Janiszewski D, O'Brian CA, Lipman RD. At that visit, we started J.W. The National Diabetes Prevention Program also provides information and resources to clinicians and patients. The burden of type 1 diabetes remains substantial, and more research is needed to improve the lives of people with type 1 diabetes and to find a cure. Studies were identified from multiple databases and screened according to an a priori defined protocol. If a community program is not available or if the patient is unwilling or unable to participate in such a program, clinicians can provide lifestyle counseling and support during clinic visits. Diabetes Educ. If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Reliance on the FPG value alone may have prompted us to initially prescribe a diabetes medication that could have potentially affected the patient's employment status and health care coverage and could have important side effects. The guide can be downloaded free of charge from the NDEP Web site (http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=71). He is a nonsmoker and has a family history of CAD. on metformin (500 mg/day). When seen in January 2012, D.W. weighed 281 lb (BMI 38 kg/m2) and had normal blood pressure and elevated lipid and fasting glucose levels (Table 5). was at very high risk for developing type 2 diabetes within the next 5 years (PreDx score 8.5, 5-year diabetes risk of 16.5%). There is a lot of research on diabetes happening all around the world and the latest include: March 19, 2015: Research to Identify and Correctly Treat Rare Forms of Diabetes Some very rare forms of diabetes are caused by single gene mutations. OBJECTIVE— Evaluate type 2 diabetes susceptibility variants identified from genome-wide association studies in Hispanic Americans and African Americans from the Insulin Resistance Atherosclerosis Family Study (IRAS-FS) for association with quantitative measures of glucose homeostasis and determine their biological role in vivo. Methods. Development and validation of a model for predicting incident type 2 diabetes using quantitative clinical data and a Bayesian logistic model: A nationwide cohort and modeling study . & Copyright Info. In a recent analysis of the European Diabetes Prevention Study, Tuomilehto et al.30 demonstrated that the test not only identifies those who are most likely to develop diabetes, but also facilitates monitoring the efficacy of therapeutic interventions through follow-up testing, thus enabling clinicians to modify the intervention if the PreDx test indicates that it has not been successful. Rich, MD, is a physician at Comprehensive Physician Associates, LLC, in Youngstown, Ohio. Although efforts have been made to address the significant and growing epidemic of diabetes, strategies to activate clinicians to aggressively screen for and treat individuals with prediabetes have been minimally successful. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition We acknowledge our small sample size (n = 12); but each group provided detailed and unique description of their experiences, which remain relevant as giving us insight into the thinking processes of young people with diabetes. Study shows Diabetes Education Highly Effective in Accredited Federally Qualified Health Centers. Results show low use of qualitative methods in diabetes research over the past 30 years. Physical Assessment and Laboratory Values, Case 3. In addition, diabetes self-management is related to enhanced knowledge of diabetes, These techniques are summarized in Table 1. In type 2 diabetes, your body doesn’t make enough insulin or doesn’t use insulin well. Rich, MD, Charles F. Shaefer, MD, FACP, Christopher G. Parkin, MS, and Steven V. Edelman, MD A n estimated 79 million American adults are at risk for developing type 2 dia - betes, based on a condition referred to as prediabetes. At his next annual exam (March 2012), his blood pressure, fasting glucose, and lipid levels were improved, and his PreDx score was significantly lower (PreDx score 4.5). Apart from the establishment of the cohort study, qualitative research will also be carried out. Charles F. Shaefer, MD, FACP, is a physician at University Physicians, Primary Care, in Augusta, Ga. Christopher G. Parkin, MS, is president of CGParkin Communications, Inc., in Boulder City, Nev. Steven V. Edelman, MD, is a professor of medicine at the University of Southern California, San Diego. Recent Diabetes Research and Clinical Practice Articles Recently published articles from Diabetes Research and Clinical Practice. Moreover, there is growing evidence questioning the reliability of the A1C test. Objective: This study was aimed at increasing our understanding of the lived experiences of diabetes burnout among adults with type 1 diabetes. The qualitative results from this study suggest need for more formalized exploration of effective means to meet the ongoing support needs of people with diabetes. Objectives Diabetes is a global epidemic, and the high cost of annually and quantitatively measuring urine albumin excretion using the turbidimetric immunoassay is challenging. In a previous article we report how people with type 2 diabetes who are being cared for by a DSN in a nurse-led, shared-care unit view autonomy [ 9 ]. The aim of this study was to investigate the effectiveness of a