que los profesionales de AP. 2) En AE se trabaja en mayor proporción con programas de ETD estructurados pero en ambos ámbitos se debería mejorar. De acuerdo con los resultados obtenidos y la evidencia científica disponible sería necesario acreditar la formación de los PE que trabajan en la atención de personas con diabetes, aumentar la utilización de programas estructurados y la investigación propia en ambos ámbitos de asistencia

The nursing outlook of the self- and family management support programs among Indonesian with diabetes: An umbrella review.

BACKGROUND AND AIMS: Diabetes is one of the most critical diseases particularly in developing countries such as Indonesia. Various diabetes approaches have been well conducted to prevent complications. However, little has been discussed in association with the achievement of self- and family management support programs in Indonesia. Thus, the objective of the umbrella review is to evaluate the implementation of the self- and family management support programs among Indonesian with diabetes. METHOD: To guide this review, the revised self- and family management framework developed by Grey, Schulman-Green, Knafl, and Reynolds (2015) was used. A literature search was conducted via online databases including Cochrane, Scopus, ProQuest, SAGE, EBSCO, and PubMed. The inclusion criteria were diabetes studies related to self- and family management in Indonesia; articles published from 2000 to 2019; quantitative, qualitative, and review studies; used humans as research subjects; and English articles were prioritized. Meanwhile, the exclusion criteria were studies not addressing the nature of self- and family management in Indonesia, laboratory-based research using human cell and study protocol. RESULTS: A total of 78 studies were involved in the final analysis. The facilitators and barriers, process, and outcomes (distal and proximal) were presented. The results indicated that the implementation of the self- and family management process generated favorable outcomes for the diabetes population in Indonesia. CONCLUSIONS: The self- and family management support program is a promising strategy to improve the facilitators and overcome the barriers to diabetes care. Patients, families, diabetes nurses, and health policymakers are recommended to work in tandem to achieve successful diabetes care, particularly in the community.

The impact of the COVID-19 pandemic on people with diabetes and diabetes services: A pan-European survey of diabetes specialist nurses undertaken by the Foundation of European Nurses in Diabetes survey consortium.

AIM: To describe diabetes nurses' perspectives on the impact of the COVID-19 pandemic on people with diabetes and diabetes services across Europe. METHODS: An online survey developed using a rapid Delphi method. The survey was translated into 17 different languages and disseminated electronically in 27 countries via national diabetes nurse networks. RESULTS: Survey responses from 1829 diabetes nurses were included in the analysis. The responses indicated that 28% (n = 504) and 48% (n = 873) of diabetes nurses felt the COVID-19 pandemic had impacted 'a lot' on the physical and psychological risks of people with diabetes, respectively. The following clinical problems were identified as having increased 'a lot': anxiety 82% (n = 1486); diabetes distress 65% (n = 1189); depression 49% (n = 893); acute hyperglycaemia 39% (n = 710) and foot complications 18% (n = 323). Forty-seven percent (n = 771) of respondents identified that the level of care provided to people with diabetes had declined either extremely or quite severely. Self-management support, diabetes education and psychological support were rated by diabetes nurse respondents as having declined extremely or quite severely during the COVID-19 pandemic by 31% (n = 499), 63% (n = 1,027) and 34% (n = 551), respectively. CONCLUSION: The findings show that diabetes nurses across Europe have seen significant increases in both physical and psychological problems in their patient populations during COVID-19. The data also show that clinical diabetes services have been significantly disrupted. As the COVID-19 situation continues, we need to adapt care systems with some urgency to minimise the impact of the pandemic on the diabetes population.

