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Patients with diabetes have physical and psychological issues due to chronic illness. According to the guidelines of the Chinese Diabetes Society, after the diagnosis of patients with diabetes, they should receive routine health education, but this is the passive installation method of education. Nurses have made important contributions to the follow-up, education, and support of patients with diabetes and their families. The objective of this study was to evaluate the effectiveness of nurse-led follow-up care in routine health education and follow-up for patients with diabetes. Medical records of 721 patients with type 1 and type 2 diabetes were reviewed. Patients received nurse-led follow-up care including educational programs + Tai Chi exercises (patients received nurse-led follow-up care including educational programs for 6 months, n = 108), routine health education and follow-up + Tai Chi exercises (patients received routine health education and follow-up for 6 months, n = 205), or Tai Chi exercises only, but did not receive nurse-led follow-up care or routine health education and follow-up (patients received Tai Chi exercises only for 6 months, n = 408) for 6-months. The Zung Self-Rating Depression and Anxiety Scale and Summary of Diabetes Self-Care Activities were used to evaluate anxiety, depression, and self-care activities, respectively. Before the start of follow-up care (BFC), knowledge regarding diabetes and its threat was ≤1.75, anxiety and depression scores were ≥52 each, and self-care activities were ≤37. After 6 months of follow-up care, patients in the patients received nurse-led follow-up care including educational programs for 6 months improved their knowledge regarding diabetes and its threat, anxiety, depression, and self-care activities as compared to their before the start of follow-up care conditions and patients in the RF and patients received Tai Chi exercises only for 6 months at after 6 months of follow-up care conditions (P < .001 for all). Chinese type 1 or 2 diabetes patients had worse physical and psychological conditions and less knowledge regarding diabetes and its threat. Nurse-led aftercare, including educational programs with Tai Chi exercises for 6 months, decreased anxiety and depression and improved knowledge regarding diabetes and its threat and self-care activities in diabetic patients (Level of Evidence: IV; Technical Efficacy: Stage 5).

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Background: Despite the innovative advancements in diabetes care, providers may not recognize patients with type 2 diabetes mellitus (T2DM) who qualify for a continuous glucose monitoring (CGM) device or the benefits of a telemedicine program for improving self-management behaviors. Objective: This quality improvement (QI) project aimed to determine if an advanced practice registered nurse (APRN)-led telemedicine program using CGM could improve glycemic control and self-management in patients with insulin-dependent T2DM. Methods: A 6-week telemedicine program was developed and implemented using the CGM's time-in-range to deliver patient-specific education. Clinical metrics were collected at each visit. All patients completed a pre- and postintervention Diabetes Self-Management Questionnaire-Revised (DSMQ-R) survey. Results: A repeated measures analysis of variance revealed that the telemedicine program had a statistically significant impact on time-in-range outcomes, F(2, 14) = 18.203, p < .001. Paired-samples t tests indicate that APRN-led education improved body mass index, t(8) = 4.232, p = .002; decreased systolic blood pressure, t(8) = 2.90, p = .010, and diastolic blood pressure, t(8) = 3.21, p = .007; and increased self-management skills as evidenced by DSMQ-R, t(8) = -5.498, p < .001. Conclusions: This QI project highlights multiple interventions for improving diabetes management in a primary care facility. Implications for Nursing: An APRN-led telemedicine program integrating CGM time-in-range data can improve glycemic control and self-management skills in patients with T2DM who administer insulin.

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BACKGROUND: The comorbidity of acute coronary syndrome and diabetes affects patient prognoses. Therefore, it is important to manage these diseases simultaneously. PURPOSE: In this study, the effect of nursing counseling on treatment compliance was investigated in patients who had received surgical treatment for acute coronary syndrome and had been recently diagnosed with diabetes. METHODS: A quasi-experimental design with pretest-posttest control group was used. The study sample consisted of 60 patients (intervention group = 30, control group = 30). The data were collected using a patient information form, the Patient Learning Needs Scale, and the Scale for Patient Compliance with Type 2 Diabetes Mellitus Treatment. This study was conducted in compliance with the Transparent Reporting of Evaluations with Nonrandomized Designs checklist. RESULTS: The intervention group earned significantly higher posttest scores on the Patient Learning Needs total scale and subscales than the control group. Moreover, intervention group compliance with treatment was higher than that of the control group. Furthermore, although significant improvements were found in the average posttest body mass index, fasting blood glucose, HbA1c, total cholesterol, triglyceride, and low-density lipoprotein cholesterol values of the control group, the between-group differences in these values were not significant. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: It is important for nurses to provide counseling services that align with the learning needs of their patients. Also, nursing counseling units should be created and staffed by both specialist nurses and nurse trainers working in healthcare institutions.

