Title: Advanced Nursing Practice in Diabetic Care Outcome of Empowerment in Diabetes Education
1Advanced Nursing Practice in Diabetic Care
Outcome of Empowerment in Diabetes Education
- Rebecca Yee Man WONG
- RN, BN, MSc
- Nurse Specialist (Diabetes Care)
- Diabetes Endocrine Centre
- Prince of Wales Hospital
- Hong Kong SAR
2Diabetes Mellitus
- Diabetes is a chronic disease
- A successful diabetes treatment program
requires patientsactive involvement in the
management of diet, exercise and medication - Making changes in their lifestyle is one of the
greatest challenges patients face in controlling
their diabetes
3Diabetes Mellitus
- Glycemic control is an important predictor of
many of the chronic complications of diabetes - ADA Position Statement 2001
4Diabetes Control and Complications Trial (DCCT)
- Significant risk reduction with tight glucose
control - Reductions in microvascular complications with
HbA1c 7.2 - - 76 retinopathy
- - 60 for neuropathy
- - 56 for nephropathy
- N Eng J Med 1993329683-689
5United Kingdom Prospective Diabetes Study (UKPDS)
- For every 1 reduction in the HbA1c, there is a
35 reduction in microvascular complications - - Control group 7.9
- - Intervention group 7
- Lancet 1998352837-853.
6Results of Diabetes Self-Management Education
(DSME) on Glycemic Control
- Systematic review reports of 31 published,
randomized controlled trials to ascertain the
efficacy of diabetes self-management education
(DSME) in adults with type 2 diabetes - Examine the effect of baseline HbAlc, follow-up
interval and intervention characteristics on
HbAlc - HbA1c improved with DSME, with an average change
of 0.76 - Norris et al., 2002
7Results of Diabetes Self-Management Education
(DSME) on Glycemic Control
- HbA1c was lowered in patients who received
education from dieticians or diabetes nurses than
those who had not (7.9 vs 8.7 ) - Chan et al., 2000
- Patients discharged early and received a follow
up programme by diabetes nurse specialist had a
decrease in HbA1c at 24 weeks when compared with
those who remained in hospital until the glycemic
control is stable (7.6 vs 8.1) - Wong et al., 2004
8Intensive Insulin Therapy Program (IITP) in PWH
- Pilot program started since 1998
- Saturday morning session in Diabetes Centre
- Target groups
- Type 1 and Type 2 patients with multiple dose
injection per day (MDI), - BD injection pending
to MDI - Patients with insulin pump
9Intensive Insulin Therapy Program (IITP) in PWH
- Our Objectives
- To offer Diabetes self care knowledge and skills
- To enhance participants self-efficacy in disease
management - To facilitate peer group support and sharing
10Intensive Insulin Therapy Program (IITP) in PWH
- Contents of the Empowerment program
- Patient contract
- Intensive education
- Group sharing
- Clinic follow up
- Lunch together
11Intensive Insulin Therapy Program (IITP) in PWH
- Patients with insulin pump are designated as
group leaders to lead the experience sharing - DM nurses as partners to provide information on
diabetes self care knowledge and skills - Other health care professionals such as
dietitians, doctors to give education on specific
topics
12Intensive Insulin Therapy Program (IITP) in PWH
- Topics of the IITP Education Program
- Diet food exchange, food labels, glycemic
index, dining out - Exercise and weight reduction
- Insulin dose adjustment
- Self Monitoring of Blood Glucose (SMBG)
- Acute complications Diabetic ketoacidosis,
Hypoglycaemia - Special issue traveling, sick day management
- Stress management
13Intensive Insulin Therapy Program (IITP) in PWH
- Mode of education delivery
- Group - Role play - Games - Competition
Program duration
- - 22.9 11 months
- - 6.74 2.9 visits
14Intensive Insulin Therapy Program (IITP) in PWH
- A summary of subjects characteristics n39
Characteristics Frequency ()
Male 19 (48.7)
Female 20 (51.3)
Age 18 25 8 (20.5)
26 35 13 (33.3) mean 34.489.33
36 - 45 14 (35.9)
46 53 4 (10.3)
Type 1 32 (82.1)
Type 2 7 (17.9)
MDI 24 (61.5)
BD injection 15 (38.5)
15Intensive Insulin Therapy Program (IITP) in PWH
Results
16Intensive Insulin Therapy Program (IITP) in PWH
- Conclusion
- Up to 12/2005, total no. of patients on multiple
dose insulin injection (gt4 times injection per
day) 258, - increase in 10 folds at 5 years
- Friday afternoon session in diabetes specialist
clinic - Group education session and experience sharing
- Clinic follow up visit
17Intensive Insulin Therapy Program (IITP) in PWH
- Picture of Peer Group Education Session
18Intensive Insulin Therapy Program (IITP) in PWH
- Picture of Peer Group Education Session
19Weight Management Program for Patients with
Diabetes in PWH
- Pilot programme12.2003-3.2004 (14 weeks)
- Target group type 2 patients with BMI over 25
- Organised by DM nurses and social worker from
Centre of Rehabilitation Network
20Weight Management Program for Patients with
Diabetes in PWH
- Our Objectives
- To facilitate participants in learning various
weight management skills and knowledge. - To enhance participants self-efficacy in disease
management. - To promote lifestyle modification through
psychosocial interferences by group dynamic and
peer support.
