Kelley Newlin Lew

State of the Science Diabetes Self-Management Interventions Led By Nurse Principal Investigators

Over the past decade, diabetes self-management (DSM) interventions have become increasingly heterogeneous to address the needs of diverse populations. The purpose of this integrative review is to summarize the state of the science regarding DSM interventions led by nurse principal investigators. The Preferred Reporting Items of Systematic Reviews and Meta-Analyses framework informed identification, selection, and appraisal of the literature. A total of 44 national and international studies (RCTs [randomized controlled trial] and quasi-experimental studies) were identified for inclusion. Across national studies, diverse ethnic groups (Latinos, African Americans, Asians, and Native Americans) were most frequently sampled (67%). Review findings identified (a) DSM intervention typologies (primary DSM intervention, DSM reinforcement intervention, and primary DSM intervention plus reinforcement intervention) and selection of blended or bundled intervention components; (b) DSM intervention translation to community-based, electronic, and home settings; and (c) DSM intervention delivery (interventionists, dosages, and fidelity).

Type 2 diabetes prevention and self-management among Nicaraguan ethnic minorities: findings from phase 3 of a community-based participatory research study

Purpose The purpose of this paper is to explore physical environmental, medical environmental, and individual factors in a sample of ethnic minority adults with or at-risk for type 2 diabetes (T2D) on the Atlantic Coast of Nicaragua. Design/methodology/approach The study used a cross-sectional descriptive design guided by a community-based participatory research framework. Three coastal communities in the South Atlantic Autonomous Region (RAAS) of Nicaragua were sampled. Inclusion criteria were: lay adult with or at-risk for T2D, ⩾21 years of age, self-identification as Creole or Miskito, and not pregnant. Convenience sampling procedures were followed. Data were collected via objective (A1C, height, and weight) and self-report (Pan American Health Organization surveys, Diabetes Care Profile subscales, and Medical Outcomes Survey Short Form-12 (MOS SF-12) measures. Univariate and bivariate statistics were computed according to level of measurement. Findings The sample (N=112) was predominately comprised of Creoles (72 percent), females (78 percent), and mid-age (M=54.9, SD±16.4) adults with T2D (63 percent). For participants with T2D, A1C levels, on average, tended to be elevated (M=10.6, SD±2.5). Those with or at-risk for T2D tended to be obese with elevated body mass indices (M=31.7, SD±8.1; M=30.2, SD±6.0, respectively). For many participants, fresh vegetables (63 percent) and fruit (65 percent) were reported as ordinarily available but difficult to afford (91 and 90 percent, respectively). A majority reported that prescribed medication(s) were available without difficulty (56 percent), although most indicated difficulty in affording them (73 percent). A minority of participants with T2D reported receipt of diabetes education (46 percent). A1C levels did not significantly vary according to diabetes education received or not (M=10.9, SD±2.9; M=10.4, SD±2.5; t=−0.4, p=0.71). Participants at-risk for T2D were infrequently instructed, by a provider, to follow an exercise program (4.8 percent) or meal plan (4.8 percent) and receive diabetes education (2.38 percent). MOS SF-12 findings revealed participants with T2D (M=41.84, SD=8.9; M=37.8, SD±8.5) had significantly poorer mental and physical health quality of life relative to at-risk participants (M=45.6, SD±8.4; M=48.1, SD±9.5) (t=−2.9, p<0.01; t=−2.5, p=0.01). Research limitations/implications Salient physical environmental, medical environmental, and individual factors were identified in a sample of adults with or at-risk for T2D on Nicaragua’s Atlantic Coast. Practical implications Findings informed the development of community-based clinics to address the problem of T2D locally. Social implications The community-based clinics, housed in trusted church settings, provide culturally competent care for underserved ethnic minority populations with or at-risk for T2D. Originality/value This is the first quantitative assessment of the T2D problem among diverse ethnic groups in Nicaragua’s underserved RAAS.

Diabetes prevention and management among minority ethnic groups in Nicaragua: Findings from Phase 2 of a community-based participatory research study

Objectives: To (1) describe barriers to diabetes prevention and self-management, (2) explore how religious beliefs inform diabetes prevention and self-management and (3) describe community action strategies to address the problem of diabetes locally. Design: Qualitative, descriptive design. Setting: Three Moravian Churches located, respectively, in Bluefields, Pearl Lagoon and Tasbapounie on Nicaragua’s Southern Atlantic Coast. Methods: Using convenience sampling procedures, local church pastors or leaders, health professionals and local lay adults with or at-risk for type 2 diabetes were recruited. Structured by an interview guide, focus groups were conducted. Data were analysed using Krippendorff’s content analysis method. Results: Barriers to diabetes prevention and self-management behaviours included financial constraints, inconsistent availability of diabetes medications and testing supplies, and limited diabetes knowledge. Religious faith was identified as central in coping with the daily demands of preventing or self-managing diabetes. Community action strategies to address diabetes included (1) the formation of interdisciplinary diabetes teams, (2) church-based diabetes care and (3) public health announcements. Conclusion: Findings informed culturally sensitive diabetes prevention and self-management education through the identified community action strategies.

