Susan J. Appel

“They Care But Don’t Understand”: Family Support of African American Women With Type 2 Diabetes

PURPOSEnThis study evaluated the relationship between perceived social support among African American women with type 2 diabetes and diabetes self-management.nnnMETHODSnThe sample included 12 African American female patients at a diabetes clinic in the southeastern United States. Focus group participants responded to questions related to social support and its influence on diabetes management.nnnRESULTSnSupport comes particularly from family, but also friends and/or healthcare providers. The dual challenges of diabetes management and multicaregiving were an expected theme from the sessions. A unique emerging theme, however, was the womens perception of a lack of understanding of their needs by members of their social networks. Participants believed that those who provide support claim they care and try to be helpful but provide minimal physical assistance or emotional understanding of their needs, which could vary daily. Those who provide informational support seem to care but misunderstand the type of information actually needed and how best to deliver it.nnnCONCLUSIONSnHealthcare providers can help improve communication with these women by actively seeking to meet their support needs and educating families so that provisional support is more meaningful and diabetes management more attainable.

A Review of the Health Beliefs and Lifestyle Behaviors of Women with Previous Gestational Diabetes

OBJECTIVEnTo critically review and synthesize original research designed to examine the health beliefs, including risk perceptions and health behaviors related to diet and physical activity of women with previous gestational diabetes mellitus.nnnDATA SOURCESnPubMed and CINAHL databases were searched for studies published in the last decade (1998-2008) that examined variables related to the health beliefs and behaviors of women with previous gestational diabetes mellitus. Keyword searches included health beliefs, health behaviors, perceived risk, gestational diabetes, type 2 diabetes, diet, physical activity, and postpartum.nnnSTUDY SELECTIONnEight articles, representing 6 studies, were selected that met the inclusion criteria of original research, dependent variable of health beliefs and behaviors of women with previous gestational diabetes mellitus, and measurement after pregnancy.nnnDATA EXTRACTIONnArticles were reviewed and discussed according to the concepts of risk perception and health beliefs, health behaviors related to diet and physical activity, and psychosocial factors related to womens health beliefs and behaviors.nnnDATA SYNTHESISnData revealed common health beliefs and behaviors of women with previous gestational diabetes mellitus, including low risk perceptions for future type 2 diabetes mellitus and suboptimal levels of physical activity and fruit and vegetable intake. The majority of studies revealed a distinct knowledge-behavior gap among women with previous gestational diabetes mellitus, whereas others revealed a lack of knowledge regarding necessary lifestyle modifications.nnnCONCLUSIONSnFindings from this review may assist womens health researchers and clinicians in developing appropriate interventions for increasing risk awareness, promoting self-efficacy for weight loss and physical activity behaviors, and decreasing rates of diabetes and cardiovascular disease among women with previous gestational diabetes mellitus. Further research is necessary to identify factors that influence the health beliefs and behaviors of women with previous gestational diabetes mellitus. Future research should focus on populations of greater racial, ethnic, and socioeconomic diversity, as the majority of studies have been conducted with non-Hispanic White, socioeconomically advantaged women.

Central Obesity and the Metabolic Syndrome: Implications for Primary Care Providers

Purpose To describe screening measures that will determine which clients are at risk for the metabolic syndrome, common manifestations of the syndrome, preventive diagnostic considerations, and management and treatment options that primary care providers can implement. Data Sources Review of the clinical and research literature, supple mented with specific diagnostic criteria. Conclusions Central obesity is the cornerstone of the metabolic syndrome, which may lead to type 2 diabetes and cardiovascular disease. Generalized obesity is defined body weight that is considerably greater than the ideal weight and that is distributed on all parts of the body. Generalized obesity has long been considered a significant risk factor for developing type 2 diabetes and cardiovascular disease.Those clients of ideal body weight have been considered at less risk for developing these conditions. However, this perception may not always be accurate. Weight distribution plays a major role in acquiring the metabolic syndrome.Because waist circumference is important as overall body weight, central obesity is key determining the risk. Implications for Practice The metabolic syndrome has now been given a CPT code (277.7). It is more likely that clients at risk for or with the metabolic syndrome may first be seen by a primary care provider. Primary care providers need to be able to diagnose treat and provide preventive interventions for the metabolic syndrome. Clients at risk will likely be identified during routine health screening. Early detection of and interventions focused on the metabolic syndrome may reduce the occurrence of type 2 diabetes and cardiovascular disease. Use of a tape measure to determine waist circumference may help the provider to identify at‐risk clients who are of normal weight and thus not previously believed to be at risk, as well as those more obviously at risk. It is necessary to determine not only patients overall body weight but also their waist circumference. A measuring tape may be the key tool for establishing a patients early risk for the metabolic syndrome and ultimately for prevention of type 2 diabetes and cardiovascular disease.

