Several nutrition strategies and eating patterns can help support self-management among persons with diabetes. This article details the effectiveness of popular eating patterns and nutrition strategies, as well as the role of nurses in facilitating informed patient choices and decisions.
Historically, "diabetes educators" were expected to be knowledgeable and supportive advocates and coaches who provided comprehensive education for people living with diabetes, a description that fails to communicate the depth of "innovative clinical care, education, management, and support offered by the specialty." 1 As the science that guides diabetes education and care advanced, so did our professional organization, our profession, and our practices. 2 To reflect this, the Association of Diabetes Care and Education Specialists (ADCES) recently redefined our title and role as "diabetes care and education specialists (DCES[s]), who, as integral members of the care team, provide collaborative, comprehensive and person-centered care and education to people with diabetes and related conditions." 1 This is more than just a name change; it requires taking on new responsibilities, and it provides DCESs with the opportunity to evaluate the efficacy and relevance of diabetes selfmanagement education and support (DSMES) programs and services. So, as you changed your title, did you also change your practice? What Makes an Educator a Specialist?
A gap exists between diabetes self-management education (DSME), DSMS practices, and the infrastructure needed to foster sustainability of improved outcomes, particularly in low-resource communities. We determined the relative effectiveness of 3 parallel DSMS approaches in improving A1c and diabetes distress (DD). Moderate DD was 2.0-2.9 and high DD was ≥ 3.0. 370 individuals [mean age: 64.6 years, 74% female, 100% African American (AA), mean A1c: 7.7%±1.9, 22.8% with moderate DD] from 21 AA churches in southeast Michigan and northwestern Ohio, took part in a cluster randomized trial from 2016-2020. Data were collected at baseline, 6, 9, 21, and 33 months. Churches were randomized to one of three DSMS approaches [Parish Nurse (PN) + Peer Leader (PL) DSMS (n=123), PL DSMS (n=127), or PN DSMS (n=109)]. Twenty-one PNs and 28 PLs were trained to facilitate DSMS at each church. Sustained reduction in A1c was observed in all groups (PNPL: -0.2%, p=0.68; PN: -0.2%, p=0.13). PL had borderline statistically significant reductions (-0.3%, p=0.08). The proportion of participants with A1c < 7% also improved over time in each group (PNPL: 57.3 vs. 60.7%, p=0.21; PL: 57.3 vs. 62.7%, p=0.44; PN: 40.9 vs. 44.1%, p=0.66), but not significantly. Of those who achieved A1c < 7% following DSME (9-month follow-up), 81.3% of participants, across all groups, sustained the goal at 33 months. PN had the most participants with sustained glycemic control (PNPL: 81.6%, PL: 76.7%, PN: 86.9%). Significant improvements in mean DD scores were observed from baseline to 33 months in all groups (PNPL: 2.1 vs. 1.8, p=0.05; PL: 2.0 vs. 1.7, p=0.004). Moreover, there was a 50% reduction in the proportion of participants with moderate DD in PL (31.7% vs. 12.2%) and PN (27.5% vs. 15%) and severe DD in PN (10% vs. 5%). Varied approaches to DSMS within the context of existing community infrastructures (AA churches) fostered the sustainability of improvements in diabetes-related outcomes. Disclosure G. Piatt: None. A. M. Provenzano: None. R. Nwankwo: None. D. Hall: None. K. A. Kloss: None. J. M. Hawkins: None. M. M. Funnell: Other Relationship; Self; American Diabetes Association. Funding National Institutes of Health (R01DK103733)
While the incidence and prevalence of type 2 diabetes is higher among Latino/as, Latino men are disproportionately affected and have poorer outcomes. We aimed to determine whether gender impacted any outcomes in a culturally tailored type 2 diabetes (T2D) intervention and to evaluate the effects of gender and intervention participation intensity on outcomes at 6-month follow-up. Nested path and regression models were compared with the likelihood ratio test and information criteria in a sample of Latino/a adults with T2D (n = 222) participating in a T2D community health worker (CHW)-led intervention. Path analysis showed that the effect of the intervention did not vary by gender. The intervention was associated with significant improvements in knowledge of T2D management 0.24 (0.10); p = 0.014, diabetes distress, −0.26 (0.12); p = 0.023, and self-efficacy, 0.61 (0.21); p = 0.005. At 6-month follow-up, improved self-management was associated with greater self-efficacy and Hemoglobin A1c (HbA1c) was lower by −0.18 (0.08); p = 0.021 for each unit of self-management behavior. Linear regressions showed that class attendance and home visits contributed to positive intervention results, while gender was non-significant. Pathways of change in a CHW-led culturally tailored T2D intervention can have a significant effect on participant behaviors and health status outcomes, regardless of gender.
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