Purpose The primary purpose of this study is to report a systematic review of evidence and gaps in the literature among well-conducted studies assessing the impact of diabetes education on hypoglycemia outcomes and secondarily reporting the impact on other included target outcomes. Methods The authors used a modified Cochrane method to systematically search and review English-language titles, abstracts, and full-text articles published in the United States between January 2001 and December 2017, with diabetes education specified as an intervention and a directly measurable outcome for hypoglycemia risk or events included. Results Fourteen quasi-experimental, experimental, and case-control studies met the inclusion criteria, with 8 articles reporting a positive impact of diabetes self-management education and support (DSMES) on hypoglycemia outcomes; 2 of the 8 reported decreased hypoglycemia events, and 1 reported decreased events in both the intervention and control groups. In addition, 5 studies targeted change in reported hypoglycemia symptoms, with all 5 reporting a significant decrease. DSMES also demonstrated an impact on intermediate (knowledge gain, behavior change) and long-term (humanistic and economic/utilization) outcomes. An absence of common hypoglycemia measures and terminology and suboptimal descriptions of DSMES programs for content, delivery, duration, practitioner types, and participants were identified as gaps in the literature. Conclusions Most retained studies reported that diabetes education positively affected varied measures of hypoglycemia outcomes (number of events, reported symptoms) as well as other targeted outcomes. Diabetes education is an important intervention for reducing hypoglycemia events and/or symptoms and should be included as a component of future hypoglycemia risk mitigation studies.

Objective: To examine aerobic physical activity (PA) among non-Hispanic Black pregnant women.Design: Longitudinal prospective cohort study. Sample:A subset of 161 non-Hispanic Black pregnant women from the Midwestern US participating in a larger study completed questionnaires about aerobic physical activity (PA) before pregnancy (reported at 24.46±2.13 weeks gestation), mid-pregnancy (24.46±2.13 weeks gestation), and late pregnancy (31.78±1.95 weeks gestation).Measurements: Aerobic PA was measured using the Rapid Assessment of Physical Activity (RAPA).Results: Most participants reported being active prior to pregnancy (n = 101, 63%), with 60 (37%) underactive/sedentary. Aerobic RAPA scores were highest prepregnancy (3.29±1.11, median = 4, interquartile range [IQR] = 1) compared with mid-pregnancy (3.05±1.26, median = 4, IQR = 2) and late pregnancy (3.05±1.24, median = 4, IQR = 2). Pre-pregnancy scores were significantly higher than midpregnancy scores (Wilcoxon test = 1472, p = .008) and late pregnancy scores (Wilcoxon test = 1854, p = .01). Conclusion:Most Black pregnant participants reported high levels of aerobic PA both before pregnancy and during pregnancy. However, many were underactive or sedentary. Aerobic PA decreased during pregnancy compared with pre-pregnancy, without the drop in third trimester PA found in other populations. Providers should assess PA across pregnancy and promote adequate PA for maternal and infant health, particularly among Black women.

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Background and objectives: Obesity prevalence rates for adults are at an all-time high. This systematic review of the literature aimed to examine the practice patterns of nurse practitioners (NPs) related to weight management in primary care and recommend future areas of research as it relates to the diagnosis and management of patients with obesity by NPs. Data sources: The databases CINAHL PLUS with Full Text, Cochrane Central Register of Controlled Trials, ERIC, MEDLINE, PsycINFO, and SPORTDiscuss were searched. Conclusions: The initial search resulted in 169 articles. Fifteen peer-reviewed articles from 13 studies were included in the analysis. Four themes emerged from the analysis: approach to practice; the practitioner's role within the interdisciplinary team; communication; and resources and tools. Implications for practice: This review was conducted to better understand the challenges and facilitators to the management of patients with obesity in primary care. Future research between NPs and variables related to obesity are necessary to further identify areas for education, training, and policy development.

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Purpose: It is well documented that chronic conditions, such as diabetes, impact quality of life (QoL). QoL assessment is essential when developing and evaluating diabetes self-management education support interventions. The aim of this systematic review was to evaluate the evidence and gaps in the research and the impact of diabetes self-management education (DSME) on QoL outcomes in persons with type 1 diabetes mellitus (T1DM). Methods A systematic review of English language studies published between January 1, 2007, and March 31, 2020, was conducted using a modified Cochrane review method. Studies were included if they were randomized controlled trials (RCTs), participants had T1DM with or without caregivers, a DSME intervention alone or a component(s) of the ADCES7™ Self-Care Behaviors was described, and QoL was a primary or secondary outcome. A 3-tiered review process was utilized for selecting articles. Retained articles were assessed for risk of bias. Results: Nineteen articles, reporting on 17 RCTs, met inclusion criteria, of which 7 studies reported QoL as the primary outcome and 10 as a secondary outcome. Seven studies detected significant impact of DMSE on QoL outcomes in either the participants or family caregivers, which varied in participant populations, selection of QoL tools (generic vs diabetes-specific), intervention type, intervention length, and type of interventionist. Conclusion: DSME has the potential to influence QoL outcomes in people with T1DM. Research using more standardized methods are needed to delineate impact on a broader range of factors that influence QoL for those living with T1DM across the life span and their caregivers.

Background: Women with a gestational diabetes mellitus (GDM) history have increased lifetime type 2 diabetes (T2D) risk, with 16 times greater risk 3 to 6 years after the pregnancy, compared with women without GDM. Offspring from diabetes-complicated pregnancies also face increased health risks.Purpose: The study purpose was to describe the primary care practices of nurse practitioners (NPs) aimed at reducing T2D-related health risks in women with a history of GDM.Methodology: Florida-licensed primary care NPs (n = 47) completed a 57-item online survey that included an 8-item scale about recommended practices to reduce T2D risks for women with GDM history. Descriptive statistics, Chi Square test, and Fisher exact test were conducted.Results: Most (67%) participants "often/always" screened for T2D every 1-3 years per guidelines, but only 31.8% "often/always" advised about pregnancy planning/preconception T2D assessment. Compared with "none" or #2 hours of GDM care education, participants with >2 hours were more likely (p < .05) to "often/always" perform five recommended practices: 1) counsel about increased T2D risks; 2) educate about self-advocacy for T2D screening; 3) T2D screening every 1-3 years; 4) counsel about breastfeeding to reduce T2D risk; and 5) discuss postpartum weight loss and increased physical activity to lower T2D risk. Conclusion:Findings indicate inconsistent care practices and suggest that >2 hours of education about care of women with GDM history may increase primary care NPs performing recommended practices to reduce T2D risks and prevent health problems for women and future offspring.Implications: Nurse practitioner education is needed involving care of women with GDM history to mitigate risks for T2D.