nursing research topics on diabetes

The clinical effectiveness of nursing models of diabetes care: A synthesis of the evidence

Affiliations.

• 1 Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand. Electronic address: [email protected].
• 2 Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
• 3 Nurse Maude, 24 McDougall Ave, Christchurch, New Zealand.
• PMID: 30908959
• DOI: 10.1016/j.ijnurstu.2019.03.004

Objectives: To determine the clinical effectiveness (glycemic control, other biological measures, cost-effectiveness and patient satisfaction) of primary care nurse-led interventions for diabetes.

Design: A systematic review following methods described for complex interventions and using PRISMA guidelines for reporting was undertaken. Nurse-led care for diabetes can be regarded as a complex intervention requiring the measurement of more than one outcome and for this reason we chose a range of outcomes clinical (symptoms), patient-centred (experiences) and organisational (cost-effectiveness).

Data sources: An extensive literature search using MEDLINE (PubMed) EMBASE, and CINAHL was conducted.

Review methods: Primary studies with adults in primary care with both quantitative (comparison with physician-led care and cost-effectiveness) and qualitative (patient experiences of nurse-led care) methodologies from 2003 until June 2018. All studies were appraised using the Cochrane Collaboration's tool for assessing risk of bias. The appraisal involved evaluation of the degree of risk of bias in selection, performance, detection, attrition and reporting. Because of the complexity of multiple outcomes (quantitative and qualitative) a narrative synthesis was undertaken.

Results: The search generated 18 published studies that met our eligibility criteria. Three randomized controlled trials and one historical control trial found statistically significant differences in glycemic levels in favour of the nurse-led interventions. Two cluster randomized trials, two randomized pragmatic trials and two randomized controlled trials found no differences between groups. The three open-label studies found statistically significant improvements in HbA1c levels. The audit identified that more patients had lower HbA1c levels after the initiation of a nurse-led intervention. Three randomized controlled trials found significant improvements in biological outcomes and one did not. The four studies measuring cost-effectiveness found the nurse-led intervention was associated with less costs. Four studies examined patient satisfaction with nurse-led care and found this was very good.

Conclusion: This review which incorporated a broad range of studies to capture the complexity of nurse-led interventions has identified that there is evolving evidence that nurse-led interventions for community treatment of diabetes may be more clinically effective than usual physician-led care.

Keywords: Clinical effectiveness; Diabetes; Nurse; Nursing; Primary care; Systematic review.

Copyright © 2019 Elsevier Ltd. All rights reserved.

Publication types

• Blood Glucose / analysis
• Cost-Benefit Analysis
• Diabetes Mellitus / blood
• Diabetes Mellitus / nursing*
• Middle Aged
• Models, Nursing*
• Nurse-Patient Relations
• Patient Satisfaction
• Blood Glucose

• Call to +1 844 889-9952

189 Diabetes Research Topics & Essay Examples

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• Type 2 Diabetes Effect on African American Community The paper focuses on an effective learning program that will create awareness about Type 2 diabetes so that members can avoid behavior that may put them at the risk.
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• Support for Diabetes Using Technology by Hunt et al. Although technology applications can be used in the self-management of diabetes, people need to understand the multifaceted treatment plan.
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• Indicators in Black Diabetes Mellitus Type II Patients This paper aims to analyze the importance of the variables and their topicality to the chosen PICOT question about black diabetes mellitus type II patients.
• The BlueStar Diabetes Mobile Health Application The mobile health application "BlueStar Diabetes" is advised for the client to help improve his quality of life and prevent any complications.
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• Type 2 Diabetes Mellitus and Coronary Artery Disease The paper demonstrates that type 2 diabetes mellitus and coronary artery disease (CAD) can cause the symptoms of feeling extremely tired and gaining weight.
• Diabetes and Healthy People 2020 The paper will address diabetes from the point of view of Healthy People 2020 and discuss diabetes' impact on individual health and the overall health of the nation.
• Type 2 Diabetes Prevention: Health Promotion Program The prevention of type 2 diabetes can be accomplished by ensuring that patients exercise, maintain a proper diet, get an annual physical, and participate in lifestyle seminars.
• Diabetes Intervention as Evidence-Based Practice Project The development of artificial pancreas technology provides an opportunity for more effective and safe treatment that is ongoing 24/7.
• Rapid Weight Loss in Elderly Diabetic Patient The paper discusses about measures for diagnostic causes problem of weight loss in diabetic and importance of right diagnostics.
• Quality Healthcare: Measuring NP Performance Out of six domains of care proposed by the National Committee for Quality Assurance, the paper focuses on such domains as the effectiveness of care.
• Diabetes in Children: Policies and Programs Diabetes is a chronic disease, the onset of which is caused due to the lack of insulin produced by the pancreas or organism's inability to use this insulin.
• Reducing Hospital Readmissions Among Diabetes Patients This paper proposes to use several strategies that may not only improve outcomes in patients with diabetes but also reduce related workload and cost burden on the industry.
• Constant Glucose Monitoring in Diabetic Patients The paper discusses the importance of Constant Glucose Monitoring in diabetic patients. It includes that GCM improves treatment satisfaction.
• Health Belief Model in Diabetes Care It is important to note that diabetes is a chronic condition where an individual’s body experiences issues with blood sugar regulations.
• The Type 2 Diabetes Patient Education Knowledge of type 2 diabetes and mortality from this disease will help to raise awareness of patients in this matter.
• A Diabetes Patient's Challenging Experiences The current paper provides one with a better understanding of individuals’ experiences with chronic illnesses and associated vulnerabilities.
• Reducing Hospital Readmissions With Diabetes The current paper will review the ways of reducing frequent hospital readmissions among the population of patients with diabetes.
• Type 2 Diabetes Treatment Plan for Teenager The patient is a female teenager who goes to high school and frequently attends soccer practice, as she is the goalie of the soccer team.
• Factors That Affect the Increase of Type 2 Diabetes Worldwide
• Diabetes Mellitus and Contemporary Naturopathic Medicine
• Glucose Tolerance Tests Accuracy in Diagnosing Diabetes
• Metformin and Biliary Tract Cancer in Patients With Type 2 Diabetes
• Diabetes Among Ethnic Minorities and the Aging Population
• Diabetes, Ethnicity, and Genetics
• Type Two Diabetes Mellitus as a Disease That Discriminates Against Lifes
• Medications Adherence and Associated Factors Among Patients With Type 2 Diabetes Mellitus in the Gaza Strip, Palestine
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• Obesity and Diabetes: Implications for Brain-Immunometabolism
• Optimizing Exercise for the Prevention and Treatment of Type 2 Diabetes
• Obesity and Diabetes: Energy Regulation by Free Fatty Acid Receptors
• Living With Diabetes: The Benefits of a High Fat and Low Carbohydrate Diet
• Sex and Gender Aspects in Diabetes
• Childhood Obesity and Its Correlation With Type 2 Diabetes
• Diabetes Mellitus and Erectile Dysfunctions
• Vegetarian and Vegan Diets on Type 2 Diabetes Management
• Genetic Origins and Interventions of Insulin-Dependent Diabetes Mellitus
• Understanding Autoimmune Diabetes Through the Prism of the Tri-Molecular Complex
• Mediterranean Diet and Type 2 Diabetes
• Alzheimer’s Disease and Type 2 Diabetes: A Critical Assessment of the Shared Pathological Traits
• Novel Biomarkers for Type 2 Diabetes
• Family-based Diabetes Intervention for Hispanic Adults and Their Family Members
• Type Two Diabetes Mellitus Among African Americans
• Diabetes Alters Activation and Repression of Pro- And Anti-inflammatory Signaling Pathways in the Vasculature
• Diabetes: All About the Disease, Its Causes, Effects, Treatments, and Possible Future Treatments
• Diabetes Health and Prevention for Asian Americans
• Traditional and Alternative Medicine for Type Two Diabetes
• Camel Milk and Its Effects on People With Type One Diabetes
• Diabetes, Pancreatic Cancer, and Metformin Therapy
• Platelet Measurements and Type 2 Diabetes: Investigations in Two Population-based Cohorts
• Gestational Diabetes and How To Treat the Disease During Pregnancy
• Connecting Alzheimer’s Disease With Diabetes Mellitus Through Amyloidogenic Evolvability
• Phosphatidylserine-liposomes Promote Tolerogenic Features on Dendritic Cells in Human Type 1 Diabetes by Apoptotic Mimicry
• Factors That Affect the Health Condition of Diabetes
• Native Americans and the Effects of Diabetes
• Type 1 Diabetes Symptoms, Causes, Diagnosis, and Treatments
• Asian Indians With Prediabetes Have Similar Skeletal Muscle Mass and Function to Those With Type 2 Diabetes
• Diabetes and Complementary and Alternative Therapies
• Diabetes Disease and Its Effect on the Digestive System
• Type One Diabetes and the Consequences
• What Are the Screening Tools for Type 1 Diabetes?
• How Does Insulin Help Diabetes Be Controlled?
• What Is the Prophylaxis To Prevent Type 2 Diabetes?
• How Does Diabetes Not Cause Depression?
• Why Are Approximately 1,800 New Cases of Diabetes Diagnosed in America Every Day?
• Does Alcohol Decrease the Risk of Diabetes?
• What Is the Relationship Between Excess Iron and Type 2 Diabetes?
• Does Overeating Cause Diabetes, Cavities, Acne, Hyperactivity and Make You Fat?
• How Fat and Obesity Cause Diabetes?
• What Is Nephrogenic Diabetes Insipidus?
• What Are the Effects of Diabetes on the Peripheral Blood Vessels and the Consequences?
• How Diabetes Insipidus Takes Place in the Human Body?
• Cell-Based Therapy for Type 1 Diabetes: Should We Take Hyperglycemia Into Account?
• What Is the Prevalence and Statistics of Diabetes in Australia?
• How Diabetes Mellitus Changes Urine Formation?
• What Is the Public Awareness of Diabetes?
• Can Diabetes Become Preventable?
• What Are the Main Causes and Treatments of Diabetes?
• Can Exercising and Dieting Prevent People From Type 2 Diabetes?
• What Is Pharmacotherapy and How Does It Help in the Treatment of Type 2 Diabetes?
• Can Coffee Reduce the Risk of Diabetes?
• What Factors Are Involved in the Increasing Prevalence of Type II Diabetes in Adolescents Living in Sub-saharan Africa?
• Is It Possible to Manage Diabetes Through Diet and Weight Control?
• What Is the Relationship Between Depression and Diabetes?
• How Does the Treatment With Insulin Affect Type 2 Diabetes?
• What Is the Relationship Between Genetic Predisposition, Obesity, and the Development of Type 2 Diabetes?
• How to Reduce the Likelihood of Rehospitalization of Patients With Diabetes?
• Why Diabetes Mellitus and How It Affects the United States?
• Does Valproic Acid Have Potential in the Treatment of Diabetes Mellitus?
• What Is the Relationship Between Genetics and Diabetes?

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• Published: 10 March 2022

The impact of nursing staff education on diabetes inpatient glucose management: a pilot cluster randomised controlled trial

• Milan K. Piya 1 , 2 ,
• Therese Fletcher 1 , 2 ,
• Kyaw P. Myint 1 ,
• Reetu Zarora 1 ,
• Dahai Yu 3 &
• David Simmons 1 , 2  

BMC Endocrine Disorders volume  22 , Article number:  61 ( 2022 ) Cite this article

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An increasing number of patients in hospital have diabetes, with most of them cared for by non-specialist staff. The effect of diabetes education for staff on patient outcomes, as well as the most effective method of staff education is unclear. Therefore, the aim of this study was to compare diabetes outcomes in medical wards where nursing staff were offered one face-to-face (F2F) session followed by access to online education (online), F2F education only, or standard care (control).

We conducted a pilot cluster randomised controlled trial involving 16-weeks baseline/rollout followed by a 28-week post-intervention period across three medical wards (clusters) in a Sydney Teaching Hospital. The online ward provided an online competency-based diabetes education program and 1-h F2F teaching from a diabetes nurse educator (DNE), the F2F ward provided four separate 1-h teaching sessions by a DNE, with no additional sessions in the control ward. The primary outcome was length of stay (LOS); secondary outcomes included good diabetes days (GDD), hypoglycaemia and medication errors. Poisson and binary logistic regression were used to compare clusters.

Staff attendance/completion of ≥ 2 topics was greater with online than F2F education [39/48 (81%) vs 10/33 (30%); p  < 0.001]. Among the 827/881 patients, there was no difference in LOS change between online [Median(IQR) 5(2–8) to 4(2–7) days], F2F [7(4–14) to 5(3–13) days] or control wards [5(3–9) to 5(3–7) days]. GDD improved only in the online ward 4.7(2.7–7.0) to 6.0(2.3–7.0) days; p  = 0.038. Total patients with hypoglycaemia and appropriately treated hypoglycaemia increased in the online ward.

Conclusions

The inclusion of online education increased diabetes training uptake among nursing staff. GDD and appropriate hypoglycaemia management increased in the online education wards.

Trial registration

Prospectively registered on the Australia New Zealand Clinical Trials Registry (ANZCTR) on 24/05/2017: ACTRN12617000762358 .

Peer Review reports

Introduction

The increasing prevalence of diabetes places a huge burden on health systems, with one in every 4 or 5 patients in hospital having diabetes [ 1 , 2 , 3 ]. People with diabetes have higher mortality, hospital readmission as well as complications including hypoglycaemia and infections [ 3 , 4 , 5 , 6 ]. The resulting increased length of hospital stay has both financial as well as hospital capacity implications [ 6 , 7 ]. Although studies have shown a reduced hospital readmission rate and hospitalisation cost when patients are looked after by a specialist inpatient diabetes team rather than the primary service team that includes ward-based nurses [ 8 ], the increase in number of inpatients with diabetes means that the majority of care provided to people with diabetes in hospital is not provided by diabetes specialist staff, making diabetes education for non-specialist nursing staff a priority [ 9 ]. Errors in medication, in particular insulin, can result in poor diabetes control in hospital including hypoglycaemia [ 1 , 3 , 10 ]. One previous way of measuring diabetes management in hospital has been with the use of good diabetes days (GDD) based on the (NaDIA, UK) definition [ 1 ], where a GDD was a day where there were no hypos and one or less episodes of hyperglycaemia.

However, healthcare practitioners face difficulty in accessing face to face education due to understaffing, workplace demands, personal commitments, expense and variation in individual learning needs [ 11 ]. Previous studies have shown a low confidence in diabetes management among healthcare professionals in hospital including junior doctors, nursing staff and pharmacists [ 12 ]. Attendance at traditional face to face continuing professional development (CPD) programs does have advantages but usually involve days away from clinical duties, and often involve travel and additional cost [ 13 ]. For time poor busy health professionals, particularly ward nursing staff, online programs are appealing and offer similar positive effect on learning compared to traditional face to face learning programs [ 14 ]. A range of hospital ward staff education approaches are available both face to face and online [ 15 ], but none have been rigorously evaluated in randomised controlled trials.

The purpose of this pilot study was to evaluate uptake of an online competency-based program among ward-based nursing staff, followed by a comparison of reach and clinical outcomes in a pilot cluster randomised controlled trial.

Subjects, methods and materials

Formative evaluation.

The online competency based program used was an Australian [ 16 ] adaptation of the Cambridge Diabetes Education Program (CDEP), itself underpinned by the UK national diabetes competencies frameworks [ 9 ]. The program contains multiple choice questions, linkages to national and international learning resources, and level progression through 100% mastery. The program was made available to all staff on a single medical ward in a 306-bed tertiary hospital in Sydney, Australia in 2016, which was a different ward to the three wards in the cluster randomised trial, but was similar in terms of nursing staff numbers and nurse to patient ratios on the ward. Staff were invited by email and information sessions to voluntarily undertake two online modules (Suppl table 1 ): “ What is Diabetes” and “ Managing Diabetes in Hospital” over a 6-week period. Following each module, an embedded evaluation score graded 1–5 (1 = much worse, 2 = worse, 3 = same, 4 = better, 5 = much better) was completed regarding increase in overall competency in diabetes patient care, increase in overall confidence with managing patients with diabetes, and an increase in familiarity with diabetes guidelines in relation to managing patients with diabetes. Formative evaluation included three focus groups among participants undertaking the online modules which were recorded, transcribed verbatim and de-identified. Thematic analysis was used to identify and group themes [ 17 ].

