Exploring How Self-care Language Is Used for Adults With Type 2 Diabetes in the Canadian and American Literature.

Barbara Riegel's theory of self-care has been used to create a Self-Care of Heart Failure Index, which has been adapted by researchers into a Self-Care of Diabetes Inventory (SCODI) for individuals living with type 2 diabetes mellitus (T2DM). The SCODI measures how an individual is currently caring for their T2DM to identify areas in need of health-care provider support. The SCODI tool appears to have widespread international dissemination, but it is unknown how the SCODI or Riegel's concept of self-care are being utilized in the Canadian or American diabetes literature. In this critical review we seek to determine how the concept of self-care, including Riegel's concept of self-care, and the SCODI are being utilized in the Canadian and American diabetes literature for adults with T2DM. Critical review methodology was used to identify publications that had an adult T2DM population and self-care language. All included studies (n=11) were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology statement and Joanna Briggs Institute critical appraisal checklist to determine methodologic quality. Included studies were of medium to high quality and often did not define or measure self-care. When studies measured self-care, they utilized the Summary of Diabetes Self-Care Activities (SDSCA) more often (46%) than the SCODI (18%). Future research should collaborate with the international community to set a clear definition of self-care and create a theory-driven approach to self-care for T2DM as well as consider understanding the differences and similarities between the SDSCA and SCODI tools.

Evaluating the Effect of a Diabetes Health Coach in Individuals with Type 2 Diabetes.

OBJECTIVES: Diabetes health coaching has not been adequately assessed in individuals with type 2 diabetes. The objective of this review was to synthesize the evidence of health coaching for individuals with diabetes to determine the effects of coaching on diabetes control, specifically on glycated hemoglobin (A1C) levels. METHODS: The EMBASE, MEDLINE, CINAHL, PsychINFO and Cochrane Central Register of Controlled Trials databases were searched from inception to January 2015. Reference lists from important publications were also reviewed. At least 2 evaluators independently screened and extracted data from eligible studies. RESULTS: A total of 8 trials met the selection criteria, which included 724 adult participants; 353 participants were randomized to a diabetes health coaching intervention, and 371 were randomized to usual care. The pooled effect of diabetes health coaching overall was a statistically significant reduction of A1C levels by 0.32 (95% CI, -0.50 to -0.15). Longer diabetes health coaching exposure (>6 months) resulted in a 0.57% reduction in A1C levels (95% CI, -0.76 to -0.38), compared to shorter diabetes health coaching exposure (≤6 months) (-0.23%; 95% CI, -0.37 to -0.09). Across all studies, diabetes health coaching consisted of goal setting, knowledge acquisition, individualized care and frequent follow up. CONCLUSIONS: Diabetes health coaching has an emerging role in healthcare that facilitates self-care, behaviour change and offers frequent follow up and support. This review finds that health coaching for those with diabetes is an effective intervention for improving glycemic control, which may be of greater benefit when offered in addition to existing diabetes care.

Rare case of optic pathway glioma with extensive intra-ocular involvement in a child with neurofibromatosis type 1.

We present a case of a 3-year-old girl with a positive family history of neurofibromatosis type-1 (NF1) presented with best corrected visual acuity of 20/40 in the right eye and <20/400 in the left eye. External ocular examination revealed left eye proptosis of 3 mm, grade II left relative afferent pupillary defect and full range of ocular motility with no strabismus. Slit lamp examination revealed iris lisch nodules bilaterally. Dilated fundus examination of the right eye was normal. Left eye disclosed a large mass extending from the optic nerve head, with associated subretinal fluid. There was neovascularization at the optic disc as well as a superior retinal hemorrhage. Computed tomography of brain/orbits showed an enlarged left optic nerve with a large mass at the optic nerve head, with no evidence of calcification. In addition, a large left optic pathway glioma (OPG), multiple hamartomas within the brain and a smaller low-grade right OPG was also reported. The remarkable feature of our case is the rare intraocular optic nerve involvement of the OPG. Early and regular ophthalmological assessment of all NF1 suspect/confirmed cases is of paramount importance in order to detect OPG early, resulting in timely intervention and salvage of vision.