Sandra L. Upchurch

Promoting Weight Loss in Type II Diabetes

OBJECTIVE To examine strategies—behavioral therapies, exercise, diet, anorectic drugs, surgery, or a combination of strategies—used for promoting weight loss in people with type II diabetes. RESEARCH DESIGN AND METHODS Meta-analysis was used to synthesize research of promoting weight loss in the population. Literature search strategies involved reviewing bibliographies, conducting computer searches and surveys of relevant masters degree programs, and contacting representatives of the Centers for Disease Control. The final sample consisted of 89 studies involving 1,800 subjects. Data were extracted on 80 variables characterizing the sample of studies/subjects and on 23 outcome variables, including weight, metabolic control, lipids, and other physiological parameters. RESULTS Diet alone had the largest statistically significant impact on weight loss (−20 lb) and metabolic control (−2.7% in glycosylated hemoglobin). All diets significantly improved fasting blood sugar. Behavioral programs alone had a statistically significant impact on weight loss (−6.4 lb) and metabolic control (−1.5%) but effects were < for diet alone. Data from the few exercise studies indicated that weighted average effects for exercise on weight loss (−3.4 lb) and metabolic control (−0.8%) were < diet alone. Behavioral therapy plus diet plus exercise was associated with statistically significant effect size estimates for weight loss (−8.5 lb) and metabolic control (−1.6%). Diet alone achieved better results. Effects of weight promotion strategies, in general, were smaller in experimental studies and for individuals over age 55. CONCLUSIONS Dietary strategies are most effective for promoting short-term weight loss in type II diabetes. A number of gaps exist in the extant literature—descriptions of subjects, interventions, or longitudinal outcomes beyond 12 months after intervention.

A framework for developing a coding scheme for meta-analysis.

The prominence of systematic reviews as bases for evidence-based practice is increasingly recognized and has significance for practice disciplines such as nursing. Synthesizing research findings is key to informing the clinical care of individuals burdened with health problems. A major issue in conducting such reviews involves developing reliable and valid coding procedures for extracting data from the research literature. A formalized process is described for developing coding instruments that have been used in five separate studies. Initial instrument development for a diabetes self-management education meta-analysis is described, followed by a discussion of adapting the instruments for subsequent meta-analytic studies of self-management interventions in diabetes care and of interventions to reduce caregiver burden of individuals with Alzheimer’s disease dementia. Although time and effort are required for development of coding processes for research synthesis, these instrument development activities are one of the critical elements of producing reliable and clinically useful information.

Symptom-Related Self-Care of Mexican Americans With Type 2 Diabetes: Preliminary Findings of the Starr County Diabetes Education Study

Starr Country Texas, a Texas-Mexico border community, was the site of a study involving culturally-appropriate education and group support for Mexican Americans with type 2 diabetes. Data were collected from 63 subjects on frequency of diabetes-related symptoms during the previous month and on self-care symptom treatments. On average, subjects were 57-year-old females, diagnosed with diabetes for 10 years, and exhibiting HbA 1c levels of 12.5%. Almost 50% experienced excessive urination, excessive thirst, shakiness/nervousness, and numbness and/or tingling in their extremities. More than 50% of those who experienced symptoms did not view them as serious. Only one subject checked blood sugar levels when symptoms occurred. Significantly higher mean glycosylated hemoglobin levels were found for individuals who experienced dizziness and/or chest pain compared with those who did not. A variety of self-care treatments were employed, including over-the-counter medications and home remedies.

Self-transcendence and activities of daily living. The woman with the pink slippers.

The number of older adults in our population is steadily increasing. Many older adults continue to remain active and care for themselves. However, differences exist in older adults’ ability to perform activities of daily living. The purpose of the study was to explore relationships among self-transcendence (ST), health status (SHS), and ability to perform activities of daily living (ADL) in noninstitutionalized older adults. The 88 participants were primarily widowed, White women, 65 years of age and older (M = 73.4), who perceived their health positively, and had 12 years or more of education. Findings included statistically significant relationships between ST and ADL and SHS and ADL. Twenty-two percent of the variance in ability to perform ADL was explained by SHS, and an additional 6% was explained by ST. Nurses are encouraged to explore factors that contribute to older adults’ ability to remain independent.

