A holistic approach to educating and empowering patients with diabetes can significantly improve their health, according to a new study led by diabetes nurse educators from NewYork-Presbyterian Hospital's Ambulatory Care Network. Participants in the study enrolled in a Diabetes Self-Management and Education program (DSME) to reduce their blood sugar, blood pressure and cholesterol levels.
Nearly one in 11 Americans have diabetes, a chronic condition associated with serious complications.
Presented at the American Association of Diabetes Educators annual meeting on August 8, the study included 1,263 diabetic patients in a low-income immigrant population in Northern Manhattan. As part of the DSME program's multifaceted approach, participants underwent a comprehensive initial assessment and received four 30-minute individual sessions with a diabetes nurse educator, followed by group sessions focused on reinforcing self-management behaviors and individual goals. Individual patient sessions concentrated on helping patients achieve their goals, while group sessions helped give patients a deeper understanding of their condition and the implications of their actions.
The program's components concentrated on seven self-care behaviors: healthy eating, physical activity, monitoring vital signs, medication management, problem solving, healthy coping and risk reduction. Using the holistic medical home approach to care, patients were referred to specialty services, such as endocrinologists, ophthalmologists, podiatrists, dentists, dietitians, social workers and other providers on an as needed basis.
"Apart from assessing a patient's physical condition," said the study's lead educator, Yesenia Cabral, BSN, RN, disease care manager, NewYork-Presbyterian/Ambulatory Care Network, "nurse educators asked patients questions, actively listened to their responses and engaged them in conversation to capture critical information about their lifestyle and eating habits, medication adherence, stress management, self-care and a host of related issues. For example, since most patients forget to take their medication from time to time, we talk about what actually happens to the body when it doesn't receive the proper medication dosage at the proper time. That really hits home the importance of compliance. As nurses, we believe that organized patient education can empower patients and lead to better outcomes."
After 15 months, participants on average lowered their A1C (blood sugar) levels by 67 percent and their LDL cholesterol levels by 53 percent. Twenty-five percent of participants had high blood pressure at the end of the study, versus 32 percent beforehand. Also noteworthy, there was a 7 percent increase in participants with a recommended AIC below 7 percent at the conclusion of the study. The A1C test, which measures blood glucose levels, is an indicator of how well diabetes is being managed.
"What sets this program apart is its patient-centered approach," said the study's lead investigator, Lovelyamma Varghese, MS, FNP, BC, RN, director of nursing practice and quality and DSME for NewYork-Presbyterian/Ambulatory Care Network. "Nurse educators forge a strong bond with patients to help them build a foundation of knowledge and a sense of control over their condition, which allows them to manage the myriad challenges they face in making powerful changes to keep diabetes under control and avoid complications. We are able to go into their homes, speak their language and identify opportunities for behavioral changes. It's was a win-win partnership for everyone." She adds that the educators also partner with providers, dietitians, nurses, and community health workers to implement the program.
As a result of the study's impressive results, best practices culled from this program are being implemented throughout New York-Presbyterian/Ambulatory Care Network.