Objectives To assess the effect of self monitoring of blood glucose concentrations on glycaemic control and psychological indices in patients with newly diagnosed type 2 diabetes mellitus.Design ...Prospective randomised controlled trial of self monitoring versus no monitoring (control).Setting Hospital diabetes clinics.Participants 184 (111 men) people aged <70 with newly diagnosed type 2 diabetes referred to the participating diabetes clinics. Major exclusion criteria were secondary diabetes, insulin treatment, previous self monitoring of blood glucose.Interventions Participants were randomised to self monitoring or no monitoring (control) groups for one year with follow-up at three monthly intervals. Both groups underwent an identical structured core education programme. The self monitoring group received additional education on monitoring.Main outcome measures Between group differences in HbA1c, psychological indices, use of oral hypoglycaemic drugs, body mass index (BMI), and reported hypoglycaemia rates.Results 96 patients (55 men) were randomised to monitoring and 88 (56 men) to control. There were no baseline differences in mean (SD) age (57.7 (11.0) in monitoring group v 60.9 (11.5) in control group) or HbA1c (8.8 (2.1)% v 8.6 (2.3)%, respectively). Those in the monitoring group had a higher baseline BMI (34 (7) v 32 (6.2)). There were no significant differences between groups at any time point (12 months values given) in HbA1c (6.9 (0.8)% v 6.9 (1.2)%, P=0.69; 95% confidence interval for difference −0.25% to 0.38%), BMI (33.1 (6.4) v 31.8 (6.0); adjusted for baseline BMI, P=0.32), use of oral hypoglycaemic drugs, or reported incidence of hypoglycaemia. Monitoring was associated with a 6% higher score on the depression subscale of the well-being questionnaire (P=0.01).Conclusions In patients with newly diagnosed type 2 diabetes self monitoring of blood glucose concentration has no effect on glycaemic control but is associated with higher scores on a depression subscale.Trial registration ISRCTN 49814766.
Translating Chronic Illness Research into Practice presents recent developments in chronic illness research and their implications for clinical practice. It delivers both a synthesis and a critique ...of current chronic illness research and its applications to chronic illness prevention, treatment and care. It promotes advances in knowledge about chronic illness, including discussion of the future directions for chronic illness research and gaps in present knowledge about effective chronic illness prevention, treatment and care. Key features: Contains contributions from internationally renowned researchers in chronic illness Focuses on three key concepts, translating research into practice, chronic illness and practice, and bridges the boundaries between them Is applicable to an international, multi-disciplinary readership For researchers and practitioners across health disciplines
Abstract
Background
Research into the use of digital technology for weight loss maintenance (intentionally losing at least 10% of initial body weight and actively maintaining it) is limited. The aim ...of this article was to systematically review randomized controlled trials (RCTs) reporting on the use of digital technologies for communicating on weight loss maintenance to determine its’ effectiveness, and identify gaps and areas for further research.
Methods
A systematic literature review was conducted by searching electronic databases to locate publications dated between 2006 and February 2018. Criteria were applied, and RCTs using digital technologies for weight loss maintenance were selected.
Results
Seven RCTs were selected from a total of 6541 hits after de-duplication and criteria applied. Three trials used text messaging, one used e-mail, one used a web-based system and two compared such a system with face-to-face contact. From the seven RCTs, one included children (n = 141) and reported no difference in BMI Standard Deviation between groups. From the seven trials, four reported that technology is effective for significantly aiding weight loss maintenance compared with control (no contact) or face-to face-contact in the short term (between 3 and 24 months).
Conclusions
It was concluded that digital technologies have the potential to be effective communication tools for significantly aiding weight loss maintenance, especially in the short term (from 3 to 24 months). Further research is required into the long-term effectiveness of contemporary technologies.
Education for Patients and Clients sets out basic principles for providing patient education as an integral part of nursing care. It challenges the view that simply giving information is enough and ...investigates strategies for making education as effective as possible. The author explores: *the effect of psychosocial factors such as personal beliefs and family support on our behaviour *the importance of taking such factors into account when planning education for patients and clients *compliance and non-compliance *the role of the nurse as educator *the patient's right to knowledge regarding their health and treatment. Education for Patients and Clients will be essential reading for both pre and post-registration nurses studying health education in all settings.
Dr Vivien Coates is Lecturer in Nursing at University of Ulster and a registered nurse. Before going into education she practised in a variety of medical and surgical settings.
