Stephanie Monroe, Shenna Meredith, Barbara Lentz, and Alanna Fant

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What does literature reveal about diabetic
education decreasing the incidence of heart
diseases in a diabetic?

• Stephanie Monroe, Shenna Meredith, Barbara Lentz,
  and Alanna Fant

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Introduction

• There is a high correlation between diabetes and
  heart disease. If we can prove that an increase
  in diabetic management education reduces the
  incidence of heart disease in diabetics, we can
  indicate the need for increased use in hospitals
  and outpatient diabetics.

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Article 1

• Patients who monitored blood glucose for six
  months decreased HbA1c levels and risk for
  coronary heart disease (CHD)
• Hba1c levels went from 9.2 to 7.3 in six months
• Risk for CHD nearly cut in half

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Article 1 Analysis

• Problem / Purpose statement
• -Clean and concise
• -Included variables, population and is
  empirically testable
• Population
• - Afro-Caribbean diabetic women
• Limitations
• -Small sample size
• -Population selected were motivated individuals
• -Medication and lifestyle of individuals was not
  factored into the study

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Article 1 Analysis

• Research Design
• - Time series design
• Measurement tools
• -UKPDS risk engine
• -Glucose monitors.
• Results
• -HbA1c levels of the intervention group decreased
  
• -Intervention groups 10 year risk for CHD
  decreased

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Article 2

• The patients who were given extensive education
  and consultation on Diabetes management suffered
• 25 less MI
• 50 less strokes
• 30 less Open Heart Bypass and Stent Placement
• 50 less non fatal cardiovascular events
• 15 less deaths

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Article 2 Analysis

• Strength in Evidence
• Decrease in all risk factors of cardiovascular
  progression
• Eight year follow up study

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• Weakness in Evidence
• Small sample size
• Glucose lowering therapy not presented
• Assessment bias of both intervention and data
  collection done by same researchers (consultants)

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Nursing Experience ofDiabetes Education on Heart
Unit and Recommendation

• Lacking in Diabetic Education
• Education done by Diabetic Educator
• More emphasis on Cardiovascular Medication
• More emphasis on smoking cessation
• Recommend to increase education in patient with
  Type 2 Diabetes

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Article 3

• Patients were evaluated on knowledge retention 18
  months after care
• One group received standard follow up other group
  received intensive nurse-led education
• No difference in knowledge retention was shown in
  the two groups
• Education should be tailored to each individual

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Article 3 Analysis

• Posttest only design
• No other tools to validate questionnaire
• Self-reporting
• No way to verify accuracy of answers
• Additional studies needed
• No Theory or Conceptual basis discussed
• Problem and purpose clearly stated
• Population Clearly defined

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Recommendations

• Bridge between acute and preventative care
• Tailor education to individual

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Article 4

• Effects of a diabetic self-management program on
  glycemic control, coronary heart disease (CHD)
  risk, and quality of life (QOL) among Thai
  patients with type 2 diabetes
• HbA1c mean levels decreased from 8.08 to 7.40
  for the experimental group vs 8.09 to 8.02 for
  the control group
• The experimental group had a decrease in CHD risk
  factors, including total cholesterol,
  triglycerides, LDL levels, diastolic BP, and BMI
  and had a higher increase in HDL-C levels when
  compared to the control group
• Experimental group exhibited greater increase in
  QOL than control group

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Article 4 Analysis

• Hypothesis
• Diabetic patients receiving a self-management
  program would have lower levels of HbA1c and CHD
  risk, and a better QOL than those receiving the
  usual nursing care.
• Population
• Thai patients with type 2 diabetes
• Over 35 years of age
• Fasting plasma glucose level gt140mg for at least
  2 follow-up visits
• Were able to speak, read, and write in Thai
• Limitations
• Small sample size
• Single geographical area

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• Article 4 Analysis
• Research Design
• Randomized controlled trial
• Measurement Tools
• Blood Samples before and after
• Quality of life questionnaire
• Coronary heart disease risk profile
• Results
• Decrease HbA1c
• Dereased Coronary Heart Disease Risk
• Increased Quality of life

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Conclusion

• Overall reduction in risk and improvement of
  quality of life
• Long term education
• Education needs to occur in both the acute and
  primary care settings