Diabetes: PICOT Statement and Literature Search

PICOT Statement

PICOT Statement: Adults with Type 1 and Type 2 Diabetes undergoing self-management education compared to not undergoing self-management education can achieve better glycemic control within six months.

P: – Population – Adults with Type 1 and Type 2 Diabetes

I: – Intervention – Undergoing self-management education

C: – Comparison – Not undergoing self-management education

O: – Outcome – Can achieve better glycemic control

T: – Time – Six months

References

Carolan, M., Holman, J., & Ferrari, M. (2015). Experiences of diabetes self‐management: a focus group study among Australians with type 2 diabetes. Journal of clinical nursing, 24(7-8), 1011-1023.

The aim of this study is to explore the experiences and concerns of type 2 diabetes patients in a low socio-economic environment. The researchers performed an exploratory qualitative study with a focus group of 22 people aged between 40 and 70 with type 2 diabetes mellitus. The data collected from this focus group study was analyzed using a thematic analysis approach. The participants of the group described their experiences and they were categorized as physical, emotional, and psychological. The data analysis showed four main themes in the experiences of the patients including personal journey, diabetes the silent disease, access to resources and services, and the work of managing diabetes. The research subjects highlighted that the impact of the diabetes management is not only on the patient but also the support group that assists in the self-management efforts. In conclusion, he members of this study are generally satisfied with their self-management techniques but they are in need of additional information to understand more about their condition.

Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016). Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient education and counseling, 99(6), 926-943.

The purpose of this article is to determine the effect of self-management education and the support methods, duration, and contact time or glycemic control for patients of type 2 diabetes. The researchers used online databases such as MEDLINE, ERIC, CINAHL, EMBASE and PsycINFO for article that assess diabetes interventions that involve patients’ participation in self-management activities. The review assessed 118 unique intervention techniques with 61.9% reporting significance. The overall mean reduction in A1C was 0.74 for the study groups and 0.17 for the control groups. A combination of individual and group engagement groups had the largest decreases in A1C with 0.88. Patients with elevated glycemic values reported a statistically significant reduction in their A1C with 83.9%. The data of this study suggests that the mode of self-management education delivery, the hours of engagement, and the baseline glycemic level affect the significant achievement in glycemic control after diabetes self-management.

Milajerdi, A., Shab-Bidar, S., Azizgol, A., & Khosravi-Boroujeni, H. (2015). Provision of nutritional/lifestyle counseling on diabetes self-management: A chance to improve metabolic control in new cases of type 2 diabetes. Journal of Nutritional Sciences and Dietetics, 1(2), 98-106.

The purpose of this study was to evaluate the efficacy of self-management education on metabolic control for type 2 diabetes patients. This was a quasi-experimental study that was done with 300 type 2 diabetes patients as the primary research subjects. The patients participated in 16-week educational program where they were trained on metabolic control by a dietician. At baseline, there was an intervention group attending a 20 minute lifestyle and nutrition educational program. The participants were analyzed at baseline and a 2 to 4 months follow-up for changes in the glycemic status, BMI, and lipid profile were done. Later a pre-education and post education analysis of variance was done to evaluated the differences. This study found that a lifestyle and nutrition education program were effective in helping patients of type 2 diabetes to improve their metabolic control. This study suggested that metabolic control can be done through educational intervention rather that the pharmacological interventions.

Nasab, M. N., Ghavam, A., Yazdanpanah, A., Jahangir, F., & Shokrpour, N. (2017). Effects of self-management education through telephone follow-up in diabetic patients. The health care manager, 36(3), 273-281.

The aim of this study was to investigate the effect of self-management education with a telephone follow-up for diabetic patients living in rural areas of Iran. The study was done using an experimental study design with 64 participants randomly assigned to the intervention and control groups of 32 each. The intervention group included patients who attended four educational sessions lasting 90 minutes each. The control group went through the traditional care routine. The outcome of the experinment was measured using the Diabetes Self-Managemnt Questionnaire (DSMQ) before and after the intervention. The results were analysed using Mann-Whitney U tests. The results found that there was a significant difference in the glycemic control for the intervention and control groups. This study suggests that self-management education facilitates better self-care.

Pereira, K., Phillips, B., Johnson, C., & Vorderstrasse, A. (2015). Internet delivered diabetes self-management education: a review. Diabetes technology & therapeutics, 17(1), 55-63.

The purpose of this article was to investigate the effectiveness of internet-delivered diabetes self-management education on glycemic control. A quantitative analysis was done on literature from various online databases such as PubMed, EBSCO, CINAHL, and Web of Science. The search led to the analysis of 111 relevant articles, but only 14 met the criteria for the review. Nine of the reviewed articles were randomized control trials with study lengths varying between 2 weeks and 24 months. The results of the study showed that internet delivered self-management education is effective in reducing glycemic control among diabetes patients. Additionally, the results showed that self-management education help to increase rates if clinical attendance and change eating habits after the online engagement with patients through the internet. The implications of this study are that education on self-management techniques can be offered through online platforms and help improve self-care among diabetes patients.

Tang, T. S., Funnell, M., Sinco, B., Piatt, G., Palmisano, G., Spencer, M. S., … & Heisler, M. (2014). Comparative effectiveness of peer leaders and community health workers in diabetes self-management support: results of a randomized controlled trial. Diabetes care, 37(6), 1525-1534.

The objective of this article was to compare the differences between the effects of a peer leaders versus community health worker led telephone outreach intervention compared to a six months self-management education program. The study was done using a randomized control trial with 116 Latino adults with type 2 diabetes. The participants were selected from a federally qualified health center and randomly selected for a 6-month self-management education program followed by 12 months of weekly group discussions delivered by peer leaders. Another group was enrolled for the 6-moth education program and later a 12 month outreach program by a community health worker. The results suggested that the group that underwent the peer leadership groups maintained their improvements after the education program for a period of 18 months. Both groups maintained their improvements in waist circumference, diabetes distress, and diabetes support with no significant differences between each of the groups. This study suggests that both low cost peer group interventions and community health worker led outreach programs help diabetes patients to maintain their diabetes management after their education program.