Population Health: The Diabetes Educator’s Evolving Role
Teresa L. Pearson, MS, RN, CDE, FAADE, Joan Bardsley, MBA, RN, CDE, FAADE, Susan Weiner, MS, RDN, CDE, FAADE, Leslie Kolb, MBA, RN, BSN
First Published June 23, 2019; pp. 333–348
Abstract
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Purpose
The US health care system’s focus on high-quality, efficient, and cost-effective care has led payers and provider groups to identify new models with a shift toward value-based care. This perspective on clinical practice describes the population health movement and the opportunities for diabetes educators beyond diabetes self-management education, as well as steps to engage in and drive new care models to demonstrate individual, organizational, and payer value.
Conclusion
Diabetes educators have an opportunity to position themselves as diabetes specialists for diabetes management, education, and population health care delivery. With expertise that extends beyond diabetes self-management education and with a wide variety of skills, diabetes educators recognize that there is a range of personal, social, economic, and environmental factors that influence diabetes health outcomes. Diabetes educators should align with organizational strategic plans and support the population-level performance measures and quality initiatives, thus enhancing the value that diabetes educators bring to health care organizations.
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Meta-analysis, systematic reviews, and integrative reviews
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Diabetes Education Impact on Hypoglycemia Outcomes: A Systematic Review of Evidence and Gaps in the Literature
Jacqueline LaManna, PhD, ANP, BC-ADM, CDE, Michelle L. Litchman, PhD, FNP-BC, FAANP, Jane K. Dickinson, RN, PhD, CDE, Andrew Todd, MLIS, BSN, Mary M. Julius, RDN, LD, CDE, Christina R. Whitehouse, PhD, AGPCNP-BC, CDE, Suzanne Hyer, PhD, RN, Jan Kavookjian, MBA, PhD, FAPhA
First Published June 18, 2019; pp. 349–369
Abstract
Hide Preview
Purpose
The primary purpose of this study is to report a systematic review of evidence and gaps in the literature among well-conducted studies assessing the impact of diabetes education on hypoglycemia outcomes and secondarily reporting the impact on other included target outcomes.
Methods
The authors used a modified Cochrane method to systematically search and review English-language titles, abstracts, and full-text articles published in the United States between January 2001 and December 2017, with diabetes education specified as an intervention and a directly measurable outcome for hypoglycemia risk or events included.
Results
Fourteen quasi-experimental, experimental, and case-control studies met the inclusion criteria, with 8 articles reporting a positive impact of diabetes self-management education and support (DSMES) on hypoglycemia outcomes; 2 of the 8 reported decreased hypoglycemia events, and 1 reported decreased events in both the intervention and control groups. In addition, 5 studies targeted change in reported hypoglycemia symptoms, with all 5 reporting a significant decrease. DSMES also demonstrated an impact on intermediate (knowledge gain, behavior change) and long-term (humanistic and economic/utilization) outcomes. An absence of common hypoglycemia measures and terminology and suboptimal descriptions of DSMES programs for content, delivery, duration, practitioner types, and participants were identified as gaps in the literature.
Conclusions
Most retained studies reported that diabetes education positively affected varied measures of hypoglycemia outcomes (number of events, reported symptoms) as well as other targeted outcomes. Diabetes education is an important intervention for reducing hypoglycemia events and/or symptoms and should be included as a component of future hypoglycemia risk mitigation studies.
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Active Learning: Lessons From Women With Type 2 Diabetes in a Walking Program
Cynthia Fritschi, PhD, RN, APRN, CDE, Pamela Martyn-Nemeth, PhD, Bingqian Zhu, PhD, Min Jung Kim, MSN
First Published May 10, 2019; pp. 370–379
Abstract
Hide Preview
Purpose
The purpose of this study was to explore the experiences and preferences of sedentary women with type 2 diabetes who had recently completed a pilot 12-week supervised treadmill walking study.
Methods
A qualitative design was used. Content analysis was used to assess major themes and subthemes embedded within participants’ responses to open-ended questions about their experiences of participating in a walking program. Women were recruited from a database of patients willing to be contacted for research studies.