21Weight Management Program for Patients with
Diabetes in PWH
- A total of 7 sessions
- Each session was focused on different themes
- general concepts - individual counseling -
exercise, diet therapy - lifestyle
modification - stress management - common myths
- Diabetes self-care knowledge was incorporated
22Weight Management Program for Patients with
Diabetes in PWH
Contents of the Program
- Lecturing - Practicum - Sharing -
Therapeutic Games
23Weight Management Program for Patients with
Diabetes in PWH
Mode of delivery
- Telephone follow-up by social worker in between
of visits - Weekly peer-group partners phone contact
- Learning contract
- Biweekly objectives were set with participants
24Weight Management Program for Patients with
Diabetes in PWH
- Pre Post Assessment tools
- Diabetes knowledge score (DKN)
- Self-efficacy rating on disease management
- Health parameters e.g. BW, HbA1c and lipids
profile.
25Weight Management Program for Patients with
Diabetes in PWH
- Overview of the patient group
- Total no. of patients 6
- Female 6
- Occupation housewife
- Age 45-53
- Initial BW 68.9kg - 93.9kg
- Initial BMI 30.8 - 35.7kg/m/m
26Weight Management Program for Patients with
Diabetes in PWH
Results
Pre program Post program
DKN (n15) 6.7 11.7
Self efficacy (n10) 6 7.1
BW (kg) 77 76.4
Fat Mass (kg) 36.1 35.5
HbAlc () 7.3 6.7
Cholesterol (mmol/l) 4.9 4.7
Triglyceride (mmol/l) 2.12 2
27Weight Management Program for Patients with
Diabetes
Twelve aerobic training studies and two
resistance training studies were included (total
504 subjects). Post intervention HbA1c was
significantly lower in exercise than control
groups (7.65 vs. 8.31). But post intervention
body weight did not differ between exercise and
control groups. Boule et al 2001
28Weight Management Program for Patients with
Diabetes in PWH
- A significant improvement in health parameters
should be proven in the future programme. - Mutual-aid support group (fit ??) was set up in
5/2004 - Frequency of group meeting once a month
- No. of attendance per visit 25 35 patients
- Patient as group leader to lead other patients to
do exercise and experience sharing - DM nurses and social workers as partners to
provide update information regarding diabetes
related knowledge and psycho-social support
29Weight Management Program for Patients with
Diabetes in PWH
- Patient-led Exercise Session
30Weight Management Program for Patients with
Diabetes in PWH
- Patient-led Discussion Session
31Weight Management Program for Patients with
Diabetes in PWH
- Patient-led Discussion Session
32Constraints of the Empowerment Program
- Healthcare Administrators
- Acute, symptom-driven patient-care
- Limited resources
- Practitioners
- DSME program is complex
- Limited resources
- High volume patients load
- No time
33Constraints of the Empowerment Program
- Patients
- Ability to comprehend the materials
- Lifestyle socio-cultural, health belief
- Motivation and collaboration
- Financial issue
34We are each of us angels with only one wing, and
we can only fly by embracing one
anotherLuciano de Crescenzo
35Thank Youfor Your Participation