nurse-led diabetes self-management education on glycosylated hemoglobin. Although each method has advantages and disadvantages, all are adequate for assessing the presence of diabetes or prediabetes as defined by the ADA.6 Table 2 presents the glycemic thresholds for diabetes and prediabetes. Insulin, a hormone made by the pancreas, helps glucose get into your cells to be used for energy. is a 62-year-old white man who is, 6′1″ tall and has a family history of coronary artery disease (CAD) and hypertension but no history of type 2 diabetes. it. Although J.N. Patients in waiting: a qualitative study of type 2 diabetes patients' perceptions of diagnosis. However, treatment with metformin in elderly patients has shown limited effectiveness.28 Furthermore, use of metformin is not approved by the U.S. Food and Drug Administration (FDA) in individuals with prediabetes,29 and many clinicians are reluctant to prescribe this medication without strong evidence for its necessity. Sources of information for this article included published dietary guidelines or medical nutrition therapy guidelines for diabetes, and systematic reviews and primary research articles based on randomised clinical trials or prospective observational studies. However, qualititative research produces detailed information, giving insights that cannot be realised by quantitative research. Instead, we focused our attention on lifestyle intervention efforts and his other cardiovascular risk factors. Sample of the PreDx test report form. Given the growing, worldwide diabetes epidemic, there is an everincreasing need for new testing methodologies that can accurately diagnose individuals who have the highest likelihood of developing diabetes and that can support both clinicians and patients in initiating and sustaining effective prevention strategies. All patients with prediabetes, irrespective of their PreDx score, should receive counseling related to increased diabetes risk and the importance of good nutrition and physical activity for diabetes prevention and general health. In this study, 56 outpatients with confirmed type I or II diabetes were administered the standardized quantitative components required to diagnose and stage diabetic … A key advantage of the PreDx test is its potential to motivate patients to make necessary lifestyle modifications to reduce their risk. Many factors can influence glycation and, thus, the test's accuracy.17,20 These include weaknesses in analytical methods, ethnicity, and various medical conditions such as presence of hemoglobinopathies, iron deficiency, any type of anemia, chronic liver disease, and fast or slow glycation.20, Other methods, such as measuring components of the metabolic syndrome or calculating risk scores based on clinical measures (e.g., lipid levels, blood pressure, and waist circumference), have also been used to identify patients most likely to develop diabetes.21 However, these approaches require multiple measures and also suffer from low specificity.8,22. A Quantitative Research on Self-management of Type 2 Diabetes. Qualitative Health Research 2019 30: 2, 228-235 Download Citation. Screening for prediabetes is the essential first step in diabetes prevention, and although current tools and assessment protocols are relatively effective for the initial identification of at-risk individuals, they do not adequately address the need to identify individuals who are at the highest risk for progressing to diabetes in the near term. & Copyright Info | Site Map, Disclaimer This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Family Practice 2004; 21:131–136. Methods: A qualitative descriptive study was conducted with a sample of 18 adults with type 1 diabetes who reported a current or previous experience of diabetes burnout. The patient's risk relative to the general population is also provided. provided a framework for integrating the resources and supports for self-management with key components of clinical care in a chronic care model. from a baseline of 16.5% to 2.8%—less than half of the 5-year risk of the general population within his age-group (6.7%).4, Physical Assessment and Laboratory Values, Case 1, Physical Assessment and Laboratory Values, Case 2. The majority of articles (75%) reported using substantive qualitative research, while mixed-methods research has remained underutilised. Given the growing diabetes epidemic and the alarming prevalence of unawareness among those at risk for developing this disease, the American Diabetes Association (ADA) recommends screening of all patients who are at risk for prediabetes or who may have undiagnosed diabetes (Table 1).6, Individuals meeting the criteria in Table 1 should have their glycemic status assessed by fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), or A1C. All authors contributed to drafting this manuscript, with NGF taking a lead role and she is also the guarantor of the manuscript. After initiating the above interventions, clinicians may then use the PreDx test quarterly or biannually to monitor treatment effectiveness, make any necessary adjustments to patients' treatment plan, and provide feedback to patients to sustain and enhance motivation and engagement in their diabetes prevention efforts. Furthermore, although A1C testing has recently been added to the armamentarium