Transcript Management of Type II Diabetes

Management of Type II Diabetes
Amy Douglas
NURS 7940
April 3, 2014
Online Presentation
Objectives


Introduction
•
Background and significance
•
PICO
•
Literature search and summary of evidence
•
Recommendations
Small Test of Change
•
Methods
•
Results
•
Summary/conclusion
Background/Significance

Diabetes affects approximately 21 million Americans

6th leading cause of death in the United States

Type II diabetes is one of the leading causes of kidney
failure, non-traumatic lower limb amputations,
blindness, heart disease, and strokes

It is imperative that education to improve selfmanagement of the disease is part of the treatment
plan to improve patient outcomes and quality of life.
PICO

"In newly diagnosed adult patients with Type II
Diabetes, how well does interactive computer
technology compared to written educational
materials with lifestyle modifications such as
diet, exercise, and medication management
improve glucose control?"
Literature Search

Auburn Database (Cochrane, CINAHL, ERIC,
MEDLINE, and Academic Search Premier)

Phrases used: “newly diagnosed”, “Diabetes Type II”,
“adults”, “interactive computer technology”, “written
educational materials”, “glucose control”, “diet”,
“exercise”, “lifestyle modifications”
Summary of Evidence
Liang and others completed a systematic review using mobile
phone intervention to teach diabetic self-care. Patient
outcomes included significant reduction in HbA1c levels.
 Polisena and others used telehealth and telephone support in
their systematic review to improve diabetes self-care with
positive effects on glycemic control.
 Dyson and others conducted a randomized controlled trial by
the use of a short video to teach diabetic self-care techniques.
HbA1c levels were improved.
 Fradiand others conducted a randomized control trial by using
internet and cell phones to assist with diabetes self-care.
Improvement in HbA1c levels were noted after 3 months.

Summary of Evidence

Kim conducted a randomized control trial using cellular phone
interventions by nurses to educate patients about diabetes self-care
with significantly HbA1c levels reported.

Sacco and others completed a randomized control used proactive
telephone intervention on diabetic information and self-care which
resulted in significant reduction in HbA1c levels.

Zolfaghari and others completed a quasi-experimental pre-test and
post-test to test the effectiveness of nurses’ short diabetic education
message. Significant mean changes in HbA1c levels were reported.

Zyskind and others conducted a randomized control trial by using
computer based diabetic information teaching which resulted in a
slight decrease in HbA1c levels.
Recommendations

Educational diabetes material should be tailored on an
individual basis (Grade A)

Home telehealth is an extension of health-care delivery in a
patient’s home environment and has shown to be clinically
effective in management of diabetes (Grade A)

The health care provider can offer innovative technological
teaching tools that can aid in the self-management of diabetes
(Grade B)

Dietary and physical activity modifications, weight reduction,
and self-monitoring of blood glucose should be a part of the
diabetic patient’s daily regime (Grade B)
Recommendations

Health care providers must educate patients about the
importance of the maintenance of the target postprandial
glucose (Grade B)

Home telehealth has a positive impact on the use of numerous
health services and glycemic control (Grade B)

Coaching interventions by a health care team can be used to
improve diabetes management (Grade B)

Patients with diabetes need more frequent contacts with nurses
and health providers for managing the disease (Grade B)

Computer based patient education can be used to positively
impact both clinical and behavioral outcomes in patients with
diabetes (Grade B)
Small Test of Change

Methods

Setting and participants

Baptist Health Center for Diabetes and Nutrition Education

Inclusion criteria
•
Diagnosed with Type II Diabetes within the last 6 months
•
Access to a smart phone or tablet
•
Age 19 and older
Small Test of Change

6 patients consented to participate
•
3 Males, 3 Females
•
Age: Range of 43-64; Mean- 53.67
•
Ethnicity: 83.3% African American, 16.7% Caucasian
•
Education: 66.7% High School graduates; 16.7%
College graduates; 16.7% Master’s degree
•
Medications: 66.7% diet only; 33.3% on oral
medications
Small Test of Change