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BACKGROUND: Type 2 diabetes can lead to severe foot complications, making self-care education, guided by clinical guidelines, crucial. However, fragmented and dispersed recommendations challenge effective implementation of these guidelines. Bringing together recommendations and presenting them according to a self-care model can provide a solid framework and facilitate the interpretation of results. AIMS: to map the international guidelines that provide recommendations to nurses to enable people with type 2 diabetes for foot self-care and synthesize the recommendations according to the key concepts of the middle-range theory of self-care for chronic diseases. DESIGN: A scoping review was undertaken, using the methodological guidance of the Joanna Briggs Institute. DATA SOURCES: Databases were searched between September 2022 and June 2023, including PubMed, CINAHL, PsycINFO, Scopus, Web of Science Core Collection, ProQuest Dissertations and Theses Global, guideline websites and related professional association websites. The databases were chosen for their comprehensive coverage of the area. METHODS: Eligible articles included guidance documents providing foot care recommendations for diabetes, published or updated between 2013 and 2023. Two reviewers summarized the recommendations presented in at least two guidelines according to the key concepts of the self-care model. The PRISMA-ScR checklist was used. RESULTS: Seventeen guidelines were included. In total, we synthesized 175 recommendations. The recommendations were framed in three dimensions and their respective categories: Self-care maintenance (education for prevention, control of risk factors, daily foot care, footwear, and socks), Self-care monitoring (foot inspection, detection of signs of infection, and detection of other diabetes-related foot disease complications), and Self-care management (responses to signs and symptoms, foot wound care, follow-up with health professionals, and health services). CONCLUSIONS: The main aspect of foot care revolves around daily care, including cleaning, moisturizing, nail care, selecting appropriate footwear, and regular inspection of both feet and footwear.

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AIM: A limited number of studies discuss the changes in patients' self-care skills and needs for assisted self-care after discharge from in-patient treatment due to diabetes foot ulcer-related complications. The aim of this study was to examine the ability to perform self-care and needs for assisted nursing interventions at hospital discharge, compared to pre-admission, for people with diabetes admitted and treated for foot ulcer-related complications. DESIGN: Retrospective patient record study. METHODS: A retrospective assessment was done on the medical records of a total of 134 patients with diabetes consecutively admitted to a specialist in-patient unit due to foot ulcer complications, between 1 November 2017 and 30 August 2018. Data on daily self-care needs and home situations at admission and discharge were recorded. RESULTS: The median age was 72 years (38-94), 103 (76.9%) were men and 101 (73.7%) had diabetes type 2. The median length of admission was 10 days (2-39). Infection was the most common cause of admission (51%), with severe ischaemia in 6%, and a combination of both in 20% of patients. Surgical treatment was performed in 22% and vascular intervention in 19% of patients. The percentage of patients discharged to their home without assistance was 48.1% compared to 57.5% before admission, discharge to home with assistance was 27.4% versus 22.4% before admission and 9.2% were discharged to short-term nursing accommodation versus 6% before admission. Three patients died during their stay in hospital. The need for help with medications increased from 14.9% of patients at admission to 26.7% at discharge and for mobility assistance from 23.1% to 35.9%. Social services at home were increased in 21.4% of patients at discharge.

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In community nursing, the administration of insulin for people with type 2 diabetes can be delegated by registered nurses to healthcare support workers. Although a voluntary framework in England provides national guidance, little is known about its uptake. The project aim was to determine the roll-out, characteristics and support needs in relation to the delegation of insulin administration in community settings. An online survey was disseminated to community nursing services in England via social media and nursing networks. Of the 115 responding organisations, 81% (n=93) had an insulin delegation programme, with most initiated since 2018. From these services, 41% (n=3704) of insulin injections were delegated daily, with benefits for patients, staff and services reported, along with some challenges. Delegation of insulin administration is an established and valued initiative. Awareness of the national voluntary framework is increasing. National guidance is considered important to support governance arrangements and safety.

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BACKGROUND: The COVID-19 pandemic resulted in decreased access to routine diabetes care in rural areas and adversely affected self-management of diabetes. METHODS: This article describes a descriptive pretest-posttest study conducted to assess efficacy in managing hemoglobin A1C (A1C) among patients with type 2 diabetes mellitus (T2DM) using a continuous glucose monitoring (CGM) system for 1 year. RESULTS: A total of 14 participants completed the Diabetes Mellitus Self-Efficacy Scale survey. Of those 14, 11 used CGM for 1 year; of the 11 who maintained CGM use, A1C levels improved in 9. CONCLUSIONS: Results indicate that CGM combined with medication management positively impacts self-efficacy in managing A1C levels among patients with T2DM. Interdisciplinary collaboration optimizes patient outcomes.