Results
Seven inner-city women with type 2 diabetes (71% African American, age 62 ± 4.2 years, A1C 6.8% ± 1.3, years since diagnosis 6.6 ± 3.4 years) completed the postprogram interview. Only 3 of the 7 women had ever received any diabetes education. Four major themes emerged: (1) supportive environment, (2) personal commitment: overcoming ambivalence, (3) learning, and (4) outcomes, and 8 subthemes emerged. A supportive environment (encouraging, person centered, social, and structured) in combination with actively learning about diabetes and self-monitoring the effects of exercise seemed to be associated with personal commitment and confidence in participating in a walking program.
Conclusions
Active/experiential learning in a supportive environment may enhance both personal diabetes knowledge and behaviors among women with little diabetes education and low activity levels.
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Correlates of Self-Care Behaviors in Adults With Type 2 Diabetes and Comorbid Heart Failure
Fekadu B. Aga, MSc, PhD Candidate, Sandra B. Dunbar, RN, PhD, FAAN, FAHA, FPCNA, Tedla Kebede, MD, Melinda Kay Higgins, PhD, Rebecca A. Gary, RN, PhD, FAHA, FAAN
First Published June 14, 2019; pp. 380–396
Abstract
Hide Preview
Purpose
The purpose of this study was to describe sociodemographic, clinical, and psychosocial correlates of diabetes self-care behaviors in adults with type 2 diabetes mellitus (T2D) and comorbid heart failure (HF).
Method
Baseline data of 180 participants from a clinical trial that tested a 6-month integrated self-care intervention for persons with comorbid HF and T2D were analyzed. Correlational bivariate and multiple logistic regression analyses were performed to examine correlates of diabetes self-care behaviors.
Result
Participants had a mean age of 58 ± 11years; the majority were male (n = 118, 66%) and African American (n = 119, 66%). Number of comorbidities >2 (P < .001), having more than a high school education (P < .05), and African American ethnicity (P < .05) predicted better exercise, self-monitoring blood glucose (SMBG), and foot care behaviors, respectively. The use of an aldosterone inhibitor (P < .05) predicted worse exercise performance, higher Charlson Comorbidity Index scores (P < .01) predicted worse SMBG, and treatment with diet plus medication (P < .05) and dyslipidemia (P < .001) predicted worse foot care.
Conclusion
Findings from this study provide new insights into the complex self-care requirements for T2D patients with comorbid HF. Integrated self-care interventions are clearly warranted in persons living with multiple chronic conditions for optimal health outcomes and the prevention of complications. Our sample of predominately African American men showed they had better T2D self-care behaviors than whites than previously reported. Additional research is needed to determine racial and gender differences on health outcomes in persons with T2D and comorbid HF.
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Characteristics of Households of People With Diabetes Accessing US Food Pantries: Implications for Diabetes Self-Management Education and Support
Marianna S. Wetherill, PhD, MPH, RDN-AP/LD, Mary B. Williams, PhD, Kayla C. White, MPH, RDN/LD, Hilary K. Seligman, MD, MAS
First Published June 16, 2019; pp. 397–407
Abstract
Hide Preview
Purpose
The purpose of this study is to explore the associations between food insecurity (FI) and coping strategies of relevance to diabetes self-management among households of people with diabetes (HHDM) who access US food pantry programs.
Methods
The authors conducted a secondary data analysis of HHDM accessing US food pantry programs from the Hunger in America 2014 study (n = 16 826). Weighted analyses included descriptive statistics for household sociodemographics, food pantry service utilization, FI, and coping behaviors. The authors used chi-square and logistic regression to estimate the relationship between FI and coping behaviors.
Results
Nearly one-half of HHDM reported visiting food pantries at least 6 times in the past year. Most HHDM were FI, with the majority experiencing the most severe form of FI. Over one-fifth of households reported lacking health insurance. The majority of HHDM reported purchasing inexpensive unhealthy foods to ensure household food adequacy, and many reported watering down food and beverages. The odds of reporting these behaviors significantly increased as FI worsened.