of prediabetes detection options,6 use of A1C levels often fails to identify most adults with prediabetes.17–19 A recent study by Fajans et al.17 found that ~ 33% of individuals with early diabetes or impaired glucose tolerance (IGT) have A1C levels < 5.7%. The knowledge gained from this combined research will be used to further improve GDM related detection, counselling, treatment and postpartum follow-up. Ann Gen Psychiatry. J.N. A Quantitative Research on Self-management of Type 2 Diabetes. Use the PreDx test to assess the patient's 5-year likelihood of progressing from prediabetes to type 2 diabetes. We also examine content and characteristics of cultural adaptations and the extent to which the recommended “how” and “what” of adaptation have been adopted. Older adults valued an effective physician-patient treatment relationship and quality of life in their diabetes care. Recommendations for next steps are provided. This qualitative study aimed to describe older adults' values and preferences for type 2 diabetes care. Links provided will take you to an article abstract, with options to login or purchase to read the full article. Studies have reported that nurses, compared to other healthcare professionals, are more likely to promote preventive healthcare seeking behaviors. Background: A quantitative content analysis of research on parenting and childhood obesity was conducted to describe the recent literature and to identify gaps to address in future research. The PreDx test is a relatively new prognostic blood test that may help clinicians address these issues. P.L.A.N.) View More on Journal Insights; Help expand a public dataset of research that support the SDGs. Enter multiple addresses on separate lines or separate them with commas. However, if the risk:benefit profile for individual patients is deemed to be favorable, these medications may be considered for use in combination with lifestyle interventions or when behavioral interventions have failed.6. Although his FPG was only slightly elevated, the PreDx score indicated that J.N. Despite his elevated FPG of 110 mg/dl, which placed him in the prediabetes glucoregulatory category, his PreDx score was 6.3. The purpose of this short communication is to highlight the aims of this study which is using quantitative approach and methodology to determine the relationship between cultural beliefs and illness, social support in the population (40-60 years) of the rural area of Pakistan. Heather L. Voorhees and Michelle C. Howell Smith. PMCID: PMC6198430 . The PreDx test report (Figure 1) provides a single numerical score from < 1 to 9.9 (lowest to highest risk) that indicates each patient's likelihood of progressing to type 2 diabetes within the next 5 years. The multimarker PreDx test is based on seven biomarkers (glucose, A1C, insulin, C-reactive protein, ferritin, interleukin-2 receptor α, and adiponectin) that are independently associated with diabetes risk.22 The test measures these markers in a fasting blood sample, and its results, along with patients' sex and age, are placed into an algorithm that generates an objective and quantitative score to distinguish among people at high, moderate, and low 5-year probability of developing type 2 diabetes.10–12 This information enables clinicians to focus interventions on the relatively few patients who are genuinely at a high 5-year risk of developing diabetes, thus avoiding unnecessary treatment and expenses for patients who are less likely to develop diabetes within the next 5 years. is a nonsmoker and drinks alcohol occasionally. Note of disclosure: The authors have received consulting fees from Tethys, Bioscience, Inc., which developed the PreDx test. Factors influencing self-management in patients with type 2 diabetes: A quantitative systematic review protocol. Over half (54%) of research questions focused on patient experience and … RESEARCH DESIGN AND METHODS. These tools and approaches are either difficult to implement in clinical practice or lack the specificity required for accurate detection of high-risk individuals. This should allow for more efficient and effective use of health care resources and optimize health care outcomes. A key contributor to this suboptimal care is lack of physician time.26,27 Yarnell et al.27 determined that clinicians would require 21.7 hours/day to effectively meet the needs of a typical patient population of 2,500. For example, a score of 5.8 corresponds to a 4.6% 5-year risk of developing type 2 diabetes, which represents a 1.4-fold increase in risk compared to the 5-year risk in the general population (3.4%).9 The second page of the report provides results and reference ranges of the individual biomarkers used to determine the PreDx score. Other studies have shown that presenting A1C results to patients in graphic formats is linked to improved glycemic control.33,34 These studies suggest that providing patients with an objective measure of risk can be an effective motivator for making lifestyle changes. We do not capture any email address. Diabetes in elderly adults is metabolically distinct from diabetes in younger patient populations, and the approach to therapy needs to be different in this age group. The individual analytes that are used to calculate the PreDx score and their reference ranges are also provided. 