While no formative evaluation was conducted for the F2F teaching ward, feedback was taken into account from previous F2F teaching sessions on the wards and discussions with the nurse unit manager. Based on this feedback, the F2F teaching was arranged to be conducted on the ward itself rather than a lecture theatre, and the time of the session was chosen by the nurse unit manager to allow for the maximum number of nursing staff to be available to attend the session.

Pilot cluster randomised controlled trial (CRCT)—study design and intervention

This was a pilot cluster randomised controlled trial (CRCT) (ACTRN12617000762358) on three medical wards in the same hospital in Sydney, Australia. Each medical ward was a cluster, and randomised to receive either (1) one hour of protected time on three occasions with access to complete online education modules followed up by 1-h of face to face education for a total of four hours (online), (2) face-to-face (F2F) education for four 1-h sessions with protected time for a total of four hours, or (3) staff diabetes education as usual (control) (Fig.  1 ). Randomisation was undertaken through a sealed envelope delivered through an independent person. All investigators except TF were blinded to the allocation until after analyses were completed. Each ward included 26–30 beds, with 33–48 nurses. From June 2017, as shown in Fig.  1 , baseline data was collected over three weeks and the three-month roll out period when education was delivered/made available. Post-intervention data were collected for the subsequent six months. Ethics approval was granted by the South Western Sydney Local Health District HREC (formative evaluation: LNR/16/LPOOL/503; CRCT: HE17/047).

Study timeline and interventions on the three randomised wards

Participants and data collection

A daily census was conducted of all inpatients with pre-existing diabetes on the three wards. Length of stay was calculated post-discharge, and electronic medical records were reviewed by a blinded researcher using a pre-specified audit form, based on the National Diabetes Inpatient Audit (NaDIA, UK) [ 1 ]. Glucose data, hypo and hyperglycaemia episodes and medication errors were extracted from paper charts, with confirmation from patient notes. Diabetes medication errors included wrong medication charted or given; prescription not signed for, wrong dose charted or given, correct medication or dose not charted, correct medication charted but at the wrong time, as well as charted medication not give at the appropriate time. If patients moved between wards, patient data were analysed by the ward where they were first identified by the daily census.

Intervention

Nursing staff on the online ward were given access to the online modules with advice to complete at least two modules in three hours of protected time in an office with a computer away from the clinical environment, during work hours, as shown in Fig.  1 . This was followed by one face to face session on The Role of Nursing in the Continuum of Inpatient Diabetes Care developed by the American Association of Clinical Endocrinologists (AACE), at the end of the rollout phase. Staff had ongoing access to the online modules. On the F2F ward, nursing staff were provided with three separate one-hour face to face sessions over three months, developed by the National Association of Diabetes Centres (NADC, Australia), plus the hour long AACE session identical to the online ward. The control ward had no scheduled diabetes education sessions in the intervention period.

The primary outcome measure was the difference between wards in the change in length of stay. Secondary outcomes are shown in Fig. 1 including good diabetes days (GDD) based on the (NaDIA, UK) definition [ 1 ], where a GDD was a day where there were no hypos and one or less episodes of hyperglycaemia. Hypos were defined as documented capillary glucose ≤ 4.0 mmol/L, severe hypos as documented capillary glucose ≤ 3.0 mmol/L and hyperglycaemia as ≥ 11.0 mmol/L. GDD was adjusted to a standardised 7-day admission, so that the outcome was measured as GDD per week. For admissions less than 7 days, GDD = (number of good diabetes days/LOS) *7.

Statistical analysis

As a pilot study, no power calculations were undertaken and the duration of the study (and ergo the sample size of 400) was defined pragmatically. We predicted that it would take three months to undertake the study but roll out was delayed for administrative reasons, so this actually took 6 months. An intention to treat (ITT) analysis of the inpatient data was undertaken by a blinded statistician in the UK (DY). Analysis of variance (ANOVA) was used to detect differences in baseline characteristics between clusters (wards) and between the baseline/rollout and intervention period. Poisson regression and binary logistic regression analysis were used to analyse the change in primary and secondary outcomes including of lengths of stay (LOS) and good diabetes days, adjusting for clustering and baseline differences. STATA MP15.1 (Stata Corporation, College Station, TX, USA) was used for all analyses. Tests are 2-tailed and P  < 0.05 was considered statistically significant.

Before the CRCT, formative evaluation was undertaken on a separate ward that was similar in nursing staff numbers and patient bed numbers, to ensure acceptability of the online program. Overall, 18/33 ward nursing staff registered for the online program, of whom nine completed two topics, one completed one topic and eight nurses started but did not complete any topics. Thirteen ward staff members voluntarily participated in three focus groups convened between 13 December 2016 and 2 February 2017, lasting between 27–32 min. Four themes emerged in the formative evaluation as shown in Supplementary Table 1 (see Supplementary Table 2 for quotes):

Perceptions and Experience

Functionality of program/webpage

Contextual and Clinical Relevance

Perceived Access: Barriers and Facilitators

Staff self-reported an increase in overall competency in diabetes patient care mean score of 4.4/5, an increase in overall confidence with managing patients with diabetes mean score of 4.3/5, and an increase in familiarity with diabetes guidelines in relation to managing patients with diabetes mean score of 4.3/5. Adjustments to the program were made following the formative evaluation (Suppl table 1 ).

Pilot cluster randomised controlled trial

Uptake of diabetes education was greater on the online ward compared to the F2F ward; 90% ( n  = 43/48) nurses completed one diabetes topic compared to 45% ( n  = 15/33) on the F2F ward ( p  < 0.01). Two diabetes topics were completed by 81% ( n  = 39/48) on the online ward compared to 30% ( n  = 10/33) on the F2F ward ( p  < 0.001). Of the 43 nurses completing at least one topic in the online ward, only nine (19%) attended the face to face teaching session on that ward.

Embedded online evaluation survey—CRCT participants

Staff from the online ward self-reported an increase in overall competency in diabetes patient care- mean score of 4.1/5, an increase in overall confidence with managing patients with diabetes- mean score of 4.0/5, and an increase in familiarity with diabetes guidelines in relation to managing patients with diabetes- mean score of 4.0/5.

Baseline patient data

Of the 881 eligible patients, 827 were included in the trial as shown in the Consort diagram (Fig.  2 ). The overall mean age of patients in the CRCT wards was 69 ± 12.4 years, with 46.1% female, and 73.3% of European descent. (Other population groups included 3% Aboriginal, 8.2% Pacific Islanders, 6.2% Asians, 9.3% others). Over 85% of the patients had T2DM, most were emergency admissions, and a quarter of patients were using insulin on admission. Table 1 shows no significant difference in characteristics between wards at baseline, or between baseline/rollout vs post-intervention period apart from during the post-intervention phase on the online ward where there was a change in mix of elective admissions and transfers ( p  = 0.01), less diet/more medication treated patients ( p  = 0.012), more hyperglycaemia ( p  < 0.001) and more patients with macrovascular disease ( p  < 0.001). The F2F ward had less patients admitted for a diabetes related reason in the post-intervention period ( p  = 0.044).

Consort Diagram

Outcomes for the CRCT

Table 2 shows no differences in hospital length of stay. The online ward, but not the F2F or control wards showed increased number of good diabetes days (GDD) from median (IQR) 4.7 (2.7–7.0) at baseline/rollout to 6.0 (2.3–7.0) in the post-intervention phase ( p  = 0.04), along with increased hypos treated appropriately by ward staff (80% vs 85%, p  = 0.026) and total hypos (10% vs 16%, p  = 0.043), while severe hypos was borderline significant (3% vs 6%, p  = 0.05). In the control ward alone, there was a reduction of the proportion of hypos being appropriately treated by ward staff from 88 to 68% in the post-intervention phase ( p  = 0.028), and an increase in the number of total medication errors in the control ward from 9 to 20% ( p  = 0.0028).

This pilot study is the first randomised trial to evaluate the impact of non-specialist nursing staff education on patient outcomes, and directly compare uptake of online learning with traditional F2F education. The study demonstrated a significantly greater uptake of online learning compared to F2F learning, accompanied by a self-reported improvement in confidence and competency in diabetes patient care as well as an increased familiarity with diabetes guidelines. The primary outcome of the pilot CRCT of length of stay did not differ between the wards. However, there was an increase in the number of GDD/week in the online ward only.

Computer based and online learning tools for staff education have been in place for a number of years, with increasing accessibility with smart phones and handheld devices [ 13 ]. Studies have shown an improvement in healthcare professional confidence in managing diabetes with face to face education in hospital [ 12 , 18 , 19 ]. While online learning complemented by face to face education (blended online learning) has been shown in a recent meta-analysis to demonstrate consistently better effects on knowledge outcomes compared to traditional learning in health education [ 20 ], this has not been shown in studies in diabetes. However, the advantage of being able to complete online CPD modules at a time and place convenient to you does have advantages, but also means that staff need the motivation and time to complete these modules.

In this study, the face to face sessions were conducted on the study ward at a time agreed with the ward nurse unit manager to make it easily accessible for staff to attend. In spite of this ease of access, staff not being on shift on the specified days and some staff not being able to attend the sessions due to clinical needs on the wards meant the attendance rate for the four education sessions was < 50%. This is in contrast to the 90% completion of one module and 81% completion of two modules in the online ward. Even in the online ward, < 20% attended the single face to face teaching session provided. Formative thematic analysis showed that main themes as seen in Suppl Table 1  and 2  include perceptions and experience, functionality of program, contextual and clinical relevance and perceived access barriers and facilitators. This was used to help modify the online delivery of the modules, and also the addition of a face to face component to make it blended online learning, as well as agreement to allow protected time at work. These themes on barriers are similar to those in a recent qualitative evaluation of nursing teams on using iPad delivered diabetes education, where the four themes that emerged were educational program and content, platform usability, tablet feasibility and workflow considerations [ 21 ]. Addressing these themes in the pilot phase formative evaluation before rollout of the Pilot CRCT may have helped completion rates and uptake. Also, with all the staff on the ward asked to complete the modules, there was opportunity for peer learning and support to encourage each other to complete these modules and improve the care of patients with diabetes.

Length of stay (LOS) was the primary outcome of the study but this was not affected by staff education in this study. This may not have been too surprising as LOS is affected by a multitude of factors beyond diabetes such as acuity of the co-morbidity, social circumstances, availability of the destination and overall efficiency of the inpatient care [ 22 ]. Hence, while a whole systems approach to managing inpatient diabetes, the Diabetes Inpatient Care and Education (DICE) initiative did reduce length of stay in people with diabetes [ 23 ], a randomised study in Australia with an early diabetes team intervention did not show changes in length of stay [ 4 ]. Interestingly, that study also showed a reduction in adverse glycaemic days (capillary glucose ≤ 4.0 mmol/L or ≥ 15.0 mmol/L) in the post-intervention phase.

On the other hand, good diabetes days/week (GDD/week) is a direct measure of diabetes control in hospital and has been used to describe glycaemic control in hospital in the UK National Diabetes Inpatient Audit [ 1 ]. With over 800 patients in this CRCT, the improvement in GDD/week in the online ward, but not the F2F ward or control ward suggests that an increased uptake and completion rate of competency-based diabetes education by nursing staff can improve glycaemic control in hospital. Previous studies have suggested an increased risk of infections in people with diabetes admitted to hospital [ 4 ], and improved glycaemic control in hospital has the potential to reduce this, although this was not measured in this study. It was interesting to find that in spite of an increase in the number of GDD/week, there was a statistically significant increase in hypos and severe hypos in the online ward between the baseline/rollout phase and post-intervention phase. These actual numbers were relatively small and the post-intervention percentages seemed to be closer to the values in the other wards for both durations and comparable to the UK National Diabetes Inpatient Audit data that showed 18.4% of patients had an episode of hypo in the previous 7 days [ 1 ]. It is known that hypoglycaemia in hospital can be asymptomatic and often goes undetected [ 24 , 25 ]. One potential explanation for the increase in hypos detected in this study could be that the nursing staff were involved in increased vigilance, testing and documentation in the online ward that led to increased testing and detection of hypos, severe hypos and hyperglycaemia, whereas some of the patients developing hypo symptoms were given food or hypo corrections without testing or documenting the capillary blood glucose level.

Hypos are a major problem in people with diabetes in hospital and have been linked to greater length of stay in hospital as well as in-hospital mortality [ 5 , 26 ]. However, in this study, length of stay did not seem to be affected by the increase in hypos on the online ward. However, of the hypos treated, there was an increase in the number of hypos treated appropriately in the online ward, which was encouraging and this is probably a direct effect of the online learning of nursing staff who are critical in the recognition, documentation and management of hypoglycaemia on the ward [ 27 ]. Worryingly, there was a reduction in the number of hypos treated appropriately in the control ward. This was also accompanied by an increase in medication errors in the control ward only, which in addition to errors in prescription included inappropriate omissions or delays in administering medications including insulin. While these results are surprising and unexpected, this may be a result of nursing staff being less engaged in diabetes care compared to the other wards due to not being offered any diabetes education. Many hospitals have come up with functionalities on both electronic and paper-based insulin prescription systems to reduce errors, but approaches, terminology and outcome measures have not been standardised as shown in a recent systematic review, which makes it difficult to compare the various interventions [ 28 ].

One of the ways to improve diabetes care in hospital has been use of technology including networked blood glucose meters with a dashboard or the use of Flash Glucose continuous glucose monitoring systems [ 29 ]. The use of Flash Glucose found a greater use during the Covid-19 pandemic where staff did not have to perform capillary blood glucose readings [ 30 ]. There is also potential for closed loop insulin delivery systems being used in hospital in the near future, which reduces the potential for human error [ 31 ]. However, this would still need ward staff to support patients and help them. If anything, this technology could identify which wards or staff needed education. The extent of the increase in uptake in staff education in this study through the additional access to online learning, and the associated improved GDD and hypo management, suggests the importance of such educational programs when social distancing limits the capacity to provide or attend face to face education sessions.

The lack of difference in medication errors in the online or F2F wards may be linked to the fact that the education was limited to nursing staff and not medical staff, who are the ones prescribing the medications including insulin. The fact that medical doctors and teams cover more than one ward, especially when providing out of hours cover, made it too difficult to randomise them into groups in this study. The lack of difference in LOS in the same way, may be because often the decision to discharge is led by the medical team.

The strengths of this study are that this is the first RCT assessing the effect of nursing staff education on patient outcomes with such a large number of patients over 6 months. The RCT was implemented robustly, with unbiased randomisation, blinding of the investigators and of the statistician. Also, the online learning modules were modified following formative evaluation from staff, before the CRCT. The main limitations of this study are that the baseline planned phase of 2 weeks had to be extended to 3 weeks’ baseline and 13 weeks’ rollout phase to allow more time for both the face to face education sessions to be organized for the ward nursing staff, as well as more protected time to be allowed for the online ward-based nursing staff. This delay in implementation is perhaps a sign that nursing education, whether it be online or face to face, was a low priority even in this CRCT setting. Another limitation is that we did not have the demographic data for the nursing staff involved in the study. However, the wards were chosen for the study as they were all medical wards of a similar size with a similar number of nursing staff and patient beds, and they were randomised after the start of the trial. We were also unable to include patient reported outcomes or patient satisfaction data from these wards.

In conclusion, the addition of access to online learning as well as face to face to education, significantly increased uptake of diabetes education among hospital non-specialist nursing staff. Although length of stay was not reduced, glycaemic control and hypoglycaemia treatment were improved. The findings of this pilot study suggest that there would likely be further benefits if online learning was rolled out to include medical staff, which, with social distancing and meeting restrictions amidst the Covid-19 pandemic, may offer a better alternative to traditional methods of diabetes education. Further randomised clinical trials to confirm these findings are required.

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Acknowledgements

The authors would like to thank the patients and staff working on the three wards involved in this trial, especially Karen Kenmir, Patricia Mason, Sharon Edwards and Donna Lynn. The authors would also like to thank the Macarthur Diabetes Team, especially Daisy Yogendran who provided the face to face diabetes education sessions alongside TF. The authors would also like to acknowledge the technical support for the online modules by Paul Smedley from Hertsmedia, Ware, Hertfordshire, UK as well as Candice Ward and Katy Davenport from Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK, for their contributions.

This trial was funded by South Western Sydney Local Health District, New South Wales, Australia through its Academic Unit funding.

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Milan K. Piya, Therese Fletcher, Kyaw P. Myint, Reetu Zarora & David Simmons

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Milan K. Piya, Therese Fletcher & David Simmons

Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK

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DS conceived the study and DS and TF wrote the initial the research proposal. RZ and KPM collected clinical data. DY performed the statistical analysis. MKP and TF wrote the initial draft of the manuscript. RZ and DS reviewed and edited the manuscript. All authors have read and approved the final version of this manuscript. DS is the guarantor of the data.