Conclusion
Food pantries represent an opportunity for the delivery of community-based diabetes self-management education and support programs. These programs should be adapted to address population barriers to self-management and to support access to healthful foods and medical care.
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Predictors of Health-Protective Behavior and Glycemia After Gestational Diabetes, NHANES 2007-2014
Kerri Lynn Knippen, PhD, MPH, RDN, LD, BC-ADM, Jiunn-Jye Sheu, PhD, MSPH, MCHES, Reena Oza-Frank, PhD, MS-MPH, RD, Kimberly McBride, PhD, MA, Joseph Dake, PhD, MPH
First Published May 10, 2019; pp. 408–419
Abstract
Hide Preview
Purpose
This study examined weight loss behavior and the prevalence of hyperglycemia unawareness (unknown high blood glucose) after gestational diabetes mellitus (GDM), within a nationally, representative sample. This study also examined social-demographic, psychosocial, provider communication, and health care access/utilization factors as predictors of A1C and health-protective behavior after GDM.
Methods
A secondary analysis of 2007-2014 National Health and Nutrition Examination Surveys (NHANES) data was conducted, including 205 women, aged 20 to 44 years, with a history of GDM, whose last live birth was in the past 10 years, excluding pregnant women and those with diabetes. Weighted bivariate, stepwise linear, and binary logistic regression analyses were conducted to examine correlates of A1C, weight change, weight loss attempt and behavior, diabetes screening, and physical activity.
Results
Hyperglycemia unawareness was associated with increased A1C and weight gain in the past year. Personal weight loss goal and perception of overweight increased the odds of weight loss attempt. Depressive symptoms were associated with weight gain over the past year. A third of the sample failed to have their glucose tested in the past 3 years. Two-thirds were never told about their personal risk for diabetes, but provider communication increased the odds of meeting weekly activity recommendations and glucose screening. Hispanic women and non-Hispanic black women were less likely to have had glucose screening than non-Hispanic white women.
Conclusion
Diabetes educators should address gaps in provider communication, while supporting psychosocial needs and reducing disparities to encourage health-protective behavior after GDM. The American Association of Diabetes Educators, 7 Self-Care Behaviors (AADE-7TM) provides an excellent framework for interventions to support health-protective behavior after GDM.
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Home Telemedicine (CoYoT1 Clinic): A Novel Approach to Improve Psychosocial Outcomes in Young Adults With Diabetes
Marwan Bakhach, MD, Mark W. Reid, PhD, Elizabeth A. Pyatak, PhD, CDE, Cari Berget, RN, MPH, CDE, Cindy Cain, NP, CDE, John “Fred” Thomas, PhD, Georgeanna J. Klingensmith, MD, Jennifer K. Raymond, MD, MCR
First Published June 27, 2019; pp. 420–430
Abstract
Hide Preview
Purpose
To assess the impact of a home telemedicine clinic model (CoYoT1 Clinic) on psychosocial and behavioral outcomes designed for young adults (YAs) with type 1 diabetes (T1D).
Methods
YAs self-selected to participate in the CoYoT1 Clinic or serve as a usual care control. CoYoT1 Clinic visits consisted of an individual appointment with a provider and a group appointment with other YAs with T1D using home telemedicine. Psychosocial and behavioral functioning was assessed by 4 measures: Diabetes Distress Scale, Self-Efficacy for Diabetes Scale, Self-Management of Type 1 Diabetes in Adolescence Scale, and Center for Epidemiologic Studies Depression Scale.
Results
Forty-two patients participated in the CoYoT1 Clinic and 39 patients served as controls. CoYoT1 participants reported lower levels of distress (P = .03), increased diabetes self-efficacy (P = .01), and improved ability to communicate with others about diabetes (P = .04) over the study period compared to controls. YA males in the control group reported increases in depressive symptoms (P = .03) during the study period, but CoYoT1 participants showed no changes.
