Showing papers on "Diabetes management published in 1991"

A Modified Quality-of-Life Measure for Youths: Psychometric Properties

Abstract: In the Diabetes Control and Complication Trial (DCCT), a Diabetes Quality of Life (DQOL) measure was developed to assess the psychosocial impact of intensified regimens. Its applicability for use with children and adolescents was limited by the exclusion criteria of the DCCT. In this study, the DQOL was modified for specific use in young diabetes populations. The result is an instrument composed of three intercorrelated scales--a Diabetes Life Satisfaction scale, a Disease Impact scale, and a Disease-Related Worries scale--with satisfactory levels of reliability. While the scale variances were independent of glycosylated hemoglobin values, they were related to adolescents' perception of their general health status. Self-perceived quality of life related to diabetes management is an important alternative outcome for diabetes education programs.

Intensive education improves knowledge, compliance, and foot problems in type 2 diabetes.

Abstract: Despite the established role of foot care education in diabetes management, reports evaluating such interventions are rare. The effectiveness of an intensive foot care intervention programme and a conventional one were therefore compared in Type 2 diabetes. The intensive group showed significantly greater improvements than the conventional group in foot care knowledge (p less than 0.001), compliance with the recommended foot care routine (p = 0.012), and compliance with the initial advice to consult a podiatrist (other than the project podiatrist) for further treatment (p = 0.008). At the first follow-up visit the intensive group also showed a significantly greater reduction in the number of foot problems requiring treatment than the conventional group.

Change in metabolic control and functional status after hospitalization. Impact of patient activation intervention in diabetic patients.

Abstract: Objective To determine whether a short intervention to enhance patient information seeking and decision making during hospitalization results in improved metabolic control and functional status in patients with diabetes mellitus. Research Design and Methods A randomized clinical trial was conducted in which control patients received a comprehensive 3-day evaluation and educational program, whereas experimental patients received a 45-min patient activation intervention and a 1-h self-administered booster in addition to the program. Metabolic control and functional status were measured at baseline and 4 mo postdischarge. Results During their discharge discussions, experimental patients asked significantly more questions than control patients (7.4 vs. 3.0, P > .001) and 4 mo later reported significantly fewer physical limitations in activities of daily living than the control group ( P = 0.02). Improvement in metabolic control was statistically significant only for experimental patients ( P = 0.02), although their glycosylated hemoglobin levels were not significantly lower than control patients9 at follow-up. The intervention did not diminish physician satisfaction with patient interactions, although it may have increased physician frustration with responsibilities that competed with patient care. CONCLUSIONS These results suggest that the addition of a patient activation intervention to a comprehensive diabetes management program may substantially enhance physical functioning among adults with diabetes mellitus.

Nutrition management for individuals with noninsulin-dependent diabetes mellitus in the 1990s: A review by the Diabetes Care and Education dietetic practice group

Abstract: Noninsulin-dependent diabetes mellitus (NIDDM), or Type II diabetes, is characterized by two primary defects: insulin resistance and insulin secretion. The two major goals of management of NIDDM are to achieve near normal metabolic control and to prevent/ delay the microvascular and macrovascular complications of diabetes. Nutrition, exercise, and, if necessary, medication are the three primary treatment modalities used in NIDDM. Treatment regimens need to be individualized and developed with consideration for diabetes management goals and quaIity-of-1ife issues. Lean individuals with NIDDM should be encouraged to maintain their body weight and modify food composition and eating pattern to minimize glucose excursions. The primary treatment goal for an obese individual with NIDDM is weight loss. The process of teaching nutrition and meal planning involves developing a cooperative alliance, gathering information, setting realistic goals, intervention, and maintaining change. Nutrition intervention involves providing information in stages, beginning with “survival skill” information and progressing to in-depth information. The dietitian’s responsibility is to promote continuity of learning by introducing new ideas and concepts and altering the learning environment. Dietitians can expand their role in the 1990s to that of a diabetes educator taking a leadership role to ensure that the individual with NIDDM receives comprehensive and individualized care.

Diabetes in minority populations.

Abstract: The prevalence and incidence of diabetes are higher in several ethnic minority populations in the US, including Hispanic, Asian, African, and Native Americans. Nurse practitioners will encounter increasing numbers of patients from these population groups in the future. Of major concern is the high prevalence of additional risk factors, such as smoking, obesity, hypertension, hyperlipidemia, and low socioeconomic status, which contribute to the increased rate of complications of this disease in these groups. Emphasis must be placed on screening and risk reduction, and diabetes management in these groups must be culturally sensitive and relevant.

An interactive perspective on the health beliefs & practices of rural elders.

Abstract: 1. In this study, major themes involving health were closely tied to an affective response of "feeling good" and cognitive appraisal of health status as "being able to function." 2. Rural elderly who participated in the study reported engaging in at least one activity to maintain their health and tended to rely on their own appraisal and resources to manage health problems. 3. Half of the participants indicated a need for services such as blood pressure and diabetic screening, health education classes on diet, cholesterol reduction, hypertension and diabetes management, new therapies in health care, and life management counseling.