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Correspondence to Milan K. Piya .

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This study was conducted in accordance with the Declaration of Helsinki. Ethics approval was granted by the South Western Sydney Local Health District HREC (formative evaluation: LNR/16/LPOOL/503; CRCT: HE17/047). As part of this approval, a waiver of individual participant consent was approved by the ethics committee. Instead, the ethics committee asked that written informed consent was provided by the cluster guardian (Nurse Unit Manager) for each ward.

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DS is one of the founders and developers of the Cambridge Diabetes Education Program but receives no financial benefit from the products which are the property of Cambridge University Hospitals. Other authors declare no competing interests. This trial used an Australian adaptation of the Cambridge Diabetes Education Program.

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Piya, M.K., Fletcher, T., Myint, K.P. et al. The impact of nursing staff education on diabetes inpatient glucose management: a pilot cluster randomised controlled trial. BMC Endocr Disord 22 , 61 (2022). https://doi.org/10.1186/s12902-022-00975-y

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DOI : https://doi.org/10.1186/s12902-022-00975-y

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Latest List of Best Diabetes Dissertation Topics

Published by Owen Ingram at January 2nd, 2023 , Revised On May 17, 2024

The prevalence of diabetes among the world’s population has been increasing steadily over the last few decades, thanks to the growing consumption of fast food and an increasingly comfortable lifestyle. With the field of diabetes evolving rapidly, it is essential to base your dissertation on a trending diabetes dissertation topic that fills a gap in research. 

Finding a perfect research topic is one of the most challenging aspects of dissertation writing in any discipline . Several resources are available to students on the internet to help them conduct research and brainstorm to develop their topic selection, but this can take a significant amount of time. So, we decided to provide a list of well-researched, unique and intriguing diabetes research topics and ideas to help you get started. 

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List of Diabetes Dissertation Topics

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• In long-term research, people getting intensive therapy for the condition had a worse quality of life. What role should health professionals have in mitigating this effect?
• Why do so many individuals experience severe depression the months after their diagnosis despite displaying no other signs of deteriorating health?
• Discuss some of the advantages of a low-carbohydrate, high-fat diet for people with diabetes
• Discuss the notion of diabetes in paediatrics and why it is necessary to do this research regularly.
• Explain the current threat and difficulty of childhood obesity and diabetes, stressing some areas where parents are failing in their position as guardians to avoid the situation
• Explain some of the difficulties that persons with diabetes have, particularly when obtaining the necessary information and medical treatment
• Explain some of the most frequent problems that people with diabetes face, as well as how they affect the prevalence of the disease. Put out steps that can be implemented to help the problem.
• Discuss the diabetes problem among Asian American teens
• Even though it is a worldwide disease, particular ethnic groups are more likely to be diagnosed as a function of nutrition and culture. What can be done to improve their health literacy?
• Explain how self-management may be beneficial in coping with diabetes, particularly for people unable to get prompt treatment for their illness
• Discuss the possibility of better management for those with diabetes who are hospitalised
• What current therapies have had the most influence on reducing the number of short-term problems in patients’ bodies?
• How have various types of steroids altered the way the body responds in people with hypoglycemia more frequently than usual?
• What effects do type 1, and type 2 diabetes have on the kidneys? How do the most widely used monitoring approaches influence this?
• Is it true that people from specific ethnic groups are more likely to acquire heart disease or eye illness due to their diabetes diagnosis?
• How has the new a1c test helped to reduce the detrimental consequences of diabetes on the body by detecting the condition early?
• Explain the difficulty of uncontrolled diabetes and how it can eventually harm the kidneys and the heart
• Discuss how the diabetic genetic strain may be handed down from generation to generation
• What difficulties do diabetic people have while attempting to check their glucose levels and keep a balanced food plan?
• How have some individuals with type 1 or type 2 diabetes managed to live better lives than others with the disease?
• Is it true that eating too much sugar causes diabetes, cavities, acne, hyperactivity, and weight gain?
• What effect does insulin treatment have on type 2 diabetes?
• How does diabetes contribute to depression?
• What impact does snap participation have on diabetes rates?
• Why has the number of persons who perform blood glucose self-tests decreased? Could other variables, such as social or environmental, have contributed to this decrease?
• Why do patients in the United States struggle to obtain the treatment they require to monitor and maintain appropriate glucose levels? Is this due to increased healthcare costs?
• Nutrition is critical to a healthy lifestyle, yet many diabetic patients are unaware of what they should consume. Discuss
• Why have injuries and diabetes been designated as national health priorities?
• What factors contribute to the growing prevalence of type II diabetes in adolescents?
• Does socioeconomic status influence the prevalence of diabetes?
• Alzheimer’s disease and type 2 diabetes: a critical assessment of the shared pathological traits
• What are the effects and consequences of diabetes on peripheral blood vessels?
• What is the link between genetic predisposition, obesity, and type 2 diabetes development?
• Diabetes modifies the activation and repression of pro- and anti-inflammatory signalling pathways in the vascular system.
• Understanding autoimmune diabetes through the tri-molecular complex prism
• Does economic status influence the regional variation of diabetes caused by malnutrition?
• What evidence is there for using traditional Chinese medicine and natural products to treat depression in people who also have diabetes?
• Why was the qualitative method used to evaluate diabetes programs?
• Investigate the most common symptoms of undiagnosed diabetes
• How can artificial intelligence help diabetes patients?
• What effect does the palaeolithic diet have on type 2 diabetes?
• What are the most common causes of diabetes and what are the treatments?
• What causes diabetes mellitus, and how does it affect the United Kingdom?
• The impact of sociodemographic factors on the development of type II diabetes
• An examination of the link between gut microbiome and diabetes risk
• The effectiveness of lifestyle interventions in preventing type II diabetes
• The role of maternal diabetes in offspring’s risk of developing diabetes
• Artificial intelligence in diabetes diagnosis and management
• Continuous glucose monitoring
• Telehealth interventions for improving diabetes self-management
• The role of wearable technology in diabetes management
• Personalised medicine approaches for diabetes treatment
• The impact of diabetes on mental health and well-being
• The link between diabetes and cognitive decline
• The potential of stem cell therapy for diabetes treatment
• Advances in closed-loop insulin delivery systems
• The use of glucagon-like peptide-1 (GLP-1) receptor agonists in diabetes treatment
• Investigating the efficacy of new oral medications for type II diabetes
• The role of bariatric surgery in the management of type II diabetes
• Improving patient adherence to diabetes treatment regimens
• The role of social support in diabetes management
• Developing culturally sensitive diabetes education programs
• The role of dietary patterns in diabetes prevention and management
• Low-carbohydrate vs. Mediterranean diet for diabetes: A comparative study
• The use of artificial sweeteners in diabetes management: Benefits and risks
• The impact of the gut microbiome on dietary interventions for diabetes
• The role of exercise in improving glycemic control
• Developing effective exercise programs for individuals with diabetes
• The impact of physical activity on diabetic complications
• Promoting physical activity adherence in people with diabetes
• The use of exercise gamification to increase physical activity in diabetes
• The potential of CRISPR gene editing for diabetes treatment
• The role of the microbiome in the development and treatment of diabetes
• An analysis of the artificial Pancreas systems
• The use of big data analytics in diabetes research
• The impact of environmental factors on diabetes risk
• Cost-effectiveness of different diabetes treatment strategies
• Developing effective diabetes prevention programs for communities
• The role of government policies in addressing the diabetes epidemic
• Improving access to diabetes care in underserved populations
• The impact of social determinants of health on diabetes risk
• Management of diabetes in children and adolescents
• The unique challenges of diabetes management in older adults
• Diabetes in ethnic minorities: Disparities in prevalence and care
• The impact of diabetes on LGBTQ+ populations

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357 Diabetes Essay Topics & Examples

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⭐ most interesting diabetes research paper topics, ✅ simple & easy diabetes essay topics, 🎓 good research topics about diabetes, 💡 interesting topics to write about diabetes, 👍 good essay topics on diabetes, ❓ diabetes research question examples.