Prevalence of Obesity, Prediabetes, and Diabetes in Sexual Minority Women of Diverse Races/Ethnicities: Findings From the 2014-2015 BRFSS Surveys

Purpose The purpose of this study is to assess the weighted prevalence and odds ratios of obesity, prediabetes, and diabetes by (1) female sexual orientation (lesbian, bisexual, and straight) with racial/ethnic (Hispanic, non-Hispanic black, and non-Hispanic white) groups combined and (2) across and within racial/ethnic groups by sexual orientation. Methods A secondary analysis of pooled 2014-2015 Behavioral Risk Factor Surveillance System data from 28 states (N = 136 878) was conducted. Rao-Scott chi-square test statistics were computed and logistic regression models were developed to assess weighted prevalence and odds ratios of obesity, prediabetes, and diabetes with adjustments for demographics (age, income, and education), depression, and health care access factors. Results With racial/ethnic groups combined, lesbian and bisexual women, relative to straight women, had a significantly increased likelihood for obesity when controlling for demographics. Bisexual women were found to have significantly reduced odds for diabetes, compared with straight women, with adjustments for demographics, depression, and health care access factors. Compared with their non-Hispanic white counterparts, Hispanic lesbian women had significantly increased odds for obesity and diabetes, while non-Hispanic black bisexual women had a significantly greater likelihood for obesity, holding demographics, depression, and health care access factors constant. Non-Hispanic white lesbian women had an increased likelihood for obesity relative to their straight, ethnic/racial counterparts. Prediabetes subsample analysis revealed the prevalence was low across all female sexual orientation groups. Conclusion Sexual minority women, particularly those of color, may be at increased risk for obesity and diabetes. Research is needed to confirm the findings.

Prevalence of Obesity, Prediabetes, and Diabetes in Sexual Minority Men: Results From the 2014 Behavioral Risk Factor Surveillance System

Purpose The purpose of this study is to assess the prevalence and related odds ratios for obesity, prediabetes, and diabetes in sexual minority men (SMM) in relation to straight men. Methods A secondary analysis of 2014 Behavioral Risk Factor Surveillance System data from 19 states (n = 53 542) was conducted. Weighted means and standard errors were computed to estimate prevalence rates of obesity, prediabetes, and diabetes across male sexual orientation groups, respectively. Unadjusted and adjusted (demographics, depression, and health care access factors) weighted logistic regression models were developed. Results Obesity prevalence was lower in gay men relative to straight men with logistic regression modeling indicating gay men were significantly less likely to be obese, relative to their straight counterparts, in the unadjusted and adjusted models. In terms of prediabetes, rates were low across all sexual orientation groups with no significant differences observed. Yet bisexual men, relative to straight men, had higher rates of diabetes with significantly increased odds for the disease in both the unadjusted and adjusted models. Conclusion Findings indicate gay men have reduced risk for obesity while bisexual men may have increased diabetes burden. Across all male sexual orientation groups, prediabetes prevalence was low, suggesting the need for more aggressive prediabetes screening. Additional research is necessary to confirm the findings.

Correction to: HRQOL in Diverse Ethnic Groups with Diabetes: Findings from the 2014 BRFSS

The following corrections to this article as originally published should be noted:In the first sentence of the abstract, “non-Hispanic Whites, non-Hispanic Blacks, and Hispanics adults with diabetes” should read “non-Hispanic White, non-Hispanic Black, and Hispanic adults with diabetes”.