The incidence of gestational diabetes mellitus (GDM)--hyperglycemia with onset or first recognition during pregnancy--is increasing and will have a significant impact on diabetes services. This study ...aimed to determine the feasibility and acceptability of using telemedicine in the diabetes care of women with GDM and the possibility of replacing alternate (one in every two) diabetes review appointments with telemedicine.
A feasibility study for a randomized controlled trial was conducted across two sites. Fifty women with GDM were randomized to usual care (n = 26) or usual care plus telemedicine (n = 24). Telemedicine entailed weekly blood pressure and weight measurements and transmission of these data, along with blood glucose readings, for review by the healthcare team. Patients were contacted about these results as necessary. Patients completed questionnaires to measure their satisfaction with telemedicine or blood glucose monitoring. The intervention group and healthcare providers also took part in qualitative interviews. Analysis involved descriptive statistics for the satisfaction questionnaires and framework analysis for the qualitative interviews.
Eighty-nine percent of patients were satisfied with telemedicine and would use it again. Both HCPs and patients found the equipment easy to use and were positive about using it to replace alternate diabetes review appointments in the future. If used in this way, healthcare providers felt that protected time in which to perform the telemedicine review would be necessary.
Telemedicine may help meet the growing demand on diabetes services due to increasing numbers of women being diagnosed with GDM.
More people living into old age with dementia. The complexity of treatment and care, particularly those with multiple health problems, can be experienced as disjointed. As part of an evaluation of a ...'healthcare passport' for people living with dementia we undertook a realist review of communication tools within health and social care for people living with dementia.
To explore how a 'healthcare passport' might work in the 'real world' of people living with dementia through a better understanding of the theoretical issues related to, and the contextual issues that facilitate, successful communication.
A realist review was considered the most appropriate methodology to inform the further development and evaluation of the healthcare passport. We undertook a purposive literature search related to communication tools to identify (a) underlying programme theories; (b) published reports and papers on their use in various healthcare settings; (c) evidence on barriers and facliitators of their use.
Communication tools were noted as a way of improving communication and outcomes through: (1) improvement of service user autonomy; (2) strengthening the therapeutic alliance; and (3) building integrated care. However, while intuitively perceived to of benefit, evidence on their use is limited and key barriers to their acceptance and use include: (1) difficulties in clearly defining purpose, content, ownership and usage; (2) understanding the role of family caregivers; and (3) preparation among healthcare professionsals.
Patient-held communication tools may be helpful to some people living with dementia but will require considerable preparation and engagement with key stakeholders.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Aims and objectives
To investigate factors influencing patients' self‐management of urgent diabetes problems that precipitated unscheduled hospital care.
Background
Diabetes is placing increasing ...resource demands on health services and current policy advocates management in primary care and community settings whenever possible. Such policy has implications for patient education and empowerment and on mechanisms within primary and community care to support the management of diabetes when urgent healthcare problems arise.
Design
Qualitative, descriptive investigation, across two contrasting sites.
Methods
Forty‐five people admitted to hospital for urgent/emergency care due to diabetes‐related problems were recruited from urban and rural localities in the UK. Semi‐structured interviews were conducted and data analysed using nvivo version 8 and framework techniques.
Results
Self‐management of diabetes was typically habitual, and urgent problems that proved difficult to resolve necessitated recourse to unscheduled hospital care. Though skills relating to problem‐solving, decision‐making, resource use and formation of patient–provider partnerships were evident among some participants, these required further development. Evidence of action planning or self‐tailoring skills was sparse.
Conclusions
Education plays an important role in assisting individuals to self‐manage their diabetes on a daily basis, but urgent, unexpected health problems proved challenging for both patients and health service providers. A greater focus on empowering patients with core self‐management skills is required to enhance ability to successfully manage unexpected diabetes complications, coupled with enhanced primary care resources, particularly out‐of‐hours.
Relevance to clinical practice
The importance of informal and structured diabetes education should not be underestimated; however, the challenge of improving skills such as problem‐solving to manage urgent healthcare needs must be tackled. This study provokes debate regarding how best to deliver appropriate education and health services to cover urgent unscheduled care needs without automatically referring to emergency department hospital care.
To examine the efficacy of clinical practice strategies in improving clinical outcomes and reducing length of hospital stay for inpatients with Type 1 and Type 2 diabetes.
