Diabetes Self care: PICOT and Literature Review
Diabetes self care us an integral part of diabetes therapy and entails active involvement of family members. Effective self management is associated with positive clinical outcomes in diabetic patients. However, effective self management can be challenging because of the naturally evolving and age appropriate attitudes as well as biological factors in young adults. Several studies have shown low self discipline and management which results into higher hemoglobin A1C (HbA1c) (Jackson, Adibe, Okonta, & Ukwe, 2014).
In addition, standard self care of diabetes management involves prescribing constant drug dosages, which are often titrated based to patients condition during their clinic visits. The clinical visits for most patients are usually 2-3 times every month. Consequently, the patient drug dosage is determined by only these visits, which is not the true representation of daily patient health needs. This is associated with significantly elevated levels of blood glucose and frequent recurrent admission episodes attributed to treatment failure (Hinshaw & Basu, 2015).
In this context, the study aims at investigating whether the use of social network (SocialDiabetes.com) can reduce the incidences of hypoglycaemia in adolescents patients diagnosed with diabetes type 1. The PICOT statement is as follows: In adolescent patients diagnosed with diabetes type 1 (P), is integration of social network (SocialDiabetes.com App) (I), in comparison with standard care (C), reduce hypoglycaemia incidences (O), in a period of eight months?
Literature review
De Jongh, T., Gurol-Urganci, I., Vodopivec- Jamsek, V., Car, J., Atun, R. (2012). Mobile phone messaging for facilitating self management of long term illnesses. Cochrane Database System Rev 12 (12) : CD007459. doi: 10.1002/14651858.CD007459.pub2.
This paper assesses the impact of mobile phone messaging applications in self management of chronic illnesses. The study evaluates the health outcomes and patients capacity to manage their health complication. This systematic review examined randomized controlled trials, quasi controlled studies, interrupted time series (ITS) and controlled before- after (CBA) studies to ass the effects of mobile phone messaging.
The paper found some limited information regarding the implication of integrating technology in improving self management for chronic diseases. However, the study found some significant knowledge gaps regarding long term effects, costs, acceptability and risks associated with these interventions.
Dobson, R., Whittaker, R., Jiang, Y., Shepherd, M., Maddison, R., Carter, K., Cutfield, R., McNamara, C., Khanolkar, M., and Murphy, R. (2016). Text message-based diabetes self management support (SMS4BG): Study protocol for a randomized controlled trial. Trials 17: 179. doi: 10.1186/s13063-016-1305-5.
According to this article, utilization of technology to deliver self management is an effective support strategy that allows people to have patient centered care. The Self- Management Support for Blood Glucose (SMS4BG) is a novel technology that is text message based, and is used to support people diagnosed with diabetes to support self management strategy and to achieve better glycaemic control as well as patient education that is tailored to individual patient needs and preferences.
This randomized controlled study was conducted in New Zealand Health districts, where one thousand participants were randomized into 1:1 ratio to receive SMS4BG and usual standard care. The study findings indicated that this technology is associated with better glycaemic control (HbA1c), enhanced self efficacy, diabetes distress, and perceived social support and improved health related quality of life.
Hinshaw, L., & Basu, A. (2015). Technology Use for Problem Solving in Adolescent Type 1 Diabetes. Diabetes Technology & Therapeutics, 17(7), 443–444. http://doi.org/10.1089/dia.2015.0175
According to this article, technology and use of social media in adolescent care has been associated with improved glucose control among the adolescents because it provides them with practical platform to solve their therapeutic issues, thereby improving their quality of life. The qualitative study evaluated the relationship between use of modern technology and glycemic control.
The study findings indicated that the modern technologies have significant impact in enhancing self care management because it provides an opportunity for individualized care for a given patient, making it need based and focuses. However, the paper warns that one size fits all approach in this approach may not effective due to unique health demands and preferences.
Jackson, I. L., Adibe, M. O., Okonta, M. J., & Ukwe, C. V. (2014). Knowledge of self-care among type 2 diabetes patients in two states of Nigeria. Pharmacy Practice, 12(3), 404.
