Abstract:
OBJECTIVE — To evaluate the efficacy of self-management education on GHb in adults with type 2 diabetes.
RESEARCH DESIGN AND METHODS — We searched for English language trials in Medline (1980–1999), Cinahl (1982–1999), and the Educational Resources Information Center database (ERIC) (1980–1999), and we manually searched review articles, journals with highest topic relevance, and reference lists of included articles. Studies were included if they were randomized controlled trials that were published in the English language, tested the effect of self-management education on adults with type 2 diabetes, and reported extractable data on the effect of treatment on GHb. A total of 31 studies of 463 initially identified articles met selection criteria. We computed net change in GHb, stratified by follow-up interval, tested for trial heterogeneity, and calculated pooled effects sizes using random effects models. We examined the effect of baseline GHb, follow-up interval, and intervention characteristics on GHb.
RESULTS — On average, the intervention decreased GHb by 0.76% (95% CI 0.34–1.18) more than the control group at immediate follow-up; by 0.26% (0.21% increase - 0.73% decrease) at 1–3 months of follow-up; and by 0.26% (0.05–0.48) at 4 months of follow-up. GHb decreased more with additional contact time between participant and educator; a decrease of 1% was noted for every additional 23.6 h (13.3–105.4) of contact.
CONCLUSIONS — Self-management education improves GHb levels at immediate followup, and increased contact time increases the effect. The benefit declines 1–3 months after the intervention ceases, however, suggesting that learned behaviors change over time. Further research is needed to develop interventions effective in maintaining long-term glycemic control.
My Opinion:
The article from Norris et al. discusses the meta-analysis carried out on one type of intervention to curb type 2 diabetes among adults via self-management. Self-management simply means that the individual takes full responsibility in dealing with the situation and handling all factors and outcomes. In the case of type 2 diabetes, these factors may be the person's lifestyle and diet. The outcome of this is the glycohemoglobin (GHb) levels of the person.
Diabetic self-management education (DSME) is essential because diabetic persons vary from one another due to their multi-factorial condition. Through DSME, the person will be able to customize their lifestyle and diet that fits their needs specifically to help them manage their condition. Self-management can optimize metabolic control, prevent acute and chronic complications, and optimize quality of life, while keeping costs acceptable. DSME need only be given once or twice a year and has been proved to reduce GHb after standard and nutrition educations.
In an Asian setting, this method could prove effective because DSME does not require high-end technology, gadgets or complicated measures. DSME can be started from the main hospitals patients obtain treatment from and further monitored by their family physicians, general physicians, nurses or midwives who live in the vicinity of the patients. In order for the aforementioned task forces to be able to educate and monitor the progress of the patients, seminars and clinical updates can be held to equip these medical professionals with the necessary knowledge and skills.
In Yogyakarta, diabetes is a common enemy due to the lifestyle and diet of a developing country. Rice is the staple food of the nation and is consumed a minimum of thrice daily. It is proven that carbohydrates affect postprandial glycemia and research has been done to prove if the source or amount of carbohydrate bears more importance. With DSME, patients can have a better understanding of what is happening to them individually and therefore they may be able to help themselves better, rather than seeking general assistance. DSME in Yogyakarta has to tackle this disease medically, culturally and socially.
References:
Diabetic self-management education (DSME) is essential because diabetic persons vary from one another due to their multi-factorial condition. Through DSME, the person will be able to customize their lifestyle and diet that fits their needs specifically to help them manage their condition. Self-management can optimize metabolic control, prevent acute and chronic complications, and optimize quality of life, while keeping costs acceptable. DSME need only be given once or twice a year and has been proved to reduce GHb after standard and nutrition educations.
In an Asian setting, this method could prove effective because DSME does not require high-end technology, gadgets or complicated measures. DSME can be started from the main hospitals patients obtain treatment from and further monitored by their family physicians, general physicians, nurses or midwives who live in the vicinity of the patients. In order for the aforementioned task forces to be able to educate and monitor the progress of the patients, seminars and clinical updates can be held to equip these medical professionals with the necessary knowledge and skills.
In Yogyakarta, diabetes is a common enemy due to the lifestyle and diet of a developing country. Rice is the staple food of the nation and is consumed a minimum of thrice daily. It is proven that carbohydrates affect postprandial glycemia and research has been done to prove if the source or amount of carbohydrate bears more importance. With DSME, patients can have a better understanding of what is happening to them individually and therefore they may be able to help themselves better, rather than seeking general assistance. DSME in Yogyakarta has to tackle this disease medically, culturally and socially.
References:
- http://care.diabetesjournals.org/content/diacare/25/7/1159.full.pdf
- http://www.chronicdisease.org/?page=DiabetesDSMEresource
- http://link.springer.com/article/10.1007/s11892-001-0031-9
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