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Structured education using Dose Adjustment for Normal Eating (DAFNE) reduces long-term HbA1c and HbA1c variability.
Walker, GS, Chen, JY, Hopkinson, H, Sainsbury, CAR, Jones, GC
Diabetic medicine : a journal of the British Diabetic Association. 2018;(6):745-749
Abstract
AIMS: Previous evidence has demonstrated that participation in the Dose Adjustment for Normal Eating (DAFNE) education programme can reduce HbA1c and severe hypoglycaemia in people with Type 1 diabetes. In a number of studies, increased HbA1c variability has been associated with higher diabetic morbidity and mortality. No studies have examined the impact of structured education on HbA1c variability in Type 1 diabetes. METHODS People with Type 1 diabetes who had attended DAFNE were identified for inclusion from the Scottish Care Information-Diabetes dataset. HbA1c median and variability, expressed as coefficient of variation (CV) before and after DAFNE was calculated. RESULTS Some 1061 individuals participated in DAFNE education and 687 met the inclusion criteria. A significant median reduction in HbA1c [-3.5 mmol/mol (-0.3%)] was seen at 12 months with a significant reduction [-1.5 mmol/mol (-0.1%)] still seen at 60 months of follow-up. HbA1c variability as measured by CV was significantly lower during the post-DAFNE period: 0.08 (IQR 0.05-0.12) reduced to 0.07 (IQR 0.05-0.10); P = 0.002. CONCLUSION The data confirm that DAFNE participation improves glycaemic control in Type 1 diabetes with benefits being sustained for 5 years. This study is the first to demonstrate reduced HbA1c variability after completion of structured education. This is new evidence of the beneficial impact of DAFNE on glycaemic profile.
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Evaluation of a short, interactive diabetes self-management program by pharmacists for type 2 diabetes.
Singh, RF, Kelly, P, Tam, A, Bronner, J, Morello, CM, Hirsch, JD
BMC research notes. 2018;(1):828
Abstract
OBJECTIVE Numerous barriers prevent patients with type 2 diabetes (T2D) from completing a diabetes self-management program. We investigated whether patients with T2D exhibited improved clinical outcomes after attending a relatively short, interactive diabetes self-management program conducted by pharmacist diabetes educators, compared to a physician's usual care. RESULTS We retrospectively analyzed the data of adults with T2D who attended a diabetes self-management program (≥ 1 group meeting or individual appointment followed by a telephone interview from a pharmacist diabetes educator between May 2010 and Dec. 2012; n = 513) and compared their outcomes with those of T2D patients who received only their physician's usual care (n = 857). Each patient's A1C was assessed at baseline, 3 months, and 6 months post-intervention. The mean [SD] reduction in A1C percentage points in the T2D patients was significantly greater in the diabetes self-management program group compared to the physician's usual care group at both 3 months (- 0.8% [1.5] vs. - 0.2% [0.9], p < 0.001) and 6 months post-intervention (- 0.6% [1.3] vs. - 0.2% [1.1], p < 0.001). T2D patients significantly improved their glycemic control within 3-6 months of attending the diabetes self-management program compared to patients who only received their physician's usual care.
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Effect of non-surgical weight management on weight and glycaemic control in people with type 2 diabetes: A comparison of interventional and non-interventional outcomes at 3 years.