Consulta à beira do leito e os diagnósticos de enfermagem em pessoas com diabetes mellitus / Bedside nursing consultation and nursing diagnoses in people with diabetes mellitus / Consulta de enfermería a la beira del lecho y los diagnósticos de enfermería en la en personas con diabetes mellitus

Objetivo: Identificar o perfil sociodemográfico, clínico e os diagnósticos de enfermagem pessoas com diabetes mellitus estabelecidos em consultas de enfermagem à beira do leito. Método: Estudo observacional descritivo, realizado em 2017 com 37 participantes, amostra não probabilística, em unidade de clínica médica ou cirúrgica de um hospital escola do sul do Brasil. Variáveis do estudo: dados sociodemográficos, clínicos e diagnósticos de enfermagem da North American Nursing Diagnosis Association, submetidos à estatística descritiva simples. Resultados: 89,21% dos participantes diabéticos tipo 2; tempo médio de diagnóstico de 9,6 anos; 70,2% hipertensos; 56,7% tabagistas; 16,2% insulinodependentes; 32,4% faziam uso de açúcar refinado; 59,45% associavam dois ou mais carboidratos na mesma refeição. Os diagnósticos mais frequentes: Risco de glicemia instável (97,37%), Risco de infecção (97,37%), Conhecimento deficiente (81,58%), Estilo de vida sedentário (60,53%), Controle ineficaz da saúde (60,53%). Conclusão: A identificação do perfil e dos diagnósticos de enfermagem possibilita melhor planejamento de enfermagem

Objective: To identify the sociodemographic, clinical profile and nursing diagnoses established through bedside nursing consultation in people with diabetes mellitus. Method: Descriptive observational study, conducted in 2017 with 37 participants (non-probabilistic sample), in a medical or surgical clinic unit of a school hospital in southern Brazil. Study variables: sociodemographic, clinical and nursing diagnoses according to the North American Nursing Diagnosis Association, submitted to simple descriptive statistics. Results: 89.21% type 2 diabetic; mean time of diagnosis of 9.6 years; 70.2% hypertensive; 56.7% smokers; 16.2% insulin-dependent; 32.4% used refined sugar; 59.45% associated two or more carbohydrates in the same meal. The most frequent diagnoses: Risk for unstable blood glucose level(97.37%), Risk for infection (97.37%), Deficient knowledge (81.58%), Sedentary lifestyle (60.53%), Ineffective health management (60.53%). Conclusion: The identification of profile and nursind diagnoses enables better nursing planning

Objetivo: Identificar el perfil sociodemográfico, clínico y diagnósticos de enfermería establecidos en la consulta de enfermería a la beira del lechoen personas con diabetes mellitus. Método: Estudio observacional descriptivo, realizado en 2017 con 37 participantes (muestra no probabilística), en unidad de clínica médica o quirúrgica de un hospital escuela del sur de Brasil. Variables del estudio: datos sociodemográficos, clínicos y diagnósticos de enfermería según la North American Nursing Diagnosis Association, sometidas a la estadística descriptiva simple. Resultados:89,21% diabéticos tipo 2; tiempo promedio de diagnóstico de 9,6 años; 70,2% hipertensos; 56,7% fumadores; 16,2% insulinodependientes; 32,4% hacía uso de azúcar refinado; 59,45% asociaba dos o más carbohidratos en la misma comida. Diagnósticos más frecuentes: Riesgo de glucemia inestable (97,37%), Riesgo de infección (97,37%), Conocimiento deficiente (81,58%), Estilo de vida sedentario (60,53%), Control ineficaz de la salud (60,53%). Conclusión: La identificación del perfil y de los diagnósticos de enfermería posibilita mejor planificación de enfermería

Eficácia dos protocolos de enfermagem direcionados ao paciente com complicações diabéticas / Effectiveness of patient-directed nursing protocols with diabetic complications / Eficacia de los protocolos de enfermería dirigidos al paciente con complicaciones diabéticas

Objetivo: Investigar na literatura científica a eficácia dos protocolos de enfermagem direcionados ao paciente com complicações diabéticas. Método: Revisão integrativa, realizada de agosto a setembro de 2019, seguindo as recomendações do PRISMA. As bases de dados utilizadas foram: Web of Science e Scopus, através dos cruzamentos: "Diabetes Mellitus AND Nursing AND Protocols" e "Amputation AND Nursing AND Protocols". Identificaram-se 672 artigos, sendo selecionados 17. Resultados: A maior parte dos estudos foram publicados em inglês e realizados nos Estados Unidos. Verificaram-se protocolos de controle glicêmico, da cetoacidose e do autocuidado, os quais apresentaram bons resultados para o que se propõem. Um artigo abordou superficialmente os cuidados de enfermagem direcionados a pessoas com amputação. Conclusão: Os protocolos de enfermagem direcionados ao paciente com complicações diabéticas apresentaram-se eficazes.