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BACKGROUND: Complications related to diabetes mellitus impose substantial health and economic burdens to individuals and society. While clinical practice guidelines improve diabetes management in primary care settings, the variability in adherence to these guidelines persist. Hence, there is a need to comprehensively review existing evidence regarding factors influencing nurses' adherence to implementation of clinical practice guidelines to improve clinical care and patient safety. OBJECTIVE: This integrative review seeks to investigate nurses' adherence to clinical guidelines for diabetes management in primary healthcare settings and to explore factors influencing effective implementation, focusing on the role of nurses and impacts on patient outcomes. METHODS: A comprehensive search was conducted in March 2023 across six electronic databases. The search targeted studies that examined the use of Type 2 diabetes mellitus guidelines by nurses in primary healthcare settings with a focus on clinical management outcomes related to diabetes care or patient safety. Included studies were classified using the Effective Practice and Organisation of Care taxonomy, synthesised narratively and presented thematically. Reporting of the review adhered to PRISMA guidelines. (PROSPERO ID CRD42023394311). RESULTS: The review included ten studies conducted between 2000 and 2020, and the results were categorised into three themes. These were: (i) Implementation strategies to promote clinical practice guidelines adherence, including health professional development, reminders for clinicians, patient-mediated interventions, health information systems, role expansion, and comprehensive package-of-care. A multifaceted educational approach emerged as the most effective strategy. (ii) Impact of guidelines adherence: These strategies consistently improved clinical management, lowering HbA1c levels, improving blood pressure and lipid profiles, and enhancing patient self-care engagement, along with increased nurses' adherence to diabetes clinical guidelines. (iii) The role of nurses in guideline implementation, enabling independent practice within multidisciplinary teams. Their roles encompassed patient education, collaborative practice with fellow healthcare professionals, program planning and execution, and comprehensive documentation review. Nurse-led interventions were effective in improving patient outcomes, underscoring the necessity of empowering nurses with greater autonomy in providing primary diabetes care. CONCLUSION: Implementing a diverse range of strategies, focusing on comprehensive education for healthcare providers, is paramount for enhancing guideline adherence in diabetes care, to improve clinical management towards optimal patient health outcomes. Tailoring these strategies to meet local needs adds relevance to the guidelines. Empowering nurses to take a leading role in primary care not only enhances patient safety but also promotes quality of care, resulting in improved overall outcomes. TWEETABLE ABSTRACT: In primary care, empowering nurses with diabetes guideline education and tailoring strategies to local needs enhance guideline adherence and improve patient outcomes.

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Objetivo: determinar el impacto del confinamiento domiciliario por la pandemia de COVID-19 sobre el control de la hemoglobina glicosilada (Hb1Ac) y el riesgo cardiovascular de personas diabéticas residentes en una zona rural de Cataluña, así como su autopercepción del control de la enfermedad.Método: estudio descriptivo longitudinal retrospectivo con personas diagnosticadas de DM2 usuarias de los servicios de Atención Primaria del Institut Català de la Salut, en el área rural del Ripollés (Cataluña, España). Se recogieron datos de la historia clínica sobre: Hb1Ac, riesgo cardiovascular (según la ecuación Framingham-REGICOR), edad, sexo, tabaquismo, tensión arterial, peso, índice de masa corporal y variables bioquímicas; tanto antes como después del confinamiento y se compararon. Además, se les administró un cuestionario ad hoc sobre salud autopercibida.Resultados: participaron N= 233 personas con una edad media de 69,8 (DE: 10) años, mayoritariamente hombres (56,2%) y no fumadores (90,3%). El 46,3% tenía un buen control de Hb1Ac preconfinamiento que aumentó al 48,1% (p= 0,555). No se detectaron diferencias significativas entre el promedio de HbA1c antes (7,26; DE: 1,17) y después (7,28; DE:1,23) del confinamiento. La mayoría de los participantes tenía un riesgo cardiovascular medio (51,4%) o alto (25,7%) y aumentó 0,11 puntos posconfinamiento (p= 0,307). El 18% de los encuestados (N= 42) percibió un empeoramiento del control de la DM2 tras el confinamiento, principalmente debido al sedentarismo (42,8%) y a cambios en la dieta (21,4%).Conclusiones: el confinamiento no generó impacto en los niveles de Hb1Ac en el riesgo cardiovascular, ni en la autopercepción del manejo de la DM2 de los pacientes con diabetes de un área rural.(AU)

