Aade Position Statement

Tomky, Donna; Cypress, Marjorie; Dang, Devra K.; Maryniuk, Melinda D.; Peyrot, Mark; Mensing, Carolé

doi:10.1177/0145721708316625

Cited by 207 publications

(96 citation statements)

References 13 publications

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“…All patients with diabetes are encouraged to adopt and adhere to many self-care behaviors (8, 9). This is particularly challenging for those with T1DM, who require lifelong insulin therapy and therefore should undertake rigorous self-monitoring and regulation of blood glucose levels through frequent adjustments to insulin dose, diet, and physical activity (10).…”

Section: Discussionmentioning

confidence: 99%

“…For instance, intensive lowering of blood pressure has reduced major cardiovascular events by 11% (6). In addition, findings from 2 large cross-national studies support interventions to address other outcomes of importance for patients, such as diabetes-related distress (7).All patients with diabetes are encouraged to adopt and adhere to many self-care behaviors (8, 9). This is particularly challenging for those with T1DM, who require lifelong insulin therapy and therefore should undertake rigorous self-monitoring and regulation of blood glucose levels through frequent adjustments to insulin dose, diet, and physical activity (10).…”

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confidence: 99%

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Behavioral Programs for Type 1 Diabetes Mellitus

et al. 2015

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Background: Whether behavioral approaches for selfmanagement programs benefit individuals with type 1 diabetes mellitus is unclear.Purpose: To determine the effects of behavioral programs for patients with type 1 diabetes on behavioral, clinical, and health outcomes and to investigate factors that might moderate effect. Study Selection: 36 prospective, controlled studies involving participants of any age group that compared behavioral programs with usual care, active controls, or other programs. Data Extraction:One reviewer extracted and another verified data. Two reviewers assessed quality and strength of evidence (SOE). Data Synthesis:Moderate SOE showed reduction in glycated hemoglobin (HbA 1c ) at 6 months after the intervention compared with usual care (mean difference, Ϫ0.29 [95% CI, Ϫ0.45 to Ϫ0.13] percentage points) and compared with active controls (Ϫ0.44 [CI, Ϫ0.69 to Ϫ0.19] percentage points). At the end of the intervention and 12-month follow-up or longer, there were no statistically significant differences in HbA 1c (low SOE) for comparisons with usual care or active control. Compared with usual care, generic quality of life at program completion did not differ (moderate SOE). Other outcomes had low or insufficient SOE. Adults appeared to benefit more for glycemic control at program completion (Ϫ0.28 [CI, Ϫ0.57 to 0.01] percentage points) than did youth (Ϫ0.12 [CI, Ϫ0.43 to 0.19] percentage points). Program intensity appeared not to influence effectiveness; some individual delivery appears beneficial.Limitations: All studies had medium or high risk of bias. There was scarce evidence for many outcomes. Conclusion:Behavioral programs for type 1 diabetes offer some benefit for glycemic control, at least at short-term followup, but improvement for other outcomes has not been shown. T ype 1 diabetes mellitus (T1DM), one of the most common chronic diseases in childhood and adolescence, is increasing in prevalence in the United States (1). The landmark DCCT (Diabetes Control and Complications Trial) and its related longitudinal study (EDIC [Epidemiology of Diabetes Interventions and Complications]) found that intensive glycemic control prevents development and progression of micro-and macrovascular complications (2, 3) and death (4). However, the intervention was initiated early (duration of T1DM <3 years for prevention group) in relatively young (mean age, 27 years), healthy patients. A meta-analysis of 12 trials of intensive control in diverse patient populations confirmed only a reduction in development of microvascular complications. Authors of that analysis stressed that benefits may apply only for interventions initiated early and should be weighed against risks for severe hypoglycemia (5). Factors other than glycemic control appear necessary to improve outcomes. For instance, intensive lowering of blood pressure has reduced major cardiovascular events by 11% (6). In addition, findings from 2 large cross-national studies support interventions to address other outcomes of importance for patients, suc...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Behavioral Programs for Type 1 Diabetes Mellitus

et al. 2015

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“…[3][4][5] Therefore, the lack thereof among approximately half of our participant population, may limit their ability to fully benefit from support offered through formal education. 19 While there are likely many factors, beyond just availability, that influenced whether participants engaged in formal diabetes education and received eye and foot exams, it will be important to further explore those that promote or hinder receipt of services. This is particularly salient when lack of insurance, a common barrier to receiving these services, 20,21 may not be a significant factor as in our mostly insured participant group.…”

