Running head: DIABETES MANAGEMENT PROGRAM STUDY

Diabetes Management Programs: Examination of a Diabetes Management Comparison Study

Leigh Anne Koonmen
Ferris State University

DIABETES MANAGEMENT

Examination of Diabetes Management Programs

Type II Diabetes Mellitus is a disorder in which excess glucose in the bloodstream is not
adequately taken up by the appropriate receptors due to an insulin resistance at the receptor sites
or an inadequate insulin production by the individuals pancreas (Hinkle and Cheever, 2014).
The overall therapeutic goal for diabetes management is to obtain normal serum glucose levels
through medication administration, nutritional therapy, exercise, education on the disease and its
processes, and careful monitoring of blood glucose levels (Hinkle and Cheever, 2014).
The nursing care problem addressed in this study is patient management of diabetes care
through the examination of two different methods of diabetes management programs and the
quality of each method in outcomes of diabetes when used in conjunction with standard medical
diabetes treatment plans. In this study, various aspects of the patients lives are measured and
evaluated to determine the effectiveness of one method of diabetes management over another.
Welch et al. (2011) identify that a medically determined diabetes treatment plan can significantly
reduce complications of Type 2 Diabetes, but can be better supported by adding diabetes
education and individualized, comprehensive lifestyle modifications, ultimately allowing the
patient to have better metabolic control as well as more positive outcomes (p. 681).
Method
Participants
Hispanic patients from a community health care center were randomly selected to
participate in the study. To be considered for the study participants were required to meet specific
criteria that included a diagnosis of Type 2 Diabetes Mellitus for at least one year, falling within
the age range of 30 to 85 years, an A1C measurement of 7.5% or greater (but not exceeding
14%) within the three months prior to the study, and to live an independent lifestyle that included
being able to perform walking exercises in addition to being able to attend seven one-hour studyrelated meetings over the course of a year. A patient would be excluded from consideration in the
study if they have severe complications as a result of diabetes (Welch et al., 2011).

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Procedure
Participants were randomly assigned to one of two groups: the attention control group, of
which 18 of the participants were assigned, and the intervention group, of which 21 of the
participants were assigned. The participants in the attention control group attended one hour
bicultural/bilingual diabetes management meetings seven times throughout the course of a year
that were conducted by trained clinic support staff. At the attention control group meetings,
diabetes education booklets were reviewed that covered such topics as dietary, medication,
exercise, blood glucose monitoring, and eye and foot care information (Welch et al., 2011). The
participants in the intervention group also attended one hour bicultural/bilingual diabetes
management meetings seven times throughout the course of a year that were conducted by
certified diabetes nurses and dietitians. Individuals in the intervention control group additionally
participated in a Comprehensive Diabetes Management Program (CDMP), in which each
individual patients medical and social history was thoroughly examined by the diabetes
management team and interventions were established to best treat that individual.
At the end of a year, the researchers evaluated the effectiveness of each method of
diabetes management by comparing baseline levels obtained at the start of the study to levels
obtained at the end. Factors measured in the study include A1C level, blood pressure, blood
glucose levels, eye and foot care practices, prophylactic use of aspirin for cardiovascular risk
reduction, and levels of emotional distress related to diabetes diagnosis (Welch et al., 2011).
Results
The findings of this study revealed that those participants who were involved in the
CDMP group had significant improvements across multiple assessment levels in comparison to
those participants in the attention control group. For example, results showed a significant
difference in decreased blood glucose levels between the two groups, with participants from the
CDMP group having a greater decrease than those in the attention control group. Additionally,

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A1C levels, blood pressure readings, eye screenings, and foot exam screenings were all found to
be more desirable for those participants in the CDMP group versus the attention control group.
The levels of diabetes-related stress between the two groups proved to be another interesting
finding obtained from the results of the study, showing decreased levels from baseline in the
CDMP group and increased levels from baseline in the attention control group (Welch et al.,
2011).
Examination of the Study
This study is important to the field of nursing in that it examines the importance of
thorough management of a disease down to the individual level. Patient outcomes were greatly
improved by thorough diabetes education as well as careful examination of individual health and
social factors that allowed for treatment modifications that best suited each individual patient
without excluding any cultural considerations. This study highlighted that simply providing
medical treatment and an overview on diabetes management information is not enough to
significantly improve patient outcomes, and may in fact cause the patient more distress. It is the
responsibility of the nurse to be an advocate by ensuring that the diabetic patient is receiving the
best medical treatment for their individual needs, while also providing them with thorough
education and access to assistance programs that can help the patient with their diabetes
management.
Relevant nursing diagnoses to this study include Ineffective Health Maintenance,
Knowledge Deficit, and Risk for Infection. Observing for signs of infection and educating the
patient and family members on the disease process are two nursing interventions that are
important to these nursing diagnoses. A desired outcome for a diabetic patient through the
identification of a nursing diagnosis and its intervention is to achieve and maintain ideal blood
glucose levels.

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Limitations to this study include the age of the participants, which excludes children and
young adults with diabetes, and the culture-specific population, which focused solely on
Hispanics. Treatments may vary for different age groups (e.g., one hour meetings may not be the
best method for diabetes education when the participants are young children) as well as for
participants of different cultural backgrounds, who may have different beliefs and attitudes
towards health and healthcare than the Hispanic participants.
This study highlights the individual and cultural needs of the participants and provides a
framework for future studies to examine the effectiveness of these diabetes management
programs across other ages, cultures, and disease processes. Therefore, the relevance of this
study to daily nursing practice is very high in that it provides an evidence based methodology to
obtain results that show a significant benefit to patients.

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References
Hinkle, J.L., & Cheever, K.H. (2014). Brunner & Suddarths Textbook of Medical-Surgical
Nursing (13th ed.). Philadelphia: Lippincott Williams & Wilkins.
Welch, G., Allen, N.A., Zagarins, S.E., Stamp, K.D., Bursell, S.E, & Kedzioram R.J. (2011).
Comprehensive diabetes management program for poorly controlled Hispanic type 2
patients at a community health center. The Diabetes Educator, 37(5), 680-688.
doi: 10.1177/0145721711416257