Daring to Defy Diabetes:

1. Daring to Defy Diabetes: Analysis of Physiological Outcomes in Patients with Type 2 Diabetes Through the Understanding of the Self-Care Model Christina M. Beyers, BS Jillian Inouye, PhD James Davis, PhD

2. Grant and Project Information • Primary Investigator & Co-author: Jillian Inouye, PhD, APRN School of Nursing and Dental Hygiene University of Hawaii • Biostatistician: James Davis, PhD Clinical Research Center John A. Burns School of Medicine • Christina Beyers, BS University of Hawaii Masters of Public Health-Epidemiology Graduate Student • The project described was supported in part by Award Numbers RO07883 and P20NR010671 from the National Institute of Nursing Research and G11HD054969 from the National Institute of Child Health Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health.

3. Problem: • Drastic increase of reported cases of type 2 diabetes in patients every year • “The prevalence of type 2 diabetes mellitus has risen so sharply over the past-half century that it is now commonly referred to as an epidemic…” Yates,T.,Davies,M., & Khunti,K.(2009).Preventing type 2 diabetes: can we make the evidence work? Post Graduate Medical Journal,85,475-480. doi: 10.1136/pgmj.2008.076166

4. Significance: • Research helps to further develop intervention programs • Increasing self-care/self-management • Increasing knowledge • Increasing self-efficacy/ disease control • Increasing patient quality of life

5. Aim: To determine if Asian Pacific Islander’s who have Type 2 Diabetes and have better knowledge and self-management will have better baseline Hemoglobin A1C and total cholesterol values.

6. Review of the Literature • Research shows that lifestyle changes equal the greatest impact • Understanding why there is a disconnect between knowledge and self-care implementation • Recognition that persons with Type 2 Diabetes may require additional education to increase self-management • Significant that Asian Pacific Islanders (API) high risk population • AADE promotes a self-care model of 7 behavioral steps

7. Self-Care Model The American Association of Diabetes Educators promotes a “Self-Care Behavior Framework” in 7 steps • Below represents 5 behaviors analyzed within this study. Figure1. Pictorially represents the five behaviors analyzed in this cross-sectional study as modified from the “AADE7™ Self-Care Behaviors Framework.” Adapted from “Measurable behavior change is the desired outcome of diabetes education” [Electronic Version] by American Association of Diabetes Educators, 2010. Retrieved September 15, 2010 from http://www.diabeteseducator.org/ProfessionalResources/AADE7/

8. Activities Involved in Self-Care

9. Methodology • Study design is a descriptive cross sectional • Participants:207 Asian Pacific Islander’s with Type 2 diabetes that met the inclusion criteria for the study participated. • Subjects signed IRB approved consent form and assigned randomized numbers • The ages ranged from 18-75 • Study involved analysis of pre-existing data set (baseline surveys)

10. Measures • Initial questionnaire responses (T1) were used to test whether the research prediction held statistical significance. • 2 Questionnaires: • “SDSCA”-The Summary of Diabetes Self-Care Activities (derived from Toobert,Hampson and Glasgow, 2007)  Survey questions relate to: general diet, specific diet, exercise, blood- glucose testing, foot care and smoking • “DKA”-Diabetes Knowledge Assessment (derived from Bielamowicz,Miller,Elkins &Ladewig, 1995) Series of multiple choice questions regarding knowledge of the disease

11. Procedures • “DKA”- 14 Multiple choice questions- where one point was awarded for each correct answer • “SDSCA”- asked the participant to recall out of the last 7 days how may days did he or she do the following… - Scale of 0-7 and final score based on averages of each section

12. Reliability and Validity • The Cronbach’s Alpha test • Each variable (SDSCA) or question (DKA) assessed through raw alpha and standardized alpha scores • Results placed in tables- outcome totals listed below • SDSCA total Raw Alpha= 0.71 and Standardized Alpha= 0.72 • DKA total Raw Alpha=0.66 and Standardized Alpha=0.67

13. Methodology:Analyses • Statistical analysis includes: -Regressions run from knowledge to HbA1C and total cholesterol -And regressions from self- care to HbA1C and total cholesterol • Patient confidentiality was maintained during the study as well as during any statistical analysis

14. Limitations • No labs were drawn on site • Participants responses were based on his or her recall • Distinctions within the diverse API population were not addressed in this study

15. Results • Data entered using double entry method • Scoring of surveys completed and regressions were run • Tables were constructed to display the results

16. Regression of SDSCA Table 1. A total of 104 subjects’ labs were obtainable and the mean HbA1C level was 8.45%. * Indicates Statistical Significance

17. Regression of SDSCA Table 2. A total of 104 subjects’ labs were obtainable and the mean total cholesterol value was 174.7564 mg/dL

18. Regression of DKA Table 3. A total of 93 subjects’ labs and scores were obtainable and the mean HbA1C was 8.45%. A total of 78 subjects’ labs and scores were obtainable and the mean total cholesterol value was 174.7564 mg/dL. *Indicates statistical significance

19. Statistically Significant Findings • Self-efficacy with taking medications and the affect on the HbA1c • General diet affecting the HbA1C • Diabetes knowledge affecting HbA1C

20. Discussion Literature review after findings generally corroborates results In particular positive outcomes related to: • Medication usage • Diabetes knowledge • General diet Discrepancies included: • Exercise • Variables affecting total cholesterol

21. Conclusion:Expected Outcome • Prior knowledge may not necessarily lead to self-management • Participants with initial active self-management regimens were expected to show better baseline lab values of HbA1C and total cholesterol, than those who did not implement self-management

22. Conclusion:Inherent Outcome Overcoming barriers to self-management and knowledge are meant to improve the desired inherent outcome of: • See improvements in lab values (such as HbA1C and total cholesterol) • Increasing patient quality of life

23. Future Research • Diabetes prevention • Additional barriers to self-management beyond knowledge/education • Other factors include: • Socio-economic status • Available support systems • Depression/psychological assessment • Religious/cultural beliefs • Accessibility to health care • Underprivileged or high risk populations as primary focus