Botha, S, Forde, L, MacNaughton, S, Shearer, R, Lindsay, R, Sattar, N, Morrison, D, Welsh, P, Logue, J
Diabetes, obesity & metabolism. 2018;(4):879-888
Abstract
AIMS: To examine the long-term effectiveness of lifestyle weight management interventions, recommended in clinical guidelines for patients with type 2 diabetes mellitus (T2DM) and obesity. MATERIALS AND METHODS Electronic health records were used to follow 23 208 patients with T2DM and obesity in Glasgow, UK, for up to 3 years between 2005 and 2014. Patients were stratified by referral to and attendance at a lifestyle weight management intervention, and by attainment of a target weight loss of ≥5 kg over 7 to 9 sessions ("successful completers"). Outcomes were change in weight, glycated haemoglobin (HbA1c) and diabetes medications. RESULTS A total of 3471 potentially eligible patients were referred to the service, and fewer than half of these attended (n = 1537). Of those who attended 7 to 9 sessions, >40% successfully completed and achieved 5-kg weight loss (334/808). Successful completers maintained greater weight loss (change at 3 years -8.03 kg; 95% confidence interval [CI] -9.44 to -6.62) than the non-completers (-3.26 kg; 95% CI -4.01 to -2.51; P < .001) and those not referred to the service (-1.00 kg; 95% CI -1.15 to -0.85; P < .001). Successful completers were the only patient group who did not increase their use of diabetes medication and insulin over 3 years. In adjusted models, successful completers had a clinically significant reduction in HbA1c (-3.7 mmol/mol; 95% CI -5.82 to -1.51) after 3 years; P ≤ .001) compared with non-completers and unsuccessful completers. CONCLUSIONS A real-life structured weight management intervention in patients with diabetes can reduce weight in the medium term, result in improved glycaemic control with fewer medications, and may be more effective than pharmacological alternatives. Challenges include getting a higher proportion of patients referred to and engaged with interventions.
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Influence of the 5A's Counseling Strategy on Weight Gain During Pregnancy: An Observational Study.
Washington Cole, KO, Gudzune, KA, Bleich, SN, Bennett, WL, Cheskin, LJ, Henderson, JL, Caulfield, LE, Guan, Y, Roter, DL
Journal of women's health (2002). 2017;(10):1123-1130
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Abstract
BACKGROUND Healthy weight gain during pregnancy may improve health outcomes for women and infants. The objective of this study was to examine providers' use of the 5A's (Assess, Advise, Agree, Assist, and Arrange) in discussions of weight, nutrition, and physical activity during prenatal visits and evaluate the effect of this approach on gestational weight gain. MATERIALS AND METHODS We studied audio recordings of prenatal visits between 22 obstetrics providers and 120 of their patients, coding visits for providers' use of the 5A's. The relationship between the 5A's and gestational weight gain (total weight gain and excess gestational weight gain) was evaluated using multilevel models to account for patient clustering within provider, and adjusted for prepregnancy body mass index, parent study intervention assignment, gestational age at the study visit, and study visit length. RESULTS Overall, 55% of prenatal visits included any weight-related behavioral counseling. Of these, 59.1% included one of the 5A's and 40.9% included two or more of the 5A's. Counseling conversations most commonly included Assess or Advise (49% and 85% of counseling conversations, respectively). No recorded visits used all 5A's. In adjusted analyses, patients who received counseling with two or more of the 5A's gained an average of 11.8 fewer pounds than patients who received no counseling (p = 0.001). The odds of excess gestational weight gain were lower among women receiving counseling with at least one of the 5A's (p < 0.05). CONCLUSIONS The 5A's were associated with lower gestational weight gain and may be a promising counseling strategy to promote healthy weight gain during pregnancy.
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The relationship between different information sources and disease-related patient knowledge and anxiety in patients with inflammatory bowel disease.
Selinger, CP, Carbery, I, Warren, V, Rehman, AF, Williams, CJ, Mumtaz, S, Bholah, H, Sood, R, Gracie, DJ, Hamlin, PJ, et al
Alimentary pharmacology & therapeutics. 2017;(1):63-74
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Abstract
BACKGROUND Patient education forms a cornerstone of management of inflammatory bowel disease (IBD). The Internet has opened new avenues for information gathering. AIM: To determine the relationship between different information sources and patient knowledge and anxiety in patients with IBD. METHODS The use of information sources in patients with IBD was examined via questionnaire. Anxiety was assessed with the hospital anxiety and depression scale and disease-related patient knowledge with the Crohn's and colitis knowledge score questionnaires. Associations between these outcomes and demographics, disease-related factors, and use of different information sources were analysed using linear regression analysis. RESULTS Of 307 patients (165 Crohn's disease, 142 ulcerative colitis) 60.6% were female. Participants used the hospital IBD team (82.3%), official leaflets (59.5%), and official websites (53.5%) most frequently in contrast to alternative health websites (9%). University education (P < 0.001), use of immunosuppressants (P = 0.025), Crohn's and Colitis UK membership (P = 0.001), frequent use of the hospital IBD team (P = 0.032), and frequent use of official information websites (P = 0.005) were associated with higher disease-related patient knowledge. Female sex (P = 0.004), clinically active disease (P < 0.001), frequent use of general practitioners (P = 0.014), alternative health websites (homoeopathy, nutritionists, etc.) (P = 0.004) and random links (P = 0.016) were independently associated with higher anxiety. CONCLUSIONS Different patient information sources are associated with better knowledge or worse anxiety levels. Face-to-face education and written information materials remain the first line of patient education. Patients should be guided towards official information websites and warned about the association between the use of alternative health websites or random links and anxiety.