Conclusion
Group home telemedicine for YAs with T1D positively affects diabetes distress, self-efficacy, and diabetes-specific communication. These positive findings have the potential to also affect the YAs’ long-term diabetes outcomes. Further investigation of the model is needed.
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Low Health Literacy Is Associated With Risk of Developing Type 2 Diabetes in a Nonclinical Population
Lydia O’Meara, BMedSc, Susan L. Williams, PhD, Kate Ames, PhD, Celeste Lawson, PhD, Sonia Saluja, MD, Corneel Vandelanotte, PhD
First Published June 21, 2019; pp. 431–441
Abstract
Hide Preview
Purpose
The purpose of this study was to examine associations among risk of type 2 diabetes (T2D), health literacy levels, and sociodemographic characteristics in a nonclinical adult population to assist in the development of effective T2D prevention programs.
Methods
The Health Literacy Questionnaire and Australian Type 2 Diabetes Risk Assessment Tool were included in an online survey. Participants were a random sample of adults residing in each Australian state and territory. Data were analyzed with descriptive statistics and multinomial logistic regression.
Results
A total of 1279 Australian adults participated (52% female; mean ± SD age, 61 ± 12 years). Most were at medium (42.4%) or high (46.9%) risk of developing T2D. The lowest health literacy scores were found for the domains “critical appraisal of health information” and “navigating the health care system.” After controlling for covariates, participants at the highest risk of developing T2D were significantly more likely to be unemployed, have ≥1 chronic conditions, or have a mental health condition. Furthermore, they were significantly more likely to develop T2D if they scored low in 1 of the following health literacy domains: critical appraisal of health information, navigating the health care system, actively managing health, social support, and health care provider support.
Conclusions
Health literacy was associated with increased risk for developing T2D and should therefore be part of diabetes prevention initiatives. Specifically, new health promotion initiatives need to help people develop skills required to critically appraise health information and navigate the health care system. Health practitioners and educators should ensure that health information developed for consumers is uncomplicated and easily understood.
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Cooking Education Improves Cooking Confidence and Dietary Habits in Veterans
Ashley S. Dexter, MS, RD, Janet F. Pope, PhD, RD, LDN, Dawn Erickson, MPH, RD, LDN, Catherine Fontenot, PhD, RD, LDN, Elizabeth Ollendike, MS, RD, LDN, CDE, Emily Walker, MS, RD, LDN, FAND
First Published May 10, 2019; pp. 442–449
Abstract
Hide Preview
Purpose
The purpose of the study was to evaluate a 12-week cooking education class on cooking confidence, dietary habits, weight status, and laboratory data among veterans with prediabetes and diabetes.
Methods
The sample for this study included 75 veterans within the Overton Brooks Veteran Affairs Medical Center who completed the 12-week class in an in-person group setting in Shreveport, Louisiana, or via Clinical Video Telehealth (CVT) in Longview, Texas. Veterans were referred to the Healthy Teaching Kitchen by their primary care provider or primary care dietitian. Enrollment in the class was on a volunteer basis. The cooking and nutrition education classes included topics such as carbohydrate counting, safety and sanitation, meal planning, and creating budget-friendly recipes. Participants completed 2 questionnaires for assessment of healthy dietary habits and confidence related to cooking. Changes in body weight, lipid panel, and hemoglobin A1C were assessed. Differences in class settings were tested via independent samples t tests. Paired samples t tests were completed to compare changes in mean laboratory results, weight, and questionnaire responses.
Results
Subjects lost a mean 2.91 ± 5.8 lbs (P < .001). There was no significant difference in percent change in laboratory data and weight between subjects participating via CVT and subjects in the live class. Overall, there was significant improvement in the confidence questionnaire ratings and Healthy Habits Questionnaire responses.
Conclusions
Cooking and nutrition education can increase cooking confidence and dietary quality. These results provide support for the need for further research on the long-term effects of nutrition cooking education and for the benefits of using CVT software to provide education to remote facilities.
