This paper provides a broad overview of diabetes education, examining the nature of diabetes as a chronic disease, the populations most at risk, and the range of interventions available for management. It discusses dietary strategies, physical activity, electronic education platforms, and behavioral therapy as tools for controlling blood glucose. The paper also addresses self-care competencies across age groups — particularly school-age children — and outlines the collaborative team approach to diabetes management. It concludes by reviewing the American Diabetes Association's clinical practice recommendations and the growing role of electronic education in improving patient outcomes such as LDL and HbA1C levels.
Diabetes is considered a chronic disease that requires long-term nursing and medical intervention. Research shows that patients also need to take an active part in their own treatment and management, and to alter their lifestyles in order to keep their metabolic state at a normal level (Sperl-Hillen, 2010). One significant transformation in education is electronic learning. This approach is notable because it offers unique features that users find engaging, makes it possible to learn anywhere, facilitates both individual and group learning, and allows material to be tailored to users' specific needs. In the last decade, it has become increasingly clear that the Internet has become a rich source of healthcare data, supporting health services, private and public education, healthcare, and counseling.
Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both (Marzieh Moattari, 2012). Research shows that diabetes can lead to severe complications and premature death; however, individuals with diabetes are able to take steps to control the disease and reduce the risk of complications.
Diabetes affects approximately 25 million adults and children in the United States, even though one-third are not even aware that they have it. There are another estimated 54 million Americans who have what is called pre-diabetes, meaning they are at risk of developing the disease. African-Americans have higher incidence rates and greater disability from diabetes complications — such as visual impairment, kidney failure, and amputations — than other groups. In ideal situations, African-Americans with diabetes will have their disease under good control and continue to be monitored regularly by a healthcare team well-informed in the care of this serious but manageable disease.
Based on available statistics, the impact of diabetes among older adults is very high compared to other age groups. The high infection rate among the aging population is connected to the growing number of elderly individuals in the American population, the lifestyle factors that make them especially susceptible to the disease, and economic conditions that affect their dietary habits. Combined with the limited physical activity common among older people, these factors make it critically important to direct diabetes management strategies toward this age group in order to reduce the rate at which they are affected (Sperl-Hillen, 2010).
Type 2 diabetes is diagnosed at alarmingly high rates among ethnic and racial minorities in the U.S. Diabetes is considerably more common among Latinos, African-Americans, Native Americans, Pacific Islanders, and Asian-Americans than among Caucasians (Whittemore, 2012).
Risk for type 2 diabetes increases with age, especially after age 45. Being overweight or obese is another important risk factor — particularly when excess weight is carried around the waist. Individuals younger than 45 can develop type 2 diabetes if they have a strong genetic predisposition and are overweight (EIJJ, 2009). One study led by Dr. Caballero and his team at the Latino Diabetes Initiative at Joslin found that overweight Hispanic children also have significant abnormalities in their circulation (endothelial dysfunction), placing them at much greater risk not only for type 2 diabetes but also for cardiovascular disease.
Other risk factors include a family history of type 2 diabetes, an inactive lifestyle, high levels of fat in the blood (particularly high triglycerides and/or low HDL cholesterol), high blood pressure, a history of gestational diabetes, or having pre-diabetes. Having these risk factors does not mean you will develop diabetes, but it does mean you should be screened for it regularly.
Research shows that physical activity and exercise alone have only a modest weight-loss effect. However, exercise and physical activity are still strongly encouraged because they improve insulin sensitivity independent of weight loss, significantly lower blood glucose, and play an important role in long-term weight maintenance (EIJJ, 2009). Further research indicates that behavioral therapy alone also produces modest weight loss, and behavioral methods are most valuable as a complement to other weight-loss approaches.
Standard weight-loss diets typically prescribe 500–1,000 fewer calories than estimated for weight maintenance, initially producing a loss of approximately 1–2 pounds per week (Marjatta Kelo, 2011). Although many individuals can lose some weight — as much as 13% of initial body weight within six months — with various types of diets, individuals typically regain the weight they lost without ongoing support and follow-up.
Research indicates that meal replacements — whether solid prepackaged or liquid — provide a defined quantity of energy, frequently in the form of a formula product (Marjatta Kelo, 2011). Using meal replacements once or twice daily to substitute a typical meal can result in significant weight loss. Meal replacements are also an important component of the Look AHEAD weight-loss intervention (Sperl-Hillen, 2010); however, meal replacement treatment must be continued indefinitely if weight loss is to be maintained.
Very-low-calorie diets providing approximately 800 calories per day produce significant weight loss and rapid improvements in lipemia and glycemia in people with type 2 diabetes (Whittemore, 2012). When very-low-calorie diets are discontinued and self-selected meals are resumed, weight regain is typical. As a result, very-low-calorie diets appear to have limited utility in the management of type 2 diabetes and should only be considered as part of an organized weight-loss program.
Electronic education intervention is another approach based on an educational website designed to train patients with diabetes (Marzieh Moattari, 2012). The site covers educational topics and includes frequently asked questions, educational videos, forums, chat rooms, a question-and-answer section, useful links, and patients' personal records, with password-protected access to the latter. Educational content was selected based on established resources and the patient education site maintained by the American Diabetes Association. A panel of experts selected material appropriate for patients, organized under four key categories: type of diabetes, diabetes and diet, prevention of diabetes complications, and general content.
Individuals with diabetes should receive medical care from a team that may include doctors, nurse practitioners, physician assistants, nurses, dietitians, pharmacists, and mental health specialists with expertise and a particular focus in diabetes. It is essential in this collaborative, integrated team approach that people with diabetes take an active role in their care.
The management plan should be developed as a cooperative, supportive partnership among the patient and family, the physician, and other members of the healthcare team (Marzieh Moattari, 2012). A variety of approaches and techniques should be used to provide adequate education and to develop problem-solving skills across the many areas of diabetes management. Implementation of the management plan requires that goals and treatment strategies be individualized and take patient preferences into consideration. The management strategy should recognize diabetes self-management education (DSME) and ongoing diabetes support as essential elements of care. In developing the plan, consideration should be given to the patient's age, school or work schedule and conditions, physical activity level, eating patterns, social situation, cultural issues, and the presence of diabetes complications or other medical conditions.
"Self-care skills and children's diabetes management"
"Gaps in patient information and need for education systems"
"Evidence-based standards and individualized care goals"
Marzieh Moattari, M.H. (2012). The impact of electronic education on metabolic control indicators in patients with diabetes who need insulin: A randomised clinical control. Journal of Clinical Nursing, 22, 32–38.
Sperl-Hillen, J. (2010). Are benefits from diabetes self-management education sustained? American Journal of Managed Care, 104–113.
Whittemore, R. (2012). An Internet coping skills training program for youth with type 1 diabetes. Nursing Research, 61(6), 395–404.
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