4. Self-management of diabetes is challenging, especially for adolescents who face multiple changes, including closer peer relationships. Using the PreDx test in our own practices, we have observed similar findings with many of our patients. Quantitative analyses. Although it is clear that diabetes prevention should remain a high priority for patients, clinicians, and payers, it is also crucial that new technologies such as the PreDx test be used to accurately diagnose individuals who have the highest likelihood of developing diabetes in the near term to enhance the clinical efficacy of prevention efforts and ensure the viability of the national health care system. for diabetes prevention strategies and patient counseling. The following case studies are representative of our experiences. Patients meeting the criteria in Table 1 should have their glucoregulatory status assessed using FPG, A1C, or OGTT. J.W. These resources can be obtained from the Centers for Disease Control and Prevention at its Web site (http://www.cdc.gov/diabetes/prevention). We have identified two major obstacles to these diabetes prevention efforts: 1) limitations of current assessment tools and 2) constraints on clinicians' time and resources. Quantitative MRI refers to the objective measurement of parameters derived from digital images that characterize tissue attributes . June 2013 ; Journal of Advanced Nursing 70(1) DOI: 10.1111/jan.12178. A quantitative research on self-management of type 2 diabetes in middle-aged population of rural area of Pakistan Journal Article Download full-text (Open Access) Overview; Background; Identity; Additional Document Info; View All; Overview. A Research Critique on a Quantitative Study of Diabetes Ugommah Miller MRSHison 433V Emgi Lawson 07/20 A Research Critique on a Quantitative Study of Diabetes Diabetes is one of the world’s most emergent diseases that gains worldwide attention due to being linked to lifestyle choices, and is considered to be a growing epidemic among the global population (Barnett, Barnett, & Kumar, 2009). The PreDx test is a multimarker blood test that can be used in primary care practices to help determine the 5-year likelihood of a patient progressing from prediabetes to type 2 diabetes.9 Early detection of these highest-risk individuals may facilitate more effective patient management by enabling clinicians to focus health care resources earlier and to more effectively initiate and monitor diabetes prevention interventions. It is important to note that, although the three cases presented above illustrate the use of the PreDx test in white men, a recent analysis using blood samples from the Insulin Resistance and Atherosclerosis Study (a study in a multiethnic U.S. cohort) demonstrated that PreDx test performance characteristics were similar in whites, Hispanics, and African Americans and did not differ based on sex.36 Many insurers currently provide reimbursement for the test; the reimbursement rate varies by payer. 2018; 17: 44. However, this method of screening for prediabetes casts a very wide net, identifying ~ 26% of the adult population as at risk (prediabetes),16 with minimal stratification for level of risk of progressing to type 2 diabetes. BMJ Open Diabetes Research & Care is published in partnership between the American Diabetes Association and BMJ. As demonstrated in the second case, the PreDx test not only helped motivate the patient to lose a significant amount of weight but, on follow-up, it provided an indication that lifestyle changes were not effective enough and that pharmacological treatment with metformin was needed. Qualitative and Quantitative Method Integration in Diabetes Communication Research: Applications and Contributions. Abstract . He continues to eat an unhealthy diet (high in calories and saturated fat) and remains sedentary with no formal exercise program. Use the screening criteria presented in Table 1 to identify and screen all patients who may be at risk for diabetes or prediabetes. Ansari, R. M., Harris, M., Zwar, N. & Hosseinzadeh, H. (2017). Therefore, there is a need for all the required resources to be integrated in order to achieve the benefits associated with selfmanagement. is a 71-year-old white man who is 5′10″ tall and has a history of hypertension, hyperlipidemia, obesity, and IFG dating back to 2008. Pharmacological treatment with metformin has also been shown to delay or prevent progression to diabetes. Paul A. Contrary to the findings of a previous study that reported people with type 1 diabetes as having poorer self-management; our study participants who had type 1 diabetes scored higher than those with type 2 diabetes in skills and self-efficacy to care for their diabetes. As shown in Table 2, the diagnosis of prediabetes is based on glucose or A1C values that are higher than normal but not at levels diagnostic of diabetes.6, According to ADA recommendations, individuals who are identified as having prediabetes should be referred to an ongoing support program that targets weight loss Lifestyle interventions such as dietary modification, physical exercise, and modest weight loss have been shown to prevent or delay the progression from prediabetes to frank type 2 diabetes.2,23,24 Because these interventions often involve significant changes in eating habits