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Teresa L. Pearson, MS, RN, CDE, FAADE, Joan Bardsley, MBA, RN, CDE, FAADE, Susan Weiner, MS, RDN, CDE, FAADE, Leslie Kolb, MBA, RN, BSN
First Published June 23, 2019; pp. 333–348
Abstract
Hide Preview
Purpose
The US health care system’s focus on high-quality, efficient, and cost-effective care has led payers and provider groups to identify new models with a shift toward value-based care. This perspective on clinical practice describes the population health movement and the opportunities for diabetes educators beyond diabetes self-management education, as well as steps to engage in and drive new care models to demonstrate individual, organizational, and payer value.
Conclusion
Diabetes educators have an opportunity to position themselves as diabetes specialists for diabetes management, education, and population health care delivery. With expertise that extends beyond diabetes self-management education and with a wide variety of skills, diabetes educators recognize that there is a range of personal, social, economic, and environmental factors that influence diabetes health outcomes. Diabetes educators should align with organizational strategic plans and support the population-level performance measures and quality initiatives, thus enhancing the value that diabetes educators bring to health care organizations.
Full Text
PDF Download
|
Permissions
Meta-analysis, systematic reviews, and integrative reviews
No Access
Diabetes Education Impact on Hypoglycemia Outcomes: A Systematic Review of Evidence and Gaps in the Literature
Jacqueline LaManna, PhD, ANP, BC-ADM, CDE, Michelle L. Litchman, PhD, FNP-BC, FAANP, Jane K. Dickinson, RN, PhD, CDE, Andrew Todd, MLIS, BSN, Mary M. Julius, RDN, LD, CDE, Christina R. Whitehouse, PhD, AGPCNP-BC, CDE, Suzanne Hyer, PhD, RN, Jan Kavookjian, MBA, PhD, FAPhA
First Published June 18, 2019; pp. 349–369
Abstract
Hide Preview
Purpose
The primary purpose of this study is to report a systematic review of evidence and gaps in the literature among well-conducted studies assessing the impact of diabetes education on hypoglycemia outcomes and secondarily reporting the impact on other included target outcomes.
Methods
The authors used a modified Cochrane method to systematically search and review English-language titles, abstracts, and full-text articles published in the United States between January 2001 and December 2017, with diabetes education specified as an intervention and a directly measurable outcome for hypoglycemia risk or events included.
Results
Fourteen quasi-experimental, experimental, and case-control studies met the inclusion criteria, with 8 articles reporting a positive impact of diabetes self-management education and support (DSMES) on hypoglycemia outcomes; 2 of the 8 reported decreased hypoglycemia events, and 1 reported decreased events in both the intervention and control groups. In addition, 5 studies targeted change in reported hypoglycemia symptoms, with all 5 reporting a significant decrease. DSMES also demonstrated an impact on intermediate (knowledge gain, behavior change) and long-term (humanistic and economic/utilization) outcomes. An absence of common hypoglycemia measures and terminology and suboptimal descriptions of DSMES programs for content, delivery, duration, practitioner types, and participants were identified as gaps in the literature.
Conclusions
Most retained studies reported that diabetes education positively affected varied measures of hypoglycemia outcomes (number of events, reported symptoms) as well as other targeted outcomes. Diabetes education is an important intervention for reducing hypoglycemia events and/or symptoms and should be included as a component of future hypoglycemia risk mitigation studies.
Full Text
PDF Download
Supplemental Material
|
Permissions
Features
No Access
Active Learning: Lessons From Women With Type 2 Diabetes in a Walking Program
Cynthia Fritschi, PhD, RN, APRN, CDE, Pamela Martyn-Nemeth, PhD, Bingqian Zhu, PhD, Min Jung Kim, MSN
First Published May 10, 2019; pp. 370–379
Abstract
Hide Preview
Purpose
The purpose of this study was to explore the experiences and preferences of sedentary women with type 2 diabetes who had recently completed a pilot 12-week supervised treadmill walking study.
Methods
A qualitative design was used. Content analysis was used to assess major themes and subthemes embedded within participants’ responses to open-ended questions about their experiences of participating in a walking program. Women were recruited from a database of patients willing to be contacted for research studies.