Addressing attitudes during diabetes education: suggestions from adult education.

Abstract: Suggestions from adult education can improve the effectiveness of diabetes education programs. While information and knowledge are noted as important factors in diabetes education, the literature indicates that they are insufficient to insure improved treatment outcomes. Research suggests that addressing psychosocial variables can improve diabetes education effectiveness. Although there are a multitude of psychosocial variables, attitude is consistently identified as an important contributor to positive diabetes management. Practical suggestions from adult education are offered to improve the learner's attitude about diabetes, the learning process, and the instructor.

Exercise: Part I. Physiological response to exercise in diabetes mellitus.

Abstract: Exercise is a valuable and effective tool for assisting with diabetes management. The benefits of exercise are significant. Metabolic responses to various workloads vary greatly and depend on many factors, including type of diabetes; time, dosage, and type of diabetes medication; time and content of last meal; fitness level; and intensity and duration of activity performed. Exercise-induced hypo- and hyperglycemia can occur in diabetes, and strategies to avoid this should be taught. Weight loss is a common goal in NIDDM, although often difficult to attain. Exercise plays a critical role in weight loss and should be considered part of the treatment plan when fat loss is a goal.

Locus of control and efficacy in healthy children and those with diabetes

Abstract: Eight-five healthy children (mean age = 11.5 years) and 61 with diabetes completed measures of health locus of control and health-related self-efficacy. Those with diabetes also completed a diabetes specific self-efficacy scale. Low but significant correlations were found between locus of control and both efficacy measures. Factor analysis of the health efficacy scale yielded three factors (personal responsibility, safety and communication). Three factors were also derived for the diabetes efficacy scale (personal responsibility, social communication and minimization of threat). In terms of locus of control, children with diabetes expressed weaker beliefs in powerful others and personal control than healthy children, and weaker beliefs in the personal responsibility sub-scale of general health efficacy. Results are discussed in terms of the theoretical and practical implications of locus of control and efficacy in diabetes management.

Shaping the course of a marathon: using the Trajectory Framework for diabetes mellitus.

Abstract: Persons with either insulin-dependent or non-insulin-dependent diabetes mellitus live with a chronic illness that can have both acute and long-term complications. The therapeutic regimen for glycemic control in diabetes is often complex and is lifelong; it requires special knowledge and skills for both patients and health care providers. In this article, the Corbin and Strauss trajectory framework for chronic illness management is clinically applied to the planning of patient care in two case studies of persons with diabetes. The benefits of using the trajectory framework as a model for care in diabetes include: introduction of the concepts of "locating" the patient on the trajectory and assessing the trajectory projection for both patient and provider, and a more realistic evaluation of incremental change in chronic illness. Two possible barriers to clinical application of the framework for diabetes management are: difficulty in translating the framework for clinical use, and some terminology in the framework that does not seem to describe reimbursable care. The trajectory framework provides a necessary shift in focus to quality of life issues in diabetes management over the lifespan.

Understanding the use of the exchange lists for meal planning in diabetes management.

Abstract: The Exchange Lists for Meal Planning has been in existence since 1950 and was updated in 1976 and 1986. The lists were designed to provide a universal system for the nutrition management of diabetes mellitus. The current edition emphasizes a high-carbohydrate, low-fat diet and is widely used by persons with diabetes and by diabetes educators. To use the exchange lists, the educator must understand how to develop a meal plan. The meal plan serves as the tool to help patients select appropriate foods and amounts. The necessary steps for establishing the meal plan are outlined, and a suggested sequence for educating persons with diabetes in the use of the lists is presented.

Self-monitoring: the patient-practitioner alliance.

Abstract: Self-monitoring of blood glucose (SMBG) is an essential component of the therapeutic regimen in diabetes management and new technology offers a variety of options for patients and practitioners. This article presents guidelines for appropriate use of SMBG in persons with diabetes and a discussion of quality assurance and infection control issues. A strong patient-practitioner alliance encourages compliance and supports the maximum use of information obtained by SMBG.

The psychosocial treatment of recurrent diabetic ketoacidosis: an interdisciplinary team approach.

Abstract: The professional expertise of the diabetes mental health professional is integral to the interdisciplinary team approach to recurrent diabetic ketoacidosis (DKA). A case report provides the context to illustrate the interconnection of concurrent strategies of diabetes management, teaching, and counseling. Specific methods include a practical approach to manipulative behavior in blood glucose monitoring, supervision of insulin administration, education, and intensive psychotherapy. In this case study, the adolescent's removal from her home environment, along with medical supervision and extensive psychosocial support, was instrumental in reversing the pattern of self-destructiveness. Recurrent DKA is a very specific problem for which the mental health professional can play an effective treatment role.

