Diabetes Self-Management
Topic to be discussed
• Practice Issue
• PICOT Question
• Literature Review
• Recommendations
PRACTICE ISSUE
Area
... [Show More] of interest
• Type II Diabetes (T2DM)
• Self-Management
• Practice issue and how it relates to NP
practice
• Impacts on health outcomes
TYPE II DIABETES
Define T2DM:
• What is Type II Diabetes?
• Costly to society
• In America, diabetes will increase by 54% by
2030
• Highly preventable with lifestyle interventions
PICOT
QUESTION
• P (Population) Patients with T2DM
• I (Intervention) Will self management tools including in
person counseling reduce HbA1c
• C (Comparison) Self management in person interviews
compared to technology-based application
• O (Outcome) Improved or decreased HbA1c levels
• T (Time frame) Time 3 months to 1 year
• PICOT question: In adult patients with type II DM, who
follow self-management education including via in person
counseling have have decreased HbA1c level in contrast
to those, who use technology-based app to self manage
diabetes 3-12 months (T)?
LITERATURE REVIEW
• 10 articles reviewed
• Implementation of self management education + in person counseling
versus technology-based application
• Common themes
• Insight and perspective
LITERATURE REVIEW
Evidence: DSME Tools that promote self-management behaviors
• Group sessions assist patients in managing their disease
• Assisting with implementing personal goals that are realistic
and evaluating progress
• Peer groups provide additional learning and support
• Ethnic Minority People with Diabetes & Traditional Educational
Setting
LITERATURE REVIEW
• In person counseling versus technology-based application for DSME
• Literature shows patients strictly utilizing technology-based application
for DSME
• Technology-based diabetes interventions have an effect on (−0.2%) of
HbA1c, and in the mobile phone group (−0.5). Text messaging, used
as educational tool, improved outcome of A1C of 0.53%. was reported
RECOMMENDATION
IMPLEMENT GLUCOSE SELF-MONITORING PROGRAM
Self-monitoring glucose raises patient's
awareness
Although successful this intervention is
primarily used in conjunction with monitoring
dietary habits
Community based programs are cost –
effective and achieve good outcomes
Key stakeholders:
• Health Care Providers
• Health insurance companies
• Patients
RECOMMENDATIONS:
IDENTIFY KEY STAKEHOLDERS
RECOMMENDATIONS:
ANALYZE FIT,
FEASIBILITY, AND
APPROPRIATENESS
Does this recommendation add
value?
Does it
improve
clinical
outcomes
Would it
improve
patient or
provider
satisfaction
Would it
reduce the
cost of care
Would this
change
improve unit
operations
Fit, feasibility and
appropriateness
CONCLUSION
REFERENCES
Bene, B. A., O’Connor, S., Mastellos, N., Majeed, A., Fadahunsi, K. P., & O’Donoghue, J.
(2019). Impact of mobile health applications on self-management in patients with type 2
diabetes mellitus: protocol of a systematic review. BMJ Open, 9(6), e025714.
https://doi.org/10.1136/bmjopen-2018-025714
Jimenez, G., Lum, E., & Car, J. (2019). Examining Diabetes Management Apps
Recommended From a Google Search: Content Analysis. JMIR MHealth and UHealth,
7(1), e11848. https://doi.org/10.2196/11848
Mensa-Wilmot, Y., Bowen, S.-A., Rutledge, S., Morgan, J. M., Bonner, T., Farris, K., Blacher,
R., & Rutledge, G. (2017). Early Results of States’ Efforts to Support, Scale, and Sustain
the National Diabetes Prevention Program. Preventing Chronic Disease, 14.
https://doi.org/10.5888/pcd14.170478
Rowley, W. R., Bezold, C., Arikan, Y., Byrne, E., & Krohe, S. (2017). Diabetes 2030:
Insights from Yesterday, Today, and Future Trends. Population Health Management,
20(1), 6–12. https://doi.org/10.1089/pop.2015.0181
Sherifali, D., Berard, L. D., Gucciardi, E., MacDonald, B., & MacNeill, G. (2018). SelfManagement Education and Support. Canadian Journal of Diabetes, 42, S36–S41.
https://doi.org/10.1016/j.jcjd.2017.10.006
REFERENCES
Schmittdiel, J. A., Gopalan, A., Lin, M. W., Banerjee, S., Chau, C. V., & Adams, A. S. (2017).
Population Health Management for Diabetes: Health Care System-Level Approaches for
Improving Quality and Addressing Disparities. Current Diabetes Reports, 17(5).
https://doi.org/10.1007/s11892-017-0858-3
Schub, E. B., & Walsh, K. C. (2017). Evidence-Based Nursing Practice: Implementing.
CINAHL Nursing Guide
Shirinzadeh, M., Afshin-Pour, B., Angeles, R., Gaber, J., & Agarwal, G. (2019). The effect of
community-based programs on diabetes prevention in low- and middle-income countries: a
systematic review and meta-analysis. Globalization and Health, 15(1).
https://doi.org/10.1186/s12992-019-0451-4
Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., Maryniuk, M.
D., Siminerio, L., & Vivian, E. (2016). Diabetes Self-management Education and Support in
Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the
American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics.
Clinical Diabetes, 34(2), 70–80. https://doi.org/10.2337/diaclin.34.2.70
Van Smoorenburg, A. N., Hertroijs, D. F. L., Dekkers, T., Elissen, A. M. J., & Melles, M. (2019).
Patients’ perspective on self-management: type 2 diabetes in daily life. BMC Health
Services Research, 19(1). https://doi.org/10.1186/s12913-019-4384-7 [Show Less]