• Type 2 Diabetes The two major types of diabetes are type 1 diabetes and type 2 diabetes. Doctor: The first step in the treatment of type 2 diabetes is consumption of healthy diet.
• Adult-Onset Type 2 Diabetes: Patient’s Profile Any immediate care as well as post-discharge treatment should be explained in the best manner possible that is accessible and understandable to the patient.
• Living With a Chronic Disease: Diabetes and Asthma This paper will look at the main effects of chronic diseases in the lifestyle of the individuals and analyze the causes and the preventive measures of diabetes as a chronic disease.
• Leadership in Diabetes Management Nurses can collaborate and apply evidence-based strategies to empower their diabetic patients. The involvement of all key stakeholders is also necessary.
• Diabetes in Adults in Oxfordshire On a national level, Diabetes Research and Wellness Foundation aims to prevent the spread of the decease through research of the causes and effective treatment of diabetes 2 type.
• Case Study of Patient with DKA and Diabetes Mellitus It is manifested by a sharp increase in glucose levels and the concentration of ketone bodies in the blood, their appearance in the urine, regardless of the degree of violation of the patient’s consciousness.
• Intervention Methods for Type 2 Diabetes Mellitus An individual should maintain a regulated glycemic control using the tenets of self-management to reduce the possibility of complications related to diabetes.
• Relation Between Diabetes And Nutrition Any efforts to lessen and eliminate the risk of developing diabetes must involve the dietary habit of limiting the consumption of carbohydrates, sugar, and fats. According to Belfort-DeAguiar and Dongju, the three factors of obesity, […]
• Diabetes Mellitus: Symptoms, Types, Effects Insulin is the hormone that controls the levels of glucose in the blood, and when the pancreas releases it, immediately the high levels are controlled, like after a meal.
• Health Promotion: Diabetes Mellitus and Comorbidities This offers a unique challenge in the management of diabetes and other chronic diseases; the fragmented healthcare system that is geared towards management of short-term medical emergencies often is not well prepared for the patient […]
• Type 2 Diabetes as a Public Health Issue In recent years, a steady increase in the incidence and prevalence of diabetes is observed in almost all countries of the world.
• Diabetes Management: Case Study Type 1 and Type 2 diabetes contrast based on their definitions, the causes, and the management of the conditions. Since the CDC promotes the avoidance of saturated fat and the increase of fiber intake for […]
• Diabetes Mellitus Management in the Elderly Diabetes mellitus is a health complication involving an increase in the concentration in the concentration of blood sugar either due to a failure by cells to effectively respond to the production of insulin in the […]
• A Study of Juvenile Type 1 Diabetes in the Northwest of England The total number of children under seventeen years living with type 1 diabetes in North West England by 2009 was 2,630.
• Diabetes Prevention: The Sanofi-Aventis Leaflet Review Using the Flesh formula, it can be concluded that the leaflet has a good level of readability, but it can be improved in case it is shorter because a few sections of it are better […]
• Gestational Diabetes in a 38-Year-Old Woman The concept map, created to meet B.’s needs, considers her educational requirements and cultural and racial hurdles to recognize her risk factors and interventions to increase her adherence to the recommended course of treatment.B.said in […]
• Type 2 Diabetes Mellitus and Its Implications You call an ambulance and she is taken in to the ED. Background: Jean is still very active and works on the farm 3 days a week.
• Development of Comprehensive Inpatient and Outpatient Programs for Diabetes Overcoming the fiscal and resource utilization issues in the development of a comprehensive diabetes program is essential for the improvement of health and the reduction of treatment costs.
• Healthcare Cost Depending on Chronic Disease Management of Diabetes and Hypertension A sufficient level of process optimization and the presence of a professional treating staff in the necessary number will be able to help improve the indicators.
• Improving Glycemic Control in Black Patients with Type 2 Diabetes Information in them is critical for answering the question and supporting them with the data that might help to acquire an enhanced understanding of the issue under research. Finally, answering the PICOT question, it is […]
• Shared Decision-Making That Affects the Management of Diabetes The article by Peek et al.is a qualitative study investigating the phenomenon of shared decision-making that affects the management of diabetes. The researchers demonstrate the racial disparity that can arise in the choice of approaches […]
• Managing Obesity as a Strategy for Addressing Type 2 Diabetes When a patient, as in the case of Amanda, requires a quick solution to the existing problem, it is necessary to effectively evaluate all options in the shortest possible time.
• Tests and Screenings: Diabetes and Chronic Kidney Disease The test is offered to patients regardless of gender, while the age category is usually above 45 years. CDC1 recommends doing the test regardless of gender and is conducted once or twice to check the […]
• Obesity Management for the Treatment of Type 2 Diabetes American Diabetes Association states that for overweight and obese individuals with type 2 diabetes who are ready to lose weight, a 5% weight reduction diet, physical exercise, and behavioral counseling should be provided.
• COVID-19 and Diabetes Mellitus Lim et al, in their article, “COVID-19 and diabetes mellitus: from pathophysiology to clinical management”, explored how COVID-19 can worsen the symptoms of diabetes mellitus.
• The Importance of Physical Exercise in Diabetes II Patients The various activities help to improve blood sugar levels, reduce cardiovascular cases and promote the overall immunity of the patient. Subsequently, the aerobic part will help to promote muscle development and strengthen the bones.
• Diabetes Education Workflow Process Mapping DSN also introduces the patient to the roles of specialists involved in managing the condition, describes the patient’s actions, and offers the necessary educational materials.
• Diabetes: Treatment Complications and Adjustments One of the doctor’s main priorities is to check the compatibility of a patient’s medications. The prescriptions of other doctors need to be thoroughly checked and, if necessary, replaced with more appropriate medication.
• The Type 2 Diabetes Mellitus PICOT (Evidence-Based) Project Blood glucose levels, A1C, weight, and stress management are the parameters to indicate the adequacy of physical exercise in managing T2DM.
• Chronic Disease Cost Calculator (Diabetes) This paper aims at a thorough, detailed, and exhaustive explanation of such a chronic disease as diabetes in terms of the prevalence and cost of treatment in the United States and Maryland.
• Diabetes Mellitus Epidemiology Statistics This study entails a standard established observation order from the established starting time to an endpoint, in this case, the onset of disease, death, or the study’s end. It is crucial to state this value […]
• Epidemiology: Type II Diabetes in Hispanic Americans The prevalence of type II diabetes in Hispanic Americans is well-established, and the search for inexpensive prevention methods is in the limelight.
• Diabetes: Risk Factors and Effects Trends in improved medical care and the development of technology and medicine are certainly contributing to the reduction of the problem. All of the above indicates the seriousness of the problem of diabetes and insufficient […]
• Barriers to Engagement in Collaborative Care Treatment of Uncontrolled Diabetes The primary role of physicians, nurses, and other healthcare team members is to provide patients with medical treatment and coordinate that care while also working to keep costs down and expand access.
• Hereditary Diabetes Prevention With Lifestyle Modification Yeast infections between the fingers and toes, beneath the breast, and in or around the genital organs are the common symptoms of type 2 diabetes.
• Health Equity Regarding Type 2 Diabetes According to Tajkarimi, the number of research reports focusing on T2D’s prevalence and characteristics in underserved minorities in the U. Adapting the program’s toolkits to rural Americans’ eating and self-management habits could also be instrumental […]
• Diabetes Mellitus: Treatment Methods Moreover, according to the multiple findings conducted by Park et al, Billeter et al, and Tsilingiris et al, bariatric surgeries have a positive rate of sending diabetes into remission.
• Diagnosing Patient with Insulin-Dependent Diabetes The possible outcomes of the issues that can be achieved are discussing the violations with the patient’s family and convincing them to follow the medical regulations; convincing the girl’s family to leave her at the […]
• Human Service for Diabetes in Late Adulthood The mission of the Georgia Diabetic Foot Care Program is to make a positive difference in the health of persons living with diabetes.
• Diabetes: Symptoms and Risk Factors In terms of the problem, according to estimates, 415 million individuals worldwide had diabetes mellitus in 2015, and it is expected to rise to 642 million by the year 2040.
• Diabetes: Types and Management Diabetes is one of the most prevalent diseases in the United States caused when the body fails to optimally metabolize food into energy.
• Type 2 Diabetes’ Impact on Australian Society Consequently, the most significant impact of the disease is the increased number of deaths among the population which puts their lives in jeopardy. Further, other opportunistic diseases are on the rise lowering the quality of […]
• Epidemiology of Diabetes and Forecasted Trends The authors note that urbanization and the rapid development of economies of different countries are the main causes of diabetes. The authors warn that current diabetes strategies are not effective since the rate of the […]
• The Aboriginal Diabetes Initiative in Canada The ADI’s goal in the CDS was to raise type 2 diabetes awareness and lower the incidence of associated consequences among Aboriginal people.
• Communicating the Issue of Diabetes The example with a CGM sensor is meant to show that doctors should focus on educating people with diabetes on how to manage their condition and what to do in extreme situations.
• Obesity and Diabetes Mellitus Type 2 The goal is to define the features of patient information to provide data on the general course of the illness and its manifestations following the criteria of age, sex, BMI, and experimental data.
• The Prevention of Diabetes and Its Consequences on the Population At the same time, these findings can also be included in educational programs for people living with diabetes to warn them of the risks of fractures and prevent them.
• Uncontrolled Type 2 Diabetes and Depression Treatment The data synthesis demonstrates that carefully chosen depression and anxiety treatment is likely to result in better A1C outcomes for the patient on the condition that the treatment is regular and convenient for the patients.
• Type 2 Diabetes: Prevention and Education Schillinger et al.came to the same conclusion; thus, their findings on the study of the Bigger Picture campaign effectiveness among youth of color are necessary to explore diabetes prevention.
• A Diabetes Quantitative Article Analysis The article “Correlates of accelerometer-assessed physical activity and sedentary time among adults with type 2 diabetes” by Mathe et al.refers to the global issue of the prevention of diabetes and its complications.
• A Type 2 Diabetes Quantitative Article Critique Therefore, the main issue is the prevention of type 2 diabetes and its consequences, and this paper will examine one of the scientific studies that will be used for its exploration.
• The Diabetes Prevention Articles by Ford and Mathe The main goal of the researchers was to measure the baseline MVPA of participants and increase their activity to the recommended 150 minutes per week through their participation in the Diabetes Community Lifestyle Improvement Program.
• Type 2 Diabetes in Hispanic Americans The HP2020 objectives and the “who, where, and when” of the problem highlight the significance of developing new, focused, culturally sensitive T2D prevention programs for Hispanic Americans.
• Diabetes Mellitus as Problem in US Healthcare Simultaneously, insurance companies are interested in decreasing the incidence of diabetes to reduce the costs of testing, treatment, and provision of medicines.
• Diabetes Prevention as a Change Project All of these queries are relevant and demonstrate the importance of including people at high risk of acquiring diabetes in the intervention.
• Evidence Synthesis Assignment: Prevention of Diabetes and Its Complications The purpose of this research is to analyze and synthesize evidence of good quality from three quantitative research and three non-research sources to present the problem of diabetes and justify the intervention to address it.
• Diabetes Mellitus: Causes and Health Challenges Second, the nature of this problem is a clear indication of other medical concerns in this country, such as poor health objectives and strategies and absence of resources.
• Diabetes Mellitus (DM) Disorder Case Study Analysis Thus, informing the patient about the importance of regular medication intake, physical activity, and adherence to diet in maintaining diabetes can solve the problem.
• Diabetes Mellitus in Young Adults Thus, programs for young adults should predominantly focus on the features of the transition from adolescence to adulthood. As a consequence, educational programs on diabetes improve the physical and psychological health of young adults.
• A Healthcare Issue of Diabetes Mellitus Diabetes mellitus is seen as a primary healthcare issue that affects populations across the globe and necessitates the combination of a healthy lifestyle and medication to improve the quality of life of people who suffer […]
• Control of LDL Cholesterol Levels in Patients, Gestational Diabetes Mellitus In addition, some patients with hypercholesterolemia may have statin intolerance, which reduces adherence to therapy, limits treatment efficacy, and increases the risk of CVD.
• Exploring Glucose Tolerance and Gestational Diabetes Mellitus In the case of a glucose tolerance test for the purpose of diagnosing GDM type, the interpretation of the test results is carried out according to the norms for the overall population.
• Type 2 Diabetes Health Issue and Exercise This approach will motivate the patient to engage in exercise and achieve better results while reducing the risk of diabetes-related complications.
• Diabetes Interventions in Children The study aims to answer the PICOT Question: In children with obesity, how does the use of m-Health applications for controlling their dieting choices compare to the supervision of their parents affect children’s understanding of […]
• Diabetes Tracker Device and Its Advantages The proposed diabetes tracker is a device that combines the functionality of an electronic BGL tester and a personal assistant to help patients stick to their diet plan.
• Disease Management for Diabetes Mellitus The selection of the appropriate philosophical and theoretical basis for the lesson is essential as it allows for the use of an evidence-based method for learning about a particular disease.
• Latino People and Type 2 Diabetes The primary aim of the study is to determine the facilitators and barriers to investigating the decision-making process in the Latin population and their values associated with type 2 diabetes.
• Diabetes Self-Management Education and Support Program The choice of this topic and question is based on the fact that despite the high prevalence of diabetes among adolescents in the United States, the use of DSMES among DM patients is relatively low, […]
• Diabetes Mellitus Care Coordination The aim is to establish what medical technologies, care coordination and community resources, and standards of nursing practice contribute to the quality of care and safety of patients with diabetes.
• Healthy Lifestyle Interventions in Comorbid Asthma and Diabetes In most research, the weight loss in cases of comorbid asthma and obesity is reached through a combination of dietary interventions and physical exercise programs.
• PDSA in Diabetes Prevention The second step in the “Do” phase would be to isolate a few members of the community who are affected by diabetes voluntarily.
• Diabetes: Statistics, Disparities, Therapies The inability to produce adequate insulin or the body’s resistance to the hormone is the primary cause of diabetes. Diabetes is a serious health condition in the U.S.and the world.
• Type 2 Diabetes Prescriptions and Interventions The disadvantage is the difficulty of obtaining a universal model due to the complexity of many factors that can affect the implementation of recommendations: from the variety of demographic data to the patient’s medical history.
• Health Education for Female African Americans With Diabetes In order to address and inform the public about the challenges, nurses are required to intervene by educating the population on the issues to enhance their understanding of the risks associated with the conditions they […]
• Diabetes Risk Assessment and Prevention It is one of the factors predisposing patients suffering from diabetes to various cardiovascular diseases. With diabetes, it is important to learn how to determine the presence of carbohydrates in foods.
• Diabetes Mellitus: Preventive Measures In addition to addressing the medical specialists who will be of service in disease prevention, it will emphasize the intervention programs required to help control the spread of the illness.
• “The Diabetes Online Community” by Litchman et al. The researchers applied the method of telephone interviews to determine the results and effectiveness of the program. The study described the value of DOC in providing support and knowledge to older diabetes patients.
• Mobile App for Improved Self-Management of Type 2 Diabetes The central focus of the study was to assess the effectiveness of the BlueStar app in controlling glucose levels among the participants.
• Type 2 Diabetes in Minorities from Cultural Perspective The purpose of this paper is to examine the ethical and cultural perspectives on the issue of T2DM in minorities. Level 2: What are the ethical obstacles to treating T2DM in ethnic and cultural minorities?
• Ethics of Type 2 Diabetes Prevalence in Minorities The purpose of this article analysis is to dwell on scholarly evidence that raises the question of ethical and cultural aspects of T2DM prevalence in minorities.
• Type 2 Diabetes in Minorities: Research Questions The Level 2 research questions are: What are the pathophysiological implications of T2DM in minorities? What are the statistical implications of T2DM in minorities?
• Improving Adherence to Diabetes Treatment in Primary Care Settings Additionally, the patients from the intervention group will receive a detailed explanation of the negative consequences of low adherence to diabetes treatment.
• An Advocacy Tool for Diabetes Care in the US To ensure the implementation and consideration of my plea, I sent a copy of the letter to the government officials so it could reach the president.
• Diabetes and Allergies: A Statistical Check The current dataset allowed us to test the OR for the relationship between family history of diabetes and the presence of diabetes in a particular patient: all variables were dichotomous and discrete and could take […]
• Type 2 Diabetes in Adolescents According to a National Diabetes Statistics Report released by the Centers for Disease Control and Prevention, the estimated prevalence of the disease was 25 cases per 10,000 adolescents in 2017. A proper understanding of T2D […]
• Analysis of Diabetes and Its Huge Effects In the US, diabetes is costly to treat and has caused much physical, emotional and mental harm to the people and the families of those who have been affected by the disease.
• Nursing: Self-Management of Type II Diabetes Sandra Fernandes and Shobha Naidu’s journal illustrates the authors’ understanding of a significant topic in the nursing profession.”Promoting Participation in self-care management among patients with diabetes mellitus” article exposes readers to Peplau’s theory to understand […]
• The Impact of Vegan and Vegetarian Diets on Diabetes Vegetarian diets are popular for a variety of reasons; according to the National Health Interview Survey in the United States, about 2% of the population reported following a vegetarian dietary pattern for health reasons in […]
• “Diabetes Prevention in U.S. Hispanic Adults” by McCurley et al. This information allows for supposing that face-to-face interventions can be suitable to my practicum project that considers measures to improve access to care among African Americans with heart failure diseases. Finally, it is possible to […]
• Diabetes Disease of the First and Second Types It is a decrease in the biological response of cells to one or more effects of insulin at its average concentration in the blood. During the first type of diabetes, insulin Degludec is required together […]
• The Trend of the Higher Prevalence of Diabetes According to the CDC, while new cases of diabetes have steadily decreased over the decades, the prevalence of the disease among people aged below twenty has not.
• Person-Centered Strategy of Diabetes and Dementia Care The population of focus for this study will be Afro-American women aged between sixty and ninety who have diabetes of the second type and dementia or are likely to develop dementia in the future.
• Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services For example, during one of my interactions with the patient, I was asked whether the hospital had the policy to avoid face-to-face interaction during the pandemic with the help of video examinations.
• Diets to Prevent Heart Disease, Cancer, and Diabetes In order to prevent heart disease, cancer, and diabetes, people are required to adhere to strict routines, including in terms of diet. Additionally, people wanting to prevent heart disease, cancer, and diabetes also need to […]
• The Centers for Diabetes’ Risks Assessment In general, the business case for the Centers for Diabetes appears to be positive since the project is closely aligned with the needs of the community and the targets set by the Affordable Care Act.
• Diabetes Mellitus as Leading Cause of Disability The researchers used data from the Centers for Disease Control and Prevention, where more than 12% of older people in the US live with the condition.
• Depression in Diabetes Patients The presence of depression concomitant to diabetes mellitus prevents the adaptation of the patient and negatively affects the course of the underlying disease.
• The Relationship Between Diabetes and COVID-19 After completing the research and analyzing the articles, it is possible to suggest a best practice that may be helpful and effective in defining the relationship between diabetes and COVID-19 and providing a way to […]
• Pre-diabetes and Urinary Incontinence Most recent reports indicate that a physiotherapy procedure gives a positive result in up to 80% of patients with stage I or SUI and mixed form and 50% of patients with stage II SUI.
• Type 1 Diabetes: Recommendations for Alternative Drug Treatments Then, they have to assess the existing levels of literacy and numeracy a patient has. Tailoring educational initiatives to a person’s unique ethnic and cultural background is the basis of cultural competence in patient education.
• Type 2 Diabetes: A Pharmacologic Update Diabetes presents one of the most common diagnoses in causes of ED visits among adults and one of the leading causes of death in the United States.
• Type 2 Diabetes and Its Treatment The main difference in type 2 diabetes is the insensitivity of the body’s cells to the action of the hormone insulin and their insulin resistance.
• Diabetes: Vulnerability, Resilience, and Care In nursing care, resilience is a critical concept that shows the possibility of a person to continue functioning and meeting objectives despite the existing challenges.
• Diabetes Prevention in the United States The analysis of these policies and the other strategies provides the opportunity to understand what role they might play in the improvement of human health. NDPP policy, on the other hand, emphasizes the role of […]
• Teaching Experience: Diabetes Prevention The primary objective of the seminar is to reduce the annual number of diabetes cases and familiarize the audience with the very first signs of this disease.
• Summary of Type 2 Diabetes: A Pharmacologic Update The authors first emphasize that T2D is one of the most widespread diseases in the United States and the seventh leading cause of death.
• Insulin Effects in a Diabetes Person I will use this source to support my research because the perception of diabetes patients on insulin therapy is essential for understanding the impact they cause on the person.
• Diabetes and Medical Intervention In the research conducted by Moin et al, the authors attempted to define the scope of efficiency of such a tool as an online diabetes prevention program in the prevention of diabetes among obese/overweight population […]
• Diabetes Mellitus Type 2 and a Healthy Lifestyle Relationship The advantage of this study over the first is that the method uses a medical approach to determining the level of fasting glucose, while the dependences in the study of Ugandans were found using a […]
• Diabetes and Its Economic Effect on Healthcare For many years, there has been an active increase in the number of cases of diabetes of all types among the global population, which further aggravates the situation.
• Diabetes: Epidemiological Analysis I would like to pose the following question: how can epidemiology principles be applied to these statistics for further improvements of policies that aim to reduce the impact of diabetes on the U.S.population? The limited […]
• Pathogenesis and Prevention of Diabetes Mellitus and Hypertension The hormone is produced by the cells of the islets of Langerhans found in the pancreas. It is attributed to the variation in the lifestyle of these individuals in these two geographical zones.
• Parental Intervention on Self-Management of an Adolescent With Diabetes Diabetes development and exposure are strongly tied to lifestyle, and the increasing incidents rate emphasizes the severity of the population’s health problem.
• Addressing the Needs of Hispanic Patients With Diabetes Similarly, in the program at hand, the needs of Hispanic patients with diabetes will be considered through the prism of the key specifics of the community, as well as the cultural background of the patients.
• Diabetes Issues: Insulin Price and Unaffordability According to the forecast of researchers from Stanford University, the number of people with type 2 diabetes who need insulin-containing drugs in the world will increase by about 79 million people by 2030, which will […]
• Diabetes: Epidemiologic Study Design For instance, the range of their parents’ involvement in the self-management practices can be a crucial factor in treatment and control.
• What to Know About Diabetes? Type 1 diabetes is caused by autoimmune reaction that prevent realization of insulin in a body. Estimated 5-10% of people who have diabetes have type 1.
• Diabetes in Saudi Arabia It is expected that should this underlying factor be discovered, whether it is cultural, societal, or genetic in nature, this should help policymakers within Saudi Arabia create new governmental initiatives to address the problem of […]
• “Medical Nutrition Therapy: A Key to Diabetes Management and Prevention” Article Analysis In the process of MNT application, the dietitian keeps a record of the changes in the main components of food and other components of the blood such as blood sugars to determine the trend to […]
• Nutrition and Physical Activity for Children With a Diabetes When a child understands that the family supports him or her, this is a great way to bring enthusiasm in dealing with the disease.
• Global and Societal Implications of the Diabetes Epidemic The main aim of the authors of this article seems to be alerting the reader on the consequences of diabetes to the society and to the whole world.
• Diabetes and Hypertension Avoiding Recommendations Thus, the promotion of a healthy lifestyle should entail the encouragement of the population to cease smoking and monitor for cholesterol levels.
• Pregnant Women With Type I Diabetes: COVID-19 Disease Management The grounded theory was selected for the given topic, and there are benefits and drawbacks of utilizing it to study the experiences of pregnant women with type I diabetes and COVID-19.
• Current Recommendations for the Glycemic Control in Diabetes Management of blood glucose is one of the critical issues in the care of people with diabetes. Therefore, the interval of the A1C testing should also depend on the condition of the patient, the physician’s […]
• Diabetes Mellitus: Types, Causes, Presentation, Treatment, and Examination Diabetes mellitus is a chronic endocrinologic disease, which is characterized by increased blood glucose concentration.
• Diabetes Problem at Country Walk Community: Intervention and Evaluation This presentation develops a community health nursing intervention and evaluation tool for the diabetes problem affecting Country Walk community.
• The Minority Diabetes Initiative Act’s Analysis The bill provides the right to the Department of Health and Human Services to generate grants to public and nonprofit private health care institutions with the aim of providing treatment for diabetes in minority communities.
• Communication Challenges Between Nurses and Patients With Type 2 Diabetes According to Pung and Goh, one of the limitations of communication in a multicultural environment is the language barrier that manifests itself in the direct interaction of nurses with patients and in the engagement work […]
• Diabetes Type 2 from Management Viewpoint Demonstrate the effects of type 2 diabetes and provide background information on the disease; Discuss the management plans of diabetes centers and critically analyze the frameworks implemented in the hospitals; Examine the existing methodology models […]
• Nursing Plan for the Patient with Diabetes Type 2, HTN, and CAD The health of the population is the most valuable achievement of society, so the preservation and strengthening of it is an essential task in which everyone should participate without exception.
• Diagnosis and Classification of Diabetes Mellitus Diabetes is a serious public health concern that introduces a group of metabolic disorders caused by changes in the sugar blood level.
• Diabetes Mellitus Type II: A Case of a Female Adult Patient In this presentation, we are going to develop a care plan for a 47-year-old woman with a 3-year-old history of Diabetes Mellitus Type 2 (also known as Type II DM).
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• Published: 28 March 2023

Nurses’ knowledge, attitudes, and practice with regards to nutritional management of diabetes mellitus

• Mahsa Farzaei 1 ,
• Shahla Shahbazi 2 ,
• Neda Gilani 3 ,
• Alireza Ostadrahimi 4 &
• Leila Gholizadeh 5  

BMC Medical Education volume  23 , Article number:  192 ( 2023 ) Cite this article

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The prevalence of diabetes is increasing rapidly worldwide. Nurses work collaboratively with multidisciplinary teams to improve diabetes management. Yet, little is known about nurses’ role in nutritional management of diabetes. This study aimed to evaluate nurses’ knowledge, attitudes, and practice (KAP) toward nutritional management of diabetes.

