Annotated Bibliography: Diabetes Education

Annotated Bibliography: Diabetes Education
Stacey Hurst
Chamberlain College of Nursing
NR 500 Foundational Concepts and Application

Dorland, K., Liddy, C. (2014). A pragmatic comparison of two diabetes education programs in  improving type 2 diabetes mellitus outcomes. BMC Res Notes, 28(7), 186. doi: 10.1186/1756-0500-7-186
The authors, researchers in Ottawa, Canada, compared two different diabetes education programs to determine whether participation in the programs improved patient diabetic outcomes. The main difference between the two programs involved length of sessions. The researchers concluded that shorter required amounts of class participation times resulted in better outcomes or were “equally effective”

for their diabetes management patients. This information will help when I am planning my teaching sessions. It will be more important that I include all the valuable self-management education, than that I meet for a certain length of time.
The article explains it’s important to promote diabetes education. According to the authors, targeting patients with higher A1C’s resulted in the greatest effect. This is something I use in my current practice so the article is relevant for me. I will continue to reach out to the patients with the highest out of range A1C’s first. The intended audience for this research article would likely be diabetic educators. The content seems thorough and the authors are credible sources according to their educational credentials listed.
The article gives some background information about diabetes self-management topics their diabetes education sessions covered. I may use some of these topics as I work on developing my education plan. The authors explain effective diabetes management can contribute to a national health care cost savings. I can relate this to my current role because my overall goal is improving patient care outcomes along with cost savings for healthcare.
Hosomura, N., Goldberg, S.I., Shubina, M., Zhang, M., Turchin, A. (2015). Electronic documentation of lifestyle counseling and glycemic control in patients with diabetes. Diabetes Care, 38(7), 1326-32. doi: 10.2337/dc14-2016
The authors, researchers in Boston, MA medical facilities, conducted a study using electronic medical notations, to determine whether lifestyle counseling improved diabetic outcomes. They looked at detailed lifestyle counseling which included instructions for exercise and diet compared to counseling with less specific instructions. They also looked at medication changes. They concluded that documentation of intensive instruction improved diabetic outcomes for patients. This information will help as I plan my instructional sessions, remembering to document specifically in patient charts. In addition, thorough documentation of the patient’s goals will help me assure their needs are addressed at follow up appointments and during telephone calls.
I can use the topics in this article to guide my practice. The descriptive statistics given in the article include data I could track with my patients. The article addresses the limitations of the study. The authors seem credible, as it’s listed they are affiliated with endocrinology departments including Harvard Medical School.
Jaacks, L.M., Bell, R.A., Dabelea, D., D'Agostino, R.B.

Jr, Dolan, L.M., Imperatore G, … Mayer-Davis, E.J. (2014). Diabetes self-management education patterns in a US population-based  cohort of youth with type 1 diabetes. Diabetes Educ, 40(1), 29-39. doi:  10.1177/0145721713512156
The authors, researchers in pediatric hospitals in NC, CO, GA, WA, and CA conducted studies of a large group of pediatric patients from five states in the US, to determine whether diabetic education improved outcomes. They considered family environment, age of patient, and economic status. Since the study results were self-reported by patients, the results may not be totally accurate. The relevance of this study to me is to remind me to take into consideration factors such as educational level, age, and socio-economic status.
The conclusion of the study in the article is that “health care providers should work together to address gaps” in care. One of the factors utilized in the article is whether or not the patient had met with a diabetic educator, dietitian, or nurse in the past 12 months. I could use this assessment piece doing chart reviews and as part of my goals to make sure each patient with an elevated A1C is offered health coaching and diabetes education at least every 6-12

