ABUAN, MA.

KRISTINA JEZELLE B BSN 4AA3

The Prevalence of Comorbid Depression in Adults With Diabetes A meta-analysis 1. 2. 3. 4. Ryan J. Anderson, BA1, Kenneth E. Freedland, PHD1, Ray E. Clouse, MD12 and Patrick J. Lustman, PHD13 +Author Affiliations 1. 1Psychiatry and 2. 2Medicine, Washington University School of Medicine 3. 3Department of Veterans Affairs Medical Center, St. Louis, Missouri
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Abstract
OBJECTIVETo estimate the odds and prevalence of clinically relevant depression in adults with type 1 or type 2 diabetes. Depression is associated with hyperglycemia and an increased risk for diabetic complications; relief of depression is associated with improved glycemic control. A more accurate estimate of depression prevalence than what is currently available is needed to gauge the potential impact of depression management in diabetes. RESEARCH DESIGN AND METHODSMEDLINE and PsycINFO databases and published references were used to identify studies that reported the prevalence of depression in diabetes. Prevalence was calculated as an aggregate mean weighted by the combined number of subjects in the included studies. We used 2 statistics and odds ratios (ORs) to assess the rate and likelihood of depression as a function of type of diabetes, sex, subject source, depression assessment method, and study design. RESULTSA total of 42 eligible studies were identified; 20 (48%) included a nondiabetic comparison group. In the controlled studies, the odds of depression in the diabetic group were twice that of the nondiabetic comparison group (OR = 2.0, 95% CI 1.82.2) and did not differ by sex, type of diabetes, subject source, or assessment method. The prevalence of comorbid depression was significantly higher in diabetic women (28%) than in diabetic men (18%), in uncontrolled (30%) than in controlled studies (21%), in clinical (32%) than in community (20%) samples, and when assessed by self-report questionnaires (31%) than by standardized diagnostic interviews (11%). CONCLUSIONSThe presence of diabetes doubles the odds of comorbid depression. Prevalence estimates are affected by several clinical and methodological variables that do not affect the stability of the ORs.

Lasting Effects of a 2-Year Diabetes SelfManagement Support Intervention: Outcomes at 1-Year Follow-Up
Tricia S. Tang, PhD; Martha M. Funnell, RN; Mary Oh, BS
Suggested citation for this article: Tang TS, Funnell MM, Oh M. Lasting Effects of a 2-Year Diabetes SelfManagement Support Intervention: Outcomes at 1-Year Follow-Up. Prev Chronic Dis 2012;9:110313. DOI: http://dx.doi.org/10.5888/pcd9.110313 .
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Abstract
Introduction Diabetes-related health improvements achieved from self-management education interventions are not sustained long-term. We examined the health effects at 1 year follow-up of a 2-year, empowerment-based, diabetes self-management support intervention designed for African Americans. Methods We collected data from 52 African American adults with type 2 diabetes who completed the 3-year study. The intervention consisted of weekly groups led by 2 health care professionals and emphasized experiential learning, emotional coping, problem solving, goal setting, and action planning; group discussion was guided by participant-identified self-management priorities and concerns. Measurements were taken at baseline, 24 months (postintervention), and 36 months (1 year followup) to assess glycemic control; weight; body mass index; serum cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels; systolic and diastolic blood pressure; selfcare behaviors; diabetes-specific quality of life; and diabetes empowerment. Results Following the 2-year diabetes self-management support intervention, we found significant improvements for following a healthy diet (P = .03), spacing carbohydrates evenly across the day (P = .005), using insulin as recommended (P = .047), and achieving diabetes-specific quality of life (P = .02). At 1-year follow-up, not only did participants sustain the behavioral improvements made in the 2-year diabetes self-management support intervention, but they also demonstrated additional improvements in glycemic control (P < .001) and in serum cholesterol (P < .001) and low-density lipoprotein cholesterol levels (P = .001). Conclusion Participation in an empowerment-based diabetes self-management support intervention may have a positive and enduring effect on self-care behaviors and on metabolic and cardiovascular health.

The Effect of Nurse-led Diabetes Selfmanagement Education on Glycosylated Hemoglobin and Cardiovascular Risk Factors: A Meta-analysis
1. 1. 1. 1. 1. 1. Jacques Kande Tshiang Tshiananga, MPH, MSc Serge Kocher Christian Weber Katrina Erny-Albrecht Karsten Berndt karsten.berndt@roche.com Kurt Neeser

