Article Analysis of 'Self Management Interventions for Type 2 Diabetes: A Systematic Review'

Diabetes has become an epidemic in today’s society. Diabetes affects almost every system in the body, and with an estimated 346 million people in the world with diabetes, healthcare has been heavily affected by the disease (Ramasamy, Shrivastava, P., & Shrivastava, S., 2013). One of the biggest issues for healthcare workers when it comes to diabetes, is that it is such a complicated disease. With so many different systems being affected, medical professionals have had to learn how the disease process works, what causes diabetes to work through the systems, and the best treatments to address all these issues. Through much research, the healthcare system has grown very knowledgeable on diabetes. One important aspect of treating diabetes has been in the introduction of diabetic education. In the past, nurses and dieticians had been responsible for educating patients on diabetes, but now that role is also extended to other people in the healthcare team, including the patient (Tomky, 2013). In fact, patients taking an active role in the education process, including learning to self-care has now become a priority in diabetes treatment. The following paper will discuss diabetic education, the importance of self-care and how this affects a patient’s compliance.

It also shows that not having someone to help these patients manage their diabetes as an obstacle to good diabetes management. This study created a plan and this plan was able to be tested to show its effectiveness in diabetes

This essay will inform readers about the best practices, published guidelines, and clinical pathways for management of diabetes. Diabetes is a serious issue that affects millions of people. Unrecognized pre diabetes is also a growing concern that is increasing dramatically. Diabetes is not diagnosed for most homeless people, because they do not do have a yearly physical check-up. Published guidelines are useful to patients and practitioners because they focus on the improvement of care. Clinical pathways are also important, because they focus on the outcome and assessment of their achievement.

Diabetes (DM) is one the many initiatives that Healthy People 2020 have been focusing on to reduce this disease morbidity and mortality rates throughout the communities. In the United States alone, the number of individuals diagnosed with diabetes has increased from 1.5 million in 1958 to 25.8 million in 2011. The Center for Disease and prevention (CDC) also estimates in the year 2011, 79 million people age 20 and over were noted to have pre-diabetes, in which the blood sugar was higher than normal levels, however, have not reached the level for a diagnosis of DM. Eleven percent of those individuals with pre-diabetic readings of raised blood glucose will progress in full blown diabetes a matter of three years. Healthy People 2020 have used evidence –based practices to aid in the prevention and treatment of diabetes. Evidence have shown by simply modifying one’s lifestyle such regular exercising and healthy eating have been recognized to effectively prevent or delay the onset of type 2 diabetes in high-risk persons. Case in point, the Diabetes Prevention Program research trial revealed that the utilization of lifestyle interferences had its utmost impact in elderly adults and was also effective in all racial groups.

Diabetes is a chronic disease that requires constant self-care management practices among diabetic patients. The patients have to make decisions to stick to a strict diet and exercise plan, they also have to be involved in complex activities aimed towards their care and health. Diabetes self-management education provides patients with essential information and has been shown to have a positive impact on the health of patients. Self-management enhances patients with skills and knowledge and information for self-care. The problem focus for this project is lack of culturally diabetes self-management education for the diabetic Hispanic adult population who receive care at a free clinic in Indio, California. Patients who have diabetes need information about their behavior and diet plans to help in the management and maintenance

In a Guideline Summary published by the Agency for Healthcare Research and Quality (AHRQ), evidence-based practice recommends prevention programs for those at risk for type II diabetes (Agency for Healthcare Research and Quality [AHRQ], 2015). This paper will examine this recommendation, what it entails, and how it can be applied to nursing practice.

The above studies by Walton et al. Castillo et al. and Steinbeck et al. though slightly different in their approach, demonstrate positive impact of self-management education on diabetic related parameters.

