Diabetes Camp as Continuing Education for Diabetes Self-Management in Middle-Aged and Elderly People with Type 2 Diabetes Mellitus

BACKGROUND: Despite the established benefits of diabetes camps for the continuing education of children with type 1 diabetes mellitus, little is known about the long-term metabolic benefits of diabetes camps for middle-aged and elderly people with type 2 diabetes mellitus (T2DM), especially in terms of glycosylated hemoglobin (HbA1c) variability. METHODS: The 1-year mean and variability of HbA1c before and after the diabetes camp was compared between the participants of the diabetes camp (n=57; median age 65 years [range, 50 to 86 years]; median diabetes duration 14 years [range, 1 to 48 years]). Additional case-control analysis compared the metabolic outcomes of the participants of the diabetes camp and their propensity score-matched controls who underwent conventional diabetes education (n=93). RESULTS: The levels of HbA1c during the first year after the diabetes camp were comparable to those of the matched controls (P=0.341). In an analysis of all participants of the diabetes camp, the 1-year mean±standard deviation (SD) of HbA1c decreased (P=0.010 and P=0.041) after the diabetes camp, whereas the adjusted SD and coefficient of variance (CV) of HbA1c did not decrease. The adjusted SD and CV significantly decreased after the diabetes camp in participants whose 1-year mean HbA1c was ≥6.5% before the diabetes camp (n=40) and those with a duration of diabetes less than 15 years (n=32). CONCLUSION: The 1-year mean and SD of HbA1c decreased after the diabetes camp, with significant reduction in the adjusted SD and CV in those with higher baseline HbA1c and a shorter duration of diabetes.

Factors Influencing Use of Medical Alert Identification in Diabetic Patients Using Insulin / 임상간호연구

PURPOSE: The aim of this study was to identify perception, use status and factors influencing use of medical alert identification (ID) in diabetic patients who are on insulin. METHODS: A survey was conducted from December 2013 to April 2014 with 198 people who were asked to participate in the survey. RESULTS: The medical alert ID perception score was 3.54 on a 5-point scale. Most of respondents (82.8%) knew about the medical alert ID, but only 23.2% of respondents wore a medical alert ID and only 43.5% of respondents always wore a medical alert ID. Perception and frequency of possession were positively correlated (r=.41, p<.001). The most influential factor for the possession of a medical alert ID was the perception of the medical alert ID (β=.41, p<.001). The perception of the medical alert ID explained 17% of variance in possession of a medical alert ID. CONCLUSION: Most of diabetic patients who take insulin received education about hypoglycemia and knew about the medical alert ID, but only few of them wore a medical alert ID. Findings from this study indicate that perception is an important variable related to possession of a medical alert ID in this population.

Effective Diabetes Self-Management Education: Focus on Blood Glucose Pattern Management / 임상당뇨병

Diabetes self-management education (DSME) is defined as the ongoing process of facilitating the knowledge, skills, and abilities necessary for diabetes self-care. DSME focuses on the seven self-care behaviors of healthful eating, physical activity, monitoring of blood sugar, proper use of medications, problem solving, healthy coping, and reducing the risk of complications. Self-monitoring of blood glucose (SMBG) is widely recognized as a core component of effective diabetic self-management. Blood glucose pattern management is a powerful self-management tool to educate, communicate, and bring about change regarding improved glycemic management and has the potential to improve problem-solving and decision-making skills for both patients and clinicians. Pattern analysis is a systematic approach to identifying glycemic patterns within SMBG data and then performing appropriate action based on those results. This paper will review blood glucose pattern management as an effective tool of DSME.

