1. Management of Type II Diabetes
Amy Douglas, BSN, RN
Kathy Jo Ellison, PhD, RN, Faculty Advisor
Target Population and PICO Question
Introduction, Background, and Significance
Results
Introduction: As the incidence of Type II Diabetes continues to increase at an alarming rate, it is imperative that education to improve self-management of the disease is part of the treatment regime to improve patient outcomes and quality of life.
Background: The purpose of this small test of change was to determine if the use of the interactive technology program, “Diabetes In Check”, can improve patient knowledge of diabetes and enhance self-management of the disease.
Significance: Diabetes affects approximately 21 million Americans and is the 6th 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.
Target Population: Adult individuals over the age of 19 years old who have been diagnosed with Type II Diabetes within the last 6 months and have access to a Smart phone or tablet.
PICO Question: "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?"
DEMOGRAPHICS (n=6)
Variable
Age
M=53.7
SD=8.8
Gender
3 Males
3 Females
50%
Ethnicity
1 Caucasian
5 African Americans
17%
83%
HgbA1c
M=8.57
SD=2.52
Literature Search and Recommendations
T-Test Results
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”
Studies found included 2 systematic reviews and meta-analysis, 6 randomized controlled trials, and 1 quasi-experimental, 2 group, pre & post test design
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)
Home telehealth has a positive impact on the use of numerous health services and glycemic control (GradeB)
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)
Small Test of Change
Implementation:
A handout was created to inform possible participants about the project and its purpose.
Participants were selected based on inclusion criteria.
Baseline information was obtained, and pre-implementation knowledge test was completed by participants.
Participants were taught how to use the smart phone application, “Diabetes in Check” at the 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.
Evaluation: 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.
Variable
T Score
P Value
Weight
4.8
0.005
Blood Glucose
2.4
0.062
Test Score
-7.8
0.001
Conclusion
The conclusions that may be drawn from this small test of change are that the use of interactive technology (“Diabetes In Check”) is beneficial in improving knowledge of diabetes and encouraging self-management of the disease in this setting.
A larger sample size is warranted with follow-up every month to every 3 months to evaluate long-term effectiveness (HgbA1c levels).