Management of Diabetes Mellitus among a Vulnerable Population – Hispanic Population

Total Word Count: 2013
   Send article as PDF   

Introduction

Diabetes mellitus is a major health issue in the country, affecting more than 25 percent of the American population, and is classified as the seventh leading cause of mortality as of 2010 (Centers for Disease Control and Prevention, 2011). Various population groups are affected differently by diabetes melitus, with Hispanics being among the most vulnerable, with predisposing factors consisting of low household incomes, low levels of diabetes awareness, and racial disparities present in the health care industry (Schneiderman et al., 2014). As such, there is a need to formulate population-specific interventions that are aimed at reducing the impact of diabetes mellitus among Hispanics.

One of the ways that diabetes mellitus can be adequately managed is by the incorporation of health technology, specifically mobile phone text messaging services. According to de Jongh et al. (2012), the use of mobile phone messaging has been utilized in the management of various chronic conditions, including high blood pressure and diabetes mellitus. Consequently, Hispanic patients diagnosed with diabetes mellitus can benefit significantly from health programs that utilize the many features of mobile phones, particularly education and ease of communication. The main aim of this research proposal is to demonstrate the effectiveness of using text messaging and telemedicine support to facilitate self-management among Hispanic patients diagnosed with diabetes mellitus, based on the available scientific evidence from research. The following sections will analyze several research studies that provide more information on the proposed intervention, and determine their relevance and impact on the management of diabetes mellitus by Hispanic patients.

Description of Selected Studies

The first study was conducted by Quinn wt al. (2008), and investigated the effectiveness of WellDoc™ in changing the clinical and behavioral outcomes, and patient and physician satisfaction. The study was a non-blinded randomized controlled trial involving thrity patients diagnosed with type 2 diabetes, and aged between 18 and 70 years. The participants of the study were recruited from one community endocrinology center and two community primary care practices. Since the study design, is not a standard randomized controlled trial, the evidence provided can be classified as level III, and is therefore of high quality. The evidence is also highly significant to this research as it demonstrates how mobile messaging services used in combination with support from certified health care providers. This study is significant to this research proposal as it demonstrate that mobile phone messaging and support from health care professionals can be effective in the management of diabetes mellitus. This study is directly significant to the proposed intervention as it shows that mobile phone messaging is effective in facilitating self-management of diabetes mellitus among patients diagnosed with diabetes. Given the high prevalence of diabetes mellitus among Hispanics, the study contributes significant information on ways of promoting management of diabetes and increasing diabetes awareness among Hispanics.

In the second study by Kirwan, Vandelanotte, Fenning & Duncan (2013), a similar approach was adopted where the study participants were issued with a diabetes monitoring software, Glucose Buddy, and provided with support from certified diabetes educators. The study used a randomized controlled trial study design, and involved 72 diabetic patients recruited from an online type 1 diabetes support group. As such, the level of evidence is classified as level II, and is of high quality. The evidence provided in the study is highly relevant to the research proposal as it demonstrates the effectiveness of text messages and support from health care providers in the promotion of self-management among diabetes patients. The study is also relevant to my nursing practice and the Hispanic population as it provides information that can be used to formulate specific interventions targeting Hispanics in particular. By using text messages and providing support from diabetes educators, Hispanics can have more control over their blood glucose levels as they are empowered with knowledge and skills in diabetes self-management. Also, health care providers are likely to benefit from more participation of patients that improves the efficiency of health care services.

The third study by Cafazzo, Casselman, Hamming, Katzman & Palmert (2012) investigates the use of a mobile health application in the management of type 1 diabetes among adolescents, combined with gamification incentives. The study was a clinical trial, and was carried out among 20 patients between the ages of 12 and 16 who had been diagnosed with diabetes in the past one year. As such, the evidence provided in the study can be classified under level III, which denotes high quality evidence. The study is important with regards to the proposed intervention as it shows the effectiveness of the program in promoting self-management and education among young diabetes patients. By using gamification incentives such as earning points, competition with others, and accessing higher levels, adolescents can be trained on proper diabetes management, including the consequences of not adhering to the clinical guidelines.

The fourth study by Arora, Peters, Agy & Menchine (2012) investigates the impact of a text messaging program in the promotion of diabetes self-management as assessed by the Diabetes Empowerment Scale—Short Form, the Morisky Medication Adherence Scale, and self reporting. The study was a pilot trial, and involved adult patients diagnosed with diabetes mellitus. The evidence presented in the study qualifies as level III, and is also of high quality. The evidence is also of high significance to the proposed intervention as it shows how text messaging can improve the self-management practices of diabetes patients. For instance, the study indicates high levels of success among the study participants, and is likely to have a similar effect when implemented among Hispanic patients with diabetes. Using this information, nurses can develop interventions targeting Hispanics in particular, which is likely to have a significant impact on the reduction of HbA1c levels among this population group.

Finally, the fifth study by Charpentier et al (2011) investigates the usefulness of the Diabeo software application in combination with telemedicine support in promoting diabetes self-management among diabetes patients. The study design used is a randomized, open-label, parallel-group trial and targeted adult patients diagnosed with diabetes for more than one year. The sevidence provided in the research study can be classified as level II, which is of high quality and significance. According to the results of the study, significant improvements were noted in the HbA1c levels of participants in the intervention groups. Consequently, the study is highly relevant to nursing practice as it provides more information on how to promote self-management and positive outcomes among diabetes patients. Also, the study is highly relevant to the proposed intervention as it tests both elements of the intervention (mobile messaging and telemedicine support) in the promotion of better diabetes self-management.

