Joan Bardsley

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

D IABETES ISACHRONICDISEASE that requires a person with diabetes to make a multitude of daily self-management decisions and to perform complex care activities. Diabetes self-management education and support (DSME/S) provides the foundation to help people with diabetes to navigate these decisions and activities and has been shown to improve health outcomes. Diabetes self-management education (DSME) is the process of facilitating the knowledge, skill, and ability necessary for diabetes self-care. Diabetes selfmanagement support (DSMS) refers to the support that is required for implementing and sustaining coping skills and behaviors needed to self-manage on an ongoing basis. (See further definitions in Figure 1.) Although different members of the health care team and community can contribute to this process, it is important for health care providers and their practice settings to have the resources and a systematic referral process to ensure that patients with type 2 diabetes receive both DSME and DSMS in a consistent manner. The initial

Diabetes Self-management Education and Support in Type 2 Diabetes

From International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers); MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley); ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress); LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker); University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell); University of Chicago, Chicago, Illinois (Ms Fischl); Joslin Diabetes Center, Boston, Massachusetts (Ms Maryniuk); School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Siminerio); and University of Wisconsin–Madison, Madison, Wisconsin (Dr Vivian).

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

Diabetes is a chronic disease that requires a person with diabetes to make a multitude of daily self-management decisions and to perform complex care activities. Diabetes self-management education and support (DSME/S) provides the foundation to help people with diabetes to navigate these decisions and activities and has been shown to improve health outcomes (1–7). Diabetes self-management education (DSME) is the process of facilitating the knowledge, skill, and ability necessary for diabetes self-care. Diabetes self-management support (DSMS) refers to the support that is required for implementing and sustaining coping skills and behaviors needed to self-manage on an ongoing basis. (See further definitions in Table 1.) Although different members of the health care team and community can contribute to this process, it is important for health care providers and their practice settings to have the resources and a systematic referral process to ensure that patients with type 2 diabetes receive both DSME and DSMS in a consistent manner. The initial DSME is typically provided by a health professional, whereas ongoing support can be provided by personnel within a practice and a variety of community-based resources. DSME/S programs are designed to address the patient’s health beliefs, cultural needs, current knowledge, physical limitations, emotional concerns, family support, financial status, medical history, health literacy, numeracy, and other factors that influence each person’s ability to meet the challenges of self-management. View this table: TABLE 1. Key Definitions It is the position of the American Diabetes Association (ADA) that all individuals with diabetes receive DSME/S at diagnosis and as needed thereafter (8). This position statement focuses on the particular needs of individuals with type 2 diabetes. The needs will be similar to those of people with other types of diabetes (type 1 diabetes, prediabetes, and gestational diabetes mellitus); however, the research and examples referred to in this article focus …

The Strengths and Challenges of Implementing EBP in Healthcare Systems.

Background Multihospital healthcare system leaders and individual nurses are challenged to integrate standardized evidence-based practices that support continuous performance improvement in their systems. Aim This study was undertaken to evaluate the strength of and the opportunities for implementing evidence-based nursing practice across a diverse 9-hospital system located in the mid-Atlantic region. Methods A cross-sectional survey of 6,800 registered nurses (RNs), with a 24% response rate, was conducted to learn about their attitudes, beliefs, and perceptions toward organizational readiness and implementation of EBP. Results Although respondents’ beliefs about EBP were positive, they reported their ability to implement EBP as extremely low. More than one third (36%) of the respondents worked at two of the systems Magnet designated hospitals. Magnet RNs reported more resources and held more positive beliefs about their hospitals organizational readiness for EBP. Nurses who possess advanced nursing degrees, certification, and who serve in leadership roles were favorable toward EBP. Younger RNs with fewer years in practice were more likely to have positive beliefs toward EBP and embedding it into the organizational culture. Linking Evidence to Practice Findings mirror previous research where nurses internationally favor EBP yet struggle with similar barriers for implementation. Strategies to link this evidence to action can be taken at local and global levels. Locally, transformational nurse leaders within each hospital can share the vision for implementing EBP and embrace Magnet principles. At the system level, transformational nurse leaders can collectively allocate resources to create a system-wide online EBP education plan with EBP competencies and tool kit to increase RN exposure to EBP and standardize practice. Globally, promoting free and accessible EBP massive open online courses (MOOC) and sharing best practices online and at international forums such as Magnet conferences will help to lead, educate, and mentor nurses with strategies to systematically increase EBP uptake.