Objective: to determine the impact of home confinement due to the COVID-19 pandemic on the control of glycosylated hemoglobin (Hb1Ac) and cardiovascular risk in diabetic persons living in a rural area of Catalonia, as well as their self-perception of disease controlMethod: a descriptive longitudinal retrospective study with persons diagnosed with T2D and users of the Primary Care services of the Institut Català de la Salut, in the rural area of Ripollés (Catalonia, Spain). Data were collected from clinical records about: Hb1Ac, cardiovascular risk (according to the Framingham-REGICOR equation), age, gender, smoking, blood pressure, weight, body mass index and biochemical variables, both before and after lockdown; and they were compared. Besides, an ad hoc questionnaire on self-perceived health was administered.Results: the study included N= 233 persons with a mean age of 69.8 (SD: 10) years, mostly male (56.2%) and non-smoking (90.3%). Of these, 46.3% had good control of their Hb1Ac before the confinement, which increased to 48.1% (p= 0.555). No significant differences were detected between the average HbA1c before (7.26; SD: 1.17) and after the confinement (7.28; SD:1.23). The majority of participants had medium (51.4%) or high cardiovascular risk (25.7%), and this increased by 0.11 points post-confinement (p= 0.307). There was a perception of worsening in their T2D after the confinement by 18% of participants (N= 42), mainly due to sedentarism (42.8%) and changes in their diet (21.4%).Conclusions: lockdown did not generate any impact on Hb1Ac levels in cardiovascular risk, or in the self-perception of T2D management of patients with diabetes in a rural area.(AU)

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Atualmente o envelhecimento da população e consequentemente o aumento da prevalência das doenças crónicas tornam-se numa das transformações sociais e de saúde mais significativas do século XXI. A identificação desta problemática leva à necessidade de identificar novas respostas. Perante este cenário agravado pela pandemia por Sars-Cov-2, importa destacar a necessidade da gestão das doenças crónicas, nomeadamente a Diabetes Mellitus Tipo2 (DM2). As evidências científicas têm realçado que o uso a teleconsulta pode ser eficaz no tratamento e melhoria dos resultados clínicos em pessoas idosas com DM2, nomeadamente através da telemonitorização. Neste sentido, o cuidado de enfermagem através da teleconsulta por telefone pode ajudar a promover condições que permitam à pessoa idosa promover o Cuidado-de-Si própria, de acordo com o seu projeto de vida, mas também ao familiar cuidador assegurar o Cuidado do Outro em situação de dependência parcial ou total, de acordo com o modelo de parceria de Gomes (2021). No âmbito da pandemia por SARS-Cov-2, surgiu a necessidade de reestruturar e implementar a teleconsulta de enfermagem direcionada à população idosa com Diabetes Mellitus Tipo2 (DM2) incluindo os familiares cuidadores na USFX utilizando a metodologia de projeto. Desta forma, elaborámos um projeto de estágio que pretendeu dar continuidade a um já iniciado anteriormente pelas mestrandas que estagiaram anteriormente nesta unidade (Oliveira, A. & Moniz, S., 2021). O projeto que desenvolvemos teve como objetivo desenvolver competências de enfermeiro especialista e mestre na prestação de cuidados de enfermagem à pessoa idosa com DM2 e familiares cuidadores através da teleconsulta de enfermagem e simultaneamente contribuir para a capacitação dos profissionais de enfermagem de uma USF no desenvolvimento de competências para a implementação da mesma. Como resultado das atividades desenvolvidas, salientamos a realização de uma revisão scoping que nos permitiu mapear a evidência da temática em estudo, a realização de um planeamento estruturado para teleconsulta de enfermagem à pessoa idosa com DM2 e a implementação e avaliação do mesmo com a realização de um estudo qualitativo com a metodologia de estudo de caso múltiplos, que permitiu perceber a capacitação das pessoas idosas para o Cuidado-de-Si com a implantação desta intervenção. Desta forma podemos concluir que os maiores ganhos da teleconsulta de enfermagem são a possibilidade de prestar cuidados de maior proximidade, vigilância e resposta adequada e atempada perante situações complexas/urgentes como é o caso da DM2.

