This study was concerned with the impact of telephone and letter follow-up on the glycosylated hemoglobin (HbAlc) levels and quality of life of adult patients who completed the recognized diabetes education program at Ball Memorial Hospital's Diabetes Care Center between March 2002 and October 2002. The study was a quasi-experimental design, randomly assigning subjects by clusters to one of three treatment groups: telephone follow-up only, letter follow-up only, or telephone and letter follow-up. All follow-up attempts were made by certified diabetes educators employed by Ball Memorial Hospital for twelve weeks following the completion of the program. Reviewing patient records prior to and twelve weeks following the completion of the recognized diabetes education program determined HbAlc levels. Quality of life was measured, using a pre-existing instrument, prior to and twelve weeks after the completion of the program. A two-way design analysis of variance for repeated measures was used to determine if pretest/posttest differences in HbA 1 c and quality of life were different among treatment groups. There was a lack of statistical significance in mean HbAlc levels and quality of life values from pretest to posttest among subjects of the three treatment groups. However, a test of within-groups effects showed a statistically significant difference in the pretest and posttest quality of life values and HbAlc levels for all subjects included in the study. / Department of Physiology and Health Science

The objective of this study was to compare the effects on eating behavior, lipids, lipoproteins, lipid peroxidation, and glycemic control in women with type 2 diabetes of a high-monounsaturated fat diet (HM) compared to a high-carbohydrate diet (HC). In an outpatient feeding study, ten hypertriglyceridemic postmenopausal type 2 diabetic women alternately for six weeks consumed the HM and HC diets. On the HM diet, 45% of total calories were consumed as carbohydrate and 40% as fat (27% monounsaturated) compared to 55% carbohydrate and 30% fat (10% monounsaturated) in the HC diet. At the beginning and end of each diet phase, total lipids, lipoproteins, lipid peroxidation, and glycemic variables were measured. For 8 days in each diet phase eating pattern frequency, palatability of foods, hunger and fullness were assessed. At the end of each diet phase, taste testing to determine preference for fat was conducted. Total cholesterol was significantly decreased on the HC diet. Serum triglyceride, very low density lipoprotein (VLDL) triglyceride and cholesterol, and apolipoproteins A-1 and B were not significantly different on the two diets. When comparing initial to final values, both diets lowered LDL-C; however, the change was greater on the HM diet. Lipid peroxidation variables improved when the HM diet was consumed. Glycemic variables improved on both diets. No significant differences between total number of eating episodes on the HM and HC diet phases were found. Both diets were rated as highly palatable. Hunger and fullness ratings varied within and between subjects. However, fullness was more commonly experienced than hunger on both HM and the HC diet. Preference for fat was not found at the end ofHM or HC diets. However, subjects differed significantly in ratings for liking of foods that were salty, sour, and bitter when compared to nondiabetic women. Consumption of the HM and HC diets did not result in deterioration of lipid status. The HM diet by virtue of less oxidation of the LDL particle and improvement of glycemic control provides an important advantage over the HC diet. A description of eating behavior of women with type 2 diabetes emerged. / Graduation date: 2000

Maintaining appropriate glucose levels is important to patients with diabetes because it helps to improve patients' quality of life and prevents medical complications. This study was designed to determine if there was a statistically significant difference in blood glucose levels between a treatment group that completed a certified diabetes education program with telephonic follow-up by a diabetes educator and a comparison group that also received the certified diabetes education program but without telephonic follow-up. A pretest/posttest control group design was used which randomly assigned subjects to groups by clusters. From the analysis of data it was determined that there was no statistical difference in blood glucose levels between the treatment and the comparison groups. Therefore, weekly telephonic follow-up did not statistically impact blood glucose levels in the treatment group. However, the results did indicate that the telephonic follow-up may have impacted the proportion of patients who returned for post blood glucose testing and sought treatment for other related health concerns. / Department of Physiology and Health Science

