McGowen Candace Lee, Appel Susan J
The University of Memphis, College of Nursing, Memphis TN, USA
The University of Alabama System, Capstone College of Nursing, Tuscaloosa AL, USA.
J Dr Nurs Pract. 2023 Jun 27. doi: 10.1891/JDNP-2021-0046.
Diabetes self-management education and support (DSMES) can be a very valuable service for many patients with diabetes. Unfortunately, despite its expected benefits, many patients do not receive DSMES through a quality, structured program. The purpose of this quality improvement project was to determine if integrating a diabetes education program utilizing the Association of Diabetes Care and Education Specialists (ADCES)7 Self-Care Behaviors into diabetes care in a primary care clinic could improve glycemic control and body mass index (BMI). The DSMES services provided were in accordance with the ADCES and the American Diabetes Association National Standards. The program included a 1-hour face-to-face service incorporating the ADCES7 Self-Care behaviors. A retrospective chart review was conducted to extract outcome data from = 54 random medical records. This data was then analyzed to evaluate the program's effectiveness. Pre- and postintervention data from medical records were analyzed for eligible patients who participated in the DSMES service (ages 18-75 with type 2 diabetes, hemoglobin A1c [A1c] >8%). Paired tests were used to determine significant changes in BMI and A1c parameters pre- and postintervention. Preintervention A1c ( = 9.5, = 1.7) and BMI ( = 33.2, = 7.8) and postintervention A1c ( = 7.8, = 1.5) and BMI ( = 32.2, = 7.9) indicate that DSMES significantly reduced A1c, (53) = 8.1, = <.001, and BMI, (53) = 4.4, = <.001. Models were then adjusted for pretest measures, age, gender, and time since diagnosis in a regression analysis. In models adjusted for pretest measures, age, gender, and time since diagnosis was significantly predictive of the postmeasure of BMI ( = .41, = .01, = .96) and postmeasure of A1c ( = .28, = .04, =.41). This project demonstrated that integrating a simple, cost-effective diabetes education service consisting of ADCES7 Self-Care Behaviors in a primary care practice could bridge gaps in diabetes management and significantly improve patients' BMI and A1c. Long-term utilization of this service may also enhance patient satisfaction, improve the patient's health, and reduce healthcare costs related to diabetes.
糖尿病自我管理教育与支持（DSMES）对许多糖尿病患者而言可能是一项非常有价值的服务。不幸的是，尽管有预期的益处，但许多患者并未通过高质量、结构化的项目接受DSMES。本质量改进项目的目的是确定在初级保健诊所将利用糖尿病护理与教育专家协会（ADCES）7项自我护理行为的糖尿病教育项目纳入糖尿病护理是否能改善血糖控制和体重指数（BMI）。所提供的DSMES服务符合ADCES和美国糖尿病协会的国家标准。该项目包括一项1小时的面对面服务，纳入了ADCES7项自我护理行为。进行了一项回顾性病历审查，以从54份随机病历中提取结果数据。然后对这些数据进行分析，以评估该项目的有效性。对参与DSMES服务的符合条件的患者（年龄在18 - 75岁之间，患有2型糖尿病，糖化血红蛋白[A1c] >8%）的病历干预前后数据进行了分析。采用配对t检验来确定干预前后BMI和A1c参数的显著变化。干预前A1c（均值 = 9.5，标准差 = 1.7）和BMI（均值 = 33.2，标准差 = 7.8）以及干预后A1c（均值 = 7.8，标准差 = 1.5）和BMI（均值 = 32.2，标准差 = 7.9）表明，DSMES显著降低了A1c，t(53) = 8.1，p = <.001，以及BMI，t(53) = 4.4，p = <.001。然后在回归分析中对预测试量、年龄、性别和诊断后的时间进行模型调整。在针对预测试量、年龄、性别和诊断后的时间进行调整的模型中，诊断后的时间对BMI的测量后值（β = .41，p = .01，R² = .96）和A1c的测量后值（β = .28，p = .04，R² =.41）具有显著预测作用。该项目表明，在初级保健实践中纳入一项由ADCES7项自我护理行为组成的简单、经济高效的糖尿病教育服务，可以弥补糖尿病管理方面的差距，并显著改善患者的BMI和A1c。长期使用这项服务还可能提高患者满意度，改善患者健康状况，并降低与糖尿病相关的医疗成本。