Nowadays, the aging of the general population, and consequently, the increase in the prevalence of chronic diseases, became one of the most significant social transformations of the XXI century. The existence of this problem created a need for new answers and new solutions. Given this scenario, aggravated by the pandemic of Sars-Cov-2, it's important to highlight the need to manage chronic diseases, namely, Type 2 Diabetes Mellitus (DM2). The scientific evidence has emphasized the effectiveness of the teleconsultation concept in the treatment, and improvement of clinical results in elderly people affected with DM2, namely through a process of telemonitorization. In this sense, nursing care through teleconsultation by phone can help promote certain conditions that allow the elderly person to adopt a Self-Care regime, according to their life project, but also for the family caregiver to ensure the Care of the Other in a situation of partial or total dependence, according to the partnership model by Gomes (2021). In the context of the SARS-Cov-2 pandemic, the need arose to restructure and implement a nursing teleconsultation, aimed at the elderly population with Type 2 Diabetes Mellitus (DM2), including family caregivers at USFX, using the project methodology. In this way, we created an internship project that intended to continue the one already started by the master's students who had previously been interns in this Health Care Unit (Oliveira, A. & Moniz, S., 2021). The project we prepared, was aimed at the development of specialist and master nursing skills in the clinical care of elderly people with DM2, and family caregivers, through a nursing teleconsultation and simultaneously contributing to the training of nursing professionals in a USF in the development of skills for its implementation. As a result of the activities developed, we emphasize, the elaboration of a scoping review that allowed us to map the evidence of the subject under study, the creation of structured planning for a nursing teleconsultation for the elderly person with DM2, and the implementation and evaluation of the patient with the realization of a qualitative study, using the methodology of multiple case studies, which made it possible to perceive the capacity of elderly people for Self-Care with the implementation of this intervention. In this way, we can conclude that the greatest gains from nursing teleconsultation are the possibility of providing closer care, surveillance, and adequate and timely response to complex/urgent situations such as DM2.

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Objetivo: analisar a efetividade da relação interpessoal no cuidado de enfermagem e sua relação com as práticas de autocuidado geral e com os pés em pessoas com diabetes tipo 2. Método: estudo transversal, analítico, realizado em um Hospital Universitário, com 150 pessoas com diabetes tipo 2 que responderam ao Questionário relação interpessoal no cuidado de enfermagem, questionário de atividades de autocuidado com diabetes e questionário da avaliação da adesão ao autocuidado com os pés. Resultados: os resultados mostraram que a efetividade da relação interpessoal no cuidado variou de moderada a alta. Os escores do questionário mostraram significância comorbidades nefropatia, acidente vascular encefálico, aderir à dieta e receber orientações sobre cuidados som os pés. Conclusão: a relação interpessoal no cuidado efetiva pode fortalecer a criação de vínculos, a confiança e verbalização de sentimentos, contribuindo para melhoria na educação em diabetes e para adesão de comportamentos de autocuidado.

Objectives: to analyze the effectiveness of the interpersonal relationship in nursing care and its relationship with general self- care and foot care in people with type 2 diabetes. Method: this cross-sectional, analytical study was conducted at a University Hospital with 150 people with type 2 diabetes who answered the Interpersonal Relationship in Nursing Care Questionnaire, a questionnaire on self-care activities with diabetes, and a questionnaire to assess adherence to feet self-care. Results: the results showed that the effectiveness of the interpersonal relationship in care ranged from moderate to high. The questionnaire scores were significant with nephropathy comorbidities, cerebrovascular accident, diet adherence, and receiving foot care guidance. Conclusion: interpersonal relationships in effective care can strengthen bonding, trust, and verbalization of feelings, improving diabetes education and adherence to self-care behaviors.

Objetivos:analizar la efectividad de la relación interpersonal en el cuidado de enfermería y su relación con las prácticas generales de autocuidado y con los pies en personas con diabetes tipo 2. Método: estudio transversal, analítico, realizado en un Hospital Universitario, con 150 personas con diabetes tipo 2 que respondieron el Cuestionario de Relación Interpersonal en el Cuidado de Enfermería, cuestionario sobre actividades de autocuidado con diabetes y cuestionario para la evaluación de adherencia al autocuidado con los pies. Resultados:los resultados mostraron que la efectividad de la relación interpersonal en el cuidado varió de moderada a alta. Los puntajes del cuestionario mostraron significación con las comorbilidades de la nefropatía, el accidente cerebrovascular, la adherencia a la dieta y recibir orientación sobre el cuidado de los pies. Conclusión:la relación interpersonal en el cuidado efectivo puede fortalecer la creación del vínculo, la confianza y la verbalización de los sentimientos, contribuyendo para una mejoría en la educación en diabetes y la adherencia a las conductas de autocuidado.

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OBJECTIVE: To identify the key characteristics of practice nurses' communication with people living with Type 2 Diabetes (T2D) where lifestyle activities are discussed. METHODS: A scoping review of the peer-reviewed literature was conducted. Reflexive thematic analysis was used to identify key themes that emerged. The PRISMA-ScR checklist was followed. RESULTS: 25 studies were retained in the final review. Nurses who were committed to engaging in lifestyle discussions created supportive environments and built rapport to enable change conversations. However, this was present in just 20% of the studies. In most studies, (60%) nurses continued to use traditional health education communication styles, had little understanding of behaviour change theories, lacked skills in behaviour change counselling and were reluctant to engage in behaviour change discussions with people with T2D . CONCLUSIONS: Nurses require a deeper understanding of behavioural change theories and skills in behavioural counselling. PRACTICE IMPLICATIONS: Practice nurses have a unique opportunity to facilitate T2D remission by engaging in evidence-based behaviour change communication. A behaviour change training intervention is needed that recognises the environment of practice nurse consultations. It needs to be pragmatic and fully consider the enablers and barriers to addressing behaviour change in both the nurse and the person with T2D.

