Impact of Negative or Stigmatizing Messages on Diabetes Outcomes: An Integrative Review.

PURPOSE: The purpose was to determine if negative or stigmatizing language and messaging have an impact on diabetes distress, outcomes, or care behaviors in people with diabetes. Since 2012, when the first language position statement was published, the way health care professionals talk to people with diabetes has been an ongoing topic of discussion. However, there have been no recent literature reviews evaluating the impact of problem language on outcomes among people with type 1 and type 2 diabetes. METHODS: An integrative review was conducted using 4 electronic databases: CINAHL, Embase, Web of Science, and Medline (Ovid). Studies reporting on diabetes, language, stigma, diabetes distress, glycemic outcomes, and self-care behaviors were included. RESULTS: The review included 9 studies, all of which were of high quality. The impact of negative or stigmatizing language on self-care behaviors was the most commonly addressed outcome. Whereas some studies revealed no change, others reported a decrease in self-care behaviors by people with diabetes who had negative perceptions of provider messages. Actual or perceived use of negative or stigmatizing language is linked to higher A1C. Four studies reported an association between messages and diabetes distress. CONCLUSIONS: Negative/stigmatizing language has both an immediate and long-term effect on people with diabetes. The inconsistent approaches to studying language in diabetes makes it challenging to compare outcomes and identify themes. Future research is needed to identify effective interventions to change the messages in diabetes.

Effect of COVID-19 on Type 2 Diabetes Self-Care Behaviors: A Rapid Review.

OBJECTIVE: The aim of this review was to describe how the coronavirus disease 2019 (COVID-19) lockdown affected the self-care behaviors of people living with type 2 diabetes. Methods: A systematic rapid review was conducted using four electronic databases. Studies reporting on the lockdown's impact on at least one of the self-care behaviors that were published from January 2020 through October 2021 were included. Findings were synthesized narratively, using the Association of Diabetes Care & Education Specialists ADCES7 Self-Care Behaviors as a framework. The methodological level of evidence and quality ratings of the articles were assessed using the Joanna Briggs Institute Appraisal Checklist. Results: Fifteen articles were included. Most studies reported on at least five of the self-care behaviors. There were reported increases in diabetes-related stress, as well as in increases in dietary intake and changes in the timing of meals. Physical activity was reported to decrease. Overall, taking medications and glycemic self-monitoring of blood glucose (SMBG) were unaffected by the lockdown. Of the studies reporting glycemic outcomes, the lockdown appeared to have little negative effect. None of the articles assessed all the self-care behaviors. The self-care behavior of SMBG was the least assessed. Most articles had a medium level of evidence and a medium to high quality rating (scores >60%). Conclusion: The findings from this review found the COVID-19 lockdown had a variable impact on diabetes self-care behaviors. Because the potential for future COVID-19 surges and/or other virulent transmissible diseases remains a concern, health care providers should continue to address the importance of self-care behaviors to mitigate the risk of poor health outcomes in people with diabetes.

Economic impact and health care utilization outcomes of diabetes self-management education and support interventions for persons with diabetes: a systematic review protocol.

OBJECTIVE: The aim of this systematic review is to summarize and synthesize existing research on the economic impact of diabetes self-management education and support. INTRODUCTION: Diabetes self-management education and support is an essential component of diabetes care, yet it continues to be underutilized. A gap exists regarding the true measured economic impact of this intervention. INCLUSION CRITERIA: This review will consider studies that report the measured economic impact and health care utilization of diabetes self-management education and support for persons with diabetes or their caregivers. The inclusion criteria are as follows: quantitative studies providing measured data on the economic outcomes and health care utilization of diabetes self-management education and support interventions that include at least one of the Association for Diabetes Care and Education Specialists Seven Self-Care Behaviors. METHODS: The review will search the following databases: MEDLINE Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Daily and Versions; Embase; Scopus; CINAHL; ERIC, Cochrane Database of Systematic Reviews; and the Cochrane Register of Controlled Trials. Additionally, a search of gray literature will be performed using Google Scholar. Date limitations will be from January 2006 to May 2020. Two members of the research team will independently screen abstracts and full texts, and extract data. The screening process will be described using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Articles will be assessed for risk of bias using the JBI critical appraisal tools. Data will be narratively summarized. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42020166743).

Economic Impact and Health Care Utilization Outcomes of Diabetes Self-Management Education and Support Interventions for Persons With Diabetes: A Systematic Review and Recommendations for Future Research.

PURPOSE: Value-driven outcomes are important because health systems determine sustainability of diabetes self-management education and support (DSMES) programming. Health care utilization and clinical outcomes are critical factors when considering the impact of DSMES programs. OBJECTIVE: The aim of this systematic review was to describe studies that report on the economic and health care utilization outcomes of diabetes self-management programs. METHODS: A systematic literature review was performed in multiple databases. Studies reporting economic and health care utilization outcomes related to DSMES and including 1 or more of the ADCES7 Self-Care BehaviorsTM from January 2006 to May 2020 were included. Eligible articles needed to compare the intervention and comparison group and report on economic impact. The methodological quality was assessed with the Joanna Briggs Institute Critical Appraisal Checklist specific to each individual study design. RESULTS: A total of 22 of 14 556 articles published between 2007 and 2020 were included. Cost benefits varied, and there were considerable methodological heterogeneity among design, economic measures, population, perspective, intervention, and biophysical outcomes. CONCLUSION: DSMES interventions may positively impact economic outcomes and/or health care utilization, although not all studies showed consistent benefit. This review highlights an evidence gap, and future health economic evaluations are warranted.