Education and patient preferences for treating type 2 diabetes: a stratified discrete-choice experiment

Purpose Diabetes is a chronic condition that is more prevalent among people with lower educational attainment. This study assessed the treatment preferences of patients with type 2 diabetes by educational attainment. Methods Patients with type 2 diabetes were recruited from a national online panel in the US. Treatment preferences were assessed using a discrete-choice experiment. Participants completed 16 choice tasks in which they compared pairs of treatment profiles composed of six attributes: A1c decrease, stable blood glucose, low blood glucose, nausea, treatment burden, and out-of-pocket cost. Choice models and willingness-to-pay (WTP) estimates were estimated using a conditional logit model and were stratified by educational status. Results A total of 231 participants with a high school diploma or less education, 156 participants with some college education, and 165 participants with a college degree or more completed the survey. Participants with a college degree or more education were willing to pay more for A1c decreases (

Sitagliptin: an oral agent for glucose control

58.84, standard error [SE]: 10.6) than participants who had completed some college (

Transitioning the Adult with Type 2 Diabetes From the Acute to Chronic Care Setting: Strategies to Support Pragmatic Implementation Success

28.47, SE: 5.53) or high school or less (

Achievement of American Diabetes Association Clinical Practice Recommendations Among U.S. Adults With Diabetes, 1999–2002 The National Health and Nutrition Examination Survey

17.56, SE: 3.55) (p≤0.01). People with a college education were willing to pay more than people with high school or less to avoid nausea, low blood glucose events during the day/night, or two pills per day. Conclusion WTP for aspects of diabetes medication differed for people with a college education or more and a high school education or less. Advanced statistical methods might overcome limitations of stratification and advance understanding of preference heterogeneity for use in patient-centered benefit–risk assessments and personalized care approaches.

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

Sitagliptin (Januvia™) is a new oral agent approved by the US FDA to treat Type 2 diabetes. This is the first approved agent in a new class of antihyperglycemics, dipeptidyl peptidase (DPP)-4 inhibitors. Sitagliptin selectively inhibits the action of DPP-4, the primary enzyme degrading the incretin hormones, allowing glucagon-like peptide-1 and glucose-dependent insulinotropic peptide to facilitate glucose regulation in response to a meal. Studies demonstrate that sitagliptin decreases hemaglobin A1c, postprandial glucose excursion and fasting plasma glucose. Sitagliptin presents some advantages over other drugs used in the management of diabetes. One advantage is its oral administration; another, is its low incidence of hypoglycemia, similar to that of a placebo. Sitagliptin has a low incidence of adverse events, consisting of stomach discomfort, diarrhea, upper respiratory infection, stuffy or runny nose, sore throat and headache. Unlike many other drugs used to treat diabetes, sitagliptin does not cause weight gain. Animal studies have shown that it can help prevent β-cell apoptosis and improve β-cell functioning; therefore, it may have a role in preventing diabetes, although human data are currently lacking.

Diabetes Mellitus, Epidemiology

Scientific evidence is available to guide the how to of medications management when patients with diabetes are hospitalized or present to the Emergency Department. However, few clinical trials in the diabetes field have addressed the execution, coupled with established implementation effectiveness evaluation frameworks to help inform and assess implementation practices to support the transition in care. These deficiencies may be overcome by (1) applying the principles of implementation and delivery systems science; (2) engaging the principles of human factors (HF) throughout the design, development, and evaluation planning activities; and (3) utilizing mixed methods to design the intervention, workflow processes, and evaluate the intervention for sustainability within existing care delivery models. This article provides a discussion of implementation science and human factors science including an overview of commonly used frameworks which can be applied to structure design and implementation of sustainable and generalizable interventions.