This cross-sectional study was conducted with 160 nurses, who were recruited between July 4 and July 18, 2021 from two referral tertiary teaching hospitals in Iran. A validated paper-based self-reported questionnaire was used to assess nurses’ KAP. Data were analyzed using descriptive statistics and multiple linear regression analysis.

The mean knowledge score of nurses about nutritional management of diabetes was 12.16 ± 2.83, and 61.2% showing a moderate knowledge level on nutritional management of diabetes. The mean attitudes score was 60.68 ± 6.11, with 86.92% of participants demonstrating positive attitudes. The mean practice score of study participants was 44.74 ± 7.81, with 51.9% having a moderate level of practice. Higher knowledge scores were observed among male nurses (B = -7.55, p  = 0.009) and those with blended learning as a preferred learning method (B = 7.28, p  = 0.029). Having an opportunity to provide education to patients with diabetes during shifts affected nurses’ attitudes positively (B = -7.59, p  = 0.017). Practice scores were higher among nurses who perceived themselves competent in the nutritional management of diabetes (B = -18.05, p  = 0.008).

Nurses’ knowledge and practice in the nutritional management of diabetes should be increased to help improve the quality of the dietary care and patient education they provide these patients. Further studies are needed to confirm the results of this study both in Iran and internationally.

Peer Review reports

Diabetes mellitus is one of the fastest growing chronic diseases globally, with a significant burden on individuals and societies [ 1 ]. Management of diabetes includes nutritional therapy, exercise, monitoring, pharmacologic therapy, and patient education. Nutritional management is a key element of diabetes care. An effective nutritional management helps achieve and maintain glycemic control and contributes to the well-being and quality of life of patients [ 2 ]. While registered dietitians or nutritionists take the main responsibility in nutritional assessment and management of patients with diabetes, nurses and other members of the health care team must be knowledgeable about diabetes nutrition therapy and support patients in implementation of nutritional and lifestyle changes [ 3 ].

Nurses are more likely to encounter patients with diabetes as the number of associated hospital admissions rises. Further, they are in unique position to improve the outcomes for patients with diabetes due to the length of time they spend with patients. The holistic nature of the nursing profession requires nurses to be informal nutrition advisors [ 4 ], and ensure that patients in hospital receive an appropriate diet. They assist patients at meal times, during which patients may seek dietary advice [ 5 ]. Thus, nurses should be aware of the guidelines for the nutritional management of diabetes [ 6 ].

Yet, results of previous studies suggest significant knowledge gap among nurses with regards to nutritional management of patients with diabetes [ 7 , 8 ]. Poor knowledge of health care providers of dietary requirements of patients with diabetes can lead to a poor glycemic control and increase the risk of diabetes-associated complications [ 9 ]. Further, nurses had the lowest attitudes towards diabetes management among healthcare professionals in the study by Babelgaith et al. [ 10 ]. Nurses’ negative attitudes can affect their practice on nutritional management of diabetes. Other factors include time, nutrition education, organizational support, and resource availability [ 11 , 12 , 13 ].

Strategies to reduce the incidence of hypoglycemia and hyperglycemia are imperative to patient safety, and effective nutritional management can help achieve and maintain target glycemic control. Therefore, it is important that nurses have adequate knowledge and positive attitudes toward nutritional management in patients with diabetes to improve their practice [ 14 , 15 ]. The healthcare system in Iran has recently mandated a comprehensive assessment of all patients on their hospital admission. As part of this program, nurses assess the nutritional status of patients and report those with a poor nutritional status, including those with poorly controlled diabetes, to the physician to request a nutritional consultation. Adequate knowledge, positive attitudes, and good practice of nurses are important to achievement of therapeutic goals for patients in diabetes and supporting patients in their self-care practice [15,16 ].

This study was underpinned by the KAP model, which considers using a structured standardized questionnaire to quantify and analyze what is known (knowledge), believed (attitudes), and done (practices) by a target population with regard to a topic of interest. Specific to this study, we aimed to develop an understanding of the knowledge level of nurse regarding of nutritional management of diabetes, and how the knowledge affected nurses’ attitudes and practice toward nutritional management of diabetes. Overall, studies investigating nurses’ KAP with regards to nutritional management of diabetes are limited, and to the best of our knowledge, there is no such a study in Iran. This study aimed to examine nurses’ KAP with regards to nutritional management of diabetes in Iran. Understanding nurses’ KAP about nutritional management of diabetes can generate evidence to inform the development of nutritional management programs. The specific objectives were to:

identify nurses’ knowledge about nutritional management of diabetes.

identify nurses’ attitudes toward nutritional management of diabetes.

identify nurses’ practice on nutritional management of diabetes.

identify relationships between nurses’ KAP about nutritional management of diabetes.

Identify multiple factors that affect nurses’ KAP about nutritional management of diabetes.

This study applied a descriptive cross-sectional design. Participants were recruited from 35 medical and surgical wards of two teaching tertiary referral hospitals in the Northwest of Iran using random sampling method. In the first step, all eligible nurses were identified from the 35 wards and their names were written on pieces of papers and folded and put in a box. The researchers then mixed the box before drawing out the required number of sample. To be eligible for the study, participants needed to have a minimum of a bachelor’s degree in nursing and be working as a fixed term registered nurse in a medical or surgical ward for at least one month. Information from a pilot study was used to calculate the sample size in this study. The required sample size increased to 156 participants when a possible dropout rate of 20% was considered. One hundred sixty participants were recruited to the study.

There is no diabetes educator position in Iran [ 17 ]. During data collection for this study, none of the participating hospitals had a designated diabetes educator or diabetes link nurse. However, both hospitals had a nutrition unit, which was responsible for providing general nutrition care for all forms of health conditions, including nutritional consultation to patients with diabetes.

Data collection tools

Data were collected using a self-report paper-based survey package containing four sections: The first section included questions about the socio-demographic and professional characteristics of nurses. The second section included the Nutritional Management of Diabetes Knowledge Test (NMDKT), designed and validated by Mogre et al. [ 5 ]. Its original version contains 21 questions; correct answers are scored 1, and others scored 0. Higher scores on the NMDKT represent higher level of knowledge about nutritional management of diabetes mellitus. A permission to modify and use the questionnaire for the current study was obtained from the designers (personal communication, November 3, 2019). The third section was the Nurses’ Attitudes about Nutritional Management of Diabetes Questionnaire, which developed by the researchers specifically for this study based on the WHO and the American Diabetes Association nutrition guidelines and the review of the relevant literature [ 2 , 16 , 18 ]. It contained 15 questions and used a five-point Likert scale, with responses ranging from strongly disagree (1) to strongly agree (5). Total scores could range from 15 to 75. The scores were then standardized between 0 to100 and categorized to three categories of high (66.6–100), moderate (33.3–66.6), and poor attitudes (0-33.3).

The final section included the Nurses’ Practice on Nutritional Management of Diabetes Questionnaire. This questionnaire was also developed by the researchers. It contained 15 questions and used a four-point Likert scale, with responses ranging from never (1) to always. Total practice scores could range from 15 to 60. The scores on practice about nutritional management of diabetes mellitus were then standardized between 0 to100 and categorized to three categories of good (66.6–100), moderate (33.3–66.6) and poor practice (0-33.3).

Validity and reliability

The survey package was submitted to a panel of 13 experts, 4 in nutrition and 9 in nursing, for evaluation of the face and content validity. The questionnaire was revised based on the comments of the review panel and resubmitted for further evaluation. For example, question 12 was removed for a cultural reason. The panel approved all the items as appropriate, assuring good content validity. In addition, the Content Validity Ratio (CVR) and content validity index (CVI) of all questionnaires were assessed and the results supported the content validity of the used tools. The CVR and CVI for were 0.99 and 0.98, respectively. The Nurses’ Attitudes about Nutritional Management of Diabetes Questionnaire had the CVR and the CVI of 0.99 and 1.00, respectively, and the Nurses’ Practice on Nutritional Management of Diabetes Questionnaire demonstrated the CVR and the CVI of 0.99 and 1.00, respectively. Using Cronbach’s alpha to measure internal consistency, a reliability coefficient of 0.65 was attained for the NMDKT, 0.83 for the Nurses’ Attitudes on Nutritional Management of Diabetes Questionnaire, and 0.90 for the Nurses’ Practice on Nutritional Management of Diabetes Questionnaire. The questionnaire took an average 17.88 ± 9.40 min to complete.

Thus, we used the NMDKT containing 20 questions in this study. Total row scores ranged from 0 to 20. The NMDKT scores were then standardized between 0 to100 and categorized to three categories of high (66.6–100), moderate (33.3–66.6) and poor knowledge (0-33.3).

Ethical considerations

The study received ethical approval from the Regional Research Ethics Committee of Tabriz University of Medical Sciences (Approval ID: IR.TBZMED.REC.1399.844), was carried out in accordance with the Declaration of Helsinki. Potential nurses were informed about the study and what participation would entail, and all provided informed consent before participating in the study. Permission to have access to the hospitals was obtained from hospital mangers. The survey was anonymous, and participants were ensured that the data could not be traced back to individual participants or hospitals.

Data analysis

Data were analyzed using descriptive statistics to characterize respondents’ profiles. This included reporting mean values and standard deviations for continuous variables and frequency and percentages for categorical and ordinal variables. Relationship between KAP concepts was assessed by Pearson’s correlation coefficient, and multiple linear regression analysis was used to identify the significant associates of KAP. Analyses were conducted using the IBM SPSS for Windows, Version 24.0 statistical software package. A p-value of < 0.05 was considered statistically significant.

Characteristics of the participants

Demographic characteristics and professional and educational background of the study nurses were summarized in Table  1 . All potential participants, who were invited to participate, accepted the invitations except three nurses (acceptance rate of 98.16%). Two nurses rejected the study of due to heavy workload due and one nurse due to sickness. The mean age of participants was 30.31 ± 6.32 years; the majority were female (n = 110, 68.75%), and had a Bachelor’s degree in Nursing (n = 158, 98.8%) while the remaining (n = 2, 1.2%) had a Master’s degree in Nursing in addition to a Bachelor of Nursing degree. Above half of the participants (n = 90, 56.3%) were working in medical wards and the remaining (n = 70, 43.8%) in the surgical wards. Only small number of nurses (n = 34, 21.3%) were satisfied with nutrition education they had received during university training. The majority of nurses in this study (n = 147, 91.9%) did not have a refresher training on diabetes (Table  1 ).

The first objective of this study was to identify nurses’ knowledge about nutritional management of diabetes. The result showed that the mean knowledge score was 12.16 ± 2.83, with minimum score of 4 and maximum score of 18. Based on standardized scores, 93(61.2%) participants demonstrated a moderate level of knowledge (Table  2 ).

The second objective was to identify nurses’ attitudes toward nutritional management of diabetes. The mean attitudes score was 60.68 ± 6.11. Based on standardized scores, 133(86.92%) participants demonstrated positive attitudes toward nutritional management of diabetes (Table  3 ).

The third objective was to identify nurses’ practice on nutritional management of diabetes. The mean practice score was 44.74 ± 7.8. Based on standardized scores 82(51.9%) of participants demonstrated a moderate level practice (Table  4 ).

The forth objective of this study was to identify relationships between nurses’ KAP about nutritional management of diabetes. The correlation between knowledge, attitudes, and practice was evaluated using the Pearson’s correlation analysis. There was a statistically significant correlation between both knowledge (r= -0.164, p  = 0.045) and attitudes (r = 0.361, p  < 0.001) with practice scores. However, the correlation between knowledge and attitudes was not statistically significant (r=-0.067, p  = 0.423) (Table  5 ).

In the multiple linear regression analysis, gender and preferred method of learning were statistically significant correlates of participants’ knowledge of nutritional management of diabetes (Table  6 ). Higher knowledge was reported among male nurses (B = -7.55, p  = 0.009), and those reported blended learning as their preferred learning method (B = 7.28, p  = 0.029).

Only provision of diabetes education during working shifts was the statistically significant correlate of attitudes toward nutritional management of diabetes (Table  7 ). Positive attitudes scores were reported by nurses who provided diabetes education for patients during their work shifts (B = -7.59, p  = 0.017).

The multiple linear regression analysis showed statistically significant relationships between hospital and feeling competent and practice on nutritional management of diabetes (Table  8 ). Higher practice scores were observed among nurses who were employed in hospital 2 and those who perceived themselves competent in the nutritional management of diabetes (B = -18.05, p  = 0.008).

The findings of this study provide insights into nurses’ KAP about the nutritional management of diabetes. Overall, participants demonstrated a moderate level of knowledge on the nutritional management of diabetes. Knowledge forms the basis of professional practice. Knowledge deficits of diabetes care, including nutritional management of diabetes, imposes a significant risk to delivery of safe practice [ 7 ]. The results of a review study revealed a significant knowledge deficit in the core aspects of diabetes care among nurses globally [ 7 ]. Comparing our findings with the past research, the mean knowledge score in our study was higher than the overall 44% correct responses reported by Mogre et al. [ 5 ]. Also, Naz et al. reported that half nurses in their study had an unsatisfactory level of knowledge about diabetes and diabetes meal planning [ 6 ]. Badshah et al. found that the majority of nurses had poor knowledge regarding diabetic diet [ 19 ]. Likewise, the study by Oyewole et al. revealed nurses’ knowledge deficiency in some critical areas, such as diabetes diet [ 20 ]. Inadequate nutritional knowledge of nurses could lead to inaccurate information provided to diabetic patients, which may lead to poor diabetes management and an increase in the rate of diabetes-related complications and treatment costs [ 19 ].

The moderate level of knowledge found among the nurses in our study could be due the fact that nurses mostly had not received any diabetes education after graduation from university. Similar to the present study results, Samancioglu et al. reported that only 3.9% of the nurses had a certificate as a ‘diabetes educator’ in Turkey [ 21 ]. Likewise, Alhaiti et al. reported that most nurses in Saudi Arabia in their study (78.4%) had not received any refreshing training on diabetes [ 22 ]. Like many other countries [ 23 ], nurses in Iran receive 26 h of education on nutrition during their bachelor of nursing degree. Considering the dramatic rise in the prevalence of diabetes worldwide, educational curriculums in health-related fields should better focus on training health care professionals about diabetes care, including the nutritional management of diabetes [ 24 ].

The majority of nurses in our study demonstrated positive attitudes toward the nutritional management of diabetes mellitus, which is a promising finding. Similar to the present study, a study by Kim and Choue showed that most Korean nurses possessed positive attitudes about attending to nutritional needs of patients and showed a high desire to receive further training on patient nutrition [ 14 ]. In contrast to the current study, Oyewole et al. in Nigeria reported that 48.9% of nurses in their study exhibited negative attitudes toward diabetes care in general [ 20 ]. Positive attitudes can be considered as an opportunity to improve the knowledge and practice of nurses on the nutritional management of diabetes mellitus.