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People with diabetes frequently have elevated diabetes distress. Although mindfulness-based stress reduction (MBSR) therapy has been shown effective in reducing diabetes distress, it has only been delivered by psychologists or a multidisciplinary team with an attrition rate of up to 39%, which limits its dissemination to a broader audience. This study was aimed to pilot evaluate the feasibility of a nurse-led MBSR therapy and explore its potential efficacy amongst people with type 2 diabetes mellitus. A total of 100 participants were randomly allocated either to the intervention group (nurse-led MBSR therapy + regular diabetes education) or the control group (regular diabetes education). Data on diabetes distress, diabetes self-efficacy, and diabetes self-management were collected at baseline, 8 and 12 weeks. Hemoglobin A1c (HbA1c) was collected at baseline and 12 weeks. A generalized estimating equation analysis for repeated measures was used to determine intervention and time effects. As predicted, the nurse-led MBSR therapy had a significant time-by-group interaction effect on diabetes distress total score (95% confidence interval [CI]: 0.58-0.77, p < 0.001), diabetes self-efficacy (95% CI: -0.93 to -0.74, p < 0.001), diabetes self-management (95% CI: -10.80 to -7.83, p < 0.001), and HbA1c levels (95% CI: 0.04-1.14, p = 0.03) in the intervention group compared with the control group over 12 weeks. This is the first nurse-led MBSR therapy in a hospital setting that is feasible and has the potential to improve health outcomes. This approach may offer an innovative model to deliver MBSR therapy. A randomized controlled trial comparing the nurse-led MBSR plus usual diabetes education with usual diabetes education along with a mechanism to equalize intervention attention between the groups is indicated.

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OBJECTIVE: Diabetes is the fifth leading cause of death in the People's Republic of China. The aim of the article is to compare the effects of nursing care on the laboratory findings and ultrasound results of diabetic patients with chronic liver diseases (CLD) who were treated with antiglycemic drugs. METHODS: Diabetic were patients treated with metformin hydrochloride in combination with gliclazide, pioglitazone hydrochloride, sitagliptin, exenatide or liraglutide. Non-alcoholic fatty liver disease (NAFLD) was evaluated by abdominal ultrasound, and fibrosis stages were evaluated at baseline and 8 months. All the patients were equally divided into two groups depending on the therapeutic approach. RESULTS: The first group of patients additionally received nursing care, and the second group adhered to the prescribed therapy on their own. In total 90 patients, or 55.6%, had NAFLD at baseline, and its course was dependent upon changes in the weight (P = 0.009) and waist circumference (P = 0.012). The proportions of patients who demonstrated an ultrasonographic improvement in the control group were: 24 (56.8%) with gliclazide, 15 (41.3%) with pioglitazone hydrochloride, 28 (66.1%) with sitagliptin, 16 (79%) with exenatide and 15 (66.7%) with liraglutide (P = 0.2). For the group that received nursing care an ultrasonographic improvement was in: 29 (68.16%) with gliclazide, 18 (49.56%) with pioglitazone hydrochloride, 33 (79.32%) with sitagliptin, 19 (94.8%) with exenatide and 21 80.04% with liraglutide (P = 0.2). CONCLUSIONS: Outcomes from the type 2 diabetes treatment paralleling of CLD were presented. Treatment of type 2 diabetes with pioglitazone hydrochloride, gliclazide, sitagliptin, liraglutide and exenatide was proven effective.

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Objetivo: avaliar os fatores de risco do diagnóstico de enfermagem Risco de glicemia instável em pessoas idosas com diabetes mellitus tipo 2. Método: estudo transversal realizado com 152 pessoas idosas atendidas na atenção primária de agosto a outubro de 2021. Na consulta de enfermagem, avaliaram-se dados clínicos, perda de sensibilidade protetora plantar e checklist com fatores de risco do Risco de glicemia instável da NANDA. Empregaram-se análise descritiva e testes de associação. Resultados: 46,7% apresentaram HbA1c ≥ 7,0 e maior prevalência dos fatores de risco: Conhecimento insuficiente sobre o controle da doença (p<0,001); Conhecimento insuficiente sobre os fatores modificáveis (p<0,001); Controle insuficiente do diabetes (p<0,001); Falta de adesão ao plano de controle do diabetes (p=0,002); e Monitorização inadequada da glicemia (p<0,001). Conclusão: os fatores de risco foram relacionados ao conhecimento insuficiente e à falta de manejo com a doença, ressaltando a importância do enfermeiro no planejamento de cuidados adequado.