People living with diabetes ...are at increased risk of being admitted to hospital and to stay in hospital longer than those who do not have the condition. Diabetes and its complications cause substantial economic loss to those living with the condition, their families, to health systems and national economies through direct medical costs and loss of work and wages. Length of stay is a major factor driving up hospitalisation costs relating to those with Type 1 and Type 2 diabetes with suboptimal blood glucose management, hypoglycaemia, hyperglycaemia, and co-morbidities shown to considerably impact upon length of stay. The identification of attainable evidence-based clinical practice strategies is necessary to inform the knowledge base and identify service improvement opportunities that could lead to improved clinical outcomes for these patients.
A systematic review and narrative synthesis.
A systematic search of CINAHL, Medline Ovid, and Web of Science databases was carried out to identify research papers reporting on interventions that have reduced length of hospital stay for inpatients living with diabetes for the period 2010-2021. Selected papers were reviewed, and relevant data extracted by three authors. Eighteen empirical studies were included.
Eighteen studies spanned the themes of clinical management innovations, clinical education programmes, multidisciplinary collaborative care and technology facilitated monitoring. The studies demonstrated improvements in healthcare outcomes such as glycaemic control, greater confidence with insulin administration and reduced occurrences of hypoglycaemia and hyperglycaemia and decreased length of hospital stay and healthcare costs.
The clinical practice strategies identified in this review contribute to the evidence base for inpatient care and treatment outcomes. The implementation of evidence-based research can improve clinical practice and show that appropriate management can enhance clinical outcomes for the inpatient with diabetes, potentially leading to reductions in length of stay. Investment in and commissioning of practices that have the potential to afford clinical benefits and reduce length of hospital stay could influence the future of diabetes care.
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=204825, identifier 204825.
It is estimated among individuals with type 2 diabetes (T2D) requiring injectable therapies to achieve optimal glycaemic control, one-third are reluctant to initiate therapies, with approximately 80% ...choosing to discontinue or interrupt injectable regimens soon after commencement. Initiation of injectables is a complex issue, with effectiveness of such treatments undermined by non-adherence or poor engagement. Poor engagement and adherence are attributed to psychological aspects such as individuals' negative perceptions of injectables, depression, anxiety, feelings of shame, distress and perceived lack of control over their condition. The aim of this study was to describe the development of a structured diabetes intervention to address psychological barriers to injectable treatments among a cohort of those with T2D; conducted within a behavioural change framework. An evidence base was developed to inform on key psychological barriers to injectable therapies. A systematic review highlighted the need for theory-based, structured diabetes education focussed on associated psychological constructs to inform effective, patient-centric provisions to improve injectable initiation and persistence. Findings from the focus groups with individuals who had recently commenced injectable therapies, identified patient-centric barriers to initiation and persistence with injectables. Findings from the systematic review and focus groups were translated
Behavioural Change Wheel (BCW) framework to develop an intervention for people with T2D transitioning to injectable therapies: Overcoming and Removing Barriers to Injectable Treatment in T2D (ORBIT). This article describes how psychological barriers informed the intervention with these mapped onto relevant components, intervention functions and selected behaviour change techniques, and finally aligned with behaviour change techniques. This article outlines the systematic approach to intervention development within the BCW framework; guiding readers through the practical application of each stage. The use of the BCW framework has ensured the development of the intervention is theory driven, with the research able to be evaluated and validated through replication due to the clarity around processes and tasks completed at each stage.
Why you should read this article:• To understand the challenges of managing diabetes mellitus alongside dementia• To learn about the importance of sharing patient information among healthcare ...professionals in various settings• To consider how the use of IT might promote more effective communication between specialtiesBackground Managing diabetes mellitus alongside the onset and development of dementia poses many challenges for those living with these conditions as well as their families, carers and service providers.Aim To describe nurses’ positive experiences when managing adults with diabetes and dementia, as well as the issues and challenges.Method Qualitative, semi-structured focus group interviews were conducted with community and diabetes specialist nurses drawn from five health and social care trusts.Findings Four themes were identified: whose responsibility is it?; community and diabetes specialist nurses – the pivot point; education to manage comorbidities; and interprofessional communication.Conclusion Community and diabetes specialist nurses experience many challenges when supporting individuals living with diabetes and dementia. Sharing patient information among practitioners in different settings is critically important. IT could overcome the limitations of note-keeping ‘silos’, but further education is recommended to establish more effective communication and partnership working.
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