Overall nurses in the current study reported a moderate level of practice on the nutritional management of diabetes. Direct comparison to other studies is difficult due to limited studies assessing nurses’ practice with regards to nutritional management of diabetes. The available studies mostly assessed nurses’ practice in relation to diabetes in general or addressed nutritional management in hospitalized patients in general, with a few questions targeted on diabetes. Comparing our findings with available evidence, the mean practice score achieved by the nurses in this study was higher than scores reported by Emami et al. in Iran [ 18 ]. In the Emami et al.’s study, nurses acted poorly on nutritional screening and the subsequent referral to a dietician for professional assessment. Initial nutritional assessment of chronically ill patients, including those with poorly controlled diabetes can have a significant effect on patient outcomes. A reason for the suboptimal practice of nurses in our study could be due to time constraint, making the process of initial nutritional assessment of patients and their referral to a dietitian unrealistic in the clinical settings.

The current study found a positive correlation between knowledge and attitudes with practice. The research team could not find any study that attempted to find the correlation between KAP about nutrition management of diabetes among nurses in Iran. The knowledge scores of nurses about nutritional management of diabetes were significantly higher among male nurses and nurses who selected blended learning as their preferred learning method. Similar to this finding, in the study conducted by Mogre et al. in Ghana, male nurses scored higher than female nurses on the NMDKT [ 5 ].

Furthermore, the present study revealed an association between attitude scores and involvement in diabetes education. Nurses who provided education to diabetic patients during their work possessed more positive attitudes toward nutritional management of diabetes. Higher practice scores were observed among nurses who were employed in hospital 2. One reasonable explanation to this finding could be that hospital 1 had an endocrine ward, admitting most patients with diabetes. This might have caused the nurses of other wards in hospital 1 have less exposure to patients with diabetes, and develop competency in managing the nutritional care needs of patients with diabetes. Supporting this explanation, practice scores in this study were positively associated with nurses’ perceived competency in nutritional management of diabetes.

Limitations

The results of this study contributed to our understanding of nurses’ KAP on the nutritional management of diabetes in Iran. Using random sampling method and recruiting participants from two tertiary referral teaching hospitals increase the generalizability of the findings. However the self-report nature of the data is a limitation. Also, this study was conducted in hospital settings, it should be noted that only small percentage of patients with diabetes are admitted to hospitals, and the main part of diabetes care is provided in primary care settings or outpatient clinics. Thus, the results of this study are applicable to hospital settings only.

Conclusions

Nurses in this study demonstrated a moderate level of knowledge and practice in relation to the nutritional management of diabetes mellitus, although their attitude toward this aspect of patient care was positive. Being a male nurse, having a preference for blended learning, having opportunities to get involved in providing education to diabetes patients during work, hospital where employed, and perceive competency in the nutritional management of diabetes affected nurses’ knowledge, attitudes, and practice. Given the growing trend of diabetes worldwide and the role of nutrition in diabetes management, it is necessary to improve the knowledge, attitudes, and practice of nurses about the nutritional management of diabetes. The educational curriculums should be examined for adequate education of nurses about diabetes care.

Data Availability

The datasets generated and/or analyzed during the current study are not publicly available due to agreements with participants who restricted data sharing but are available from the corresponding author on reasonable request.

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Acknowledgements

The present study is a part of a master of nursing thesis. The research proposal was approved and supported by Tabriz University of Medical Sciences. Hence, the researchers feel obliged to thank Tabriz University of Medical Sciences for their support. In addition, the authors would like to thank the nurses who participated in this study. We would also like to thank Dr. Victor Mogre for the permission to use the Nutritional Management of Diabetes Knowledge Test (NMDKT) in this study. Finally, we would like to thank the Clinical Research Development Unit, Sina Educational, Research, and Treatment Center, Tabriz University of Medical Sciences, for their assistance in this research.

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Mahsa Farzaei

Department of Medical- Surgical Nursing, Faculty of Nursing and Midwifery& Clinical Research Development Unit, Sina Educational, Research and Treatment Center, Tabriz University of Medical Sciences, P.O. Box 51745347, Tabriz, Iran

Shahla Shahbazi

Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Postal code: 166614711, Iran

Neda Gilani

Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Postal code: 5166614711, Iran

Alireza Ostadrahimi

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Study design: ShSh, MF, NG, AOR; Acquisition of data: MF; Analysis and interpretation of data: NG, MF; Drafting of the article: ShSh, LG; All authors read and approved the final manuscript.

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The study received ethical approval from the Regional Research Ethics Committee of Tabriz University of Medical Sciences. (Approval ID: IR.TBZMED.REC.1399.844). The Declaration of Helsinki was followed in conducting the study. Participants received information about the objectives of the study and provided informed consent before participating in the research. Permission to access the hospitals was obtained from hospital administrators. The study was anonymous and collected data could not trace back to individual respondents or hospitals.

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Farzaei, M., Shahbazi, S., Gilani, N. et al. Nurses’ knowledge, attitudes, and practice with regards to nutritional management of diabetes mellitus. BMC Med Educ 23 , 192 (2023). https://doi.org/10.1186/s12909-023-04178-4

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Best Nursing Research Topics for Students

What is a nursing research paper.

• What They Include
• Choosing a Topic
• Best Nursing Research Topics
• Research Paper Writing Tips

Writing a research paper is a massive task that involves careful organization, critical analysis, and a lot of time. Some nursing students are natural writers, while others struggle to select a nursing research topic, let alone write about it.

If you're a nursing student who dreads writing research papers, this article may help ease your anxiety. We'll cover everything you need to know about writing nursing school research papers and the top topics for nursing research.  

Continue reading to make your paper-writing jitters a thing of the past.

A nursing research paper is a work of academic writing composed by a nurse or nursing student. The paper may present information on a specific topic or answer a question.

During LPN/LVN and RN programs, most papers you write focus on learning to use research databases, evaluate appropriate resources, and format your writing with APA style. You'll then synthesize your research information to answer a question or analyze a topic.

BSN , MSN , Ph.D., and DNP programs also write nursing research papers. Students in these programs may also participate in conducting original research studies.

Writing papers during your academic program improves and develops many skills, including the ability to:

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• Conduct effective research
• Analyze published academic literature
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• Organize and articulate findings

About Nursing Research Papers

When do nursing students write research papers.

You may need to write a research paper for any of the nursing courses you take. Research papers help develop critical thinking and communication skills. They allow you to learn how to conduct research and critically review publications.

That said, not every class will require in-depth, 10-20-page papers. The more advanced your degree path, the more you can expect to write and conduct research. If you're in an associate or bachelor's program, you'll probably write a few papers each semester or term.

Do Nursing Students Conduct Original Research?

Most of the time, you won't be designing, conducting, and evaluating new research. Instead, your projects will focus on learning the research process and the scientific method. You'll achieve these objectives by evaluating existing nursing literature and sources and defending a thesis.

However, many nursing faculty members do conduct original research. So, you may get opportunities to participate in, and publish, research articles.

Example Research Project Scenario:

In your maternal child nursing class, the professor assigns the class a research paper regarding developmentally appropriate nursing interventions for the pediatric population. While that may sound specific, you have almost endless opportunities to narrow down the focus of your writing. 

You could choose pain intervention measures in toddlers. Conversely, you can research the effects of prolonged hospitalization on adolescents' social-emotional development.

What Does a Nursing Research Paper Include?

Your professor should provide a thorough guideline of the scope of the paper. In general, an undergraduate nursing research paper will consist of:

Introduction : A brief overview of the research question/thesis statement your paper will discuss. You can include why the topic is relevant.

Body : This section presents your research findings and allows you to synthesize the information and data you collected. You'll have a chance to articulate your evaluation and answer your research question. The length of this section depends on your assignment.

Conclusion : A brief review of the information and analysis you presented throughout the body of the paper. This section is a recap of your paper and another chance to reassert your thesis.

The best advice is to follow your instructor's rubric and guidelines. Remember to ask for help whenever needed, and avoid overcomplicating the assignment!

How to Choose a Nursing Research Topic

The sheer volume of prospective nursing research topics can become overwhelming for students. Additionally, you may get the misconception that all the 'good' research ideas are exhausted. However, a personal approach may help you narrow down a research topic and find a unique angle.

Writing your research paper about a topic you value or connect with makes the task easier. Additionally, you should consider the material's breadth. Topics with plenty of existing literature will make developing a research question and thesis smoother.

Finally, feel free to shift gears if necessary, especially if you're still early in the research process. If you start down one path and have trouble finding published information, ask your professor if you can choose another topic.

The Best Research Topics for Nursing Students

You have endless subject choices for nursing research papers. This non-exhaustive list just scratches the surface of some of the best nursing research topics.

1. Clinical Nursing Research Topics

• Analyze the use of telehealth/virtual nursing to reduce inpatient nurse duties.
• Discuss the impact of evidence-based respiratory interventions on patient outcomes in critical care settings.
• Explore the effectiveness of pain management protocols in pediatric patients.

2. Community Health Nursing Research Topics

• Assess the impact of nurse-led diabetes education in Type II Diabetics.
• Analyze the relationship between socioeconomic status and access to healthcare services.

3. Nurse Education Research Topics

• Review the effectiveness of simulation-based learning to improve nursing students' clinical skills.
• Identify methods that best prepare pre-licensure students for clinical practice.
• Investigate factors that influence nurses to pursue advanced degrees.
• Evaluate education methods that enhance cultural competence among nurses.
• Describe the role of mindfulness interventions in reducing stress and burnout among nurses.

4. Mental Health Nursing Research Topics

• Explore patient outcomes related to nurse staffing levels in acute behavioral health settings.
• Assess the effectiveness of mental health education among emergency room nurses .
• Explore de-escalation techniques that result in improved patient outcomes.
• Review the effectiveness of therapeutic communication in improving patient outcomes.

5. Pediatric Nursing Research Topics

• Assess the impact of parental involvement in pediatric asthma treatment adherence.
• Explore challenges related to chronic illness management in pediatric patients.
• Review the role of play therapy and other therapeutic interventions that alleviate anxiety among hospitalized children.

6. The Nursing Profession Research Topics

• Analyze the effects of short staffing on nurse burnout .
• Evaluate factors that facilitate resiliency among nursing professionals.
• Examine predictors of nurse dissatisfaction and burnout.
• Posit how nursing theories influence modern nursing practice.

Tips for Writing a Nursing Research Paper

The best nursing research advice we can provide is to follow your professor's rubric and instructions. However, here are a few study tips for nursing students to make paper writing less painful:

Avoid procrastination: Everyone says it, but few follow this advice. You can significantly lower your stress levels if you avoid procrastinating and start working on your project immediately.

Plan Ahead: Break down the writing process into smaller sections, especially if it seems overwhelming. Give yourself time for each step in the process.

Research: Use your resources and ask for help from the librarian or instructor. The rest should come together quickly once you find high-quality studies to analyze.

Outline: Create an outline to help you organize your thoughts. Then, you can plug in information throughout the research process. 

Clear Language: Use plain language as much as possible to get your point across. Jargon is inevitable when writing academic nursing papers, but keep it to a minimum.

Cite Properly: Accurately cite all sources using the appropriate citation style. Nursing research papers will almost always implement APA style. Check out the resources below for some excellent reference management options.

Revise and Edit: Once you finish your first draft, put it away for one to two hours or, preferably, a whole day. Once you've placed some space between you and your paper, read through and edit for clarity, coherence, and grammatical errors. Reading your essay out loud is an excellent way to check for the 'flow' of the paper.

Helpful Nursing Research Writing Resources:

Purdue OWL (Online writing lab) has a robust APA guide covering everything you need about APA style and rules.

Grammarly helps you edit grammar, spelling, and punctuation. Upgrading to a paid plan will get you plagiarism detection, formatting, and engagement suggestions. This tool is excellent to help you simplify complicated sentences.

Mendeley is a free reference management software. It stores, organizes, and cites references. It has a Microsoft plug-in that inserts and correctly formats APA citations.

Don't let nursing research papers scare you away from starting nursing school or furthering your education. Their purpose is to develop skills you'll need to be an effective nurse: critical thinking, communication, and the ability to review published information critically.

Choose a great topic and follow your teacher's instructions; you'll finish that paper in no time.

Joleen Sams is a certified Family Nurse Practitioner based in the Kansas City metro area. During her 10-year RN career, Joleen worked in NICU, inpatient pediatrics, and regulatory compliance. Since graduating with her MSN-FNP in 2019, she has worked in urgent care and nursing administration. Connect with Joleen on LinkedIn or see more of her writing on her website.

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Uncommon or Rare Forms of Diabetes: From Diagnosis to Management

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Within the umbrella term of uncommon or rare forms of diabetes, many forms exist such as: monogenic diabetes, mitochondrial diabetes, cystic fibrosis related diabetes, drug-induced diabetes, and diabetes associated with rare syndromes. In these forms, early diagnosis is essential to reduce the appearance of long-term complications. But, these forms being so rare, people can often be misdiagnosed. In these cases genetics could play an important role. It is very important to recognize these uncommon types of diabetes, the treatment being directed towards the underlying etiology. Unlike type 1 and 2 diabetes, which are better known by both pediatricians and adult diabetes specialists, the rare or uncommon forms can be more difficult to diagnose and monitor. Also, we must not forget the fact that even these rare or uncommon forms can be accompanied by micro- and macrovascular complications, and periodic screening is required. This Research Topic aims to highlight the current state of diagnosis and possibilities of treatment, as well as future perspectives. We would like the articles to be published in this collection to be a real help for those involved in the diagnosis and management of these uncommon or rare forms, as well as among family doctors. We encourage clinicians and researchers worldwide to contribute their insights on the latest discoveries pertaining to the pathogenesis, advancements in diagnostic and treatment, and other relevant factors of uncommon or rare forms of diabetes. Topics include uncommon forms of diabetes, including but not limited to: - drug-induced diabetes, - diabetes secondary to infections (rubella, cytomeglaovirus), - immune-mediated diabetes, - genetic syndromes associated with diabetes (Down, Turner, Klinefelter, etc.), - diabetes from endocrinopathies (Hyperthyroidism, Acromegaly, Cushing), - genetic defects in insulin secretion and of beta-cell function. Types of manuscripts include: original research, reviews, case reports. Topic Editor Valeria Grancini has received grants for speeches from Vertex Europe; Topic Editor Irene Rutigliano has received speaking grants from Kwoya Kirin and Erbozeta, and is an external consultant for Amryt; other Topic Editors declare no conflict of interest

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Fast Facts: Diabetes and Oral Health

At a glance.

Review facts about oral health and diabetes in the United States.

• Adults aged 20 or older with diabetes are 40% more likely to have untreated cavities than similar adults without diabetes. 1
• There is an association between having diabetes and periodontal (gum) disease, a leading cause of tooth loss. 2 3 4
• About 60% of US adults with diabetes had a medical visit in the past year, but no dental visit. 1
• Expanding health care coverage for periodontal treatment among people with diabetes could save each person about $6,000 (2019 US dollars) over their lives. 5
• Adults aged 50 or older with diabetes (1) lack functional dentition (have fewer than 20 teeth) 46% more often and (2) have severe tooth loss (8 or fewer teeth) 56% more often than adults without diabetes. 6
• Adults aged 50 or older with diabetes are more likely to report that they have a hard time eating because of dental problems. 7
• Annual dental costs for an adult with diabetes are $77 (2017 US dollars) higher than for an adult without diabetes. These costs translate to $1.9 billion for the nation. 8
• Treating gum disease significantly improves blood sugar level (glycemic control) among people with diabetes compared to no treatment or routine care. 9
• Wei L, Griffin SO, Parker M, Thornton-Evans G. Dental health status, use, and insurance coverage among adults with chronic conditions: implications for medical-dental integration in the United States. J Am Dent Assoc. 2022;153(6):563–571. doi: 10.1016/j.adaj.2021.12.012
• Chávarry NG, Vettore MV, Sansone C, Sheiham A. The relationship between diabetes mellitus and destructive periodontal disease: a meta-analysis. Oral Health Prev Dent . 2009;7(2):107–127.
• Sanz M, Ceriello A, Buysschaert M, et al. Scientific evidence on the links between periodontal diseases and diabetes: consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology. J Clin Periodontol . 2018;45(2):138–149. doi:10.1111/jcpe.12808
• Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W. Global burden of severe tooth loss: a systematic review and meta-analysis. J Dent Res . 2014;93(suppl 7):20S–28S. doi:10.1177/0022034514537828
• Choi SE, Sima C, Pandya A. Impact of treating oral disease on preventing vascular diseases: a model-based cost-effectiveness analysis of periodontal treatment among patients with type 2 diabetes. Diabetes Care . 2020;43(3):563–571. doi:10.2337/dc19-1201
• Parker ML, Thornton-Evans G, Wei L, Griffin SO. Prevalence of and changes in tooth loss among adults aged ≥50 years with selected chronic conditions — United States, 1999–2004 and 2011–2016. MMWR Morb Mortal Wkly Rep . 2020;69(21):641–646.
• Griffin SO, Jones JA, Brunson D, Griffin PM, Bailey WD. Burden of oral disease among older adults and implications for public health priorities. Am J Public Health . 2012;102(3):411–418. doi:10.2105/AJPH.2011.300362
• Chen Y, Zhang P, Luman ET, Griffin SO, Rolka DB. Incremental dental expenditures associated with diabetes among non-institutionalized US adults aged ≥18 years old in 2016-2017. Diabetes Care . 2021;44(6):1317–1323. doi: 10.2337/dc20-2744
• Simpson TC, Clarkson JE, Worthington HV, et al. Treatment of periodontitis for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev. 2022;4(4):CD004714. doi:10.1002/14651858.CD004714.pub4

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New dean of School of Nursing and Health Studies named

By Robert C. Jones Jr. [email protected] 05-15-2024

Amid a setting of sutures and stethoscopes, bandages and blood pressure cuffs, medical successes and sometimes setbacks, Hudson Santos found his calling at the tender age of 9: nursing.  