Results
Seven inner-city women with type 2 diabetes (71% African American, age 62 ± 4.2 years, A1C 6.8% ± 1.3, years since diagnosis 6.6 ± 3.4 years) completed the postprogram interview. Only 3 of the 7 women had ever received any diabetes education. Four major themes emerged: (1) supportive environment, (2) personal commitment: overcoming ambivalence, (3) learning, and (4) outcomes, and 8 subthemes emerged. A supportive environment (encouraging, person centered, social, and structured) in combination with actively learning about diabetes and self-monitoring the effects of exercise seemed to be associated with personal commitment and confidence in participating in a walking program.
Conclusions
Active/experiential learning in a supportive environment may enhance both personal diabetes knowledge and behaviors among women with little diabetes education and low activity levels.
Full Text
PDF Download
|
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No Access
Correlates of Self-Care Behaviors in Adults With Type 2 Diabetes and Comorbid Heart Failure
Fekadu B. Aga, MSc, PhD Candidate, Sandra B. Dunbar, RN, PhD, FAAN, FAHA, FPCNA, Tedla Kebede, MD, Melinda Kay Higgins, PhD, Rebecca A. Gary, RN, PhD, FAHA, FAAN
First Published June 14, 2019; pp. 380–396
Abstract
Hide Preview
Purpose
The purpose of this study was to describe sociodemographic, clinical, and psychosocial correlates of diabetes self-care behaviors in adults with type 2 diabetes mellitus (T2D) and comorbid heart failure (HF).
Method
Baseline data of 180 participants from a clinical trial that tested a 6-month integrated self-care intervention for persons with comorbid HF and T2D were analyzed. Correlational bivariate and multiple logistic regression analyses were performed to examine correlates of diabetes self-care behaviors.
Result
Participants had a mean age of 58 ± 11years; the majority were male (n = 118, 66%) and African American (n = 119, 66%). Number of comorbidities >2 (P < .001), having more than a high school education (P < .05), and African American ethnicity (P < .05) predicted better exercise, self-monitoring blood glucose (SMBG), and foot care behaviors, respectively. The use of an aldosterone inhibitor (P < .05) predicted worse exercise performance, higher Charlson Comorbidity Index scores (P < .01) predicted worse SMBG, and treatment with diet plus medication (P < .05) and dyslipidemia (P < .001) predicted worse foot care.
Conclusion
Findings from this study provide new insights into the complex self-care requirements for T2D patients with comorbid HF. Integrated self-care interventions are clearly warranted in persons living with multiple chronic conditions for optimal health outcomes and the prevention of complications. Our sample of predominately African American men showed they had better T2D self-care behaviors than whites than previously reported. Additional research is needed to determine racial and gender differences on health outcomes in persons with T2D and comorbid HF.
Full Text
PDF Download
|
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No Access
Characteristics of Households of People With Diabetes Accessing US Food Pantries: Implications for Diabetes Self-Management Education and Support
Marianna S. Wetherill, PhD, MPH, RDN-AP/LD, Mary B. Williams, PhD, Kayla C. White, MPH, RDN/LD, Hilary K. Seligman, MD, MAS
First Published June 16, 2019; pp. 397–407
Abstract
Hide Preview
Purpose
The purpose of this study is to explore the associations between food insecurity (FI) and coping strategies of relevance to diabetes self-management among households of people with diabetes (HHDM) who access US food pantry programs.
Methods
The authors conducted a secondary data analysis of HHDM accessing US food pantry programs from the Hunger in America 2014 study (n = 16 826). Weighted analyses included descriptive statistics for household sociodemographics, food pantry service utilization, FI, and coping behaviors. The authors used chi-square and logistic regression to estimate the relationship between FI and coping behaviors.
Results
Nearly one-half of HHDM reported visiting food pantries at least 6 times in the past year. Most HHDM were FI, with the majority experiencing the most severe form of FI. Over one-fifth of households reported lacking health insurance. The majority of HHDM reported purchasing inexpensive unhealthy foods to ensure household food adequacy, and many reported watering down food and beverages. The odds of reporting these behaviors significantly increased as FI worsened.