Objective: to assess the risk factors of the nursing diagnosis Risk of unstable glycemia in elderly people with type 2 diabetes mellitus. Method: cross-sectional study carried out with 152 elderly people assisted in primary care from August to October 2021. In the nursing consultation, clinical data, loss of plantar protective sensitivity and a checklist with risk factors of unstable NANDA glycemia risk were evaluated. Descriptive analysis and association tests were used. Results: 46.7% had HbA1c ≥ 7.0 and higher prevalence of risk factors: Insufficient knowledge about disease control (p<0.001); Insufficient knowledge about modifiable factors (p<0.001); Insufficient control of diabetes (p<0.001); Lack of adherence to the diabetes control plan (p=0.002); and Inadequate blood glucose monitoring (p<0.001). Conclusion: risk factors were related to insufficient knowledge and lack of management with the disease, emphasizing the importance of nurses in the planning of appropriate care.

Objetivo: evaluar los factores de riesgo del diagnóstico de enfermería Riesgo de glucemia inestable en ancianos con diabetes mellitus tipo 2. Método: estudio transversal realizado con 152 ancianos atendidos en la atención primaria de agosto a octubre de 2021. En la enfermería consulta, se evaluaron datos clínicos, pérdida de sensibilidad protectora plantar y se utilizó la lista de verificación con factores de riesgo de NANDA Riesgo para glucemia inestable. Se utilizaron análisis descriptivos y pruebas de asociación. Resultados: 46,7% tenían HbA1c ≥ 7,0 y mayor prevalencia de factores de riesgo: Insuficiente conocimiento sobre control de la enfermedad (p<0,001); Conocimiento insuficiente sobre factores modificables (p<0,001); control insuficiente de la diabetes (p<0,001); Falta de adherencia al plan de control de la diabetes (p=0,002); y Monitoreo inadecuado de glucemia en sangre (p<0.001). Conclusión: los factores de riesgo se relacionaron con el conocimiento insuficiente y la falta de administración de la enfermedad, destacando la importancia de los enfermeros en la planificación de la atención adecuada.

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Objetivo: Determinar la eficacia de una intervención de enfermería de soporte social al adulto para el autocontrol de la diabetes mellitus tipo 2. Método: Ensayo Clínico Aleatorizado de tipo paralelo en una muestra de 94 sujetos, 47 sujetos asignados al grupo de intervención y 47 sujetos asignados al grupo control, que recibió la atención convencional. Los desenlaces primarios fueron el autocontrol y el soporte social, evaluados en tres momentos (pre - post y seguimiento al mes de finalizada la intervención) con las etiquetas de resultados de enfermería Autocontrol: diabetes (1619) y Soporte social (1504). La intervención de enfermería de soporte social fue diseñada con base en la Teoría de Autocontrol Individual y Familiar, y en evidencia científica; posteriormente validada por consenso de expertos. Resultados: El efecto de la intervención para el resultado Autocontrol: diabetes, mostró una diferencia estadísticamente significativa (p = <0.001) entre los grupos, en las mediciones pre - post, y pre - seguimiento. Para el resultado Soporte Social, también hubo una diferencia estadísticamente significativa (p = <0.001) entre los grupos, en las mediciones pre - post, y pre - seguimiento. Conclusiones: se pudo comprobar que la intervención de enfermería de soporte social en el adulto es más eficaz para el autocontrol de la diabetes mellitus tipo 2 que la atención convencional. De esta manera, se hace necesario considerar la implementación de esta intervención en la práctica de enfermería.

Objective: To determine the effectiveness of a social support intervention for adults for the self-management of type 2 diabetes mellitus. Method: Randomized clinical trial of parallel type in a sample of 94 subjects, 47 subjects assigned to the intervention group and 47 subjects assigned to the control group, who received conventional care. The primary outcomes were self-management and social support, evaluated in three moments (pre-post and follow-up one month after the end of the intervention) with the nursing result labels Self-management: diabetes (1619) and Social support (1504). The social support intervention was designed based on the Individual and Family Self-management Theory, and on scientific evidence; subsequently validated by expert consensus. Results: The effect of the intervention for the outcome Self-management: diabetes, showed a statistically significant difference (p = <0.001) between the groups, in the pre-post and pre-follow-up measurements. For the Social Support outcome, there was also a statistically significant difference (p = <0.001) between the groups, in the pre-post and pre-follow-up measurements. Conclusions: it was found that social support intervention in adults is more effective for self-management of type 2 diabetes mellitus than conventional care. Thus, it is necessary to consider the implementation of this intervention in nursing practice.