His mother, unable at times to arrange childcare for her young son, would sometimes bring him along to the hospital in northeastern Brazil where she cared for patients on her rounds as a licensed practical nurse. “Her professionalism was imprinted on me at a very early stage of my life,” Santos recalled. “She inspired me and nursing became our shared passion.”  

So he followed in his mother’s footsteps, becoming a nurse and caring for marginalized groups at clinics in Brazil and in the United States before conducting nursing-related education and research as an internationally renowned academician.  

Now, Santos, vice dean for research at the University of Miami School of Nursing and Health Studies , has earned what he says is “the greatest honor of my professional career.” He has been named the next dean of the University’s School of Nursing and Health Studies.  

“In Dean Santos, we have a proven leader whose prolific portfolio is matched only by his passion for guiding colleagues and students to excellence in research,” said University President Julio Frenk. “His is precisely the type of vision our School of Nursing and Health Studies needs to continue its ascent to the top echelon of nursing programs nationally.”

Santos joined the University of Miami faculty two years ago as a tenured professor and the inaugural Dolores J. Chambreau Endowed Chair in Nursing. He was formerly the Beerstecher-Blackwell Distinguished Term Scholar and a tenured associate professor at the University of North Carolina at Chapel Hill School of Nursing, where he led the Biobehavioral Laboratory and was the founder and director of the Health Resilience and Omics Science Hub for identifying genetic risk factors affecting the neurodevelopment of children. He was also the Director of Training and Mentorship Division for the Institute for Environmental Health Solutions at the Gillings School of Global Public Health.  

Over the past 15 years, he has conducted extensive research on families, studying how early life stressors affect perinatal health and child developmental outcomes in high-risk populations as well as across socioeconomic status levels and racially and ethnically diverse communities.  

For Santos, it is an area of investigation that began when he was a nurse working in a clinical setting in northeastern Brazil and noticed that mothers with psychological issues and their developmentally delayed children were being treated at separate outpatient facilities. “I saw children who were struggling developmentally, and I wanted to know what was affecting their mothers. But the health care system was fragmented; they were being seen separately and at different locations,” he recalled.  

And that sparked his desire to learn more about maternal-child health and to raise awareness that the health of children begins before they are even born.  

Santos also has examined how environmental factors such as climate change can influence the health outcomes of mothers and their children. “Heat can negatively affect health, especially the health of families who lack basic necessities and are facing other adversities. So, we want to understand that and be able to use that information for prevention,” he said. “The whole idea is to foster a healthier family ecosystem early on instead of having to treat families for serious conditions later in life.”  

Santos is spearheading an ambitious $23.57 million National Institutes of Health (NIH) study examining how social and economic inequities as well as other stressors experienced by parents can biologically and psychologically impact their children. As part of that seven-year grant, the largest ever awarded to the Coral Gables Campus, the School of Nursing joins the NIH’s Environmental Influences on Child Health Outcomes (ECHO) Program and will enroll a racially and ethnically diverse group of some 1,250 pregnant mothers from Miami-Dade County, following their offspring from birth to age 7.  

Miami-ECHO is recruiting participants through UHealth—the University of Miami Health System, and Jackson Heath System, and will join several other cohorts across the nation to create a group of over 50,000 children and their parents. “While the big picture is to understand how early environmental factors impact child health and development, we’ll also be able to answer questions that are specific to Miami,” Santos said.  

Through his leadership, the School of Nursing and Health Studies has risen dramatically in national rankings—from 24th to 16th in NIH funding—nearly doubling its research footprint from $3,396,294 in FY 2022 to $6,061,945 in FY 2023.  

And over the course of his career, he has authored more than 110 scientific publications, securing upwards of $47 million in research funding as a principal investigator or co-investigator.  

“Dean Santos is an internationally known nurse leader and scientist who has transformed research at the School of Nursing and Health Studies in his short two years at the school,” said Guillermo “Willy” Prado, interim executive vice president and provost. “I am confident that his leadership and his vision for the school’s academic programs and research will elevate the school as a premier destination for both nursing students and faculty across the country.”  

Beyond his significant research portfolio, Santos has also demonstrated effective leadership, serving as acting director of the Ph.D. in Nursing Science program and interim associate dean of the Graduate School, Frenk and Prado pointed out in their message on Santos’ appointment to the University community emailed on Wednesday.  

Santos is passionate about diversity and inclusion, a philosophy deeply rooted in his own background as a Latino male nurse, a first-generation college student, and an immigrant to the United States. Born into poverty in Brazil, he and his siblings were confronted with severe adversity. “Survival was an achievement for us and thriving seemed beyond reach,” he said. “Yet, I discovered the transformative power of education in lifting individuals out of poverty.”  

As dean he will lead a nursing school that is home to the five-story Simulation Hospital Advancing Research and Education (S.H.A.R.E.) with on-site virtual and extended-reality simulation opportunities in a variety of clinical, research, and educational settings.  

Among his goals are to enhance the relationship of the nursing school with UHealth and Jackson Health System, expand the school’s strong national and international presence, and amplify its visibility by promoting innovative education, research and scholarship, he said.  

Santos currently serves as president of the International Society of Nurses in Genetics and is also a fellow of the American Academy of Nursing, where he serves as chair-elect of the Council for the Advancement of Nursing Science National Advisory Council.  

He begins his deanship on June 1, succeeding Cindy Munro, who last year announced she was stepping down as dean at the end of the academic year after leading the school for nearly seven years.

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• v.21(2); 2018 Apr

Diabetes‐related complications: Which research topics matter to diverse patients and caregivers?

Maman joyce dogba.

1 Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada

2 Office of Education and Professional Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada

Mylène Tantchou Dipankui

Selma chipenda dansokho, france légaré, holly o. witteman.

3 Centre Hospitalier Universitaire de Québec (CHU de Québec) Research Centre [Health of populations and best health practices axis], Quebec City, QC, Canada

Associated Data

Diabetes is a chronic disease with increasing prevalence worldwide. Although research has improved its treatment and management, little is known about which research topics matter to people living with diabetes, particularly among under‐represented groups.

To explore the importance of research topics among a diverse range of people living with any type of diabetes or caring for someone living with any type of diabetes.

We used a convergent mixed‐method design with quantitative and qualitative aspects. We surveyed a national sample of people living with diabetes and caregivers of people with diabetes, asking them to rate the importance of 10 predetermined important research topics. We also held three focus groups in two major cities to explore research concerns of people who are under‐represented in research.

469 adults (57% men, 42% women) in Canada completed the online survey, indicating that all 10 areas of research mattered to them, with the highest ratings accorded to preventing and treating kidney, eye and nerve complications. Fourteen individuals participated in three focus groups and similarly noted the importance of research on those three complications. Additionally, focus group participants also noted the importance of research around daily management. No new topics were identified.

Conclusions

This study confirmed the importance of research topics among a population of people living with or caring for someone with diabetes. Findings from this study were used to inform the vision for Diabetes Action Canada—a pan‐Canadian Strategy for Patient‐Oriented Research ( SPOR ) Network on diabetes and its complications.

1. INTRODUCTION

Diabetes is a chronic disease with increasing prevalence worldwide. 1 In 2014, an estimated 422 million adults, representing 8.5% of the global population, were living with diabetes. 2 The economic burden of this disease and its complications account for a growing proportion of local and national budgets. 3 , 4 For individuals, diabetes has negative psychosocial consequences that diminish quality of life. 5 While research has improved the treatment and management of diabetes and increased longevity, 6 mismatches between the focus of research and what matters to patients may lead to research waste. 7 , 8 Involving patients in the early stages of research is the first step in reducing such waste, as it helps increase the relevance of topics studied regarding such chronic diseases as diabetes. 9 People living with chronic diseases may develop a high degree of expertise which can provide new insight into how to improve their conditions and self‐care. 10 , 11 The patient perspective may complement that of the clinician and researcher by providing a more holistic interpretation of health and the experience of a health condition. 11

When seeking to involve patients as partners in research, it is critical to avoid reproducing or even exacerbating health inequities. Major disparities persist in the diagnosis, treatment, disease management and health outcomes of groups such as ethnic minorities, immigrants, people living in poverty, people whose mental health require regular follow‐up with a psychiatrist and seniors, all of whom are more vulnerable to diabetes‐related complications. 12 , 13 , 14 , 15 , 16 In spite of these continuing disparities, minority groups continue to be under‐represented in research, and engagement in defining research questions is no exception. Additionally, there is little guidance on how to facilitate the full participation of members of these groups in setting research priorities. 17 , 18 For example, although previous research in the United Kingdom has identified research priorities among people living with type 1 diabetes, those involved were predominantly white and female. 19

This study aimed to involve a national sample of people living with diabetes and caregivers of people living with diabetes in rating the importance of research topics around diabetes‐related complications. We further sought to capture the perspectives of people who are under‐represented in research. Our primary research question was as follows: What topics are most important to people living with or caring for someone living with diabetes regarding disease‐related complications as a means to help better orient future research priorities?

2.1. Study design

We used a multipronged mixed‐methods (QUAN + QUAL) approach with a convergent design 20 to capture what was important to people living with diabetes and caregivers regarding research on diabetes‐related complications. 21 , 22 According to the convergent mixed‐methods design, quantitative and qualitative methods are complementary during data collection, data analysis or both. In our case, we combined 21 the quantitative and qualitative data after we completed both sets of data collection. The study consisted of two components accordingly: (i) quantitative: an anonymous online survey to poll a national sample of people living with diabetes or caregivers of people living with diabetes on the importance of 10 predetermined research topics; and (ii) qualitative: holding focus groups with people living with diabetes who are members of under‐represented groups, in order to explore the views and experiences of those predicted to be under‐represented in the online survey. 23

2.2. Research ethics

This study was approved by the Research Ethics Board of the Centre Hospitalier Universitaire de Québec (Quebec City, approval #: 2016‐2578). In agreeing to follow the link and take the online survey, participants provided implied consent. No survey questions were mandatory, meaning that respondents could skip questions if they wished. No attention filter was included. Prior to each focus group, we described the project and allowed participants to ask questions. Verbal consent of focus group participants was recorded.

2.3. Procedures

2.3.1. online survey.

The online survey included questions on socio‐demographics, the person's experience with diabetes‐related complications and analog scales to rate the importance of 10 pertinent disease‐related complication research topics. These topics were identified in the literature describing previous priority‐setting exercises conducted with people living with type 1 diabetes, 19 and via email consultation with researchers, clinicians, representatives of patient organizations, caregivers and patient partners as part of a 6‐month funding application planning process.

Demographic data gathered from participants included: age, gender, ethnicity, income and education levels, geographical location and country of birth (inside or outside of Canada). Prior to finalizing the survey, all survey questions were iteratively reviewed by a person living with type 1 diabetes, a person living with type 2 diabetes, and a parent of a child with type 1 diabetes. The survey also contained three validated scales 24 , 25 , 26 , 27 , 28 to measure fear or distress associated with living with diabetes and its complications (see Appendix S1 ). These scales were included because we believed that fear or distress might influence how individuals rate the importance of research topics relative to the levels of fear they experience regarding these complications. If we were to observe large variations in ratings of importance, these data would allow us to explore potential reasons for the variation. The survey also included comment boxes where participants could provide additional information, including an open‐ended question asking for their ideas on additional topics concerning diabetes and diabetes‐related complications that require more research.

2.3.2. Survey participants

Over a 3‐day period in September 2015, we recruited participants through Qualtrics online sampling services. 29 To be included in the study, participants had to be living in Canada, aged ≥18 years, living with type 1 or type 2 diabetes, or caring for a child or an adult with diabetes and able to complete the survey in English or French. To ensure demographic diversity and offset variations in response rates, we established desired quotas based on gender (50/50 men and women), type of diabetes and relationship with diabetes (people with diabetes themselves, parents of children with diabetes, caregivers for adults with diabetes). We could not put quotas in place regarding ethnicity due to sampling constraints. In keeping with standard amounts for surveys administered by panel services, participants who completed the survey received $1.00‐$1.50 in compensation for their time answering our questions. We aimed for approximately 500 respondents. This target was selected as an achievable sample size that would allow for a broad sample of respondents and aligned with previous, similar research that sought feedback from 583 people living with diabetes about research questions they would like to see addressed. 19

2.3.3. Focus groups

Members of some groups may be less likely to complete online surveys, and thus, be under‐represented in survey‐based research. Therefore, we held 3 focus groups with patients and caregivers who were members of such groups. 30 To ensure variation in perspectives, we partnered with community organizations working with seniors, economically disadvantaged people, immigrants and people whose mental health requires follow‐up with a psychiatrist. 31 , 32 , 33 Two experienced qualitative researchers (MJD and MDT) conducted the focus groups using an established protocol. During the focus groups, patients were invited to discuss their experience with diabetes and its related complications, their perspectives and their concerns about the long‐term complications of diabetes. Participants also explained why, in their view, the concerns raised should be investigated by researchers.

2.3.4. Focus group participants

We used a convenience sample of members of under‐represented populations in the province of Quebec. We recruited focus group participants through three community‐based organizations that provide services to seniors, immigrants and people whose mental health requires regular follow‐up with a psychiatrist. To be eligible to participate in the focus groups, participants needed to be: living in Canada, aged ≥18 years, living with type 1 diabetes, type 2 diabetes or caring for a person with diabetes, and able to understand and express themselves in French. Participants who were unable to comfortably express themselves in French were excluded from the study.

To recruit participants, the organizations circulated information about the study to its clients or members. Interested participants contacted the research associate either by email or by phone. The research associate contacted all potential participants to explain the study, assess their eligibility, answer questions and discuss logistics. A reminder call and/or email was sent to all participants 2 days prior to the scheduled focus group to confirm the time and location.

We held the three focus groups at times convenient for participants. Furthermore, to increase accessibility, the focus groups were held in the offices of the partnering community organizations; a common practice when working with members of vulnerable populations. 34 We conducted two focus groups in Quebec City: (i) seniors; and (ii) people whose mental health requires regular follow‐up with a psychiatrist. We conducted the third in Montreal with a group of immigrants. Each focus group was audio‐recorded and lasted between 70 and 90 minutes. Participants received $50 in appreciation for their time and 10$ for transportation. 19

2.4. Data analysis

Our interest in conducting both qualitative and quantitative portions was to ensure inclusion of diverse perspectives. In other words, while research often uses quantitative and qualitative methods to collect different types of data from the same population to inform a research question, we used different methods to collect data from groups both more and less likely to participate in different types of research, in an attempt to capture more representative results. Therefore, we carried out quantitative and qualitative analyses separately before bringing both parts together. Our first step was to conduct descriptive statistics using SPSS version 22 (Armonk, NY, USA: IBM Corp.) to measure central tendency and examine the range of variation in responses to our questions about the importance of 10 important diabetes research areas. We recorded focus group discussions and transcribed them verbatim. We performed a six‐stage thematic analysis 35 , 36 using NVivo qualitative analysis software (QSR International Pty Ltd. Version 10, 2012). We started by generating initial codes and themes, and inductively refining these themes based on the data. MTD analysed focus group data under the guidance of MJD. The codes were labelled with short phrases using the words of participants. Then, MTD sorted codes into potential themes and collated all relevant coded data extracts within the identified themes and subthemes. During this analysis, the codes, themes and subthemes were revised and refined. We used field notes 37 to validate and complete the information gathered during the focus groups. After separate analyses were completed, we combined the findings from each study to analyse how complementary or contradictory they were. We additionally examined how focus group findings could improve our interpretation of the statistical analysis.