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Diabetes education program for people with type 2 diabetes: An international perspective.
Rashed, OA, Sabbah, HA, Younis, MZ, Kisa, A, Parkash, J
Evaluation and program planning. 2016;:64-8
Abstract
BACKGROUND In the Palestinian community, lifestyle changes, rapid urbanization and socioeconomic development, stress, smoking, and changes in food habits has increased the risk of non-communicable diseases especially diabetes mellitus. Diabetes complications can be prevented if the glycemic status of patients with diabetes is maintained within a nearly normal range. Therefore, patient education is critical in controlling blood glucose levels within the normal range. OBJECTIVE This study aimed at measuring the effect of diabetes educational intervention program for patients suffering from type 2 diabetes attending the Diabetes Clinic in Tulkarim Directorate of Health. METHODS A short duration observational study involving pre- and post-test educational intervention program was carried out on a relatively small number of type 2 diabetes patients at the Diabetes Clinic in Tulkarim Directorate of Health. In total, 215 patients attended a group-based 4h educational intervention session about diabetes. The program included explaining diabetes mellitus-symptoms, risk factors, types, treatment and complications and main aspects of self-care of the disease (foot care, eye care, and blood glucose monitoring), main aspects of dietary management, weight reduction, blood pressure, smoking cessation, periodic investigations, home monitoring and importance of physical activity. Knowledge evaluation questionnaire were evaluated pre- and post-study. Anthropometric measurements such as body weight (WT), body mass index (BMI) and laboratory tests such as fasting blood glucose (FBG), hemoglobin A1C (HbA1c), cholesterol (Chol), and triglycerides (TG) were measured both at the beginning and at the end of the study. Significance of the results was assessed by paired t-test at 95% confidence interval. RESULTS The participant's mean age was 51.07 that ranged between 31 and 70 years. For a total of 215 participants, 41.4% were males and 58.6% were females. The mean weight before educational intervention was 80.81±14.95kg (82.6kg for males and 79.5kg for females) that decreased to 78.9±14.33kg (81.1kg for males and 77.3kg for females) after educational intervention program. The BMI also decreased significantly after educational intervention. The mean fasting blood sugar was 188.65±71.45mg/dL before educational intervention that decreased to 177.7±66.11mg/dL after the educational intervention (p=0.049). The mean glycosylated hemoglobin was 8.57±1.21 before educational intervention that decreased to 7.95±1.42 after educational intervention. The mean value of cholesterol before educational intervention was 183.27±37.74mg/dL that decreased to 169.57±34.23mg/dL after educational intervention. The mean triglycerides value decreased after educational intervention from 209.85±171.04mg/dL to 183.28±152.4mg/dL (p=0.025). The mean score of knowledge questionnaire before educational intervention was 60.6±20.65 that increased to 78.1±13.4 after conducting educational intervention. CONCLUSIONS Diabetes education was found to be effective on BMI, FBG, HbA1c, Chol, TG, and knowledge. RECOMMENDATIONS Diabetes education is a cornerstone in the management and care of diabetes and should be an integral part of health planning involving patient's family, diabetes care team, community, and decision makers in the education process.
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Enhancing Access to Diabetes Self-management Education in Primary Care.
