Intensive Education Improves Knowledge, Compliance, and Foot Problems in Type 2 Diabetes

“…Litzelman et al (62) noted a decrease in serious foot lesions at 1 year after an intervention consisting of group education, with three follow-up visits, provider guidelines, and chart reminders. Other studies failed to demonstrate improvements with interventions (41,46,63). Malone et al (64) found a significant decrease in foot ulcer and amputation rates, although this study had significant methodological inadequacies.…”

Section: Process Measuresmentioning

confidence: 93%

“…Both individual (38,39,66 -68) and group (72,75,93) lifestyle interventions had positive effects on diet and self-care behaviors. It is notable that skills teaching was effective in both group (41,62) and individual settings (45,58).…”

Section: Effectiveness Of Interventionsmentioning

confidence: 99%

Effectiveness of Self-Management Training in Type 2 Diabetes

2001

View full text Add to dashboard Cite

OBJECTIVE -To systematically review the effectiveness of self-management training in type 2 diabetes. RESEARCH DESIGN AND METHODS -MEDLINE, EducationalResources Information Center (ERIC), and Nursing and Allied Health databases were searched for English-language articles published between 1980 and 1999. Studies were original articles reporting the results of randomized controlled trials of the effectiveness of self-management training in people with type 2 diabetes. Relevant data on study design, population demographics, interventions, outcomes, methodological quality, and external validity were tabulated. Interventions were categorized based on educational focus (information, lifestyle behaviors, mechanical skills, and coping skills), and outcomes were classified as knowledge, attitudes, and self-care skills; lifestyle behaviors, psychological outcomes, and quality of life; glycemic control; cardiovascular disease risk factors; and economic measures and health service utilization.RESULTS -A total of 72 studies described in 84 articles were identified for this review. Positive effects of self-management training on knowledge, frequency and accuracy of selfmonitoring of blood glucose, self-reported dietary habits, and glycemic control were demonstrated in studies with short follow-up (Ͻ6 months). Effects of interventions on lipids, physical activity, weight, and blood pressure were variable. With longer follow-up, interventions that used regular reinforcement throughout follow-up were sometimes effective in improving glycemic control. Educational interventions that involved patient collaboration may be more effective than didactic interventions in improving glycemic control, weight, and lipid profiles. No studies demonstrated the effectiveness of self-management training on cardiovascular disease-related events or mortality; no economic analyses included indirect costs; few studies examined healthcare utilization. Performance, selection, attrition, and detection bias were common in studies reviewed, and external generalizability was often limited.CONCLUSIONS -Evidence supports the effectiveness of self-management training in type 2 diabetes, particularly in the short term. Further research is needed to assess the effectiveness of self-management interventions on sustained glycemic control, cardiovascular disease risk factors, and ultimately, microvascular and cardiovascular disease and quality of life. Diabetes Care 24:561-587, 2001D iabetes self-management training, the process of teaching individuals to manage their diabetes (1), has been considered an important part of clinical management since the 1930s (2). The goals of diabetes education are to optimize metabolic control, prevent acute and chronic complications, and optimize quality of life while keeping costs acceptable (3). One of the goals of Healthy People 2010 is to increase to 60% (from the 1998 baseline of 40%) the proportion of individuals with diabetes who receive formal diabetes education (4). There are significant knowledge and skill deficits in ...

show abstract

“…Results of randomized controlled trials selected for a systematic review (10) indicate that foot self-care behavioral change is short-lived (11)(12)(13)(14)(15). This finding could be attributable to the fact that these interventions have focused solely on foot self-care knowledge and behavioral skills training, and none has addressed the psychosocial processes underlying patients' foot self-care.…”

mentioning

confidence: 87%

Patient Interpretation of Neuropathy (PIN) Questionnaire

et al. 2006

View full text Add to dashboard Cite

OBJECTIVE -Using the common-sense model of illness behavior, we developed and validated a self-report instrument for assessment of patients' cognitive and emotional representations of diabetic peripheral neuropathy (DPN) influencing foot self-care. RESEARCH DESIGN AND METHODS -The PatientInterpretation of Neuropathy (PIN) questionnaire, generated from discussions with clinicians and interviews with patients with DPN, was administered to patients with DPN attending U.K. (n ϭ 325) and U.S. (n ϭ 170) diabetes centers. Psychometric tests of the PIN questionnaire comprised factor analysis, internal consistency, and test-retest reliability. Partial correlations and multivariate regressions established construct and criterion-related validity. The associations of PIN scales to past foot ulceration and foot self-care behaviors were compared with those using a generic measure of illness perception and emotion, the Revised Illness Perception Questionnaire (IPQ-R), which was adapted to neuropathy.RESULTS -Factor analysis of the PIN questionnaire produced 11 scales, which explained 69% of item variance. Nine factors measured patients' common-sense beliefs about DPN and their levels of understanding of DPN-related medical information. Two factors assessed the emotions of worry about potential consequences and anger at practitioners. Most scales demonstrated adequate internal (Cronbach's ␣ ϭ 0.62-0.90) and test-retest reliability (Pearson's r ϭ 0.51-0.64). Partial correlations between the PIN and IPQ-R scales in corresponding domains were significant but modest (r p ϭ 0.15-0.26). Finally, PIN scales showed significant associations with past foot ulceration and foot self-care behaviors, thereby confirming criterion validity.CONCLUSIONS -The 39-item PIN questionnaire is a reliable and valid measure of patients' cognitive and emotional representations of neuropathy affecting foot self-care. Diabetes Care 29:2617-2624, 2006F oot ulceration and amputations cause an extensive burden on individuals with diabetes, the health care system, and society (1). Yet diabetic foot ulcer-related morbidity could be substantially reduced, as a significant proportion of foot ulcers could be prevented by patients' active engagement in foot self-care (2). Causal pathways to foot ulceration are well defined, with diabetic peripheral neuropathy (DPN), the key risk factor, predisposing to foot ulceration through mechanisms that are either extrinsic to the foot (e.g., unperceived trauma) or intrinsic to the foot (e.g., DPN contributing to foot deformities and high pressure areas) (3,4). Therefore, it seems plausible that a series of relatively simple foot self-care actions should be effective in minimizing the impact of neuropathic risk factors and thereby reducing the incidence of insensate foot ulcers. Published guidelines on diabetic foot self-care define two types of such behaviors: engagement in preventive foot self-care (e.g., having feet measured when buying a new pair of shoes) and avoidance of behaviors which, although appropriate for people w...

show abstract

Intensive Education Improves Knowledge, Compliance, and Foot Problems in Type 2 Diabetes

Cited by 133 publications

References 4 publications

Knowledge of diabetic patients about their disease before and after implementing a diabetes education program

Knowledge of diabetic patients about their disease before and after implementing a diabetes education program

Effectiveness of Self-Management Training in Type 2 Diabetes

Patient Interpretation of Neuropathy (PIN) Questionnaire

Contact Info

Product

Resources

About