3.1. Characteristics of participants

3.1.1. online survey.

Of the 500 participants surveyed, 31 were excluded from our analyses because they either completed the survey in a time deemed too fast to provide thoughtful answers (ie, 10 minutes or less) or because their responses were inconsistent with the questions. The remaining 469 participants were 57% men, had a mean age of 44 (SD = 15), came from across the 10 provinces and 3 territories of Canada, and represented a broad range of educational backgrounds and income levels. In line with our concerns and predictions about representation, participants predominantly identified as White or Caucasian (93%). Participants completed the survey in English (78%) or French (22%) and were either living with diabetes (96%) and/or caring for a child (<1%) or adult with diabetes (3%). Ten percent (10%) of participants were dealing with type 1 diabetes; 89% with type 2 diabetes; and 1% with another or unknown type. Median time living with diabetes was 19.5 years for type 1 diabetes (IQR 9.8‐30.0 years) and 8.0 years for type 2 diabetes (IQR 4.0‐15.0 years.) (See Table  1 A,B).

Online Survey Data

SD, sample standard deviation; IQR, interquartile range.

A vast majority of participants with type 1 or type 2 diabetes (45% and 60%, respectively) reported other health concerns, some of which may be diabetes‐related complications (see Table S1 ). These concerns were, for types 1 and 2 respectively, eye complications (34% and 15% of participants), heart complications (13% and 24% of participants), kidney complications (22% and 8% of participants), mental health complications (34% and 27% of participants) and nerve complications (40% and 30% of participants). Many participants reported not having been screened for these complications in the previous year. Of those with type 1 and type 2 diabetes, respectively, 63% and 78% reported not receiving screening for eye complications within the past year; 71% and 68% reported not receiving screening for heart complications; 53% and 70% reported not receiving screening for kidney complications; 68% and 86% reported not receiving screening for mental health complications; and 61% and 70% reported not receiving screening for nerve complications.

3.1.2. Focus groups

Of the 23 people who initially expressed an interest in participating in the study, 5 were ineligible because they neither had diabetes nor cared for a person with diabetes; 2 withdrew because they were unavailable on the day of the focus group and 2 withdrew without explanation. Of the 14 remaining individuals who participated in the 3 focus groups, 7 (50%) were female and 3 total (21%) were living with type 1 diabetes. The characteristics of participants are shown in Table  2 .

Focus Groups: Characteristics of the 14 participants

3.2. Data analysis

3.2.1. online survey.

We report here the medians rather than the means because the distribution of responses to the survey questions about the importance of research topics regarding preventing and treating the complications of diabetes was not symmetrical. The median scores for people with both type 1 and type 2 diabetes were between 84 and 100 (on a 0 to 100 rating scale, with 100 indicating extremely important) indicating that participants assigned high importance to all 10 predetermined research topics with relatively little variation between topics. Topics that had the highest median scores and the least variation in responses were preventing and treating kidney, eye, heart and nerve problems. Research topics for which participants had the widest interquartile range in scores were as follows: preventing and treating mental health problems, developing and testing smart insulin, patient and caregiver education, and artificial pancreas research (type 1) (see Table  3 ).

Online survey results regarding the importance of diabetes‐related research topics

Cronbach's alphas were .94, .93 and .94, respectively, for the Fear of Complications Scale, 28 Hypoglycemia Fear Scale 24 , 25 , 26 and Diabetes Distress Scale. 27 People with type 1 diabetes and type 2 diabetes had mean scores of 23 (SD 10) and 18 (SD 10), respectively, on the Fear of Complications Scale (range 0‐45). Participants with type 1 diabetes had a mean score of 34 (SD 17) on the Hypoglycemia Fear Scale (range 0‐108) indicating sometimes fearing hypoglycaemia, while participants with type 2 diabetes had a mean score of 21 (SD 16) indicating being concerned less often. Finally, participants with type 1 diabetes and type 2 diabetes had mean scores of 2.81 (SD 1.23) and 2.23 (SD 1.27) on the Diabetes Distress Scale. Using the cut‐off score recommended by Fisher et al 38 this indicates that on average, participants with type 1 diabetes had moderate but non‐clinical levels of distress (threshold = 3) (see Table S1 ).

Comments provided by participants in the open box sections of the survey aligned with the quantitative findings and illustrate the emotional distress linked to diabetes and diabetes management, the fear associated with episodes of hypoglycaemia and its consequences, and with the long‐term complications of the disease (see Table  3 ).

3.2.2. Focus groups

The thematic analysis allowed us to identify a set of general concerns about diabetes‐related complications as reported by members of under‐represented groups.

3.3. General concerns about diabetes‐related complications

Participants in the focus groups provided further insight into the nature of their concerns about the impact of diabetes on their quality of life, life‐expectancy (Table  4 , citation 1) and vulnerability to other diseases (Table  4 , citation 2). Most participants reported being most afraid of complications that potentially lead to functional impairment (blindness), additional morbidity (chronic renal failure) or death (hypoglycaemia) (Table  4 , citation 3). Furthermore, participants pointed to the challenge of continuously monitoring and managing the disease (Table  4 , citations 4, 5 and 6).

Citations from focus groups participants

In addition to these general and common concerns, four specific themes arose from the focus group discussions:

Theme 1: The bidirectional relation between individual history and socio‐economic context, and the management of diabetes

Two aspects of individual history and context were mentioned by participants: (i) the influence of previous life‐experiences on the management of diabetes; and (ii) the impact of socio‐economic conditions on the outcomes of the disease. Regarding the first point, participants said they suspected a strong relation between their previous life‐experiences and the management of diabetes‐related complications. They wished that this relation could be investigated. For example, one participant talked about adopting bad eating habits such as dieting during the day and binging at night because she saw a loved one in a diabetic coma. (Table  4 , citations 7 and 8).

With respect to the second point, discussions in both focus groups focused on the need for studies examining the cost of diabetes treatment (Table  4 , citation 9). For example, some participants argued that they sometimes had to choose between paying their rent and buying insulin and complained that this should be a concern to researchers.

Theme 2: The need to better understand the danger of polymedication toxicity in patients with multiple comorbidities

Focus group participants who were either elderly or had experienced mental health problems expressed their concerns about toxic drug interactions resulting from polymedication. They stressed the urgent need to understand, whether and/or to what extent, there may be interactions between their diabetes medication and other treatments (Table  4 , citation 10).

Theme 3: The need to better understand barriers to quality care for immigrants living with diabetes

Focus group participants who were immigrants had two core concerns regarding diabetes and its related complications for researchers to address, notably: (i) how to improve access to quality care for immigrants with diabetes; and (ii) how to make health‐care professionals more knowledgeable about the specific care needs of immigrants living with diabetes. Most immigrants in the study talked about cultural or linguistic barriers to navigating the health system. For example, one participant talked about how she had learned to be assertive in expressing her needs (Table  4 , citation 11). Another participant talked about his experience going back and forth between the doctor and the pharmacist without answers to his needs (Table  4 , citation 12). Finally, participants who were immigrants unanimously reported that health‐care professionals were inadequately trained to detect symptoms and diagnose diabetes among individuals who are newcomers to the country. One participant, for example, said that this led to a failure to recognise pre‐diabetes symptoms, forcing this person to consult multiple physicians before a glycaemia test was requested (Table  4 , citation 13).

Theme 4: The need for better dissemination of the research results on diabetes

Focus group participants also expressed concerns about not having access to updated information on diabetes. They reported being aware of on‐going research, but were never informed by community organizations about the research results (Table  4 , citations 14 and 15).

Participants also pointed to a need for better information for their loved ones and relatives, to help them understand and provide better support in the management of the disease (Table  4 , citations 16, 17, 18).

4. DISCUSSION

This study aimed to explore the importance of diabetes‐related complication research topics relevant to those living with or caring for someone living with diabetes. Additionally, we wished to explore the reasons why these topics are important from the perspective of under‐represented populations. Findings from both the quantitative and qualitative components of the study complement each other and can be summarized in three main points.

First, the alignment of what is important for patients in diabetes research. Both survey and focus group participants indicated the importance of preventing and treating well‐known complications of diabetes such as kidney, eye and nerve problems. This finding confirms that research on such complications matters to patients and caregivers. Second, the need for more research about the bidirectional influence of the “life context” on diabetes.   Our participants also pointed out that there are a number of individual and contextual factors, such as individual circumstances (eg, life conditions, previous experiences), socio‐economic status and the experience of managing the condition that need further exploration, especially for the most under‐represented people included in this study. Finally, the third point was the need to deepen diabetes‐related research in under‐represented populations. Our results further suggest that research topics should be tailored to address specific challenges such as access to culturally relevant care for immigrants. 39

Consistent with other studies, 40 , 41 our quantitative data show that participants had moderate levels of emotional distress around diabetes‐related complications. Our qualitative analysis provided some insight into the nature of these concerns. For example, the fear that diabetes‐related complications (eg, kidney failure or blindness) may result in functional impairment or death (eg, as a result of a hypoglycaemia). Additionally, fears were often amplified not only by personal experience as shown in other studies, 42 , 43 , 44 , 45 , 46 but also by witnessing others dealing with such complications (such as having seen a loved one with kidney failure or experiencing a hypoglycaemic episode). These experiences impact how research topics are rated by those whose lives are touched by the disease. Unfortunately, further investigation of these questions was not possible with this study for two reasons: (i) the focus group participants were not asked to rate the complications as did online survey participants; and (ii) the focus groups were conducted separately from the quantitative portion of the study.

Overall, our findings point to a need for more research on diabetes, its complications and the bidirectional influence of a number of individual and contextual factors such as individual circumstances (eg, life conditions, previous experiences, emotional distress); socio‐economic status; and the experience of managing the condition, especially for the most under‐represented groups included in this study. It was suggested that research topics should be tailored to address specific challenges, such as access to culturally competent care for immigrants. 39

Our study did, however, have a few limitations. Due to time and budget constraints, focus group activities were restricted to Montreal and Quebec City, where our team is based. This limited our ability to recruit in other cities across Canada and also limited a true representation of the country's population. Although our respondents and their experiences reflect a broad sample of the population of Canada, several other groups who may have particular needs (eg, pregnant women, Indigenous peoples, parents or guardians of children with diabetes, as well as caregivers) were under‐represented in the online survey and were absent in the focus groups. Therefore, our sample lacks representation of some other under‐represented populations in Canada. Additionally, language barriers may have limited our selection of participants and excluded individuals, particularly those from under‐represented groups such as immigrants. Furthermore, because this online survey and focus group based study relied on participant self‐reports, the data could be limited by the subjects’ ability for introspection, their individual interpretations and social desirability bias. 47 Finally, because this was a preliminary study aimed at exploring the importance of different research topics to those living with diabetes and caregivers in Canada, we did not undertake prioritization activities that require trading‐off one priority against another to produce a ranked list. Such activities are planned for future research.

One strength of this study is its use of qualitative and quantitative methods to help capture the experiences of under‐represented groups and diverse participants from across Canada. This approach proved feasible as a method for efficiently exploring patients’ and caregivers’ preliminary views on research topics within a short period of time.

5. CONCLUSIONS

This study confirmed the importance of research topics regarding diabetes‐related complications within a population of people living with diabetes or caring for someone with diabetes, and further explored reasons why these topics might be important for certain groups of under‐represented people. The results of this study about what matters most to people living with, and caring for those living with diabetes, including people from under‐represented populations, informed the research program of a 5‐year pan‐Canadian Strategy for Patient‐Oriented Research Network on Diabetes and its related complications (2016‐2021). 39 A broad range of people living with diabetes are now involved as patient partners in this network, collaborating on research projects, research planning and supporting network governance. We anticipate that our results and on‐going work will contribute to the development of targeted interventions better aligned with improving the health and well‐being of people whose lives are touched by diabetes.

AUTHOR CONTRIBUTIONS

M.J.D. provided the study concept and design, supervised the protocol development and research, enrolled patients for the qualitative stage, facilitated focus groups, analysed data and provided the first draft of the manuscript. S.C.D. conducted the descriptive statistics, wrote the quantitative part of the manuscript, reviewed and edited the manuscript. M.T.D. enrolled patients for the qualitative stage, facilitated focus groups, analysed data and wrote the manuscript. F.L. reviewed and edited the manuscript. H.O.W. supervised the survey data collection, reviewed and edited the manuscript. M.J.D. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

CONFLICT OF INTEREST

The authors report no conflict of interest.

Supporting information

Acknowledgements.

The authors thank people living with diabetes, their caregivers and community organizations across Canada for their invaluable contributions to this study. The authors thank Judith Kashul for linguistic editing of this manuscript. Additionally, we thank Mary Zettl, for her contribution editing, coordinating and finalizing this article for publication.

Dogba MJ, Dipankui MT, Chipenda Dansokho S, Légaré F, Witteman HO. Diabetes‐related complications: Which research topics matter to diverse patients and caregivers? Health Expect . 2018; 21 :549–559. https://doi.org/10.1111/hex.12649 [ PMC free article ] [ PubMed ] [ Google Scholar ]

This study was funded through a subgrant of the Canadian Institutes of Health Research (CIHR SCD 139932)

Blood pressure drugs more than double bone-fracture risk in nursing home patients

Records from nearly 30,000 nursing home residents indicate that blood pressure medications more than double the risk of life-threatening bone fractures, according to Rutgers Health research.

The authors of the study, which appears in JAMA Internal Medicine , said the increased risk stems from the medications' tendency to impair balance, particularly when patients first stand up and temporarily experience low blood pressure that deprives the brain of oxygen. Interactions with other drugs and low baseline balance in many nursing home patients compound the problem.

"Bone fractures often start nursing home patients on a downward spiral," said Chintan Dave, academic director of the Rutgers Center for Health Outcomes, Policy and Economics and lead author of the study. "Roughly 40 percent of those who fracture a hip die within the next year, so it's truly alarming to find that a class of medications used by 70 percent of all nursing home residents more than doubles the bone-fracture risk."

While many patients have high enough blood pressure that the benefits of treatment outweigh these dangers, "Such patients require careful observation, particularly when treatment begins, and that's not happening," Dave said. "Caregivers think of blood pressure medication as very low risk, and that's not true in this patient population."

Dave's team analyzed Veterans Health Administration data from 29,648 elderly patients in long-term care facilities from 2006 to 2019. Researchers compared the 30-day risk of fractures to the hip, pelvis, humerus (upper arm) radius or ulna (forearm) for patients who began using blood pressure medications with similar patients who didn't. To maximize the chance that medication use -- and not some other factor -- drove the different outcomes, they adjusted for more than 50 baseline covariates, such as patient demographics and clinical history.

The 30-day fracture risk for residents who began blood pressure medication was 5.4 per 100 people per year and 2.2 per 100 people per year for patients who took no blood pressure medication.

Further analysis showed drug usage predicted particularly elevated fracture risk in certain subgroups. Patients with dementia, systolic blood pressure above 139 (the first number in the blood pressure reading), diastolic blood pressure above 79 (the second number) or no recent use of blood pressure medication all experienced at least triple the fracture risk of unmedicated patients.

About 2.5 million Americans live in nursing homes or assisted living facilities. Up to 50 percent suffer falls in any given year, and up to 25 percent of those falls result in serious injury.

The Rutgers Health study indicates that blood pressure medication causes many of those falls and that a combination of less medication and better support could significantly reduce the problem.

"Caregivers can't strike this right balance of risk and reward if they don't have accurate data about the risks," Dave said. "I hope this study gives them information that helps them serve their patients better."

• Hypertension
• Heart Disease
• Today's Healthcare
• Bone and Spine
• Multiple Sclerosis
• Mental Health
• Dehydration
• Personalized medicine
• Physical trauma
• Vaccination
• Antiretroviral drug

Story Source:

Materials provided by Rutgers University . Original written by Andrew Smith. Note: Content may be edited for style and length.

Journal Reference :

• Chintan V. Dave, Yongmei Li, Michael A. Steinman, Sei J. Lee, Xiaojuan Liu, Bocheng Jing, Laura A. Graham, Zachary A. Marcum, Kathy Z. Fung, Michelle C. Odden. Antihypertensive Medication and Fracture Risk in Older Veterans Health Administration Nursing Home Residents . JAMA Internal Medicine , 2024; DOI: 10.1001/jamainternmed.2024.0507

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