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Data-driven characterization of symptom clusters in chronic conditions is essential for shared cluster detection and physiological mechanism discovery. This study aims to computationally describe symptom documentation from electronic nursing notes and compare symptom clusters among patients diagnosed with four chronic conditions-chronic obstructive pulmonary disease (COPD), heart failure, type 2 diabetes mellitus, and cancer. Nursing notes (N = 504,395; 133,977 patients) were obtained for the 2016 calendar year from a single medical center. We used NimbleMiner, a natural language processing application, to identify the presence of 56 symptoms. We calculated symptom documentation prevalence by note and patient for the corpus. Then, we visually compared documentation for a subset of patients (N = 22,657) diagnosed with COPD (n = 3339), heart failure (n = 6587), diabetes (n = 12,139), and cancer (n = 7269) and conducted multiple correspondence analysis and hierarchical clustering to discover underlying groups of patients who have similar symptom profiles (i.e., symptom clusters) for each condition. As expected, pain was the most frequently documented symptom. All conditions had a group of patients characterized by no symptoms. Shared clusters included cardiovascular symptoms for heart failure and diabetes; pain and other symptoms for COPD, diabetes, and cancer; and a newly-identified cognitive and neurological symptom cluster for heart failure, diabetes, and cancer. Cancer (gastrointestinal symptoms and fatigue) and COPD (mental health symptoms) each contained a unique cluster. In summary, we report both shared and distinct, as well as established and novel, symptom clusters across chronic conditions. Findings support the use of electronic health record-derived notes and NLP methods to study symptoms and symptom clusters to advance symptom science.

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AIM: To develop and examine the preliminary effects of a nurse-led, community-based diabetes self management education and support program on clinical outcomes, self care behaviours, quality of life and family support through a pilot randomized controlled trial among adults living with type 2 diabetes in Western Ethiopia. METHODS: A two-arm parallel-group pilot randomized controlled trial involving participant-caregiver dyads will be conducted. A total of 76 dyads will be recruited, with 38 dyads randomly allocated to the intervention arm receiving six sessions of the diabetes self management education and support program supported by an educational handbook, flier and video on top of the usual care; the control arm will continue to receive the usual care. The intervention will be guided by social cognitive theory and related international guidelines for diabetes management, addressing misconceptions, using culturally tailored foods and involving family members in the intervention. Participants will be recruited at Nekemte Specialized Hospital over 2 months. Nurses will deliver the intervention in the community in Nekemte, western Ethiopia. Diabetes self​ care behaviour, quality of life, family support, glycosylated haemoglobin, body mass index, blood pressure and lipid profiles will be assessed. Descriptive statistics will summarize the sociodemographic variables of the dyads; people living with diabetes' clinical outcomes, self care behaviours, quality of life and the level of family support; family caregivers' behaviours; and the acceptability level. Cohen's d will be computed to estimate the effect size. TRIAL REGISTRATION: The Chinese Clinical Trial Registry prospectively registered the trial, and the registration number was ChiCTR2000040292.

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BACKGROUND: Home care services plays an important role in diabetes management, and to enable older adults remain home-dwellers. Adequate follow-up and systematic nursing documentation are necessary elements in high quality diabetes care. Therefore, the purpose of this study was to examine the diabetes treatment and management for older persons with diabetes receiving home care services. METHODS: A cross-sectional study was used to assess the diabetes treatment and management in a Norwegian municipality. Demographic (age, sex, living situation) and clinical data (diabetes diagnose, type of glucose lowering treatment, diabetes-related comorbidities, functional status) were collected from electronic home care records. Also, information on diabetes management; i.e. follow-up routines on glycated haemoglobin (HbA1c), self-monitoring of blood glucose, insulin administration and risk factors (blood pressure, body mass index and nutritional status) were registered. HbA1c was measured upon inclusion. Descriptive and inferential statistics were applied in the data analysis. RESULTS: A total of 92 home care records from older home-dwelling persons with diabetes, aged 66-99 years were assessed. Only 52 (57 %) of the individuals had the diabetes diagnosis documented in the home care record. A routine for self-monitoring of blood glucose was documented for 27 (29 %) of the individuals. Only 2 (2 %) had individual target for HbA1c documented and only 3 (3 %) had a documented routine for measuring HbA1c as recommended in international guidelines. Among 30 insulin treated older individuals, a description of the insulin regimen lacked in 4 (13 %) of the home care records. Also, documentation on who performed self-monitoring of blood glucose was unclear or lacking for 5 (17 %) individuals. CONCLUSIONS: The study demonstrates lack of documentation in home care records with respect to diagnosis, treatment goals and routines for monitoring of blood glucose, as well as insufficient documentation on responsibilities of diabetes management among older home-dwelling adults living with diabetes. This indicates that home care services may be suboptimal and a potential threat to patient safety.

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