Diabetes Mellitus is a chronic disorder that requires daily adherence to complex regimens for glucose control. The purpose of this study was to examine the relationship between the capability for self-management of diabetes and the practices of health-promoting behaviors. Instruments used were the Health Promotion Lifestyle Profile to measure health-promoting behaviors, the Insulin Management Diabetes Self-Efficacy Scale to measure self-efficacy in diabetes management, and a demographic questionnaire.Fifty participants from the outpatients of a midwestern veterans hospital responded to the questionnaires. Results showed a moderately positive significant correlation between self-efficacy in diabetes management and health-promoting behaviors (r=.52, p<001).The findings of this study point the importance of higher levels of self-efficacy and participation in health-promoting behaviors for more effective management of diabetes and improved health and well-being. / School of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing

Although the benefits of exercise to non-insulin-dependent diabetes mellitus (NIDDM) are well-known, individuals with NIDDM are at risk for macrovascular and microvascular complications associated with an abnormal systolic blood pressure (SBP) elevation during exercise. In order to compare the SBP and rating of perceived exertion (RPE) response between individuals with NIDDM and apparently healthy controls during submaximal exercise, eight individuals representative of each group completed a 10-minute submaximal treadmill exercise trial at 65% of functional capacity. Heart rate, blood pressure and RPE were monitored throughout the trial. Between group comparisons were made for SBP and RPE response, and the frequency of exercise SBP response _> 200 mmHg was investigated. No significant differences were observed in either SBP or RPE response between groups during the submaximal treadmill trials. In addition, none of the subjects from either group achieved a SBP ? 200 mmHg. While this study indicates that exercise at 65% of functional capacity is safe for this particular group of subjects with NIDDM, additional research is warranted to investigate cardiovascular response to exercise in a broader subject pool representative of the entire NIDDM population. / School of Physical Education

The use of Rate of Perceived Exertion (RPE) by those with Diabetes Mellitus participating in physical activity has not been clearly addressed. The American College of Sports Medicine has suggested that RPE may be used with diseased populations, including those with Non-insulin Dependent Diabetes Mellitus (NIDDM), but no specific guidelines for RPE use have been established for this population. The purpose of this study was to compare the RPE during graded exercise for the individuals with NIDDM and apparently healthy individuals. Specific comparisons of the RPE at the ventilatory threshold and at 60% and 80% of maximal oxygen uptake were made.Seven subjects with NIDDM were paired with seven apparently healthy CONTROLS of similar age, weight, and gender. All subjects performed a maximal graded exercise test (GXT) on a motor driven treadmill per Bruce Ramp protocol. Rate of perceived exertion was taken every minute using Borg's 6-20 point scale (Borg 1973). All subjects were given the same instructions for use of the RPE scale and were queried by the same technician. An analysis of variance was performed with a significance level set of ps0.05. Statistical analysis revealed no significant differences between the two groups for all demographic variables measured including age, weight, height, body mass index (BMI) and percent body fat. No significant difference was seen for maximal exercise data including RER, RPE, V02, and heart rate. Maximal V02 was 31.1 ± 8.2 ml•kg-lmin-l SD for the NIDDM group and 38.7 ± 11.6 for the CONTROL group when expressed in weight relative terms. Maximal heart rates for the NIDDM and CONTROL groups were 176.9 ± 17.9 bpm and 176.4 ± 8.8 bpm respectively. Ventilatory threshold (VT), heart rate at VT and percentage of VO2 at which VT occurred were not significantly different between groups.No statistically significant differences were seen between the NIDDM or the CONTROL group for RPE at the selected intensities. RPE at the VT was 13.0 ± 3.6 and 12.3 ± 1.8 for the NIDDM and CONTROL groups respectively. RPE at 60% of functional capacity was 13.3 ± 3.5 for the NIDDM group and 12.0 ± 1.7 for the CONTROL group. Likewise, no statistical difference was seen at 80% of functional capacity. The NIDDM group RPE was 16.1 ± 2.5 and the CONTROL group rating was 15.9 ± 2.0, respectively. Under the terms of this study those individuals with NIDDM perceived exertion similarly to the CONTROL group. / School of Physical Education

