La figura de la enfermera educadora hospitalaria mejora la HbA1c y el perfil lipídico de los pacientes con diabetes tipo 1

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Abstract

La educación diabetológica ha demostrado ser esencial en la atención del paciente diabético. Para realizar esta tarea educacional, la Unidad de Diabetes del Área VII Murcia Este, que incorporó a enfermeras especializadas en educación diabetológica avanzada en el Hospital General Universitario Reina Sofía de Murcia. Se realizó un estudio retrospectivo, donde se valoró la actuación de dichas enfermeras mediante la evaluación de los pacientes diabéticos tipo 1 que acudieron a sus consultas entre los años 2007 y 2011. Se analizaron un total de 179 historias clínicas de pacientes con diabetes mellitus tipo 1 (DM1) mayores de 11 años, siendo 103 (52,3%) varones y 94 (47,7%) mujeres. Los pacientes presentaban una edad media de 38.25 ± 14.02 años y un tiempo de duración de la diabetes medio de 16,22 ± 11,73 años. El valor de HbA1c inicial medio fue de 8,49 ± 2,04%. De los 197 pacientes, solo 37 (16,2%) eran menores de 25 años en el momento de acudir a consulta. Los resultados obtenidos demostraron que la disminución de la HbA1c (-0,57 ± 1,80%) era significativa a los 6 meses (p: 0,002) de la primera consulta alcanzando valores de 7,86 ± 1,39 y manteniéndose a partir de ese momento. Las dosis de insulina fueron estables a lo largo del estudio.

Translated abstract

Diabetes education has proved to be an essential tool in the care of patients with type l diabetes mellitus. To perform this educational task, the VII Area Murcia East Diabetes Unit, incorporated nurses in advanced diabetes education in the Hospital General Universitario Reina Sofia of Murcia. We carried out a retrospective study, which assessed the performance of these nurses by evaluating the type l diabetic patients attending inquiries between 2007 and 20ll. We analyzed a total of 179 medical records, of patients with type l diabetes mellitus over ll years, with 103 (52.3%) males and 94 (47.7%) women. Patients had a mean age 38.25 ± 14.02 years and a mean duration of diabetes of 16.22 ± 11.73 years. The initial mean value of HbAlc was 8.49 ± 2.04%. Only 37 (16.2%) of the 197 patients were under 25 at the start of the study. The results showed that the decrease in HbAlc (-0.57 ± 1.80%) was significant after 6 months (p = 0.002) from the first query, reaching values of 7.86 ± 1.39% and remained from that time. Insulin doses were stable throughout the study.

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Most cited references 19

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Many patients with type 1 diabetes struggle to self-manage this chronic disease, often because they have a poor knowledge and understanding of the condition. However, little attention has been paid to examining the reasons for this poor knowledge/understanding. To inform future educational interventions, we explored patients' accounts of the education and information they had received since diagnosis, and the reasons behind gaps in their diabetes knowledge. Semi-structured interviews were conducted with 30 type 1 diabetes patients enrolled on a structured education programme in the UK. Data were analysed using an inductive, thematic approach. Patients' accounts illustrated a number of knowledge deficits which were influenced by various lifecourse events. Reasons for deficits included: diagnosis at a young age and assumption of decision-making responsibility by parents; lack of engagement with information when feeling well; transitions in care; inconsistency in information provision; and, lack of awareness that knowledge was poor or incomplete. Patients' knowledge deficits can arise for different reasons, at different points in the lifecourse, and may change over time. The delivery of individualised education should take account of the origins of patients' knowledge gaps and be provided on a regular and on-going basis. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

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Summary of Revisions for the 2013 Clinical Practice Recommendations

(2012)