and physical activity, patients need initial counseling to help them understand the changes they are being asked to make, as well as ongoing support and encouragement from their health care providers to sustain those new behaviors. Albine Moser 1, Harry van der Bruggen 2, Guy Widdershoven 1 & Cor Spreeuwenberg 3 BMC Public Health volume 8, Article number: 91 (2008) Cite this article. It employed a qualitative research design, including both qualitative and quantitative data collection techniques to provide robust and trustworthy findings. Thank you for your interest in spreading the word about Clinical Diabetes. Methods: Studies were identified from multiple databases and screened according to an a priori defined protocol. Because considerable resources are required to provide diabetes prevention programs to the ever-increasing Article PubMed Google Scholar Using a Quantitative Measure of Diabetes Risk in Clinical Practice to Target and Maximize Diabetes Prevention Interventions Paul A. In addition to the cohort study, qualitative research will be done to compliment the quantitative findings. His PreDx score had increased to 8.0, giving him a 12.2% 5-year diabetes risk. Copyright © 2018 University of Wollongong. A descriptive qualitative design was used. number of patients with prediabetes, accurate tools are needed to identify prediabetic individuals who are most likely to progress to type 2 diabetes. Soc Sci Med. on the need for lifestyle changes, and referred him to a formal diabetes prevention program at a local hospital. Further research should consider implementation and sustainability. To this end, ADA-funded research continues to drive progress by funding research projects topics spanning technology, islet transplantation, immunology, improving transition to self-management and much … Wagner et al. Unfortunately, many patients do not receive the level of care they need to make and sustain these changes; barely half of patients receive the preventive, chronic disease, and acute care services recommended by national health care organizations and agencies.25. Diabetes is a disease that occurs when your blood glucose (also called blood sugar) is too high. Diabetic neuropathy is confirmed in patients with a positive assessment by a quantitative neurological examination coupled with nerve conduction studies, designated the Michigan Diabetic Neuropathy Score (MDNS). A fasting plasma glucose test to assess for impaired fasting glucose (IFG) can be performed easily in most clinical settings. Research article; Open Access; Published: 09 August 2013; Development of a quantitative food frequency questionnaire for Brazilian patients with type 2 diabetes . Sign In to Email Alerts with your Email Address. In recent years, great emphasis has been placed on the role of nonpharmacological self-management in the care of patients with diabetes. A n estimated 79 million American adults are at risk for developing type 2 diabetes, based on a condition referred to as prediabetes.1 Although there is currently no cure for type 2 diabetes, studies have definitively shown that the progression from prediabetes to diabetes can be delayed or prevented through lifestyle modifications and pharmacological treatment.2–4 Unfortunately, the vast majority of … Methods . American Diabetes Association(R) Inc., 2013. © 2020 by the American Diabetes Association. It employed a qualitative research design, including both qualitative and quantitative data collection techniques to provide robust and trustworthy findings. KEYWORDS: Type 2 diabetes, quantitative method, middle-aged population, self-management. Many clinicians have reported that use of the PreDx test has motivated their highest-risk patients to make significant lifestyle changes that could delay or prevent the progression to type 2 diabetes.22 Albeit anecdotal, these clinician-reported changes in patient motivation are supported by a recent study by Markowitz et al.32 that looked at how genetic testing for diabetes risk affects motivation. J.W. There were no numeric data, but this research can dig in several points as a key factor to increase their awareness of diabetes. 2015 Aug;41(4):466-71. Accordingly, in a research article, C. J. Gaffney et al. Studies were identified from multiple databases and screened according to an a priori defined protocol. The OGTT is a specific indicator of diabetes risk and is considered to be the gold standard for detection of prediabetes.13 However, its complexity, poor reproducibility, associated costs, time requirements, and patient inconvenience often inhibit routine use in clinical practice.6,14,15 The OGTT is rarely performed for purposes other than clinical research and to assess glycemia status in women during pregnancy. The two sites had different characteristics: one specifically served uninsured adults in a rural area and the o… Few studies have explored how friends can provide constructive support in this effort. In addition, diabetes self-management is related to enhanced knowledge of diabetes, improved overall behaviour and discipline to adhere to diet and physical activity recommendations resulting in a better outcome. We focused our attention on lifestyle intervention efforts and his FPG had risen to 101 mg/dl pressure. 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