Central Obesity, the Metabolic Syndrome, and Plasminogen Activator Inhibitor-1 in Young Adults

Purpose To determine the association of central obesity with the components of the metabolic syndrome (i.e., hyperinsulinemia, hypertension, hypertriglyceridemia, low levels of high‐density lipoprotein cholesterol [HDL‐C]) and plasma levels of plasminogen activator inhibitor‐1 (PAI‐1) in young adults. We hypothesized that central obesity as determined by waist circumference would be predictive of components of the metabolic syndrome and of PAI‐1. Data sources Participants in this descriptive study consisted of 85 healthy young adults aged 19–22 years, 62% women who fasted for 12 h prior to data collection in the General Clinical Research Center at a major university hospital medical center in the southeastern United States. Conclusions The majority of the participants had one or more components of the metabolic syndrome (n= 43, 51%). Central obesity was present in 14.1% and was more common in women than men (χ2= 5.11; p= 0.021). Central obesity was significantly and positively correlated with elevated blood pressure (BP) and levels of insulin and PAI‐1 while being negatively correlated with HDL‐C. In multiple regression analyses, diastolic BP, insulin, and HDL‐C were predictors of waist circumference (R2= 0.615). In a separate multiple regression, PAI‐1 was predicted by waist circumference (R2= 0.331). Implications for practice Many otherwise healthy young adults have one or more components of the metabolic syndrome. Assessment and institution of preventative measures for obesity and the components of the metabolic syndrome should begin in childhood. Furthermore, determination of waist circumference especially in young women may aid the practitioner to identify those at risk for the metabolic syndrome earlier in their disease trajectory. Furthermore, insulin resistance is believed to occur initially in the trajectory of the metabolic syndrome, making it a principal contender for suitable interventions to reduce risk for both type 2 diabetes and cardiovascular disease (CVD). Homeostatic model assessment for insulin resistance was used to assess for insulin resistance among the euglycemic participants. Recording the presence of insulin resistance will aid the practitioner in determining if a low‐risk patient is in peril for development of type 2 diabetes and/or CVD. Early cardiovascular risk recognition is vital to clinical practice as it allows more time for the practitioner to counsel patients for the essential planning needed to make lifestyle changes.

An Integrative Review of Community Health Advisors in Type 2 Diabetes

The purpose of this paper was to report findings from an integrative literature review conducted to identify the theoretical basis of interventions for studies using community health advisors; populations and settings served by community health advisors; characteristics, training, and roles and activities of community health advisors; and the effectiveness of interventions by community health advisors for improving self-management of patients living with type 2 diabetes mellitus. Community health advisors’ theoretical interventions were based on providing culturally appropriate care and resolution of health disparities within minority populations. Typically community health advisors were patients themselves living with type 2 diabetes mellitus. Major roles of community health advisors included: supporter, educator, case manager, advocate, and program facilitator. Activities of community health advisors were: coordinating educational programs, conducting educational courses for patients, serving as a link between patients and healthcare professionals, providing counseling, and leading peer support meetings. The effectiveness of interventions by community health advisors was mixed. Examples of outcome criteria were improvements in: knowledge, hemoglobin A1C, low density lipoprotein levels, blood pressure, and physical activity. Community health advisors provide culturally appropriate interventions to promote and restore health and prevent diseases while serving as links between community and healthcare providers.

Latent autoimmune diabetes of adulthood (LADA): An often misdiagnosed type of diabetes mellitus

Purpose: The purpose of this article is to raise awareness about a frequently misdiagnosed form of diabetes, latent autoimmune diabetes of adulthood (LADA), to describe its clinical and epidemiological characteristics, and to compare them to those of the more common and widely known types of diabetes, type 1 diabetes mellitus (DM) and type 2 DM. Data sources: A review of the pertinent literature describing the features of LADA from 2000‐2007 is summarized. Conclusions: LADA is a rather common and often underrecognized form of diabetes whose clinical presentation falls somewhere between that of type 1 DM and type 2 DM. From a pathophysiological perspective, it is more closely related to type 1 DM, and some have even used the term type 1.5 diabetes to refer to it; however, it is most often misdiagnosed and treated as type 2 DM. Implications for practice: Nurse practitioners (NPs) should always consider alternate diagnoses when patients with newly or previously identified adult‐onset diabetes mellitus do not fit the traditional stereotype of type 2 DM (i.e., overweight with signs of insulin resistance and a significant family history of diabetes). Statistically, strong consideration must be given to the diagnosis of LADA, especially in those who are of normal weight, show little evidence of insulin resistance, and have hardly any family history of diabetes. Knowing the patients exact diabetes type can give the NP a much greater understanding of the natural history of the patients disease, the changes that may occur as the patient ages, and how to optimally manage their diabetes to minimize complications. Likewise, when a patient is correctly diagnosed, they can be empowered to manage their diabetes with the appropriate therapies.