Methods

Implementation Steps

Handout created to give to the patients

Data Collected

•
23 question diabetes knowledge pre-test
•
Age, gender, baseline medication regimes, weight, and blood
glucose levels
Interventions Delivered
•
Participants were taught how to use the smart phone
application, “Diabetes in Check”, at initial visit
•
Participants kept a daily log of their blood glucose levels using
the smart phone application for 5 weeks and received weekly
phone calls from the project leader who offered
encouragement and answered questions
Small Test of Change

Methods
 Evaluation:
Outcome Measures and Tools

The diabetes knowledge post-test was administered after
5 weeks and data was collected and compared with
paired t-tests

Weight and blood glucose levels were collected at the
end of the 5 week period and compared with paired ttests
Small Test of Change
Paired T-Test Results
Standard Deviation
Post-test Mean
Standard Deviation2
P Value
WEIGHT
BLOOD SUGAR
TEST SCORE
0.001
6.369
79.17
11.839
57.83
0.062
22.187
0.005
54.029
57.122
113.67
205.675
230.5
238.83
299.33
Pre-test Mean
Small Test of Change

Summary/conclusion for larger project
 The
conclusions that may be drawn from this small test
of change are that the use of interactive technology is
beneficial in improving knowledge of diabetes and
encouraging self-management of the disease
 Data
analyzed from pre and post measures shows a
significant improvement in knowledge after use of the
Smart phone app “Diabetes In Check”.
A
larger sample size is warranted with a longer amount
of time and more follow-up to evaluate long-term
effectiveness.
References
Dyson, P., Beatty, S., & Matthews, D. (2010). An assessment of lifestyle video education for
people newly diagnosed with type 2 diabetes. Journal of Human Nutrition and Dietetics, 23(4),
353-359. doi: 10.1111/j.1365277X.2010.01
Faridi, Z., Liberti, L., Shuval, K., Ali, A., & Katz, D. (2008). Evaluating the impact of mobile
telephone technology on type 2 diabetic patients’ self-management: The niche pilot study.
Journal of Evaluation in Clinical Practice, 14(3), 465-469. doi: 10.1111/j.13652753.2007.00881.x
Kim, H. (2007). Impact of web-based nurse’s education on glycosylated haemoglobin in type 2
diabetic patients. Journal of Clinical Nursing, 16(1), 1361-1366. doi: 10.1111/j.13652702.2005.01506.x
Liang, X., Wang, Q., Yang, X., Cao, J., Chen, J., Mo, X., Huang, J., Wang, L., & Gu, D. (2011).
Effect of mobile phone intervention for diabetes on glycemic control: A meta-analysis. Diabetic
Medicine, 28(4), 455-463. doi: 10.1111/j.1464-5491.2010.03180.x
Polisena, J., Tran, K., Cimon, K., Hutton, B., McGill, B. & Palmer, K. (2009). Home telehealth for
diabetes management: A systematic review and meta-analysis. Diabetes, Obesity & Metabolism,
11(10), 913-930. doi: 10.1111/j.1463-1326.2009.01057.x
Sacco, W., Malone, J., Morrison, A., Friedman, A. & Wells, K. (2009). Effect of a brief, regular
telephone intervention by paraprofessionals for type 2 diabetes. Journal of Behavioral Medicine,
32(1), 349-359. doi: 10.1007/s10865-009-9209-4
Zolfaghari, M, Seyedeh, M., & Haghani, H. (2012). The impact of nurse short message service and
telephone follow-ups on diabetic adherence: Which ones are effective? Journal of Clinical
Nursing, 21(1), 1922-1931. doi: 10.1111/j.1365-2702.2011.03951.x
Zyskind, A., Jones, K., Pomerantz, K. & Barker, A. (2009). Exploring the use of computer based
patient education resources to enable diabetic patients from underserved populations to selfmanage their disease. Information Services & Use, 29(1), 29-43. doi: 10.3233/ISU-2009-0592