Page 159 - Encyclopedia of Nursing Research

126 n DiABETES RESEARCh

on the basis of evidence from the of Texas at Austin has revealed that cultur-
UKPDS, DCCT, and EDiC trials and the ally competent self-management education
D current recommendations of the ADA, the interventions resulted in improved glycemic
American College of Cardiology Foundation, control, with greater improvement related
and the American heart Association, the to session attendance (Brown et al., 2005).
target A1C level for adults should remain her current work consists of systematically
at 7% (Skyler et al., 2009). To minimize risks synthesizing the extant research on psycho-
of hypoglycemia, the ADA recommends logical, motivational, and behavioral factors
A1C levels <8% for school-age children and affecting diabetes outcomes using meta-
<7.5% for adolescents (ADA, 2010). To pre- analysis and model testing to best inform
vent microvascular or macrovascular com- clinical guidelines. Sandra Dunbar at Emory
plications in adults with type 2 diabetes <10 University is developing and testing an inte-
years, a more stringent A1C level <7% may grated self-care intervention for heart fail-
be appropriate. however, on the basis of post ure patients with diabetes for its effects on
hoc findings of the VADT, persons older than health-related QoL, physical function, health
60 years with 12 years of diabetes duration resource utilization, and cost- effectiveness.
experienced cardiovascular events that were With a focus on prediabetes, Deborah
either unchanged or increased with intensive Vincent at the University of Arizona is
glycemic control (Duckworth, 2009). Current examining the feasibility of translating and
evidence supports the need for further inves- culturally tailoring the Diabetes Prevention
tigation of individualized goals for diabetes Program (Knowler et al., 2002) into a commu-
self-management, particularly for those with nity-based program for overweight Mexican
longstanding diabetes and with consider- American adults and estimating the effect on
ation of comorbid conditions, risks for severe weight loss.
hypoglycemia, and life expectancy. Studies of youths with diabetes are
nurse researchers are addressing major addressing the needs of adolescents and their
strategies for developing and evaluating families. Family and developmental per-
interventions to improve self-management spectives are incorporated into the designs
and diabetes outcomes. Presented here is an of these studies. Margaret Grey at Yale
overview of some of the current theoretical University is conducting a longitudinal study
approaches, study aims, and outcomes of using QoL and glycemic control to evaluate
nurse-led investigations. Although this infor- the effects of an internet coping skills train-
mation is not intended to provide an exhaus- ing program in youths with type 1 diabetes.
tive review, it does demonstrate a focus on This investigation is an extension of the lon-
studies supported by the national institutes gest ongoing clinical trial specifically testing
of health and information retrieved from the efficacy of an intervention for youths who
the national institutes of health Research have type 1 diabetes. in the original face-to-
Portfolio online Reporting Tools (http:// face intervention, teens who received coping
projectreporter.nih.gov/reporter.cfm). skills training and intensive diabetes man-
Theoretical perspectives used to guide diabe- agement had significantly better glycemic
tes research conducted by nurse researchers control and QoL than youths receiving inten-
are based on the concepts of social learn- sive management alone after 1 year (Grey,
ing, self-efficacy, coping, self-management, Boland, Davidson, Li, & Tamborlane, 2000).
cultural competence, stages of change, and Carol Dashiff at the University of Alabama at
chronic care. Birmingham is conducting a feasibility trial
The majority of nursing studies focus on of a joint parent and adolescent (ages 15–17
adults with type 2 diabetes. Research con- years) psychoeducational multifamily group
ducted by Sharon Brown at the University autonomy support program to facilitate