Chomko, ME, Odegard, PS, Evert, AB
The Diabetes educator. 2016;(5):635-45
Abstract
PURPOSE The purpose of this continuous quality improvement project was to improve access to diabetes self-management education (DSME) and to evaluate the impact on glycemic and weight control by translating an academic medical center's DSME program, accredited per the Education Recognition Program (ERP) of the American Diabetes Association, into a program offered at primary care clinics (PCCs). METHODS Certified diabetes educators from the medical center trained PCC registered dietitian nutritionists, registered nurses, and social workers to provide DSME in their community-based clinic. Main outcomes of this retrospective, pretest/posttest, observational project were to evaluate enrollment in DSME classes and change in A1C and weight as patients underwent a combined intervention of diabetes education classes with or without consultation and support from a PCC registered dietitian nutritionist or registered nurse. RESULTS PCC DSME was associated with increased enrollment in DSME classes and a significant reduction of A1C and weight at 3 and 6 months post-DSME. Greatest A1C and weight reductions were observed in patients with newly diagnosed diabetes. Reductions were also seen in patients with diabetes duration ≥10 years, participants taking insulin, and those with depression. CONCLUSIONS PCC DSME availability increased access to group diabetes education and resulted in reduced A1C and weight for participants. This model was successful in translating an established academic accredited DSME-ERP into a PCC. Results have implications for increasing access to diabetes education programs and improving diabetes control for patients not located near major hospital-based DSME programs.
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Breaking down barriers to communicating complex retinoblastoma information: can graphics be the solution?
Chiu, HH, Dimaras, H, Downie, R, Gallie, B
Canadian journal of ophthalmology. Journal canadien d'ophtalmologie. 2015;(3):230-5
Abstract
OBJECTIVE To investigate the impact of a graphical timeline summarizing bilateral retinoblastoma disease and treatment outcomes on parents' understanding of complex medical information. DESIGN Cross-sectional survey. PARTICIPANTS Parents of children with retinoblastoma who were being actively managed at The Hospital for Sick Children were recruited. Forty-five parents from 42 families participated. METHODS After a standardized presentation on retinoblastoma and visual tool named Disease-Specific electronic Patient Illustrated Clinical Timeline (DePICT), parents completed a 19-item questionnaire designed to assess their understanding of treatment choices for 2 eyes in bilateral retinoblastoma as communicated using DePICT. SPSS was used to perform statistical analysis. RESULTS Forty-five parents from 42 families participated (65% female). Median age of participants was 34 years. Median level of participant education was completion of college/trade school. The median level of annual income was $40,000 to $70,000 CDN. Median time since diagnosis of retinoblastoma in their child was 13.5 months. Twenty-three (51%) participants were parents of children with unilateral retinoblastoma, and 22 (49%) were parents of children with bilateral retinoblastoma. Median number of correct answers was 15 of 19, and mean score was 77%. Normal distribution of scores was noted. English as a first language was significantly associated with score (p = 0.01). No significant association was observed between other variables and score in all analyses. CONCLUSIONS This study builds on the validation of DePICT by demonstrating that parents can achieve good comprehension even when considering choices for treatment for 2 eyes with bilateral retinoblastoma. Clinical application of this tool can enhance the consent process.
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Reversing social disadvantage in secondary prevention of coronary heart disease.
Jelinek, MV, Santamaria, JD, Best, JD, Thompson, DR, Tonkin, AM, Vale, MJ
International journal of cardiology. 2014;(3):346-50
Abstract
BACKGROUND To compare and contrast the coronary heart disease (CHD) risk factors of lower socio-economic status public hospital patients with those of privately insured CHD patients before and after six months of telephone delivered coaching using The COACH Program. METHODS A retrospective observational study which contrasts the lifestyle and biomedical coronary risk factor status of 2256 public hospital patients with the same risk factors of 3278 patients who had private health insurance. All patients received an average of 5 coach sessions over 6 months. RESULTS The public hospital patients were four years younger and had multiple measures confirming their lower socio-economic status than their private hospital counterparts. At entry to the program, the public hospital patients had worse risk factor levels than the privately insured patients for total and LDL-cholesterol, triglycerides, fasting glucose, smoking and physical activity levels (P<0.0001) but better status for systolic and diastolic blood pressures and alcohol intake. At exit from the program, many of these differences had diminished or disappeared. The public hospital patients had greater improvements in their risk factor status for total and LDL-cholesterol, fasting glucose, body weight, smoking status and physical activity level than did the privately insured patients (P<0.05). CONCLUSIONS This paper demonstrates that a program of initiating contact with patients with CHD, identifying treatment gaps in their management and coaching to achieve guideline recommended risk factor targets can help reduce health inequalities in such patients and thus benefit all patients in the context of ongoing secondary prevention.