Objective: To investigate in the scientific literature the effectiveness of nursing protocols directed to patients with diabetic complications. Method: Integrative review, conducted from August to September 2019, following the recommendations of the PRISMA.The databases used were: Web of Science and Scopus, through the crossovers: "Diabetes Mellitus AND Nursing AND Protocols" and "Amputation AND Nursing AND Protocols". A total of 672 articles were identified and 17were selected. Results: Most studies were published in English and conducted in the United States. Glycemic control, ketoacidosis and self-care protocols were verified, which presented good results for their purpose. One article superficially addressed nursing care directed to people with amputation. Conclusion: Nursing protocols directed to patients with diabetic complications were effective

Objetivo: Investigar en la literatura científica la efectividad de los protocolos de enfermería dirigidos a pacientes con complicaciones diabéticas. Método: Revisión integradora, realizada de agosto a septiembre de 2019, siguiendo las recomendaciones de PRISMA. Las bases de datos utilizadas fueron: Web of Science y Scopus, a través de los crossovers: "Diabetes Mellitus AND Enfermería AND Protocolos" y "Amputación AND Enfermería AND Protocolos". Se identificaron un total de 672 artículos y se seleccionaron 17. Resultados: La mayoría de los estudios se publicaron en inglés y se realizaron en los Estados Unidos. Se verificaron los protocolos de control glucémico, cetoacidosis y autocuidado, que presentaron buenos resultados para su propósito. Un artículo abordó superficialmente la atención de enfermería dirigida a personas con amputación. Conclusión: Los protocolos de enfermería dirigidos a pacientes con complicaciones diabéticas fueron efectivos

Validação de instrumento para investigação do conhecimento de enfermeiros sobre pé diabético / Validación del instrumento para la investigación del conocimiento de enfermeros sobre pie diabético / Validation of an instrument to investigate nurses' knowledge on diabetic foot

RESUMO Objetivo: construir e validar um instrumento para investigação do conhecimento de enfermeiros da Atenção Primária à Saúde sobre pé diabético. Método: estudo metodológico realizado de janeiro a junho de 2017, que seguiu o Modelo de Elaboração de Escalas Psicométricas de Pasquali, em três etapas: teórica, empírica e analítica. Para validação de conteúdo, adotou-sea técnica de Delphi em dois momentos, com a participação de 10 juízes. A validade de construto foi realizada por 73 enfermeiros que atuavam nos serviços de APS do município de Campina Grande-PB. Aos dados, aplicou-se o Índice de Validação de Conteúdo (IVC). Resultados: construiu-se o "Questionário de Investigação do Conhecimento do Enfermeiro sobre Pé Diabético (QICEPeD)" com 47 itens organizados em 12 domínios de conhecimentos sobre a temática. Após a segunda rodada de avaliação dos juízes, todos os itens atingiram escores máximos de concordância (IVC = 1,00). A análise da confiabilidade e da consistência interna total do instrumento foi considerada elevada (α=0,860). Conclusão: o instrumento QICEPeD foi considerado válido, quanto ao conteúdo e construto, podendo ser utilizado para avaliar o conhecimento de enfermeiros da Atenção Primária sobre pé diabético.