 

 

 

Synthesis Table

First Author

(Year)

Conceptual Framework

Design/Method

Sample & Setting

Major Variables Studied (and their Definitions)

Measurement

Data Analysis

Findings

Appraisal: Worth to Practice

Quinn (2008). The study supports the intervention by showing the effectiveness of the WellDoc software in improving A1c levels among participants with Type 2 Diabetes, and increasing satisfaction of the healthcare provider (HCP) and patient.

None

Nonblinded, randomized

controlled trial

Thirty patients with type 2 diabetes aged between 18 and 70 years from one community endocrinology and two community primary care practices.

Dependent variables: A1c, HCP prescribing behaviors.

Independent variable: The use of a blood glucose monitoring system.

Summary of Diabetes Self-Care Activities (SDSCA) questionnaire, A1c tests.

Data was collected at baseline and after the intervention duration.

Descriptive statistics, one-sided one-

way analysis of variance t test.

Average decrease in A1c levels for the intervention group was 2.03% compared to 0.68% (P<0.02, one tailed) for the control group.

84% of patients in the intervention group had their medications titrated or changed by their respective HCPs compared to 23% in the control group (P= 0.002).

HCPs in the intervention groups reported the system enabled better treatment decisions, provided organized data, and decreased time taken to review logbooks.

The study provides evidence in support of using mobile technology targeted at facilitating diabetes self-management. However, the investigation was a pilot study and the sample size too small for generalization.

Kirwan (2013). The study supports the intervention by showing the effectiveness of the Glucose Buddy mobile application in improving A1c levels among participants with Type 1 Diabetes, in combination with support from a certified diabetes educator.

None

Randomized control trial

Adult patients with type 1 diabetes patients recruited through an online type 1 diabetes support group (n=72).

Dependent variables: HbA1c, diabetes-related self-efficacy, self-care activities, and quality of life.

Independent variable: The use of a blood glucose monitoring application in combination with support from a certified diabetes educator..

HbA1c test, Diabetes Empowerment questionnaire (DES-SF), Summary of Diabetes Self-Care Activities (SDSCA). Data was collected at baseline and after every three months during the study.

Descriptive statistics, Linear mixed model analysis

The intervention group improved HbA1c levels from baseline  (mean

9.08%, SD 1.18) to three months after the intervention (mean 7.80%, SD 0.75) compared to the control group (baseline: mean 8.47%, SD 0.86, and after follow-up: mean 8.58%, SD 1.16)

The study provides evidence in support of using mobile technology to facilitate diabetes self-management. However, the sample size was too small and the study duration too short for generalization.

Cafazzo (2012) This study supports the intervention as it demonstrates that a mobile application can be used to improve self-management of diabetes among adolescents.

None

Clinical pilot

20 patients aged between 12-16 years, receiving care at the Diabetes Clinic at SickKids, had a diagnosis of type 1 diabetes for more than 1 year; had received care at the Diabetes Clinic at SickKids for more than 6 months; could read, speak, and understand English; and were willing to participate in the study.

The average frequency of measurement of blood glucose, rewards, Dependent variable: HbA1c.

Independent variable: Use of  a blood glucose monitoring mobile application.

Daily Average Frequency of Blood Glucose, HbA1c, Rewards.

Frequency distribution, ANOVA.

The daily average frequency of blood glucose measurement increased by 50% (from 2.4 to 3.6 per day, P = .006, n = 12). 161 rewards (average of 8 rewards each) were distributed to participants. Satisfaction was also high with 88% of the participants saying they would continue using the system.

The study provides evidence in support of the intervention. However, the study is limited by the small study sample and the short duration thus reducing the internal and external validity.

Arora (2012). this study provides evidence in support of the intervention as it shows the effectiveness of using a text message platform to facilitate diabetes education and self monitoring.

None

Pilot trial

Adult patients in the emergency department diagnosedwith diabetes and in possession of a mobile phone capable of sending and receiving text messages.

Dependent variable: Diabetes knowledge, healthy eating, exercise, self-efficacy and medication adherence. Independent variable: The use of the TEXT-MED program in the management of diabetes.

Self-reporting, Diabetes Empowerment Scale—Short Form, and the Morisky Medication Adherence Scale.

Frequency distribution

Before implementation of the TEXT-MED program, 56.5% of subjects reported eating fruits/vegetables daily versus 83% after, 43.5% reported exercising compared to 74% after, and 74% reported performing foot checks before compared to 85% after. Self-efficacy, measured by the Diabetes

Empowerment Scale—Short Form, improved from 3.9 to 4.2

The evidence presented in this study is highly relevant to the topic. However, study design and setting, sample size, and short duration are some of the study’s limitations.

Chapentier (2011). this study supports the intervention as it demonstrates how the use of the Diabeo software enabling individualized insulin dose adjustments in combination with telemediine support is effective in improving diabetes self-management.

None

Randomized, open-label, parallel-group trial

Adult patients diagnosed with type 1 diabetes for at least 1 year, and had been treated with a basal bolus insulin regimen for at least 6 months, either with MDI or with a pump.

Dependent variables: HbA1c levels and the frequency of attending hospital visits.

Independent variables: the use of the Diabeo software in combination with telemedicine support.

HbA1c high performance liquid chromatography assays, self-administered questionnaires

Frequency distribution, Kruskal-Wallis and Mann-Whitney tests, ANCOVA

After six months of intervention, the mean HbA 1c in Group 3 (8.41 +/- 1.04%) was lower than in Group 1 (9.10 +/-

1.16%; P = 0.0019). Group 2 displayed intermediate results (8.63 +/- 1.07%). The Diabeo system resulted in a 0.91% improvement in HbA1c levels, and 0.67% improvement when used without telemedicine support.

The study provides quality evidence (level II) in support of the intervention. However, the results may not be generalizable to other population groups.

 

Leave a Comment

Your email address will not be published.

Scroll to Top