Combined Diabetes Prevention and Disease Self-Management Intervention for Nicaraguan Ethnic Minorities: A Pilot Study

Abstract:Background: Informed by formative community-based participatory research (CBPR), we developed a combined model of diabetes prevention and self-management.Objectives: To assess the feasibility, acceptability, and preliminary efficacy of our CBPR-inspired model.Methods: A mixed methods study was conducted using a pre-experimental design. The setting was a church-based clinic located on Nicaraguas rural Atlantic coast. Miskitos and Creoles with or at risk for diabetes were sampled. Preliminary efficacy was assessed with A1C, weight, and quality of life (QOL) measures at baseline, 3 months, and 6 months. An open-ended survey assessed intervention satisfaction. The 8-week, registered nurse (RN)-led intervention emphasized knowledge acquisition and behavioral strategies for dietary, physical activity, and medication regimen adherence. Paired t tests were computed to assess preliminary efficacy. Content analysis was conducted to assess intervention acceptability.Results: A total of 42 participants were enrolled. For participants completing follow-up data collection (n = 33), mean A1C improved from 8.8% to 8.3% (t = –2.19; p = .04) from baseline to 3 months. Among participants with a baseline A1C of greater than 7.5% (n = 24), the mean A1C decreased from 9.7% to 9.0% from baseline to 3 months (t = –2.86; p = .01), and to 8.7% at 6 months (t = –3.00; p = .01). Nonsignificant weight changes were observed. Mental health QOL improved, on average from baseline to 3 months (t = 2.20; p = .04) and 6 months (t = 4.7; p < .01) for the sample. An increase in mean physical health QOL was observed from baseline to 3 months (t = 2.91; p < .01). The intervention was found to be acceptable. Study feasibility was good, with successful research capacitation and achievement of sampling goals.Conclusions: Findings suggest our novel intervention holds promise for wider application to reduce diabetes burden among Nicaraguan ethnic minorities.

therapeutic options for lowering Ldl-c in type 2 diabetes: A nurse practitioner's perspective

Purpose The majority of patients with type 2 diabetes mellitus (T2DM) have multiple risk factors for cardiovascular disease (CVD). Low-density lipoprotein cholesterol (LDL-C) is a key therapeutic target to reduce CVD risk. This article reviews therapeutic strategies that nurse practitioners (NPs) may use in the management of patients with T2DM requiring lipid management. Data sources The evidence used in developing this review included evidence-based reviews, clinical trials, guidelines, and consensus statements. Relevant publications were identified through a search of the literature using PubMed and other search engines. Conclusions Lowering LDL-C levels may reduce CVD risk, but achieving goals can be challenging. Lifestyle modifications (including diet, exercise, and smoking cessation) are key components of lipid management and reduction of CVD risk. Statins can be effective to reduce lipids. However, patients may not achieve lipid goals with monotherapy or may experience intolerable adverse effects. Alternative statins or statins along with other lipid-lowering agents remain good options. Implications for practice Achieving LDL-C goals requires a comprehensive treatment plan that incorporates lifestyle and pharmacologic interventions. Patient commitment in setting goals and self-management is essential. NPs can play an important role in educating patients as well as prescribing appropriate treatments.Purpose: The majority of patients with type 2 diabetes mellitus (T2DM) have multiple risk factors for cardiovascular disease (CVD). Low‐density lipoprotein cholesterol (LDL‐C) is a key therapeutic target to reduce CVD risk. This article reviews therapeutic strategies that nurse practitioners (NPs) may use in the management of patients with T2DM requiring lipid management. Data sources: The evidence used in developing this review included evidence‐based reviews, clinical trials, guidelines, and consensus statements. Relevant publications were identified through a search of the literature using PubMed and other search engines. Conclusions: Lowering LDL‐C levels may reduce CVD risk, but achieving goals can be challenging. Lifestyle modifications (including diet, exercise, and smoking cessation) are key components of lipid management and reduction of CVD risk. Statins can be effective to reduce lipids. However, patients may not achieve lipid goals with monotherapy or may experience intolerable adverse effects. Alternative statins or statins along with other lipid‐lowering agents remain good options. Implications for practice: Achieving LDL‐C goals requires a comprehensive treatment plan that incorporates lifestyle and pharmacologic interventions. Patient commitment in setting goals and self‐management is essential. NPs can play an important role in educating patients as well as prescribing appropriate treatments.

Quality improvement strategies for diabetes management decrease HbA1c, cholesterol and blood pressure, and increase screening for disease complications

Context Evidence indicates that patients with diabetes mellitus (DM) may achieve improved physiological outcome with preventative and therapeutic interventions. Given the complexities of DM management, such interventions often require coordinated services of primary care physicians, allied health professionals and subspecialists to effectively assist patients with achievement of improved outcomes. Yet, many patients with DM fail to receive such interventions. Addressing the quality of DM care, a growing body of research has examined the effect of case management, multidisciplinary teams and financial incentives, among others, on DM outcomes. To date, however, the effectiveness of QI strategies on diabetes outcomes remains uncertain. Tricco and colleagues, therefore, conducted a systematic review and meta-analysis to assess the effect of QI strategies on HbA1c, cardiovascular risk management and microvascular complication monitoring.