Conclusion
Food pantries represent an opportunity for the delivery of community-based diabetes self-management education and support programs. These programs should be adapted to address population barriers to self-management and to support access to healthful foods and medical care.
Full Text
PDF Download
|
Permissions
No Access
Predictors of Health-Protective Behavior and Glycemia After Gestational Diabetes, NHANES 2007-2014
Kerri Lynn Knippen, PhD, MPH, RDN, LD, BC-ADM, Jiunn-Jye Sheu, PhD, MSPH, MCHES, Reena Oza-Frank, PhD, MS-MPH, RD, Kimberly McBride, PhD, MA, Joseph Dake, PhD, MPH
First Published May 10, 2019; pp. 408–419
Abstract
Hide Preview
Purpose
This study examined weight loss behavior and the prevalence of hyperglycemia unawareness (unknown high blood glucose) after gestational diabetes mellitus (GDM), within a nationally, representative sample. This study also examined social-demographic, psychosocial, provider communication, and health care access/utilization factors as predictors of A1C and health-protective behavior after GDM.
Methods
A secondary analysis of 2007-2014 National Health and Nutrition Examination Surveys (NHANES) data was conducted, including 205 women, aged 20 to 44 years, with a history of GDM, whose last live birth was in the past 10 years, excluding pregnant women and those with diabetes. Weighted bivariate, stepwise linear, and binary logistic regression analyses were conducted to examine correlates of A1C, weight change, weight loss attempt and behavior, diabetes screening, and physical activity.
Results
Hyperglycemia unawareness was associated with increased A1C and weight gain in the past year. Personal weight loss goal and perception of overweight increased the odds of weight loss attempt. Depressive symptoms were associated with weight gain over the past year. A third of the sample failed to have their glucose tested in the past 3 years. Two-thirds were never told about their personal risk for diabetes, but provider communication increased the odds of meeting weekly activity recommendations and glucose screening. Hispanic women and non-Hispanic black women were less likely to have had glucose screening than non-Hispanic white women.
Conclusion
Diabetes educators should address gaps in provider communication, while supporting psychosocial needs and reducing disparities to encourage health-protective behavior after GDM. The American Association of Diabetes Educators, 7 Self-Care Behaviors (AADE-7TM) provides an excellent framework for interventions to support health-protective behavior after GDM.
Full Text
PDF Download
|
Permissions
No Access
Home Telemedicine (CoYoT1 Clinic): A Novel Approach to Improve Psychosocial Outcomes in Young Adults With Diabetes
Marwan Bakhach, MD, Mark W. Reid, PhD, Elizabeth A. Pyatak, PhD, CDE, Cari Berget, RN, MPH, CDE, Cindy Cain, NP, CDE, John “Fred” Thomas, PhD, Georgeanna J. Klingensmith, MD, Jennifer K. Raymond, MD, MCR
First Published June 27, 2019; pp. 420–430
Abstract
Hide Preview
Purpose
To assess the impact of a home telemedicine clinic model (CoYoT1 Clinic) on psychosocial and behavioral outcomes designed for young adults (YAs) with type 1 diabetes (T1D).
Methods
YAs self-selected to participate in the CoYoT1 Clinic or serve as a usual care control. CoYoT1 Clinic visits consisted of an individual appointment with a provider and a group appointment with other YAs with T1D using home telemedicine. Psychosocial and behavioral functioning was assessed by 4 measures: Diabetes Distress Scale, Self-Efficacy for Diabetes Scale, Self-Management of Type 1 Diabetes in Adolescence Scale, and Center for Epidemiologic Studies Depression Scale.
Results
Forty-two patients participated in the CoYoT1 Clinic and 39 patients served as controls. CoYoT1 participants reported lower levels of distress (P = .03), increased diabetes self-efficacy (P = .01), and improved ability to communicate with others about diabetes (P = .04) over the study period compared to controls. YA males in the control group reported increases in depressive symptoms (P = .03) during the study period, but CoYoT1 participants showed no changes.