This study aims at exploring knowledge of self care practices and factors responsible patients knowledge deficiency in patients diagnosed with diabetes type 2. The cross sectional survey was conducted on patients attending the University of Uyo teaching Hospital, where Diabetes Self Care Knowledge (DSCK-30) was used to assess the self care knowledge.
The study found that nearly 70% of the population had basic knowledge about self care, but it was associated with the level of education, household income and the length the patient has suffered from the disease. The study recommended for further investigations that will help enhance self care and individualize care based on patient’s health needs or demands.
Ng, S. M. (2015). Improving patient outcomes with technology and social media in paediatric diabetes. BMJ Quality Improvement Reports, 4(1), u209396.w3846. http://doi.org/10.1136/bmjquality.u209396.w3846
According to this article, there has been significant increase in the number of people diagnosed with diabetes Type 1 in Europe, but only small percentage of people attain better diabetes control. Recent studies have established novel digital strategies with the aim of improving overall patient health care.
The quantitative study evaluated 3 digital initiatives with the aim of implementing electronic diabetes information system that would help to undertake routine blood glucose values and calculate drug dosages with the aim of improving clinical outcomes. The study concluded that use of digital initiatives is effective in empowering patients, improving efficiencies, satisfaction, communication, reduction on emergency admissions, and to reduce diabetes related complications.
Marques, M.B., da Silva, M., Coutinho, J.V., & Lopes, M.V. (2013). Assessment of self-care competence of elderly people with diabetes. Revista da Escola de Enfermagem da USP, 47(2), 415-420. https://dx.doi.org/10.1590/S0080-62342013000200020
The prevalence rated of diabetes is highest among the USA population. Diabetes self care management is complex as it contains important recommendation for physical activity, nutrition, glucose levels and medications. Young adults and the elderly have issues that uniquely impact self care.
This is because as people age, their health status, mental abilities, nutritionl requirements and physical abilities change. Depression is also common among the diabetic patient is associated with the deterioration of self care behaviors. This descriptive cross-sectional and correlation study assess self care competencies among the population through Scale to Identify Diabetes Mellitus Patient’s Competence for Self Care as well as other factors associated with it.
The study findings indicated that only 6% of the participants had self competence, highlighting the need to integrate other health promotion activities that target this population, assess their skills and to encourage effective self care practices that enhance planning of health interventions.
References
De Jongh, T., Gurol-Urganci, I., Vodopivec- Jamsek, V., Car, J., Atun, R. (2012). Mobile phone messaging for facilitating self management of long term illnesses. Cochrane Database System Rev 12 (12) : CD007459. doi: 10.1002/14651858.CD007459.pub2.
Dobson, R., Whittaker, R., Jiang, Y., Shepherd, M., Maddison, R., Carter, K., Cutfield, R., McNamara, C., Khanolkar, M., and Murphy, R. (2016). Text message-based diabetes self management support (SMS4BG): Study protocol for a randomized controlled trial. Trials 17: 179. doi: 10.1186/s13063-016-1305-5.
Hinshaw, L., & Basu, A. (2015). Technology Use for Problem Solving in Adolescent Type 1 Diabetes. Diabetes Technology & Therapeutics, 17(7), 443–444. http://doi.org/10.1089/dia.2015.0175
Jackson, I. L., Adibe, M. O., Okonta, M. J., & Ukwe, C. V. (2014). Knowledge of self-care among type 2 diabetes patients in two states of Nigeria. Pharmacy Practice, 12(3), 404.
Ng, S. M. (2015). Improving patient outcomes with technology and social media in paediatric diabetes. BMJ Quality Improvement Reports, 4(1), u209396.w3846. http://doi.org/10.1136/bmjquality.u209396.w3846
Weinger, K., Beverly, E. A., & Smaldone, A. (2014). Diabetes Self-Care and the Older Adult. Western Journal of Nursing Research, 36(9), 1272–1298. http://doi.org/10.1177/0193945914521696
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