1. Management of Type II Diabetes Amy Douglas NURS 7940 April 3, 2014 Online Presentation

2. Objectives  Introduction Background and significance PICO Literature search and summary of evidence Recommendations  Small Test of Change Methods Results Summary/conclusion

3. Background/Significance  Diabetes affects approximately 21 million Americans  6 th leading cause of death in the United States  Type II diabetes is one of the leading causes of kidney failure, non-traumatic lower limb amputations, blindness, heart disease, and strokes  It is imperative that education to improve self- management of the disease is part of the treatment plan to improve patient outcomes and quality of life.

4. PICO  "In newly diagnosed adult patients with Type II Diabetes, how well does interactive computer technology compared to written educational materials with lifestyle modifications such as diet, exercise, and medication management improve glucose control?"

5. Literature Search  Auburn Database (Cochrane, CINAHL, ERIC, MEDLINE, and Academic Search Premier )  Phrases used: “newly diagnosed”, “Diabetes Type II”, “adults”, “interactive computer technology”, “written educational materials”, “glucose control”, “diet”, “exercise”, “lifestyle modifications”

6. Summary of Evidence  Liang and others completed a systematic review using mobile phone intervention to teach diabetic self-care. Patient outcomes included significant reduction in HbA1c levels.  Polisena and others used telehealth and telephone support in their systematic review to improve diabetes self-care with positive effects on glycemic control.  Dyson and others conducted a randomized controlled trial by the use of a short video to teach diabetic self-care techniques. HbA1c levels were improved.  Fradiand others conducted a randomized control trial by using internet and cell phones to assist with diabetes self-care. Improvement in HbA1c levels were noted after 3 months.

7. Summary of Evidence  Kim conducted a randomized control trial using cellular phone interventions by nurses to educate patients about diabetes self-care with significantly HbA1c levels reported.  Sacco and others completed a randomized control used proactive telephone intervention on diabetic information and self-care which resulted in significant reduction in HbA1c levels.  Zolfaghari and others completed a quasi-experimental pre-test and post-test to test the effectiveness of nurses’ short diabetic education message. Significant mean changes in HbA1c levels were reported.  Zyskind and others conducted a randomized control trial by using computer based diabetic information teaching which resulted in a slight decrease in HbA1c levels.

8. Recommendations  Educational diabetes material should be tailored on an individual basis (Grade A)  Home telehealth is an extension of health-care delivery in a patient’s home environment and has shown to be clinically effective in management of diabetes (Grade A)  The health care provider can offer innovative technological teaching tools that can aid in the self-management of diabetes (Grade B)  Dietary and physical activity modifications, weight reduction, and self-monitoring of blood glucose should be a part of the diabetic patient’s daily regime (Grade B)

9. Recommendations  Health care providers must educate patients about the importance of the maintenance of the target postprandial glucose (Grade B)  Home telehealth has a positive impact on the use of numerous health services and glycemic control (Grade B)  Coaching interventions by a health care team can be used to improve diabetes management (Grade B)  Patients with diabetes need more frequent contacts with nurses and health providers for managing the disease (Grade B)  Computer based patient education can be used to positively impact both clinical and behavioral outcomes in patients with diabetes (Grade B)

10. Small Test of Change  Methods  Setting and participants  Baptist Health Center for Diabetes and Nutrition Education  Inclusion criteria Diagnosed with Type II Diabetes within the last 6 months Access to a smart phone or tablet Age 19 and older

11. Small Test of Change  6 patients consented to participate 3 Males, 3 Females Age: Range of 43-64; Mean- 53.67 Ethnicity: 83.3% African American, 16.7% Caucasian Education: 66.7% High School graduates; 16.7% College graduates; 16.7% Master’s degree Medications: 66.7% diet only; 33.3% on oral medications

12. Small Test of Change  Methods  Implementation Steps  Handout created to give to the patients  Data Collected 23 question diabetes knowledge pre-test Age, gender, baseline medication regimes, weight, and blood glucose levels  Interventions Delivered Participants were taught how to use the smart phone application, “Diabetes in Check”, at initial visit Participants kept a daily log of their blood glucose levels using the smart phone application for 5 weeks and received weekly phone calls from the project leader who offered encouragement and answered questions

13. Small Test of Change  Methods  Evaluation: Outcome Measures and Tools  The diabetes knowledge post-test was administered after 5 weeks and data was collected and compared with paired t-tests  Weight and blood glucose levels were collected at the end of the 5 week period and compared with paired t- tests

14. Small Test of Change Paired T-Test Results

15. Small Test of Change  Summary/conclusion for larger project  The conclusions that may be drawn from this small test of change are that the use of interactive technology is beneficial in improving knowledge of diabetes and encouraging self-management of the disease  Data analyzed from pre and post measures shows a significant improvement in knowledge after use of the Smart phone app “Diabetes In Check”.  A larger sample size is warranted with a longer amount of time and more follow-up to evaluate long-term effectiveness.

16. References Dyson, P., Beatty, S., & Matthews, D. (2010). An assessment of lifestyle video education for people newly diagnosed with type 2 diabetes. Journal of Human Nutrition and Dietetics, 23(4), 353-359. doi: 10.1111/j.1365277X.2010.01 Faridi, Z., Liberti, L., Shuval, K., Ali, A., & Katz, D. (2008). Evaluating the impact of mobile telephone technology on type 2 diabetic patients’ self-management: The niche pilot study. Journal of Evaluation in Clinical Practice, 14(3), 465-469. doi: 10.1111/j.13652753.2007.00881.x Kim, H. (2007). Impact of web-based nurse’s education on glycosylated haemoglobin in type 2 diabetic patients. Journal of Clinical Nursing, 16(1), 1361-1366. doi: 10.1111/j.1365- 2702.2005.01506.x Liang, X., Wang, Q., Yang, X., Cao, J., Chen, J., Mo, X., Huang, J., Wang, L., & Gu, D. (2011). Effect of mobile phone intervention for diabetes on glycemic control: A meta-analysis. Diabetic Medicine, 28(4), 455-463. doi: 10.1111/j.1464-5491.2010.03180.x Polisena, J., Tran, K., Cimon, K., Hutton, B., McGill, B. & Palmer, K. (2009). Home telehealth for diabetes management: A systematic review and meta-analysis. Diabetes, Obesity & Metabolism, 11(10), 913-930. doi: 10.1111/j.1463-1326.2009.01057.x Sacco, W., Malone, J., Morrison, A., Friedman, A. & Wells, K. (2009). Effect of a brief, regular telephone intervention by paraprofessionals for type 2 diabetes. Journal of Behavioral Medicine, 32(1), 349-359. doi: 10.1007/s10865-009-9209-4 Zolfaghari, M, Seyedeh, M., & Haghani, H. (2012). The impact of nurse short message service and telephone follow-ups on diabetic adherence: Which ones are effective? Journal of Clinical Nursing, 21(1), 1922-1931. doi: 10.1111/j.1365-2702.2011.03951.x Zyskind, A., Jones, K., Pomerantz, K. & Barker, A. (2009). Exploring the use of computer based patient education resources to enable diabetic patients from underserved populations to self- manage their disease. Information Services & Use, 29(1), 29-43. doi: 10.3233/ISU-2009-0592