Posts Tagged ‘type 2 diabetes’

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Paired Glucose Testing With Telehealth Support to Empower Type 2 Diabetes Patients

February 13, 2015

Jacob Molyneux, senior editor

bloodglucosetestingType 2 diabetes is challenging for those trying to meet blood glucose target ranges, often requiring one or more daily medications, increases in exercise, changes in eating habits, and self-monitoring of glucose level. Those who are willing and able to learn about factors affecting their glucose level and to make small daily efforts in one or more areas have the potential to radically improve their sense of control over their diabetes.

This month’s Diabetes Under Control column, “Better Type 2 Diabetes Self-Management Using Paired Testing and Remote Monitoring” (free until April 1), presents a successful story of patient engagement in diabetes self-management. It describes the case of a participant in a clinical trial who, with clinician support, incorporated paired glucose testing (self-testing before and after meals) and telehealth (remote patient monitoring, or RPM).

The article is easy to follow and gives a series of biweekly updates on the patient’s progress. Before the study starts, she’s not very engaged in self-management. For example, she’s only testing her own glucose level three to four times a month. To get a sense of how much more empowered she’s come to feel by week 12 of the protocol, consider this brief excerpt: Read the rest of this entry ?

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AJN in February: Rapid Response Teams, Complications of CHD Repair, Managing Type 2 Diabetes, More

January 29, 2015

AJN0215 Cover OnlineAJN’s February issue is now available on our Web site. Here’s a selection of what not to miss.

Rapid response teams (RRTs) are teams of expert providers who can be called on in an emergency to treat patients before their condition deteriorates. The success of an RRT depends on whether it is activated properly, a task that often falls to staff nurses. The original research article, “Hospital System Barriers to Rapid Response Team Activation: A Cognitive Work Analysis,” describes the factors affecting nurses’ decisions to activate RRTs. This CE feature offers 3 CE credits to those who take the test that follows the article.

Further explore this topic by listening to a podcast interview with the author (this and other free podcasts are accessible via the Behind the Article podcasts page on our Web site, in our iPad app, or on iTunes).

Long-term complications after congenital heart defect (CHD) repair. Nurses often encounter patients with complications that occurred years after CHD repair. “Long-Term Outcomes After Repair of Congenital Heart Disease: Part 2” reviews four common CHDs, their repairs, common long-term outcomes, and implications for nurses in both cardiac and noncardiac settings. This article offers 2.5 CE credits to those who take the test that follows the article.

Making nurses full partners in reforming health care. The Institute of Medicine’s report, The Future of Nursing: Leading Change, Advancing Health, suggests that nurses should be full partners in reforming health care in this country. “A Bold New Vision for America’s Health Care System” is the first in a series that will revisit the report’s recommendations and the progress that has been made toward making them realities. Read the rest of this entry ?

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AJN’s December Issue: Staffing Issues, Wandering in Dementia, Type 2 Diabetes Meds, More

November 30, 2012

AJN’s December issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles, which you can access for free.

Data from the Military Nursing Outcomes Database project demonstrate that inadequately staffed shifts can increase the likelihood of adverse events. But what does this mean for the average nurse on a shift? In “Staffing Matters—Every Shift,” the authors present common dilemmas hospitals face in nurse staffing, illustrating the potential hazards for patients and nurses alike. This CE article is open access and can earn you 2.1 CE credits.

People with dementia are at risk for both missing incidents and wandering. In “Missing Incidents in Community-Dwelling People with Dementia,” the authors differentiate between these two risks, describe personal characteristics that may influence the outcomes in missing incidents, and suggest strategies for preventing and responding to missing incidents. This CE article is open access and can earn you 2.1 CE credits. For more information, listen to a podcast with the authors.

There is a growing consensus that primary care providers can better address patients’ needs by using different models of care, such as the patient-centered medical home. “The Patient-Centered Medical Home” discusses the guiding principles of this model, nurse care coordination, reimbursement and implementation, cost-effectiveness and quality improvement, and the need for greater nurse advocacy.

Being unaware of the realities of licensure can damage a nurse’s career, even permanently. “Professional License Protection Strategies,” the third and final article in a three-part series on nursing boards’ disciplinary actions, discusses strategies for protecting one’s nursing license.

Nearly 26 million people in the United States have diabetes and over a quarter of these are unaware of their condition. “Recent Safety Updates on Type 2 Diabetes Medications” offers providers an overview of current treatments, as well as their risks and benefits to help when deciding on drug therapy for specific patients.

And for an exploration of how bias in health care affects transgender patients, read “The Ethical Nursing Care of Transgender Patients.”

There is plenty more in this issue, so stop by and have a look. Feel free to tell us what you think on Facebook or our blog.

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Individualized A1c Targets for Type 2 Diabetes

October 23, 2012

By Jane Seley, DNP, MPH, MSN, BC-ADM, CDE, diabetes nurse practitioner at New York Presbyterian/Weill Cornell Hospital, New York City

On April 19th, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) released a joint position statement online that represented a giant step forward in the care of people with type 2 diabetes. “Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach” is a comprehensive yet easy to read primer in the most up-to-date therapies, one that also emphasizes individualizing care as the key to success.

An example of the patient-centered approach of this position statement is a refinement of the customary across-the-board hemoglobin A1c test target recommendation of less than 7% for most people with type 2 diabetes, with pre-meal blood glucose (BG) targets of less than 130 mg/dL and post-meal targets of less than 180 mg/dL. The position statement suggests “more stringent” targets of 6%–6.5% for “selected” patients who are younger and in good health, but safer targets of 7.5%–8% for older patients who have comorbidities or are prone to hypoglycemia.

When discussing therapeutic options, each medication is ranked according to its potential for lowering A1c, risk of hypoglycemia, effect on weight, adverse effects, and cost. In addition, the clinician is encouraged to individualize the treatment regimen by considering age, weight goal, and comorbidities such as heart disease and kidney function. For example, if losing weight is an important consideration for the patient, then a medication that may assist in weight loss such as metformin (oral agent) or a GLP-1 receptor agonist (injectable) would be good choices. A weight-neutral alternative would be a DPP-IV inhibitor (oral agent).

The position statement reminds us that lifestyle changes are a priority, with a focus on weight optimization, healthy meals, and increased activity levels. My favorite part of this document is the recommendation that treatment decisions be made in partnership with the patient, with a focus on each individual’s preferences, needs, and values.

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