By Jane Seley, NP, BC-ADM, CDE. Seley coordinates the Diabetes Under Control column in AJN and is a diabetes nurse practitioner at New York Presbyterian/Weill Cornell.
I’m at the American Diabetes Association (ADA) 70th Scientific Sessions, which takes place from June 25-June 29th in Orlando. The ADA Scientific Sessions is an important forum for diabetes researchers and clinicians from all over the world to present research findings, network, and share ideas.
There are over 17,000 health care professionals registered from all over the world, 700 speakers, 2000 research posters, and 175 device and pharmaceutical company exhibitors. Every year, new diabetes treatments and technologies are discussed and displayed. Some highlights of sessions so far:
1) Implications of U.S. health care reform on the care and prevention of diabetes: Health care reform has the potential to have a huge impact on the millions of people with prediabetes and diabetes who have inadequate or no insurance coverage. Many of our patients have to make difficult decisions around checking blood glucose and taking insulin because of the high cost of medications and supplies and poor reimbursement. People with diabetes can spend hundreds of dollars every month for medication and self-management supplies. Nurses need to be proactive in assisting patients in accessing all available resources and lobbying for better reimbursement for diabetes care.
2) Pancreas not to blame in gastric bypass–related hypoglycemia: Hypoglycemia that may occur post gastric bypass surgery was thought to be a result of abnormal pancreatic islet cells. A recent study found that the beta cells in the pancreas function properly postoperatively. The mechanism of post gastric bypass hypoglycemia remains a mystery. As nurses, we have to monitor our patients carefully postoperatively and make sure that diabetes medications are appropriately reduced if the insulin requirements dramatically decline.
3) The symposium on “What influences what we eat?” by Amy Ozier, PhD, RD, an expert in eating disorders and obesity at Northern Illinois University, was well received. Dr Ozier is creator of the EADES (Eating & Appraisal Due to Emotions and Stress) Questionnaire. She discussed the psychological and physical factors that modulate how much we eat. Ozier uses the questionnaire to assess whether eating is a response to stress and emotions and examines coping mechanisms. When caring for a patient with hyperglycemia or a high A1c indicating poor glycemic control, we need to look at contributing factors such as overeating as well as what may be triggering the behavior. Ozier has studied overeating and believes that binge eating is a maladaptive behavior. In other words, when we are caring for patients with poor glycemic control, we need to look beyond their glucose levels and what they eat, and pay closer attention to why they eat. If we do not identify triggers, we will be far less successful in helping people with diabetes plan their meals and count carbohydrates.
4) The results of HEALTHY, a three-year NIDDK (National Insitute of Diabetes and Digestive and Kidney Disease)-funded study, conducted in 42 schools in the US, looked at whether improving school food selections and physical activity programs could lower the risk of type 2 diabetes in 4,603 middle school students. The students’ BMI was measured in sixth grade, with half considered overweight or obese with a BMI of >85th percentile according to age and gender. Besides being overweight, many of the students came from high-risk ethnic backgrounds: 54% Hispanic, 18% black; 15% had a first-degree relative with type 2 diabetes (parent or sibling) and 75% were from low-income households.
Intervention: All food provided in the school (cafeteria, snack bars, vending machines) had lower fat choices with more fruits, vegetables, grains, legumes, low calorie desserts, water and low fat milk to choose from. Half of the 42 schools received the intervention, the other half served as the comparison group. Intervention schools offered a minimum of 225 minutes of moderate to vigorous physical activity/ for every 10 days during the study period . By the end of year three, the number of students in the ALL schools with a BMI of >85th percentile decreased by 4%. The percentage of overweight/obese children declined from 50% at the onset of the study to 46% at the end. Although the BMI decreased the same in both groups, the intervention group had a statistically significant greater improvement in decreasing waist circumference and insulin levels (an important risk factor for insulin resistance and the development of type 2 diabetes), The research group will continue to analyze the data to see why the BMI dropped equally in both groups.
How can nurses have a positive impact on the food and physical activity offered to our children? School nurses and parents should seek greater involvement in the food that is available in schools and in the content of physical activity programs. Early intervention can influence the health of our children for the rest of their lives. Ask questions, find out what is being done, and offer our expertise for guidance. Francine Kaufman, MD, a pediatric endocrinologist, former president of the ADA and author of Diabesity: A Doctor and Her Patients on the Front Lines of the Obesity-Diabetes Epidemic, successfully worked with the Los Angeles School District to change the drinks and snacks placed in vending machines in schools from junk food to healthier choices.
5) Yesterday, I attended a great symposium on New Technologies in Diabetes Education. The first speaker, Guillaume Charpentier, MD, from France discussed the use of mobile and Web technology in diabetes management. Charpentier believes that this technology has the potential to prevent episodes of hyperglycemia and hypoglycemia by advising the patient along the way, instead of waiting until the next office visit. Specially designed “smart” cellphone applications can integrate with glucose meters and transfer data and reports. These interactive devices then allow the provider to text message helpful suggestions in response to glucose patterns. This technology is just beginning to appear in the U.S., with many unanswered questions around reimbursement for provider time, confidentiality concerns, and liability if the provider does not respond immediately.
CHARMR. Kate Rutter from Adaptive Path, a design consulting firm in San Francisco, discussed the process of how her company took on the 2008 DiabetesMine Design Challenge to design a diabetes product that would make it easier to live with diabetes. They examined all of the things you need to do on a daily basis to care for one’s diabetes and created an integrated blood glucose meter/continuous glucose monitor known as CHARMR. CHARMR is easy to wear, easy to operate, and does not look like a medical advice. Please keep in mind that CHARMR is a concept design, not an available product. Think about what this would mean to our patients, making it easy for them to live with their diabetes day by day.
The next exciting speaker in this session was Kshitij Shankdhar, a physician from India who has developed an ever-expanding library of MOBI films to provide diabetes education to both health care professionals and patients. Shankdhar went to filmmaking school and learned how to improve sound, sight and design to make his films more interesting to watch. He demonstrated how simple it is to create a MOBI film, step by step. These MOBI films can be text messaged to patients and professionals, and the learning begins . . .
The last speaker was Margaret Grey, DrPH, RN, FAAN and Dean of the Yale School of Nursing. Her topic, TeenCope- Using the Internet to Engage Teens, discussed the challenges of providing diabetes education and motivation to teenagers with Type 1 diabetes. TeenCope engages teens using an Internet-based interactive coping skills program to help teens with Type 1 diabetes deal with common difficult situations. A community is created where participants can interact with other teams living with the same chronic illness. Although it was too soon to report the data, Grey expressed her delight in the level of patient engagement the Website has achieved, judging by the high number of participants that enter the program each time new content is made available and complete the exercises. It is time for us to reexamine our former nursing strategies for caring for patients with chronic illness, and seek innovative strategies such as TeenCope utilizing new technology that is available to us.