Hyperglycemia and Cancer: A State-of-the-Science Review.

PROBLEM IDENTIFICATION: Hyperglycemia can increase the risk for adverse events and outcomes in patients undergoing treatment for cancer. The purposes of this state-of-the-science review were to explore the complexity of hyperglycemia in patients with cancer and to analyze physiologic mechanisms and outcomes in individuals with or at risk for cancer. LITERATURE SEARCH: PubMed® and the Cochrane Library databases were searched, and 95 articles were included. Findings were evaluated for their methods and analyses. Studies assessed as methodologically flawed were not included. DATA EVALUATION: The synthesis of the articles provided the evidence for describing normal and glycemic pathways. Hyperglycemia in patients with cancer was explored through chronic inflammatory mechanisms that lead to increased risks for adverse events and outcomes. SYNTHESIS: This article discusses normal glucose regulation and hyperglycemic pathways, hyperglycemia in patients with cancer, hyperglycemia and cancer-related inflammation, and outcomes (e.g., infections, mortality, symptoms). IMPLICATIONS FOR RESEARCH: Understanding the contributors to and consequences of hyperglycemia can guide the development of screening tools to predict which individuals are at the greatest risk for hyperglycemic episodes prior to starting cancer therapies. Research can lead to glycemic guidelines specific to patients with cancer for better outcomes.

Insulin Therapy: The Old, the New and the Novel-An Overview.

Since its development, insulin therapy has been a mainstay in the arsenal of every practitioner battling against diabetes. For patients with type 1 diabetes mellitus, insulin is essential for survival, and for those with type 2 diabetes mellitus, as the disease progresses, it may become a necessary addition to treatment. The goal of this article is to discuss insulin therapies that are currently available for use in the management of diabetes, from the old to the new and novel, and briefly discuss insulin use in special populations.

Controlling Malglycemia in Patients Undergoing Treatment for Cancer.

Patients with or without preexisting diabetes undergoing treatment for cancer may be at risk for malglycemic events. Malglycemia, particularly hyperglycemia and diabetes in patients with cancer, may lead to adverse outcomes. Prevention, prompt recognition, and early intervention to regulate malglycemia can optimize the effects of cancer treatment, minimize the harmful consequences, and improve quality of life for patients with cancer. The development of evidence-based standards of care and protocols are needed to guide clinical practice when caring for patients with cancer.

Hyperglycemic-inducing neoadjuvant agents used in treatment of solid tumors: a review of the literature.

PURPOSE/OBJECTIVES: To review the literature regarding the development of hyperglycemia associated with neoadjuvant agents used in the treatment of solid tumor cancers. DATA SOURCES: Research articles were obtained from PubMed, CINAHL®, and Cochrane Reviews. The following search terms were used alone and in combination: diabetes, glycemic control, chemotherapy, androgen deprivation therapy, interferon-alpha, immunosuppressants, cancer, neoplasms, and hyperglycemia. DATA SYNTHESIS: Twenty-two studies were identified reporting the development of hyperglycemic events in patients who received a variety of chemotherapeutic agents. CONCLUSIONS: Findings suggest patients are at risk for the development of hyperglycemia from certain chemotherapeutic agents. Docetaxel, everolimus, and temsirolimus alone or in combination with other agents can promote hyperglycemia. Androgen-deprivation therapy commonly used in prostate cancer, increases the risk for the development of hyperglycemia and diabetes. IMPLICATIONS FOR NURSING: Oncology nurses play an important role in the identification and treatment of hyperglycemia in patients receiving chemotherapy. Future research is needed that focuses on the association between glycemic control and adverse outcomes in patients with a solid tumor cancer who are at risk for treatment-induced hyperglycemia.

Management of steroid-induced hyperglycemia in hospitalized patients with cancer: a review.

PROBLEM IDENTIFICATION: Glucocorticoids are prescribed for hospitalized patients with cancer for a variety of reasons, including cerebral edema, treatment and prevention of nausea, and as part of cancer treatment regimens. Glucocorticoids are known to cause hyperglycemia. The purpose of this study was to integrate the published research on the management and the effects of steroid-induced hyperglycemia in hospitalized adult patients with cancer with or without preexisting diabetes. LITERATURE SEARCH: MEDLINE®, PubMed, EMBASE, CINAHL®, and Scopus electronic databases were used to identify relevant articles. Bibliographies of included studies were reviewed for any pertinent studies that were not obtained through database search.Data Evaluation: 1,392 studies were identified. A total of 18 studies that met criteria were fully reviewed, 6 of which met all of the inclusion criteria. DATA ANALYSIS: Data were abstracted from the included studies using a systematic code sheet to document characteristics of the studies and findings on management of hyperglycemia. Characteristics of the studies and findings on management of hyperglycemia were organized into three tables: the patients did not have preexisting diabetes, the patients had preexisting diabetes, and patients with or without preexisting diabetes were both included in the study. Management and effects of management of hyperglycemia were then compared and synthesized.Presentation of Findings: Hyperglycemia occurs in hospitalized patients with cancer irrespective of whether patients have a prior history of diabetes. Hyperglycemia resulting from steroids is treated in a variety of ways, but the resulting glycemic control has not been consistently documented. However, this review suggests that scheduled insulin (basal-bolus) is effective in attainment of glucose targets. IMPLICATIONS FOR PRACTICE: Nurses should be aware of the effect that steroids have on glycemic control in patients and should be empowered to request or perform blood glucose monitoring when appropriate. Nurses can identify those patients receiving steroids and assess for signs and symptoms of hyperglycemia. They also can review routine laboratory results and assess for hyperglycemia in patients receiving steroids.