Overweight and Central Adiposity in School-Age Children and Links With Hypertension

The purpose of this study of school-age children was to estimate prevalence and interrelationships of overweight, central adiposity, and hypertension. It included 1,070 children in kindergarten through sixth grade (67% Hispanic, 26% African American, mean age = 8.9 years). Measures included body mass index (BMI), waist circumference (WC), systolic and/or diastolic hypertension identified by measurements on three separate occasions. Percentage overweight (BMI >or=95th percentile) was 28.7%, 17.9% were at risk of overweight, 28.8% had WC >or=90th percentile, and 9.4% had elevated (>or=90th percentile) systolic and/or diastolic blood pressure (BP). If we had screened only for BMI and examined those with BMI >or=85th percentile or underweight for hypertension, we would have missed 26% of the children with persistently elevated BP. WC explained variance in elevated BP not explained by BMI (p < .001). Measurement of WC is easily incorporated in a school-based screening protocol.

Spiritual Influences on Ability to Engage in Self-Care Activities among Older African Americans

The influence of spiritual factors on the ability of African-American elders to carry out instrumental activities of daily living (IADL) independent of age, gender, education, and self-rated health is explored using the religion-health explanatory model in a cross-sectional sample of 96 African-American community dwelling adults 62 to 93 years of age. The Reed spiritual perspective (SPS) and self-transcendence (STS) scales are used to study spiritual factors (Reed, 1991). The typical respondent was 75 years of age, female, widowed with 10.4 years of education. Self-rated health and age are strongly related to IADL in models that include the other variables (R2 = 0.41, p < 0.01). Those who are younger and those who self-report better health have higher IADL scores than those without these characteristics. Spiritual factors are significantly related to IADL in a model that includes an interaction of STS with education (R2 = 0.50). Among the least educated, STS is associated with higher scores of IADL. Addition of the interaction to the model resulted in a significant positive association of both STS and education with IADL. SPS was unrelated to IADL. Caregivers concerned with functional ability may want to consider interventions based on increasing a sense of self-transcendence, and to consider educational level as a potential moderator of this relationship. Criticism of the religion-health literature has suggested that putative health effects of religion may be exaggerated, because of failure to take confounding variables into account (Sloan, Bagiella, & Powell, 1999). However, this study and a recent survey by Musick, House, and Williams (2004) are evidence that it is just as likely that health benefits of religion would be hidden by confounders as that they would be exaggerated by them.

The cost of screening adolescents for overweight and hypertension using a community partnership model.

OBJECTIVES (1) Determine the prevalence of overweight and high blood pressure (BP) among middle and high school students over a 2-year period and, (2) measure the cost and initial outcomes of screening. DESIGN Cost and outcome description using a cross-sectional design sample. The target population was 12- to 19-year-old healthy students attending grades 7 through 12 at 3 proximal schools located in a large urban school district in Texas. RESULTS Of 2,338 students screened, 925 (39.6%) had a body mass index (BMI)>or=85th percentile and 504 (21.6%) had BMIs>or=95th percentile for age and gender. There were 346 students (14.8%) with BMIs>or=85th percentile and systolic blood pressure (SBP)>or=95th percentile for age, gender, and height. The cost of the 2-year screening program was

Features of the Built Environment Related to Physical Activity Friendliness and Children’s Obesity and Other Risk Factors

66,442, and the cost per student was

Review: culturally appropriate health education improves glycaemic control in members of ethnic minority groups with diabetesCommentary

28. The cost to identify a student with increased BMI or high SBP was

Type 2 diabetes in children and adolescents: An emerging disease

72 and