Current Status of Management in Type 2 Diabetes Mellitus at General Hospitals in South Korea

BACKGROUND: In Korea, the prevalence, complications, and mortality rate of diabetes are rapidly increasing. However, investigations on the actual condition of diabetes management are very limited due to lack of nation-wide research or multicenter study. Hence, we have minutely inquired the current status of diabetes management and achievement of glucose target goal in general hospital offering education program. That way, we are able to furnish data for policy making of diabetes education and draw up guideline which may allow us to reduce the morbidity and mortality of diabetes. METHODS: The subjects consisted of 2,610 patients with type 2 diabetes who visited the 13 general hospital in Seoul or Gyeonggi region from March 19 to May 29, 2013. General characteristics, associated diseases, complications, and management status were investigated. RESULTS: The mean age was 61.0+/-11.6 years, body mass index was 25.0+/-3.3 kg/m2, and family history of diabetes was 50.5%. The mean duration of diabetes was 10.7+/-7.9 years and 53% received education about diabetes. The prevalence of hypertension and dyslipidemia were 59.2% and 65.5%, respectively, and 18.3% of the subjects were accompanied by liver disease. Diabetic retinopathy appeared in 31.6%, nephropathy in 28.1%, and neuropathy in 19.9% of the subjects. The mean glycosylated hemoglobin (HbA1c) level was 7.3%+/-1.3% and the achieving rate based on Korean Diabetes Association guideline (HbA1c <6.5%) was 24.8%, blood pressure (130/80 mm Hg or less) was 49.4%, and low density lipoprotein cholesterol (<100 mg/dL) was 63.6%. The reaching rate to the target level in four parameters (blood glucose, blood pressure, lipids, and body weight) was 7.8%. CONCLUSION: The blood glucose control rate was lower than other parameters, and the implementation rate of diabetes education was only 53%. Thus more appropriate glucose control and systematic diabetes education are imperative.

Economic Evaluation of Diabetes Education / 임상당뇨병

BACKGROUND: Diabetes education, also known as diabetes self-management training or diabetes selfmanagement education, is effective in helping patients with diabetes control their illness and maximize their health. However, there is no established institutional strategy in South Korea because economic evaluations of the benefits and costs of diabetes education have been limited. The purpose of this study is two-fold: (1) describe economic evaluation methodologies, one of the tools available to help choose wisely from a range of alternatives and implement effective resources; and (2) suggest applications of economic evaluation in terms of diabetes education. METHODS: There are three types of commonly used economic evaluations in diabetes education: cost benefit analysis, cost effective analysis, and cost utility analysis. RESULTS: The understanding of the economic value of diabetes education for people with diabetes has a number of uses: to provide empirical evidence to influence policy-making in diabetes education, to offer proof of the benefits of diabetes self-management, to improve awareness of the importance and necessity of diabetes education, to reduce costs of diabetes management, and to enhance healthcare quality. CONCLUSION: Further research is needed to evaluate the economic benefits and costs associated with diabetes education.

Erratum: Corrected Sentence. The Appropriateness of the Length of Insulin Needles Based on Determination of Skin and Subcutaneous Fat Thickness in the Abdomen and Upper Arm in Patients with Type 2 Diabetes

An error was found in the following published article.

Diabetes Education Compliance and Knowledge among Diabetes Patients: Analysis of Patients Who Refuse Diabetes Education at an Academic Medical Center / 임상당뇨병

BACKGROUND: By determining the reasons why patients with diabetes did not take diabetes educationand by analyzingthe characteristics of these patients, this study aimed to provide baseline data to improvediabetes education participation rates. METHODS: A survey was conducted in 56 patients who had been hospitalized for diabetes treatment and who had refused to take the prescribed diabetes education. The reasons for refusing diabetes education and the level of diabetes knowledge were evaluated. Medical records were also reviewed to determine the subjects' hemoglobin A1c test results. RESULTS: The most common reason for rejecting diabetes education was 'previous experiencewith diabetes education.' The subjects also refused diabetes educations due to cost and an impression that they already have sufficient diabetes knowledge. The patients who refused the education due to expenses were among the lower income group, and 80 percent of patients who had received diabetes educationin the past declined the education because of their previous experience. CONCLUSION: In order to increase the participation rates of diabetes education, it is important that patients recognize the significance of ongoing diabetes education. Furthermore, to eliminate the cost problems, national efforts are required such as promoting National Health Insurance coverage to includediabetes education as well as expanding the patients' opportunities for receiving qualified diabetes education with systematic and standardized education materials for free.