months.
Another aspect of the article I found helpful for my practice is that it addressed some patients were only given “survival skills.” Other research shows ongoing self-management education seems most effective at helping patients meet their diabetes goals.
Khan, K.M., Windt, A., Davis, J.C., Dawes, M., Liu-Ambrose, T., Madden, K., … Adams DJ. Group Medical Visits (GMVs) in primary care: An RCT of group-based versus individual  appointments to reduce HbA1c in older people. BMJ Open, 5(7), 1-10. doi: 10.1136/bmjopen-2014-007441
The authors, researchers from Vancouver, BC, Canada, medical facilities, are conducting an on-going study involving older patients, to determine which setting has better outcomes, a group setting or individual setting. There are no conclusions in this article at this time. The relevance to me is to consider where my patients reside since encouraging them to be involved in group activities might be a valuable option to help control their diabetes.
The strength of this article is it addresses a “chronic model of care.” The patients were followed and outcomes were evaluated after one and two years. The research article will be effective for my current practice because the article explains the process for a shared diabetes medical visit. I often link a health coach visit with a office appointment with the providers in my family practice office for collaboration. It was helpful to reviews the goals mentioned in the article for these visits.
North, S.L., Palmer, G.A. (2015). Outcome analysis of hemoglobin A1C, weight, and blood pressure in a VA diabetes education program. J Nutr Educ Behav, 47(1), 28-35. doi: 10.1016/j.jneb.2014.07.006
The authors, researchers from St. Cloud Health Care System, MN, reviewed veterans’ medical records, to determine if a specific diabetes education program improved outcomes. Their conclusion was that those who had not participated in the program had no change, whereas those who participated in the specific program improved. The importance of this study to me is to consider various areas for improvement when working with patients such as other goals they may have, quitting smoking, weight loss, and exercising more, in addition to helping control their diabetes. It’s helpful to see the patient’s goals as multi-dimensional.
The article lists the educational topics listed as they are presented in three diabetes educational sessions. I found this useful as a possible guide for me to follow to make sure these are topics I cover. Also it’s helpful to see the organization of the content used in the study’s educational program. I can use all the ideas I get to improve the work that I do, my hope is that I continue to improve upon my goals lower for helping to have better diabetes management.
Another interesting finding in these author's study is they found family support to be more effective than an individual session without family support. I will use this in my practice by assessing for social support.
O’Connor, P.J., Schmittdiel, J.A., Pathak, R.D., Harris, R.I., Newton, K.M., Ohnsorg, K.A., … Steiner, J.F.  (2014). Randomized trial of telephone outreach to improve medication adherence and metabolic control in adults with diabetes. Diabetes Care, 37(12), 3317-24. doi: 10.2337/dc14-0596
The authors, researchers from clinics in Minnesota, Pennsylvania, Michigan, California, and Washington, conducted a study to determine whether telephone calls were beneficial to those patients recently prescribed medications for diabetes. The study determines even though phone calls followed the same protocol, there was not sufficient evident to prove there was more adherence to refilling prescriptions or outcomes. This information will help me determine if I need to be more thorough when telephoning my patients and to address any concerns they might have about medications.
This was a particularly interesting article. I can use some of the research notes in my current role as a health coach. The authors used their study to determine whether or not phone intervention improved compliance with taking medications and overall diabetes control. A limitation of this study is based on the information a patient might give to the educator about whether or not they are taking medications. Patients sometimes don’t tell anyone when they’ve made changes to how they're taking their medications. I will continue to assess for medication compliance.
Rachmani, R., Slavacheski, I., Berla, M., Frommer-Shapira, R., Ravid, M. (2005). Treatment of high-risk patients with diabetes: Motivation and teaching intervention: a randomized, prospective 8-year follow-up study. J Am Soc Nephrol, 3(16), 22-26. doi: 10.1681/ASN.2004110965
The authors, researchers from Departments of Medicine in Israel, conducted a study about the motivation and education of diabetic patients to improve outcomes.

