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Decreasing Glycosylated Hemoglobin with Nutrition, Exercise and Bi-Monthly Telephone Calls in Patients with Type 2 Diabetes Mellitus

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DOI: 10.4236/oalib.1100560    1,393 Downloads   1,640 Views   Citations

ABSTRACT

Background: Decreasing glycosylated hemoglobin (HbgA1c) is a primary diabetes treatment goal. Despite the simplicity of the HbgA1c goal, failure to achieve this goal is a major healthcare concern. Healthcare providers fail to adequately educate patients on how to implement behavioral modifications needed for successful goal achievement. Narrowed focused patient encounters, reliance on patient self-education, denial, and delayed follow-up appointments limit a patient’s ability to implement required behavioral changes. Aim: This study was a quality improvement intervention designed to determine whether a personalized nutrition and exercise plan in conjunction with bi-monthly telephone reinforcement calls improved the HbgA1c of patients with type 2 diabetes mellitus. Setting: The study was conducted at a community clinic located in the southeastern U.S. that provides care predominantly to the working poor and uninsured patients. Sample: Type 2 diabetic patients (n = 40) with a baseline HbgA1c > 7%. Intervention: A nurse practitioner; certified diabetic educator and an exercise physiologist developed an individualized action plan with each participant. Baseline HbgA1c values were documented and participants were scheduled for three education sessions as well as telephone calls twice monthly for three months followed by a repeat HbgA1c. Results: Pretest and posttest HbgA1c data were analyzed using the Wilcoxon T-test statistic to determine if a personalized nutrition and exercise action plan in addition to bi-monthly telephone calls to the participants contributed to a decrease in the HbgA1c. Level of significance was set at an alpha value of less 0.05. The observed value of the test statistics t = 2.2714, with df = 62, p-value = 0.01292 rejects the null hypothesis. The p-value (0.012) demonstrated a significant improvement. Conclusion: Individualized attention and frequent reinforcement facilitated patients’ need to develop and integrate self-management behaviors, thereby, reducing the HbgA1c level and helping them to reach the desired goal.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Hickson, S. , Farrell, K. , Orr, P. and Davenport, D. (2014) Decreasing Glycosylated Hemoglobin with Nutrition, Exercise and Bi-Monthly Telephone Calls in Patients with Type 2 Diabetes Mellitus. Open Access Library Journal, 1, 1-9. doi: 10.4236/oalib.1100560.

References

[1] American Diabetic Association (2013) Standards for Medical Care in Diabetes. Diabetes Care, 36, S11-S66.
http://care.diabetesjournals.org/content/36/Supplement_1/S11.full
[2] Health Resources and Service Administration (2012) Diabetes HBA1C {Poor Control}
http://www.hrsa.gov/quality/toolbox/508pdfs/diabetesmodule.pdf
[3] Bandura, A. (1977) Self-Efficacy: Toward a Unifying Theory of Behavioral Change. Psychological Review, 84, 191-215.
http://dx.doi.org/10.1037/0033-295X.84.2.191
[4] Smolin, L.A. and Grosvenor, M.B. (2013) Nutrition: Science and applications. 3rd Edition, Wiley, Hoboken.
[5] Farrell, K. (2008) Chronic Disease Self-Management Program (CDSMP) Impacts Perceived Health Status for Underserved Rural Clients. Southern Online Journal of Nursing Research.
http://www.resourcenter.net/images/snrs/files/sojnr_articles2/vol08num03art02.html
[6] Olsen, L.A. and McGinnis, J.M. (2010) Institute of Medicine (U.S.), Redesigning the Clinical Effectiveness Research Paradigm: Innovation and Practice-Based Approaches: Workshop Summary. National Academies Press, Washington DC.
[7] American Nurses Association and American Association of Diabetes Educators (2003) Scope and Standards of Diabetes Nursing Practice. 2nd Edition, American Nurses Association, Washington DC.
[8] Anderson, B. and Funnell, M.M. (2005) The Art of Empowerment: Stories and Strategies for Diabetes Educators. American Diabetes Association, Alexandria.
[9] Whitlock, E.P., Orleans, C.T., Pender, N. and Allan, J. (2002) Evaluating Primary Care Behavioral Counseling Interventions. American Journal of Preventive Medicine, 22, 267-284.
http://dx.doi.org/10.1016/S0749-3797(02)00415-4
[10] Muchiri, J., Gericke, G. and Rheeder, P. (2009) Elements of Effective Nutrition Education for Adults with Diabetes Mellitus in Resource Poor Settings: A Review. Health SA Gesondheid, 14, 1-9.
http://dx.doi.org/10.4102/hsag.v14i1.413
[11] Mann, J.I. (2006) Nutrition Recommendations for the Treatment and Prevention of Type 2 Diabetes and the Metabolic Syndrome: An Evidenced-Based Review. Nutrition Reviews, 64, 422-427.
http://dx.doi.org/10.1111/j.1753-4887.2006.tb00227.x
[12] Gulve, E.A. (2008) Exercise and Glycemic Control in Diabetes: Benefits, Challenges, and Adjustments to Pharmacotherapy. Physical Therapy, 88, 1297-1391.
http://dx.doi.org/10.2522/ptj.20080114
[13] Sweet, S.N., Fortier, M.S., Guérin, E., Tulloch, H., Sigal, R.J., Kenny, G.P. and Reid, R.D. (2009) Understanding Physical Activity in Adults with Type 2 Diabetes after Completing an Exercise Intervention Trial: A Mediation Model of Self-Efficacy and Autonomous Motivation. Psychology Health & Medicine, 14, 419-429.
http://dx.doi.org/10.1080/13548500903111806
[14] Waryasz, G.R. and McDermott, A.Y. (2010) Exercise Prescription and the Patient with Type 2 Diabetes: A Clinic Approach to Optimizing Patient Outcomes. American Academy of Nurse Practitioners, 22, 217-227.
http://dx.doi.org/10.1111/j.1745-7599.2010.00490.x
[15] Orr, P.M., McGinnis, M.A., Hudson, L.R., Coberley, S.S., Crawford, A. and Goldfarb, N.I. (2006) A Focused Telephonic Nursing Intervention Delivers Improved Adherence to A1C Testing. Disease Management, 9, 277-283.
http://dx.doi.org/10.1089/dis.2006.9.277
[16] Nesari, M., Zakerimoghadam, M., Rajab, A., Bassampour, S. and Faghihzadeh, S. (2010) Effect of Telephone Follow-Up on Adherence to a Diabetes Therapeutic Regimen: Effect of Telephone Follow-Up on Adherence. Japan Journal of Nursing Science, 7, 121-128.
http://dx.doi.org/10.1111/j.1742-7924.2010.00146.x
[17] Wu, L., Forbes, A., Griffiths, P., Milligan, P. and While, A. (2010) Telephone Follow-Up to Improve Glycaemic Control in Patients with Type 2 Diabetes: Systematic Review and Metaanalysis of Controlled Trials. Diabetic Medicine, 27, 1217-1225.
[18] Piette, J.D., Weinberger, M., McPhee, S.J., Mah, C.M., Kraemer, F.B. and Crapo, L.M. (2000) Do Automated Calls with Nurse Follow-Up Improve Self-Care and Glycemic Control Vulnerable Patients with Diabetes? American Journal of Medicine, 108, 20-27.
http://dx.doi.org/10.1016/S0002-9343(99)00298-3
[19] Thristed, R.H. (2010) What Is a P-Value? Departments of Statistics and Health Studies, The University of Chicago.
http://galton.uchicago.edu/~thisted/Distribute/pvalue.pdf.

  
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