Transcript Daring to Defy Diabetes - Cross Cultural Health Care Conference

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Daring to Defy
Diabetes:
Analysis of Physiological Outcomes in Patients
with Type 2 Diabetes Through the
Understanding of the Self-Care Model
Christina M. Beyers, BS
Jillian Inouye, PhD
James Davis, PhD
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Grant and Project Information
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Primary Investigator & Co-author: Jillian Inouye, PhD, APRN
School of Nursing and Dental Hygiene University of Hawaii
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Biostatistician: James Davis, PhD
Clinical Research Center John A. Burns School of Medicine
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Christina Beyers, BS
University of Hawaii Masters of Public Health-Epidemiology Graduate Student
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The project described was supported in part by Award Numbers
RO07883 and P20NR010671 from the National Institute of Nursing
Research and G11HD054969 from the National Institute of Child
Health Development. The content is solely the responsibility of the
authors and does not necessarily represent the official views of the
National Institute of Nursing Research or the National Institutes of
Health.
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Problem:
Drastic
increase of reported cases of
type 2 diabetes in patients every year
“The
prevalence of type 2 diabetes
mellitus has risen so sharply over the
past-half century that it is now
commonly referred to as an
epidemic…”
Yates,T.,Davies,M., & Khunti,K.(2009).Preventing type 2 diabetes: can we make the
evidence work? Post Graduate Medical Journal,85,475-480. doi:
10.1136/pgmj.2008.076166
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Significance:
 Research
helps to further develop intervention
programs
Increasing
self-care/self-management
Increasing
knowledge
Increasing
self-efficacy/ disease control
Increasing
patient quality of life
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Aim:
To determine if Asian Pacific Islander’s
who have Type 2 Diabetes and have
better knowledge and selfmanagement will have better
baseline Hemoglobin A1C and total
cholesterol values.
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Review of the Literature
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Research shows that lifestyle changes equal the greatest impact
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Understanding why there is a disconnect between knowledge
and self-care implementation
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Recognition that persons with Type 2 Diabetes may require
additional education to increase self-management
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Significant that Asian Pacific Islanders (API) high risk
population
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AADE promotes a self-care model of 7 behavioral steps
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Self-Care Model
The American Association of Diabetes Educators promotes a
“Self-Care Behavior Framework” in 7 steps
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Below represents 5 behaviors analyzed within this study.
Healthy
Eating
Being
Active
Reducing
Risks
Knowledge
Taking
Medication
Monitoring
Figure1. Pictorially represents the five behaviors analyzed in this cross-sectional study as modified from
the “AADE7™ Self-Care Behaviors Framework.” Adapted from “Measurable behavior change is the
desired outcome of diabetes education” [Electronic Version] by American Association of Diabetes
Educators, 2010. Retrieved September 15, 2010 from
http://www.diabeteseducator.org/ProfessionalResources/AADE7/
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Activities Involved in Self-Care
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Methodology
 Study
design is a descriptive cross sectional
 Participants:207
Asian Pacific Islander’s with
Type 2 diabetes that met the inclusion criteria
for the study participated.
 Subjects
signed IRB approved consent form
and assigned randomized numbers
 The
ages ranged from 18-75
 Study
involved analysis of pre-existing data set
(baseline surveys)
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Measures
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Initial questionnaire responses (T1) were used to test
whether the research prediction held statistical significance.
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2 Questionnaires:
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“SDSCA”-The Summary of Diabetes Self-Care Activities
(derived from Toobert,Hampson and Glasgow, 2007)
 Survey questions relate to: general diet, specific diet,
exercise, blood- glucose testing, foot care and smoking
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“DKA”-Diabetes Knowledge Assessment (derived from
Bielamowicz,Miller,Elkins &Ladewig, 1995)
Series of multiple choice questions regarding knowledge of
the disease
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Procedures
 “DKA”-
14 Multiple choice questions- where one
point was awarded for each correct answer
 “SDSCA”-
asked the participant to recall out of the
last 7 days how may days did he or she do the
following…
- Scale of 0-7 and final score based on averages of
each section
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Reliability and Validity
 The
Cronbach’s Alpha test
 Each
variable (SDSCA) or question (DKA) assessed
through raw alpha and standardized alpha scores
 Results
below
placed in tables- outcome totals listed
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SDSCA total Raw Alpha= 0.71 and Standardized
Alpha= 0.72
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DKA total Raw Alpha=0.66 and Standardized
Alpha=0.67
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Methodology:
Analyses
 Statistical
analysis includes:
-Regressions run from knowledge to HbA1C and
total cholesterol
-And regressions from self- care to HbA1C and
total cholesterol
 Patient
confidentiality was maintained during the
study as well as during any statistical analysis
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Limitations
 No
labs were drawn on site
 Participants
responses were based on his or her
recall
 Distinctions
within the diverse API population were
not addressed in this study
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Results
 Data
entered using double entry method
 Scoring
of surveys completed and regressions
were run
 Tables
were constructed to display the results
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Regression of SDSCA
Table 1. A total of 104 subjects’ labs were obtainable and the mean
HbA1C level was 8.45%.
* Indicates Statistical Significance
+ Regression of SDSCA
Table 2. A total of 104 subjects’ labs were obtainable and the mean total
cholesterol value was 174.7564 mg/dL
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Regression of DKA
Table 3. A total of 93 subjects’ labs and scores were obtainable and the
mean HbA1C was 8.45%.
A total of 78 subjects’ labs and scores were obtainable and the mean
total cholesterol value was 174.7564 mg/dL.
*Indicates statistical significance
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Statistically Significant Findings
 Self-efficacy
with taking medications and the affect
on the HbA1c
 General
diet affecting the HbA1C
 Diabetes
knowledge affecting HbA1C
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Discussion
Literature review after findings generally corroborates results
In particular positive outcomes related to:
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Medication usage
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Diabetes knowledge
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General diet
Discrepancies included:
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Exercise
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Variables affecting total cholesterol
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Conclusion:
Expected Outcome
 Prior
knowledge may not necessarily lead to selfmanagement
 Participants
with initial active self-management
regimens were expected to show better baseline
lab values of HbA1C and total cholesterol, than
those who did not implement self-management
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Conclusion:
Inherent Outcome
Overcoming barriers to self-management and
knowledge are meant to improve the desired
inherent outcome of:
 See
improvements in lab values (such as HbA1C
and total cholesterol)
 Increasing
patient quality of life
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Future Research
 Diabetes
prevention
 Additional
barriers to self-management beyond
knowledge/education
 Other
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factors include:
Socio-economic status
Available support systems
Depression/psychological assessment
Religious/cultural beliefs
Accessibility to health care
 Underprivileged
primary focus
or high risk populations as