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Does Self-Management Education Improve Outcome in Patient with Type 2 Diabetes?


Diabetes is now like an epidemic that is continuing to grow in the United States of the America and the world at large. It is the most common cause of blindness, amputation of the lower extremity, and end-stage of renal disease (Atak, Gurkan, & Kose, 2008). It is evident that people with diabetes are two to four times more likely to get a stroke or heart disease, and over fifteen million people suffer from diabetes. Diabetes is the seventh leading cause of death in the world, with its prevalence having risen from 0.37% to 6.9% in five decades (Heinrich, Schaper, & De Vries, 2010). Considering self-management education as a necessary factor in implementing behavior change in patients with type 2 diabetes, analysis of the literature gives an insight based on various researches.

Jack (2013) in his study investigates the relationship between self-efficacy, self-care behaviors, and health literacy of people with type 2 diabetes. He conducted a study, which showed that diabetes education materials for lower literacy level may be needed for unemployed adult population and older patients, hence signifying the need of self-care management education. Educators, who understand the essence of self-care management and positive change in attitudes and perception of the condition, stimulate behavior change (Sieber, Newsome, & Lillie, 2012). Diabetic Self-Management Education (DSME) is an important concept in alleviating the effects of diabetes. The technique incorporates goals, needs, evidence-based standards, and life experience of customers. The procedure is critical in that it improves the patient outcomes, which is effective and uniform, hence essential in managing and lowering the chances of complications, which are related to type 2 diabetes. Health care providers are responsible for teaching diabetic self-management skills to patients, and this assists in terms of self-efficacy and empowerment. The integration of knowledge and skills enables the patient to combine practical life experiences and creativity in managing type 2 diabetes (Wu et al. 2011).


Contributing to Changes in Health Care

Education is a necessary factor in implementing behavior change in patients with type 2 diabetes. Therefore, the study gives an insight based on the research by different researchers. Atak, Gurkan, & Kose (2008) in their study examine the connection among the health literacy, self-care, and self-efficacy of people with type 2 diabetes. They performed a cross-sectional study through explanatory correlational design on the levels of health literacy, self-care character, and self-efficacy. Both outcomes of the study showed that diabetes education materials for lower literacy level might be needed for an unemployed adult population and older patients, hence signifying the need to educate the patients in respect to behavioral change. In addition, the study performed by Sieber, Newsome, & Lillie (2012) determines the growth of type 2 diabetes in the world and its burden on the health system. It has made the researchers recommend the need for initiation of innovative therapeutic approach to conquering immune dysfunction. There could be the major aspect of establishment of insulin resistance in type 2 diabetes through the stem cell educator therapy. The results of this study showed that persons with the type 2 diabetes had reduced tenderness and enhanced metabolic management after taking the stem cell educator therapy. Education through behavior change is significant as it lowers tenderness and improves metabolic management.

Hollis, Glaister & Lapsley (2013) assess the usefulness of re-education in the insulin injection system for glycemic control. It showed that out of 87 insulin-treated diabetic outpatients 19 patients showed good understanding of self-care, hence an increase in the   level of  HbA1C from 7.38 ± 0.15% to 6.93 ± 0.12% (P = 0.09). They concluded that patients with poor understanding based on the lecture on re-education reduce the mean level of HbA1C. This study reveals the relevance of continued education as it improves the glycemic control in insulin injection technique.

The need of education is paramount in alleviation of type 2 diabetes. Behavior change is undertaken by educators who understand the essence of self-care management and have positive attitudes concerning change and perception of the condition. Jack (2004) did the research that provided information to furnish diabetes educators on how to instruct and direct the patients when using Humulin R U-500. The study involves an overview of U-500R pharmacology, clinical data, and strategies for inpatient and outpatient use and apparatus for patient education. The outcome reveals that diabetes educators felt confident and contented as they educate and advise patients receiving high-dose of U-500R as part of diabetes care plan. Diabetes educators play an essential role in helping patients to use U-500R safely and successfully.

Evidence Available To Improve Performance

The incorporation of behavior change theory in alleviation of type 2 diabetes entails the use of evidence-based clinical guidelines (CPGs) and encompasses the implementation of guideline strategy that will address the understood clinical barriers on guidelines for the proposed solution. The strategy capitalizes on the nurses and caretakers of the concerned units, hence will reduce and advance on the results of people with the type 2 diabetes significantly. Atak, Gurkan, & Kose (2008) argued that there is a strong evidence of attempts to manage the disease that the onset of type 2 diabetes can be postponed or prohibited. It is by the existence of interventions in old persons having the improved lenience for glucose. Though changing such interventions to useful, routine delivery remains unchallenging. Therefore, the requirement of a behavior change theory in a nursing strategy concerning management of type 2 diabetes is necessary. According to studies done by Hollis, Glaister, and Lapsley (2013), they support the need of education in implementing of behavior change. In their study, the authors’ objective was to ensure that practicing nurses are placed to facilitate major aspects of self-management education for most people with diabetes within the major health care settings. Wu et al. (2011) recommended the enhancement of glycemic management through re-education in insulin injection technique in persons suffering the disease. They determine the benefit of the re-education technique of insulin injection for glycemic management. The outcome showed that patients with understanding of self-care management increase in the average level of HbA1C, hence there is a need for behavior change through education, which is paramount in alleviation of type 2 diabetes.

This strategy should be incorporated through the guideline implementation strategies. Combination of various tools and mechanisms will enable the nursing strategy to alleviate diabetes incidences. The behavior theory is best suited to the dynamic and intensive care environment while incorporating organizational climate and multidisciplinary team. The strategy will provide a framework, through which change process can be initiated. To enable the proposed solution a successful one, critical components, which include effective feedback system, effective leadership, continued education program, and collaborative team, must be taken into consideration.

Healthcare Systems

Theoretical model should be applied in order to improve management of the diseases by the patients. The nursing practice should be based on the nursing theoretical model because it makes the nursing discipline a profession. The theoretical model provides guidelines and directions for structuring professional nursing education, research, and practice. It also identifies the focus of nursing profession from others. Theoretical model tries to include personal views, environment, and health in order to develop a perspective of nursing. They serve as a guideline for the estimation, assessment, and involvement of nursing care. They give a basis for collection of valid and persistence of the data concerning the fitness of clients, such as diabetic patients that are important to make a conclusion and execution. This model helps to develop criteria to determine the quality of nursing practice in educating patients concerning how to manage the disease. They helped develop a general nursing term to be used in communicating with other health professionals. Theoretical model in nursing study gives a common base for program planning and directs it to reach a conclusion. Theories help the nursing practitioners to identify that nursing practice is different from other disciplines. The theoretical model reflects views of people, environment, health and various concepts leading to the development of nursing knowledge (Sieber, Newsome, & Lillie, 2012). Finally, nursing theories boost the independence of nursing by defining its autonomy functions.


After analyzing the study, the evidence by researchers is adequate to make recommendations for a practice change. The type 2 diabetes evidence is relevant in that they discuss management education and self-assessment. Most authors identified medication management while citing its strengths and weaknesses, hence relaying the necessary knowledge in alleviation of type 2 diabetes. The evidence collected resulted in that implementation of collective educational interventions improved the outcome and quality of care, reduced the cost of treatment, and maximized the use of economic resources. The authors recommend and explain how to reduce the cost of treating diabetes through self-management education by the patients, hence economizing the resources. From the analysis, the improvement of diabetic patients through self-care management, such as glycemic control, is a significant practice in bringing change. Since the disease is the seventh leading cause of death in the world, consideration of self-management education is the necessary factor in implementing behavior change in persons with the disease.

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