The focus of this qualitative phenomenological research study was the lived experience of married couples between the ages of 60 and 70, one of whom has type 2 diabetes. The author sought to discover additional meanings concerning the experience of diabetic education, adherence to medications plans, modifications in lifestyle, and the role of the non-diabetic spouse in the experience. Participants were six married couples between the ages of 60 and 70. Three wives and three husbands had been diagnosed with type 2 diabetes. Two one hour interviews were conducted with each couple, both spouses present. Each couple was asked the question "Tell me what it is like living with diabetes." Interviews were audio taped and transcribed by the researcher. Informant volunteers were identified using the snowball method of sampling. The author identified the two domains of experience with the health care system and experience with the spouse..Themes of the first domain were identified as relationship with health care provider and education of patient and spouse at time of diagnosis. Themes in the second domain were spousal support, perceived compliance, and perceived risk of complications. Implications for adult education and advanced nursing practice include the importance of including the non-diabetic spouse in the education and treatment plan at time of diagnosis and offering a clear explanation of the relationship between adherence and long term complications of the disease. Suggestions for further research include investigation of the self reporting of behavior modification and outcomes of adherence, the effectiveness of provider interventions in monitoring behavioral changes, and to study women with diabetes married to men without diabetes. / Department of Educational Studies

Objective: To identify whether perceived stress is a risk-factor for higher cortisol levels and greater insulin resistance in Type 2 diabetic patients, using data from participants with and without diabetes in the National Survey of Midlife Development in the United States (MIDUS), specifically MIDUS II, Project 4. The following hypotheses were tested: (H1a) greater perceived stress would be associated with higher cortisol for Type 2 diabetic participants, (H1b) the perceived stress/cortisol relationship would be stronger for people with Type 2 diabetes than for those without it, (H2) greater perceived stress would be associated with higher Homeostatic Model Assessment-Insulin Resistance (HOMA-IR, insulin-resistance) for Type 2 diabetic participants, (H3a) subjective well-being would moderate the perceived stress/insulin resistance relationship for Type 2 diabetic participants, and (H3b) depression would moderate the perceived stress/insulin resistance relationship for Type 2 diabetic participants. Method: MIDUS, a longitudinal study of over 7,000 American adults, explores biopsychosocial factors that could contribute to variance in mental/physical health. Only complete data were utilized. Type 2 participants (n=115) consisted of 54 males and 62 females ranging in age from 36 to 81 years. Non-diabetic participants (n=1097) consisted of 470 males and 627 females ranging in age from 34 to 84 years. Results: None of the predicted relationships were statistically significant. Waist to hip ratio was significantly related to insulin resistance (r = .31, p = .001). Conclusions: Future studies should collect information about the type and duration of stressors in addition to perceptions about stress for those with Type 2 diabetes.

This study is about young people (age 11-16) with diabetes. Based on fieldwork in a paediatric diabetes centre in Scotland, it describes the ways diabetes is lived and done by young people, their health carers and insulin pumps. This enactment is contrasted with other ways of doing diabetes, as observed on short fieldwork trips to paediatric centres in Brussels, Gothenburg and Boston. I explore the dynamics of diabetes care on two levels. I consider the interaction between health carers and patients. Comparative data from various paediatric centres make apparent how culturally and socially informed approaches towards adolescence, health and illness shape both care practices and patients' experiences, resulting in different medical outcomes. Concretely in the Scottish centre, a non-hierarchical holistic care approach by health carers emphasizing quality of life over health, informs the young people's perspective on diabetes. Being a free adolescent takes priority over managing diabetes, with the results of ill health and possible future complications. The existing dynamics in this care framework change as a third actor enters the scene: the insulin pump, a pager-sized technological device continuously attached to the body. I explore the balancing act between young people and their pumps. As the adolescents actively engage with their pumps not to search for better health but rather to pursue a better quality of life, the guiding question becomes: how can a technological device for insulin injection double as a tool towards a desired identity and a different illness? This work then, can be read as a concrete case study of how a uniform technological device is embedded and used in a specific cultural and social context. It can also be read as an argument for a re-orientation of paediatric diabetes care in the Scottish centre: care centred on collaboration and inclusion rather than focused on merely containing underlying conflict (between adults and adolescents, diabetes and life, health and quality of life). Centres in Brussels, Gothenburg and Boston, and the insulin pump concretely, show how collaboration can lead to good health and quality of life. To leave us to wonder: is 'doing diabetes differently' synonymous with 'doing a different diabetes'?