Pharmacology of diabetes : present practice and future perspectives

Abstract: A rapid development has taken place within a number of pharmacological areas both with respect to insulin-dependent and non-insulin-dependent diabetes and also within the prevention and treatment of complications of both types of patients. The book is meant as a working guide for the practical diabetologists active in all parts of the health care system and, along with other volumes in this series, should cover most parts of diabetes management, not only from a treatment point of view, but also from the point of diagnosis and etiology of the disease. International authors deal with: pharmacological effects in the acute or short-term treatment of patients (eg new aspects of insulin treatment); and pharmacological effects of long-term perspective of treatment in the prevention of complications of the microvascular and macrovascular system, concerning among other biguanides, sulphonyluria, glucosylation, inhibition and alpha-glucosidase inhibitions.

Patient education and compliance in non-insulin dependent diabetes mellitus

Abstract: This prospective study investigated many compliance-related aspects involving a population of Type II (non-insulin-dependent) diabetics, who attended the out-patients' clinic of a District General hospital. The investigations were undertaken from both qualitative and quantitative perspectives; activities within the clinic were observed and knowledge levels concerning diabetes mellitus were measured. A teaching programme was constructed, drawing on general educational principles; each stage was subjected to analysis and evaluation. Information, teaching and counselling skills were incorporated and a quality assurance model described. Two groups of subjects - one diagnosed less than one year (n=20), the other diagnosed more than one year (n=18) - were entered into a teaching programme; weight change was chosen as the study variable. Three interventions were planned for each subject. No statistically significant differences were found between the study groups and an historical control group, but clinically significant trends towards the target weight were recorded. Following the intervention study, a clinic-specific video was made, which was positively evaluated by subjects after it was viewed in their own homes. An innovative method of analysis was applied to health belief attributes, including vulnerability and social support-dynamic concept analysis (Kontiainen, 1973) - and models were constructed to determine whether there were common patterns of interview response from which prediction of compliance with clinical advice could be deduced. From the analysis it was concluded that computerised models could be constructed, which would be used in the clinic setting to predict, and subsequently monitor and guide, the behaviour required of individuals with NIDDM. The home viewing of clinic-specific videos would provide an adjunct to effective management through the dissemination of information outside the immediate physician-patient interaction. The main aim of Type II diabetes management is control of body weight. A means of depicting movement out of the obesity grading (Garrow and Webster, 1985) was devised, which could be utilised in a collaborative way by the health care professional and the diabetic person. From this longitudinal study it was concluded that the unique educational needs of individuals must be met by a range of inter-linked skills, methods and materials, if a solution to the non-compliance problem is to be found.

Special issues in the management of the elderly patient with diabetes.

Abstract: The elderly patient with diabetes presents unique problems in diabetes management. It is important that practitioners managing elderly patients understand all the factors that impact on diabetes management, in particular those that increase the risk for hypoglycemia and other diabetes emergencies. Given the complexity of the problems encountered, the safe and efficient management of diabetes in the elderly patient requires a team approach.

Iatrogenic brittle diabetes: the hold-the-insulin decision.

Abstract: Modern diabetes management often involves multiple daily insulin injections (MDII) for individuals with insulin-dependent diabetes mellitus (IDDM). Such insulin regimens are increasingly composed of a larger percentage of regular insulin and a smaller percentage of intermediate- and long-acting insulin. Withholding insulin in these individuals may precipitate acute metabolic catastrophe and attendant ketosis or, even worse, frank diabetic ketoacidosis. A comprehensive understanding of normal glucose metabolism and the principles of MDII by all health care professionals both in and out of the hospital setting will foster improved metabolic control in the individual with IDDM, reduce health care costs, and have a positive effect on decreasing diabetic complications.

Who uses a diabetes “drop-in” centre

Abstract: This study aimed to document patients' reasons for attendance at a “drop-in” centre serving a general diabetic clinic (n = 756). Over six months the following data were documented: reasons for attendance (self-initiated or referred and source or referrals); length of consultation; age and sex of clients; whether NIDDM or IDDM; and treatment modes. All 133 minor consultations ( 30 min) comprising 59 NIDDM (of whom 47 were insulin-treated) and 12 IDDM, 48 were self-initiated. The main reasons for major consultations were: 20 presented with persisting hyperglycaemia > 17 mmol/l (17 required insulin adjustment); eight had unfavourable social circumstances affecting diabetes management and required counselling; 10 requested ongoing diabetes education; six presented with foot lesions (two with neuropathic ulcers); and 10 diabetics came with non-diabetes-related health problems. Unexpectedly, there were no requests for dietary advice, and few for hypoglycaemia. There were six contacts by relatives, five parents of people with IDDM expressing concern about their child's lifestyle which compromised metabolic control and one husband of a person with NIDDM. We conclude that our clients demonstrate a definite need for diabetes-related education or advice between clinic visits. In our study the major reasons for seeking advice were for hyperglycaemia needing treatment modification, counselling and to increase diabetes knowledge.