RESUMEN Objetivo: construir y validar un instrumento para la investigación del conocimiento de enfermeros de la Atención Primaria de la Salud (APS) sobre pie diabético. Método: estudio metodológico realizado de enero a junio de 2017, que siguió el Modelo de Elaboración de Propiedades Psicométricas de Pasquali, en tres etapas: teórica, empírica y analítica. Para la validación de contenido, se adoptó el método de Delphi en dos momentos, con la participación de 10 jueces. La validez del constructo fue realizada por 73 enfermeros que actuaban en los servicios de APS del municipio de Campina Grande-PB-Brasil. Para los datos, se aplicó el Índice de Validez de Contenido (IVC). Resultados: se construyó el "Cuestionario de Investigación del Conocimiento del Enfermero sobre Pie Diabético (CICEPeD)" con 47 ítems organizados en 12 dominios de conocimientos sobre la temática. Después de la segunda ronda de evaluación de los jueces, todos los elementos alcanzaron puntajes máximos de concordancia (IVC=1,00). El análisis de la confiabilidad y de la consistencia interna total del instrumento fue considerado alto (α=0,860). Conclusión: el instrumento CICEPeD fue considerado válido, en cuanto al contenido y constructo, pudiendo ser utilizado para evaluar el conocimiento de enfermeros de la Atención Primaria sobre pie diabético

ABSTRACT Objective: to construct and validate an instrument to investigate the knowledge of Primary Health Care nurseson diabetic foot. Method: methodological study carried out from January to June 2017, followed the Development Model for Psychometric Scales by Pasquali, in three stages: theoretical, empirical and analytical. In order to validate the content, the Delphi technique was adopted in two moments, with the participation of 10 judges. Construct validity was performed by 73 nurses who worked in PHC services in the municipality of Campina Grande-PB. The Content Validation Index (CVI) was applied to the data. Results: the "Questionnaire for Investigating Nurses' Knowledge on Diabetic Foot (QICEPeD, as per its Portuguese acronym)" was constructed with 47 elements organized into 12 domains of knowledge on the topic. After the second round of judges' assessment, all elements reached maximum agreement scores (CVI = 1.00). The analysis of the instrument's reliability and total internal consistency was considered high (α=0.860). Conclusion: the QICEPeD instrument was considered valid, in terms of content and construct, and can be used to assess the level of knowledge of Primary Care nurses on diabetic foot.

Improved foot management of people with diabetes by primary healthcare nurses in Auckland, New Zealand.

AIMS: Evaluate trends in foot examinations for people with diabetes by primary healthcare nurses between 2006-2008 and 2016 in Auckland, New Zealand. METHODS: All primary care nurses in 2006-2008 and 2016 were identified and 26% and 24% were randomly sampled and surveyed, respectively. Nurse participants completed a self-administered questionnaire and telephone interview about the care provided for people with diabetes. RESULTS: Significantly more patients consulted by practice nurses received foot examinations in 2016 (58%) compared with 2006-2008 (36%), and foot-care education (66% versus 26%). Of the 43% of patients who had no foot examination in 2016, 23% had no previous examination documented. Significantly more nurses in 2016 than in 2006-2008 self-reported routinely examining patients' feet (45% versus 31%) and giving foot-care education (28% versus 13%). These practices were associated with nurses undertaking >5 hours of diabetes education within the past five years. CONCLUSIONS: Practice nurses have significantly expanded their role in managing people with diabetes over the last decade by increasing the number of foot examinations and providing recommended foot-care education. Improved management was associated with nurses attending diabetes education in the past five years. Gaps were identified in conducting the recommended number of foot examinations, categorising patients' risk of foot disease and recording previous examinations.

Infectious complications of newer agents in the fight against diabetes.

Infectious complications have been reported with antidiabetic medications. Glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors have been associated with upper respiratory tract infections and urinary tract infections. Sodium-glucose cotransporter 2 inhibitors have been associated with lower limb amputations, urinary tract infections, genital mycotic infections, and Fournier gangrene.

Using telehealth for diabetes self-management in underserved populations.

Diabetes self-management is a complex process and central to well-being of patients with this chronic disorder. A patient-centered telehealth program may potentially meet needs of those in underserved populations to reduce socioeconomic disparities. Achieving this goal requires a focused concentration on health behaviors and practices of individuals in underserved populations.

One size does not fit all: Nutrition strategies for people with diabetes.

Several nutrition strategies and eating patterns can help support self-management among persons with diabetes. This article details the effectiveness of popular eating patterns and nutrition strategies, as well as the role of nurses in facilitating informed patient choices and decisions.