Abstract
Purpose The purpose of this meta-analysis was to determine the effect of nurse-led diabetes self-management education (DSME) on blood glucose control and cardiovascular risk factors. Methods The electronic databases PubMed and ISIS Knowledge were searched for relevant randomized controlled studies published between 1999 and 2009. Effect size was calculated for change in A1C, blood pressure, and lipid levels using both fixed- and random-effects models. Subgroup analyses were performed on patient age, gender, diabetes type, baseline A1C, length of follow-up, and study setting. Results A total of 34 randomized controlled trials with a combined cohort size of 5993 patients was identified. Mean patient age was 52.8 years, 47% were male, and mean A1C at baseline was 8.5%. Mean change in A1C was a reduction by 0.70% for nurse-led DSME versus 0.21% with usual care (UC). This corresponded to an effect size of 0.506, using a random-effects model for nurse-led DSME versus UC. Effect size was significantly associated with patient age older than 65 years and with duration of followup. Nurse-led DSME was also associated with improvements in cardiovascular risk factors, particularly among male patients, among those with good glycemic control, and in studies conducted in the United States. Conclusions Nurse-led DSME is associated with improved glycemic control, demonstrating that programs are most effective among seniors and with follow-up periods of 1 to 6 months. Future programs tailored to the needs of patients younger than 65 years may improve the impact of DSME on blood glucose.

Primary Care Physician Referral Patterns to Diabetes Education Programs in Southern Ontario, Canada
Enza Gucciardi1 PhD MSc, Vivian Wing-Sheung Chan2 HBSc PhD (c), Mariella Fortugno1 BASc, Sobia Khan3 HBSc MPH (c), Stacey Horodezny4 BAA RD, Susan J. Swartzack5 BScN MPA RN
School of Nutrition, Ryerson University, Toronto, Ontario, Canada Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada 3Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada 4Trillium Health Centre, Toronto, Ontario, Canada 5Mississauga Halton Local Health Integration Network, Toronto, Ontario, Canada
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ABSTRACT
Objectives: Despite the reported benefits of diabetes selfmanagement

education (DSME), participation rates are low across North America. This study examines primary care physician (PCP) referral practices to diabetes education programs (DEPs) and factors that influence referral in a large suburban region in Ontario, Canada. METHODS: Ninety-nine PCPs practicing in the Peel and Halton regions of Ontario were sampled from the Ontario Medical Association membership list, and completed questionnaires were submitted online or by fax. Frequencies were tabulated for all responses. RESULTS: Fewer than half of PCPs referred all of their diabetes patients to DEPs. Common reasons for not referring were patients unwillingness to attend, lack of evening/weekend appointments, language barriers, long referral waiting lists and inconvenient location for patients. CONCLUSION: Fewer than half of PCPs surveyed followed the Canadian Diabetes Association recommendation to refer patients to DSME. Physician referral was found to be encumbered by patient, system and operational factors. DEPs need to tailor their programming to meet the needs of their community and to commit to more outreach services to increase PCP and patient access as well as awareness of DSME services. KEYWORDS: diabetes, education, primary care physicians, referral practices, self-management
Address for correspondence: Enza Gucciardi, School of Nutrition, Ryerson University 350 Victoria Street, Toronto, Ontario, Canada M5B 2K3. E-mail: egucciar@ryerson.ca

original research

Effects of Diabetes Self-Management Education on Glycaemic Control in Children With Insulin-Dependent Diabetes Mellitus
Ayesha Abdul Qayyum, Saira Waqar Lone, Mohsina Noor Ibrahim, Irum Atta and Jamal Raza

ABSTRACT
Objective: To evaluate the effect of diabetes self-management education (DSME) on glycaemic control (HbA1c) in Pakistani children suffering from type-1 diabetes mellitus. Study Design: Quasi-experimental study. Place and Duration of Study: This study was conducted at the Diabetic OPD of National Institute of Child Health, Karachi, from April to September 2009. Methodology: Sixty children with a mean age of 9.94 years with type-1 Diabetes mellitus (T1DM) were selected conveniently from the diabetic OPD. The patients along with their parents/caregivers attended a modular series of diabetes self-management education program consisting of 2 sessions. Customized program was designed to educate children regarding general information about the disease, basic insulin therapy, planning for hypoglycaemia, hyperglycaemia, activity, traveling and basic nutritional management. It was conducted by a multidisciplinary paediatric diabetes team including an endocrinologist, general paediatrician, nutritionist and diabetic nurse. The educational sessions were followed by monthly revision exercises. HbA1c levels were measured at baseline and after 3 months and compared using paired sample t-test. Results: Out of a total of 60 patients, 50 completed the trial. There was a significant decrease in the HbA1c levels after the DSME program. The mean pre- and postintervention HbA1c levels were 9.670.65 and 8.490.53 respectively with a p-value < 0.001. Conclusion: In the studied group, DSME programs helped to improve glycaemic control. It should be an integral part of patient treatment in diabetic care setups. Key words: Type-1 Diabetes mellitus. Diabetes self-management education. HbA1c. Children.