Revisions to the Standards of Medical Care in Diabetes—2013 In addition to many small changes related to new evidence since the prior year, and to clarify recommendations, the following sections have undergone more substantive changes: Section II.C. Screening for Type 1 Diabetes has been revised to include more specific recommendations. Section IV. Prevention/Delay of Type 2 Diabetes has been revised to reflect the importance of screening for and treating other cardiovascular risk factors. Section V.C.a. Glucose Monitoring has been revised to highlight the need for patients on intensive insulin regimens to do frequent self-monitoring of blood glucose. Section V.D. Pharmacological and Overall Approaches to Treatment has been revised to add a section with more specific recommendations for insulin therapy in type 1 diabetes. Section V.F. Diabetes Self-Management Education and Support has been revised to be consistent with the newly revised National Standards for Diabetes Self-Management Education and Support. Section V.K. Hypoglycemia has been revised to emphasize the need to assess hypoglycemia and cognitive function when indicated. Section V.M. Immunization has been updated to include the new Centers for Disease Control and Prevention (CDC) recommendations for hepatitis B vaccination for people with diabetes. Section VI.A.1. Hypertension/Blood Pressure Control has been revised to suggest that the systolic blood pressure goal for many people with diabetes and hypertension should be <140 mmHg, but that lower systolic targets (such as <130 mmHg) may be appropriate for certain individuals, such as younger patients, if it can be achieved without undue treatment burden. Section VI.A.2. Dyslipidemia/Lipid Management and Table 10 have been revised to emphasize the importance of statin therapy over particular LDL cholesterol goals in high-risk patients. Section VI.B. Nephropathy Screening and Treatment and Table 11 have been revised to highlight increased urinary albumin excretion over the terms micro- and macroalbuminuria, other than when discussion of past studies requires the distinction. Section VI.C. Retinopathy Screening and Treatment has been revised to include anti–vascular endothelial growth factor therapy for diabetic macular edema. Section IX.A. Diabetes Care in the Hospital has been revised to include a recommendation to consider obtaining an A1C in patients with risk factors for undiagnosed diabetes who exhibit hyperglycemia in the hospital. Revised Position Statement The position statement “Diagnosis and Classification of Diabetes Mellitus” has been revised slightly to add newer information about monogenic forms of diabetes. Revisions to the National Standards for Diabetes Self-Management Education and Support The task force report “National Standards for Diabetes Self-Management Education and Support” represents a major revision completed in 2012.

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Forty-seven studies on the effects of patient teaching on knowledge, self-care behaviors, and metabolic control were analyzed using meta-analysis. Variables, such as type of patient instruction, type of research design, and overall quality of the study, also were analyzed. The 236 effect sizes had an unweighted mean of 0.91 (SD = 0.75) and a weighted mean of 0.33 (SD = 0.01). The weighted mean effect size for studies with control groups (N = 27) was 0.40 (SD = 0.05), and the weighted mean effect size for studies using the one group pretest-posttest design (N = 20) was 0.53 (SD = 0.05). Homogeneity analyses resulted in weighted mean effect size estimates for knowledge subvariables ranging from 0.41 to 0.91; for skill performance, 0.25 to 0.38; for compliance, 0.24 to 1.01; and for metabolic control, 0.06 to 0.84. Experimental mortality was the only variable significantly correlated with the overall weighted mean effect size, r = .52, p = .002. The results of this study clearly support the notion that patient teaching has positive outcomes in diabetic adults. Furthermore, methodological issues were important factors which influenced these findings.

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Author and article information

Contributors

Carmen López-Alegría: Role: ND

María Ángeles Núñez-Sánchez: Role: ND

María García-Palacios: Role: ND

Beatriz Santaolalla-Jiménez: Role: ND

Alexandra Mueses-Dismey: Role: ND

Pahola Gómez-Rivas: Role: ND

Antonio Pérez-Sanz: Role: ND

Dolores Ortuño-Micol: Role: ND

Amparo Inmaculada Meoro-Avilés: Role: ND

Journal

Journal ID (publisher): nh

Title: Nutrición Hospitalaria

Abbreviated Title: Nutr. Hosp.

Publisher: Sociedad Española de Nutrición Parenteral y Enteral (Madrid )

ISSN: 0212-1611

Publication date (Print): December 2013

Volume: 28

Issue: 6

Pages: 2006-2013

Affiliations

[1 ] Área VII Murcia Este

Article

Publisher ID: S0212-16112013000600033

DOI: 10.3305/nh.2013.28.6.6691

SO-VID: 8390a601-ff98-4234-8c6c-6db13c1ab72a

License:

http://creativecommons.org/licenses/by/4.0/

History

Product

SciELO Spain

Self URI (journal page): http://scielo.isciii.es/scielo.php?script=sci_serial&pid=0212-1611&lng=en

La figura de la enfermera educadora hospitalaria mejora la HbA1c y el perfil lipídico de los pacientes con diabetes tipo 1 Translated title: The figure of a nurse educator improves HbA1c levels and lipid profile in patients with type 1 diabetes

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