NURSE'S ROLE IN PROMOTING DIABETES SELF MANAGEMENT

Nurse's Role In Promoting Diabetes Self Management

Nurse's Role In Promoting Diabetes Self Management

Introduction

In 2005, the prevalence of diabetes in the U.S. was 20.8 million (7% of the population), with 1.5 million new cases diagnosed in people aged 20 years or older. The total annual economic cost of diabetes in 2007 was greater than $174 billion, with expenditures for patients with diabetes at a rate 2.3 times higher than those without the disease . Diabetes is both a financial and emotional burden, with studies showing an adverse impact on QOL and the incidence of depression . This in turn negatively affects the patient's ability to carry out self-management , which can lead to significantly worse glycemic control and .

Diabetes self-management education (DSME) is a critical element of care for all people with diabetes and is necessary in order to improve patient outcomes. The National Standards for DSME are designed to define quality diabetes self-management education and to assist diabetes educators in a variety of settings to provide evidence-based education. Because of the dynamic nature of health care and diabetes-related research, these Standards are reviewed and revised approximately every 5 years by key organizations and federal agencies within the diabetes education community (Benson and Latter, 1998). A Task Force was jointly convened by the American Association of Diabetes Educators and the American Diabetes Association in the summer of 2006. Additional organizations that were represented included the American Dietetic Association, the Veteran's Health Administration, the Centers for Disease Control and Prevention, the Indian Health Service, and the American Pharmaceutical Association. Members of the Task Force included a person with diabetes; several health services researchers/ behaviorists, registered nurses, and registered dietitians; and a pharmacist. The Task Force was charged with reviewing the current DSME standards for their appropriateness, relevance, and scientific basis. The Standards were then reviewed and revised based on the available evidence and expert consensus. The committee convened on 31 March 2006 and 9 September 2006, and the Standards were approved 25 March 2007 (ADA, 2008b).

Discussion

Self management is the primary goal of diabetes education interventions, as costs and complications associated with diabetes (i.e. end-stage renal disease, blindness, and amputations) are largely preventable. Evidence-based studies indicate that control of glucose (HbA1c < 7), BP (< 130/80), and LDL cholesterol (< 100) decreases the incidence and progression of both microvascular and macrovascular complications of diabetes, and is cost-effective and . In addition, the use of aspirin to prevent heart disease, yearly screening for nephropathy, foot and ophthalmological complications, and the use of ACE inhibitors or ARBs to prevent kidney disease is recommended (Bandura, 1995).

However, despite RCTs that have established “gold standard” approaches for diabetes, the majority of patients (93%) do not achieve the collective recommended self-management goals for HbA1C, LDL, and BP. Over one-third (36.5%) of adults have A1C levels = 8%, the level suggested by the American Diabetes Association for focused treatment intensification. Thirty-two percent are above goal for BP (130/80), ...