Calculating Insulin Resistance in the Primary Care Setting: Why Should We Worry about Insulin Levels in Euglycemic Patients?

Purpose To describe measures that would determine which patients are insulin resistant and at risk for the metabolic syndrome and its sequelae cardiovascular diseases (CVD) and to analyze methods to determine the presence of insulin resistance and the advantages or disadvantages of each. Data sources Review of the multidisciplinary clinical and research literature. Conclusions Insulin resistance occurs early in the trajectory of the metabolic syndrome, making it a prime candidate for timely interventions to reduce risk for both type 2 diabetes and CVD. Therefore, prompt recognition of insulin resistance prior to the development of the full metabolic syndrome, type 2 diabetes, and/or CVD may assist in the prevention of morbidity and premature mortality. Likewise, because many insulin‐resistant patients belong to minority racial groups (i.e., African American, Hispanic, Native American, or Pacific Islanders), early identification may have a positive impact on the reduction of cardiovascular health disparities. Implications for practice Documenting the presence of insulin resistance will assist the practitioner to determine if a low‐risk patient is in jeopardy for development of type 2 diabetes and/or CVD. Early cardiovascular risk identification is important to clinical practice as it allows more time for the practitioner to counsel patients for the essential planning needed to make lifestyle changes.

Chronic obstructive pulmonary disease: diagnosis and management.

Purpose: The purpose of this article is to provide a comprehensive review of the current modalities employed in diagnosing and treating chronic obstructive pulmonary disease (COPD). Special emphasis is placed on current guidelines, as defined by the Global Initiative for Chronic Obstructive Lung Disease. n nData source: A comprehensive literature review for COPD serves as the basis for this article. n nConclusions: According to the National COPD Coalition (2004), there are nearly 24 million Americans who suffer from COPD. The incidence of COPD is rising globally and is associated with increased morbidity and mortality. COPD is characterized by progressive decline in function, resulting in concomitant diseases, which increase healthcare dollar expenditures, thus making COPD a concern for healthcare providers in the United States and abroad. n nImplications for practice: Once a diagnosis of COPD is made, healthcare providers should explore multiple treatment options in an effort to find the most beneficial regimen. It is only when the treatments are individualized, including physiological therapies and cognitive approaches to lessen risks as well as to reduce exacerbations, that the patient with COPD is able to potentially experience a reasonable quality of life.Purpose: The purpose of this article is to provide a comprehensive review of the current modalities employed in diagnosing and treating chronic obstructive pulmonary disease (COPD). Special emphasis is placed on current guidelines, as defined by the Global Initiative for Chronic Obstructive Lung Disease. Data source: A comprehensive literature review for COPD serves as the basis for this article. Conclusions: According to the National COPD Coalition (2004), there are nearly 24 million Americans who suffer from COPD. The incidence of COPD is rising globally and is associated with increased morbidity and mortality. COPD is characterized by progressive decline in function, resulting in concomitant diseases, which increase healthcare dollar expenditures, thus making COPD a concern for healthcare providers in the United States and abroad. Implications for practice: Once a diagnosis of COPD is made, healthcare providers should explore multiple treatment options in an effort to find the most beneficial regimen. It is only when the treatments are individualized, including physiological therapies and cognitive approaches to lessen risks as well as to reduce exacerbations, that the patient with COPD is able to potentially experience a reasonable quality of life.

Understanding acid-base balance Find out how to interpret values and steady a disturbed equilibrium in an acutely ill patient.

Find out how to interpret values and steady a disturbed equilibrium in an acutely ill patient.

Type 2 Diabetes: Fueling the Surge of Cardiovascular Disease in Women

Objectives Upon completion of this activity, the learner will be able to: 1. Recognize and identify the interrelated risk factors that contribute to the development of type 2 diabetes and cardiovascular disease (CVD) in women. 2. Formulate strategies that result in the early identification of women at risk for developing type 2 diabetes and CVD. 3. Describe intervention strategies for the prevention and treatment of type 2 diabetes and CVD in women. Continuing Nursing Education (CNE) Credit A total of 2 contact hours may be earned as CNE credit for reading “Type 2 Diabetes: Fueling the Surge of Cardiovascular Disease in Women” and for completing an online post‐test and participant feedback form. To take the test and complete the participant feedback form, please visit http://JournalsCNE.awhonn.org . Certificates of completion will be issued on receipt of the completed participant feedback form and processing fees. AWHONN is accredited as a provider of continuing nursing education by the American Credentialing Centers Commission on Accreditation. Accredited status does not imply endorsement by AWHONN or ANCC of any commercial products displayed or discussed in conjunction with an educational activity. AWHONN also holds California and Alabama BRN numbers: California CNE provider #CEP580 and Alabama #ABNP0058.