Conclusion
Group home telemedicine for YAs with T1D positively affects diabetes distress, self-efficacy, and diabetes-specific communication. These positive findings have the potential to also affect the YAs’ long-term diabetes outcomes. Further investigation of the model is needed.
Full Text
PDF Download
|
Permissions
No Access
Low Health Literacy Is Associated With Risk of Developing Type 2 Diabetes in a Nonclinical Population
Lydia O’Meara, BMedSc, Susan L. Williams, PhD, Kate Ames, PhD, Celeste Lawson, PhD, Sonia Saluja, MD, Corneel Vandelanotte, PhD
First Published June 21, 2019; pp. 431–441
Abstract
Hide Preview
Purpose
The purpose of this study was to examine associations among risk of type 2 diabetes (T2D), health literacy levels, and sociodemographic characteristics in a nonclinical adult population to assist in the development of effective T2D prevention programs.
Methods
The Health Literacy Questionnaire and Australian Type 2 Diabetes Risk Assessment Tool were included in an online survey. Participants were a random sample of adults residing in each Australian state and territory. Data were analyzed with descriptive statistics and multinomial logistic regression.
Results
A total of 1279 Australian adults participated (52% female; mean ± SD age, 61 ± 12 years). Most were at medium (42.4%) or high (46.9%) risk of developing T2D. The lowest health literacy scores were found for the domains “critical appraisal of health information” and “navigating the health care system.” After controlling for covariates, participants at the highest risk of developing T2D were significantly more likely to be unemployed, have ≥1 chronic conditions, or have a mental health condition. Furthermore, they were significantly more likely to develop T2D if they scored low in 1 of the following health literacy domains: critical appraisal of health information, navigating the health care system, actively managing health, social support, and health care provider support.
Conclusions
Health literacy was associated with increased risk for developing T2D and should therefore be part of diabetes prevention initiatives. Specifically, new health promotion initiatives need to help people develop skills required to critically appraise health information and navigate the health care system. Health practitioners and educators should ensure that health information developed for consumers is uncomplicated and easily understood.
Full Text
PDF Download
|
Permissions
No Access
Cooking Education Improves Cooking Confidence and Dietary Habits in Veterans
Ashley S. Dexter, MS, RD, Janet F. Pope, PhD, RD, LDN, Dawn Erickson, MPH, RD, LDN, Catherine Fontenot, PhD, RD, LDN, Elizabeth Ollendike, MS, RD, LDN, CDE, Emily Walker, MS, RD, LDN, FAND
First Published May 10, 2019; pp. 442–449
Abstract
Hide Preview
Purpose
The purpose of the study was to evaluate a 12-week cooking education class on cooking confidence, dietary habits, weight status, and laboratory data among veterans with prediabetes and diabetes.
Methods
The sample for this study included 75 veterans within the Overton Brooks Veteran Affairs Medical Center who completed the 12-week class in an in-person group setting in Shreveport, Louisiana, or via Clinical Video Telehealth (CVT) in Longview, Texas. Veterans were referred to the Healthy Teaching Kitchen by their primary care provider or primary care dietitian. Enrollment in the class was on a volunteer basis. The cooking and nutrition education classes included topics such as carbohydrate counting, safety and sanitation, meal planning, and creating budget-friendly recipes. Participants completed 2 questionnaires for assessment of healthy dietary habits and confidence related to cooking. Changes in body weight, lipid panel, and hemoglobin A1C were assessed. Differences in class settings were tested via independent samples t tests. Paired samples t tests were completed to compare changes in mean laboratory results, weight, and questionnaire responses.
Results
Subjects lost a mean 2.91 ± 5.8 lbs (P < .001). There was no significant difference in percent change in laboratory data and weight between subjects participating via CVT and subjects in the live class. Overall, there was significant improvement in the confidence questionnaire ratings and Healthy Habits Questionnaire responses.
Conclusions
Cooking and nutrition education can increase cooking confidence and dietary quality. These results provide support for the need for further research on the long-term effects of nutrition cooking education and for the benefits of using CVT software to provide education to remote facilities.
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