Section: Discussionmentioning

confidence: 99%

Diabetes Education, Specialty Care, and Self-Care Advice among Obese African American Women with Type 2 Diabetes

2016

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Diabetes IntroductIonThe American Diabetes Association recommends that all persons with diabetes receive diabetes selfmanagement education (DSME) and referral to specialists for supplemental care.1 Diabetes self-management education, the "cornerstone of treatment for all people with diabetes," 2 has been effective in assisting patients in managing their type 2 diabetes. [3][4][5] Moreover, the involvement of specialists, such as podiatrists and ophthalmologists, is an equally important factor in the prevention and management of diabetes complications. 1Given the increasing morbidity, mortality and financial burden of diabetes in the United States, 6,7 Healthy People 2020 (HP 2020) goals includes benchmarks for DSME and specialty care. For example, a 10% increase in the numbers of diabetes patients receiving formal diabetes education, annual dilated eye exams, and annual foot exams are projected. 8To date, however, there is very little information describing existing patterns of diabetes education and specialty care among groups who experience the highest diabetes-related morbidity and mortality burdens, ethnic minorities 9,10 and those who are obese.11 Among obese African American women with type 2 diabetes, our descriptive study highlights receipt of formal diabetes education, specialty care and diabetes self-care advice. In addition, the relationship between self-care behaviors and receipt of advice is described. MaterIals and MethodsEligible participants were African American women with a clinical diagnosis of type 2 diabetes for ≥ 6 months and who were at-risk for development and/or progression of Design: Cross-sectional survey study. Participants: African American women with type 2 diabetes enrolled in dietary and weight management interventions.Main Outcome Measures: Self-report assessments of diabetes education, specialty care, self-care behaviors and advice. Associations between diabetes self-care behaviors and diabetes advice using Chisquare tests.Results: Among 96 participants (age = 53 ± 9.4; BMI = 37.9 ± 7.3 kg/m 2 ), reported diabetes education and foot exams were lower than HP2020 benchmarks, 48.9% vs 62.5% and 35.1% vs 74.8%, respectively and higher for dilated eye exams (70.1% vs 58.7%). The most frequently reported dietary advice was to increase fruit/ vegetable intake (58%) and approximately 50% reported physical activity advice. Receiving no exercise advice was associated with greater odds of little or no physical activity (OR = 3.38) and planned exercises (OR = 2.65). Conclusion:Receipt of diabetes education and some specialty care were below national benchmarks while health care provider advice influenced patient self-care behaviors. Increasing diabetes education and specialty care should be included within existing efforts to address the excess diabetes burden experienced by African American women. Longitudinal studies exploring the relationship between health care provider advice and self-care behaviors are needed.

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“…DSM is the cornerstone of diabetes care and refers to an individual's ability to integrate diabetes into one's daily life. The American Association of Diabetes Educators has identified seven essential skills for DSM: healthy eating, physical activity, BG testing, taking medications, managing stress, reducing risks, and problem solving (Tomky et al, 2008).…”

Section: Diabetes Self-managementmentioning

confidence: 99%

Perceived Unsatisfactory Care as a Barrier to Diabetes Self-Management for Coeur d’Alene Tribal Members With Type 2 Diabetes

Tiedt

Sloan

2014

J Transcult Nurs

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The prevalence of diabetes and related complications are disproportionally higher in Native Americans. Diabetes self-management (DSM) is instrumental in preventing complications. The results presented here are a part of a larger hermeneutic phenomenology study to explore living with diabetes for one Pacific Northwest tribe. This study identified barriers to DSM within the worldview of the tribal people. Using purposive sampling, 10 Coeur d'Alene tribal members, ages 26 to 86 years, participated in in-depth interviews. Data interpretation used a three-step method leading to integrated themes across the transcripts. Perceived unsatisfactory care emerged as the major barrier to self-management, including communication barriers (distrust, misunderstanding, and educational methods) and organizational barriers (quality of care and access issues). Findings highlight the need to improve cross-cultural communication and calls for different approaches to diabetes education. Our profession is challenged to create new DSM and diabetes educational approaches for acceptable and compassionate cross-cultural nursing care.

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Aade Position Statement

Cited by 207 publications

References 13 publications

Behavioral Programs for Type 1 Diabetes Mellitus

Behavioral Programs for Type 1 Diabetes Mellitus

Diabetes Education, Specialty Care, and Self-Care Advice among Obese African American Women with Type 2 Diabetes

Perceived Unsatisfactory Care as a Barrier to Diabetes Self-Management for Coeur d’Alene Tribal Members With Type 2 Diabetes

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