During this phase the clinic, its staff and the community are assessed, identifying facilitating and obstructive factors. Diabetes self-management education (DSME) is recommended by various organizations and is a standard of medical care (Schreiner & Ponder, 2013). The nine key points recommended at initial diagnosis and during follow-ups are nutritional management education, physical activity recommendations, educating on medications safely and treating for maximal therapeutic effectiveness, monitoring blood glucose, preventing, detecting, and treating acute/chronic complications, personal strategies to address psychosocial issues and concerns and personal strategies to promote health and behavior change (Schreiner

The tools for the project plan includes a Demographic Survey Item from the Behavioral Risk Factor Surveillance Survey System (BRFSS) and a diabetic self-management (DMSQ) surveys questionnaire (Carter, Barba, Kautz, 2013). The Behavioral Risk Factor Surveillance System (BRFSS) is the nation's premier system of health-related telephone surveys that collect state data about U.S. residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services (CDC, 2015). Whereas, The Diabetes Self-Management Questionnaire (DSMQ) is an instrument that assesses diabetes self-care activities associated with glycaemic control (Schmitt, Gahr, Hermanns, Kulzer, Huber and Haak, 2013). The ulilization of both BRFSS

According to Norris, Engelgau, and Narayan (2001) who were involved in a systematic review using a random trial research design, it was found out that self-management initiatives in training regarding knowledge of diabetes have a positive result to the various patients used. Out of a sample of 72 studies carried out in 84 articles analyzed effectively within a period of less than 6 months, it can be concluded that provision of self-management knowledge can be very important to the diabetes patients because it provides a similar body of knowledge concerning management of the condition from their homes. In a similar study carried out by CDC in a meta-analysis, it was revealed that knowledge in diabetes among the various patients with type 2 diabetes showed improvements in the self-management education (CDC, 2014).

According to Fiandt (2006), the goal of self-management is to empower patients to manage their health and healthcare. Some of the ways that this can be accomplished according to Fiandt (2006) are tailored educational resources, skills training, and collaboration between the provider and patient in setting goals and creating the treatment plan. An example to illustrate this would be a patient who is obese with high blood pressure and diabetes due to a diet high in processed food and a sedentary lifestyle. In this example tailored educational resources could be about the effects of poor diet choices and how they increase the risks of high blood pressure and diabetes. Some ideas for skill training would be to teach the patient how to take and record their blood pressure and how to monitor their blood glucose levels and take their insulin.

In relation to systemic factor, Brown, J. et al (2002) reported that most doctors often have limited time to study and abide to Clinical Practice Guidelines (CPG) that sometimes provide multiple guidelines and implementation changes within short time. This additional task although aids to improve effectiveness strategy in practice somehow considered troublesome especially when the healthcare system unable to address this issue. Brown, J. et al (2002) concluded that challenges arise in type 2 diabetes management were not caused by one factor instead, each roles (patient, doctor and healthcare system) play crucial responsibility and influences the elements that could be important to the others. In regards to the findings, development of diabetes management model that integrate and incorporate the patients together with other roles in diabetic care treatment was recommended by Brown, J. et al (2002). Several limitations were found in the study include the small sample size and the selection process were not explicitly

According to Johnson and Raterink (2009), Type 2 Diabetes Mellitus (DM) is a major global chronic health issue. Though, it is found that the condition is largely preventable as many of the risk factors for developing the disease such as excess weight, poor diet, inactivity, smoking and excessive alcohol consumption, are modifiable behaviours (Australian Bureau of Statistics, 2011). A client newly diagnosed with Type 2 DM may be unaware that the illness can be effectively self-managed with changes to diet, lifestyle and if necessary the inclusion of oral hypoglycemic agents (Australian Institute of Health and Welfare [AIHW], 2008). Therefore, the aim of the education plan is to assist the client to make educated lifestyle

The tools for the project plan includes an Omani Self-Management Survey also called diabetes self-management (DSM) ( Appendix G) and the Diabetes Self-Management and Education Assessment Scoring (Appendix H). DSM consists of a twenty questions survey that are a life-long journey that patients to adjust to a new lifestyle, make decisions, and perform specific tasks (Alrahbi, 2014). However, diabetes self-management education (DSME) is a five part score questionnaire that is an element of care for all people with diabetes and those at risk of developing the disease. Furthermore, the National Standards for Diabetes Self-Management Education supports and assist diabetes educators in providing evidence-based education and self-management support.

Hence, nine articles were reviewed taking in consideration the five-year restriction of using articles ranging from 2013 to 2018. The above articles pointed out the effectiveness in implementation of chronic care model, educational program for diabetes management, and reduction in readmission rates and complications.