The Appropriateness of the Length of Insulin Needles Based on Determination of Skin and Subcutaneous Fat Thickness in the Abdomen and Upper Arm in Patients with Type 2 Diabetes

BACKGROUND: Longer needle and complicated insulin injection technique such as injecting at a 45-degree angle and making skinfolds may decrease patient compliance to insulin injection therapy. In this light, shorter insulin needles have been recently developed. However, it is necessary to ascertain that such shorter needles are appropriate for Korean patients with diabetes as well. METHODS: First, the diverse demographic and diabetic features of 156 Korean adults with diabetes were collected by a questionnaire and a device unit of body fat measurement. The skin and subcutaneous fat thicknesses of each subject were measured by Ultrasound device with a 7- to 12-MHz probe. Data were analyzed using analysis of variance and multiple linear regression. RESULTS: The mean skin thickness was 2.29+/-0.37 mm in the abdomen and 2.00+/-0.34 mm in the upper arms, and the mean subcutaneous fat thickness was to 10.15+/-6.54 mm in the abdomen and 5.50+/-2.68 mm in the upper arms. Our analysis showed that the factors affecting the skin thickness of the abdomen and upper arms were gender and body mass index (BMI), whereas the factors influencing the subcutaneous fat thickness in the abdomen were gender and BMI, and the factors influencing the subcutaneous fat thickness in the upper arms were gender, BMI, and age. Insulin fluids may not appear to be intradermally injected into the abdomen and upper arms at any needle lengths. The risk of intramuscular injection is likely to increase with longer insulin needles and lower BMI. CONCLUSION: It is recommended to fully inform the patients about the lengths of needles for insulin injections. As for the recommended needle length, the findings of this study indicate that needles as short as 4 mm are sufficient to deliver insulin for Korean patients with diabetes.

A Randomized Controlled Trial of an Internet-Based Mentoring Program for Type 1 Diabetes Patients with Inadequate Glycemic Control

BACKGROUND: To determine whether an internet-based mentoring program can improve glycemic control in subjects with type 1 diabetes mellitus (T1DM). METHODS: Subjects with T1DM on intensive insulin therapy and with hemoglobin A1c (HbA1c) > or =8.0% were randomized to mentored (glucometer transmission with feedback from mentors) or control (glucometer transmission without feedback) groups and were examined for 12 weeks. Five mentors were interviewed and selected, of which two were T1DM patients themselves and three were parents with at least one child diagnosed with T1DM since more than 5 years ago. RESULTS: A total of 57 T1DM adult subjects with a mean duration after being diagnosed with diabetes of 7.4 years were recruited from Samsung Medical Center. Unfortunately, the mentored group failed to show significant improvements in HbA1c levels or other outcomes, including the quality of life, after completion of the study. However, the mentored group monitored their blood glucose (1.41 vs. 0.30) and logged into our website (http://ubisens.co.kr/) more frequently (20.59 times vs. 5.07 times) than the control group. CONCLUSION: A 12-week internet-based mentoring program for T1DM patients with inadequate glycemic control did not prove to be superior to the usual follow-up. However, the noted increase in the subjects' frequency of blood glucose monitoring may lead to clinical benefits.

Tips for Creating Effective Health Education Materials / 임상당뇨병

Health education materials are widely used to increase awareness and knowledge, change attitudes and beliefs, and help individuals adopt and maintain healthy lifestyle behaviors. Health professionals should provide patients with written health education materials that are patient-oriented and designed according to best practice principles in written health education material design. Health education materials are only effective if they are read, understood, and remembered by patients. Existing guidelines including Suitability Assessment of Materials (SAM) and Simplified Measure of Gobbledygoop (SMOG) offer concrete, useful tips on how to design visuals and how to choose appropriate language for patient education. These guidelines suggest that it is important to address key components including plain language, layout and design, organization, culturally sensitive graphics, and desired patient behavior. This report offers useful tips for creating effective health education materials.