The study compared two groups, those receiving intensive education and those with limited counseling regarding their disease. The authors concluded that the patients who received in depth information about their disease were more motivated to maintain a healthy life-style and thus improve outcomes. The importance of this research to my position is to continue to give in-depth educational information about patient disease, risk factors, and to involve them in controlling their health since motivation is a key factor in achieving improved

outcomes.
One limitation of the study is that the follow up data came from office notes from a primary care provider or consultants. Consultation notes may not be up to date or scanned to the primary care provider’s records.
Ruggiero L, Riley BB, Hernandez R, Quinn LT, Gerber BS, Castillo A, … Butler P. (2014).  Medical assistant coaching to support diabetes self-care among low- income racial/ethnic  minority populations: Randomized controlled trial. West J Nurs Res, 36(9), 1052-73. doi:  10.1177/0193945914522862
The authors, researchers from University of Illinois, Chicago, conducted a study of primary care practices involving low income minority groups, to determine whether intensive coaching improved outcomes in this population compared to patients receiving treatment as usual, without specific tailored instruction. The researchers found differences among ethnic groups, some responded to self-care better. This information is valuable to me since different approaches are required for each ethnic group when planning diabetic education and strategies for improving outcomes.
The research used to get the statistics for this article was a randomized controlled study. The limitations or weaknesses of this study is that it’s complicated. There are tables and flow charts used to help explain the statistics. A strength of the article is that multiple, credible authors contributed to the research and article.
This research applies to my practice in that I can see the results of increased self-care management. In health coaching and diabetes education, the goal is for the patient to be independent and to have an increase in success towards diabetes goals.
Ryan, J.G., Jennings, T., Vittoria, I., Fedders, M. (2013). Short and long-term outcomes from a multisession diabetes education program targeting low-income minority patients: A six-month follow up. Clin Ther, 35(1), 43-53. doi: 10.1016/ j.clinthera.2012.12.007
The authors, researchers from medical facilities in Florida, conducted a study of education offered to low income patients, to determine if participating in intensive multi-lingual sessions improved diabetic outcomes, compared to patients receiving less intensive educational sessions. The study concluded it was important to involve the patient and family members to achieve long term outcomes, being sensitive to any barriers such as language and lifestyle. The value of this research to me is to constantly remind myself to be sensitive to language and socio-economic barriers when dealing with patients.
A weakness of this article is the data isn’t very valuable because the only change report by patient’s at follow up was a “readiness to change” behaviors. The strength of the research is the study targeted low-income minority patients which concluded certain groups may need closer follow-up.

Weaver RG, Hemmelgarn BR, Rabi DM, Sargious PM, Edwards AL, Manns BJ, … James MT. (2014). Association between participation in a brief diabetes education program and  glycemic control in adults with newly diagnosed diabetes. Diabet Med, (12), 1610-4. doi: 10.1111/dme.12513
The authors, researchers from the University of Calgary, and University of Alberta, Canada, who conducted a study of newly diagnosed diabetic patients attending intervention sessions and those not attending sessions. The study indicated that those who attended sessions had favorable outcomes towards controlling their diabetes. The importance of this to me is that I will continue to work with diabetic patients and to involve them in frequent more education sessions to improve outcomes.
The strength of this study is it discusses new diabetes diagnosed patients, which is the group of patients I get referrals the most so I can follow closely. The weakness of the article is there was little, if any difference between the control group and the study group. The article is organized, and easy to understand. The article is short 6
Yuan, C., Lai, C.W., Chan, L.W., Chow, M., Law, H.K., Ying, M. (2014). The effect of diabetes self- management education on body weight, glycemic control, and other metabolic markers in patients with type 2 diabetes mellitus. J Diabetes Res, (Vol. 2014), 1-6. doi: 6610.1155/2014/789761
The authors, researchers from Hong Kong, conducted a study of patients who received intensive diabetic intervention and self-monitoring compared to those patients receiving less intensive intervention towards improving diabetic outcomes. The researchers reported improvements in the group receiving intensive intervention. The relevance of this information to my position is that I need to continue to offer intensive education interventions to achieve the improved diabetic outcomes in my patients.