Type 2 Diabetes Self-Management Variables and Predictors.

Guided by the Self and Family-Management framework, relationships between diabetes distress, self-efficacy, resilience and outcomes of A1c, quality of life and health status were explored. A cross-sectional descriptive design was used. Seventy eight individuals were enrolled from US clinics. Data were analyzed to test for associations, main effects and interactions and predictors of self-management. Results indicated low diabetes distress (M = 20.53), high self-efficacy (M = 7.32), moderate resilience (M = 80.27), and mean A1c 7.35%/56.88 mmol/mol. Seventy six percent of participants scored above the mental health norm, and 46% scored above the physical health norm. The average weighted quality of life score was -1.74. Diabetes distress was negatively associated with self-efficacy, resilience, physical health, mental health, and quality of life. Self-efficacy was positively associated with resilience, physical health, and quality of life. Resilience was positively associated with physical health, mental health and quality of life. Positive associations were found between quality of life, and physical and mental health. No associations were found between A1c and variables in the study. Multiple significant interactions were found with A1c, mental health and quality of life outcomes. Terms in the model included treatment regimen, years since diagnosis, provider collaboration, and history of diabetes self-management education. Distress was a significant predictor of health status and quality of life. The results confirm self-management facilitators self-efficacy and resilience and barrier diabetes distress and their relationships with outcomes in the framework. This study contributes to the understanding of the emotional aspect of diabetes. Continuing this work will allow researchers to better understand self-management, support self-management efforts and better outcomes.

A Statewide Survey of Clinical Nurse Specialist Practice: Opportunities and Challenges.

Clinical nurse specialists are the second largest advanced practice nursing role in the United States and remain underused in many states. Expanding access to care to improve patient outcomes is a national priority, which prompted this state clinical nurse specialist association to identify practice barriers, identify opportunities for practice expansion, differentiate registered nurse from clinical nurse specialist practice, and describe differences in those who have practiced in other states. This study was composed of a 15-question online survey, including demographic information, collected over a 4-week period in 2016. Sixty-one respondents (7% of eligible clinical nurse specialists in the state) completed the survey. Regulations limiting the scope of practice in the state were identified by 75% of participants as a practice barrier. Work environment, educational factors, and organizational support contributed to limitations in practice as delineated in the Consensus Model for Advanced Practice Registered Nurses. Participants support increasing public awareness of clinical nurse specialists as advanced practice nurses. Survey results confirm the need for a multifaceted approach in removing clinical nurse specialist practice barriers and improving access to their care by aligning state law and regulation with the National Council of State Boards of Nurses' Model Nurse Practice Act.

Self and Family Management in Type 2 Diabetes: Influencing Factors and Outcomes.

Type 2 diabetes impacts over 30 million Americans and that number is increasing. Fundamental to optimal Type 2 diabetes control and improved health outcomes consists is effective self-management. There are several factors that promote and inhibit sustained and effective self-management. The established and evidence-based self and family management framework is proposed here as a solution for guiding research and practice to improve self-management and outcomes in patients with Type 2 diabetes.

Connecting the Dots: An Interdisciplinary Diabetes Quality Improvement Initiative.

IN BRIEF "Quality Improvement Success Stories" are published by the American Diabetes Association in collaboration with the American College of Physicians, Inc., and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a collaborative effort to improve the care of patients with diabetes, with a particular focus on scheduling annual diabetic eye exams, attending to recommended quality metrics, and improving the availability of blood glucose monitoring data during appointments.

Glucocorticoid-induced hyperglycemia.

OBJECTIVE: To review the current literature on glucocorticoid-induced hyperglycemia and provide a strategy for its treatment. METHODS: We undertook an electronic (MEDLINE) and a library review of the existing pertinent literature published from 1950 to March 2009. RESULTS: Glucocorticoid-induced hyperglycemia is common in patients with and without diabetes. The odds ratio for new-onset diabetes mellitus in patients treated with glucocorticoids ranges from approximately 1.5 to 2.5. Total glucocorticoid dose and duration of therapy are strong predictors of diabetes induction. Other risk factors include age and body mass index. Failure to treat glucocorticoid-induced hyperglycemia is related to the presumed short duration of administration of glucocorticoid treatment and the emphasis on fasting plasma glucose only. Understanding the pharmacodynamics of glucocorticoids can lead to increased recognition and improved treatment of the condition. Recent demonstrations that even shortterm elevations in blood glucose level may be associated with adverse sequelae argue for greater attention to the condition. CONCLUSION: Glucocorticoid-induced hyperglycemia is an important clinical finding that, if recognized, can be effectively treated. We propose a relatively simple schema for the proactive management of corticosteroid-induced hyperglycemia that has been effective and easily adaptable to both the inpatient and the outpatient setting.

Which basal insulin should be used in patients with type 2 diabetes mellitus?

The initiation of insulin therapy is a significant event for patients with diabetes and the physicians who care for them. Reluctance to begin insulin is multifactorial, with major stumbling blocks being the perceived complexity of insulin and fear of hypoglycemia. Recent guidelines supporting earlier introduction of insulin to achieve glycemic goals in patients with type 2 diabetes mellitus will require that traditional approaches to insulin therapy be altered and a new paradigm be introduced into clinical practice. In particular, an understanding of the role of basal insulin in the regulation of glucose and the development of strategies to implement basal insulin therapy can provide a transition that is rational and highly effective in most patients. The strategy also offers a unique approach to diabetes education that permits a focused and patient-specific correction to glucose abnormalities.

Basal insulin therapy.

The initiation of insulin therapy is a significant event for patients with diabetes and the physicians who care for them. Reluctance to begin insulin is multifactorial, with a major stumbling block being the perceived complexity of insulin. However, this complexity can be easily overcome by separation of insulin administration into its two components: basal and bolus therapy. An understanding of the role of basal insulin in the regulation of glucose and the development of strategies to implement basal insulin therapy can provide a transition that is rational and highly effective in most patients. The strategy also offers a unique approach to diabetes education, which permits a focused and patient-specific correction to glucose abnormalities.