Education High Fructose Corn Syrup Diabetes Outcomes...
Transcript of Education High Fructose Corn Syrup Diabetes Outcomes...
Diabetes Outcomes and High Fructose Corn Syrup
Education Laura McIntosh, Sheila Estelle Neira, Antonio Padilla
Azusa Pacific UniversityFor Dr. Najood Azar | GNRS 508A
July 30, 2014
● 70,000 annual deaths● 16.4% Hispanic
prevalence● $116 billion direct
cost estimate in 2007● Ave. cost for hospital
inpatient day due to diabetes: ○ $1,853-$2,281
● Diabetes-related hospitalizations○ 24.3 million days
in 2007 up from 16.9 million days in 2002
Research Hypothesis ● A Certified Diabetes Educator (CDE) nurse led
educational intervention that includes avoiding high fructose corn syrup and reading labels, will result in improved health outcomes of Hemoglobin A1C (A1c), Body Mass Index (BMI), and Blood Pressure (BP), in Hispanic adults with T2DM over 18 years of age.
Literature Review: Comparison and Analysis
● Culturally Appropriate Interventions○ Reductions in A1C were greater and longer lasting in those
studies that implemented a culturally tailored intervention
● Diabetes Education○ All literature shows positive effects on A1C when participants
received specific diabetes education
● Gaps○ Hispanic population○ Anti-fructose education
Theoretical Framework● Health Promotion Model by Nola Pender● Our intervention is targeted at: Behavior-
specific Interventions (Category 2)
○ DSME Education that includes Healthy eating,○ Avoiding fructose○ Goal: affect healthy choices and outcomes
manifested by a decrease in: ■ A1C■ BMI■ BP
Research Design
● Pre/ Post Test longitudinal design● Subjects randomly assigned to two brackets
○ Bracket A: AF-DSME + support + diet monitoring○ Bracket B: DSME alone
Research Design
● Study Location: Community center classroom● Study Length: 8 months
○ BP measurement weekly○ A1C and BMI measurement every other month○ Rationale for length of study
Research Variables● Independent Variables
•Education
•Support
•Dietary monitoring
(Burke & Vannice, 2011)
● Dependent Variables•A1c
•BMI
•Blood pressure
Operational Definitions● Education: Diabetes Self Management (DMSE)
○ pre and post test● Dietary monitoring
○ Food worksheet diet “worksheet” to be collected each week
● Support○ Did you receive your weekly call? yes or no
○ Attendance measured by CDE
Conceptual Definitions●Education: Diabetes Self Management Education (DMSE)
●SupportoWeekly phone call and diabetes support group (after education portion ends)
●Dietary MonitoringoModified Idaho Plate Model
Sampling PlanInclusion Criteria ● Diagnosed with TDM2 for
at least one year ● Hispanic● Over 18 years old ● English speaking, ● Cognitively able to sign
consent form
Exclusion Criteria● Comorbid conditions● More than two
hypoglycemic meds
Sampling Plan● Target population: Hispanic adults with TDM2● Accessible Population: those adults living in LA county● Convenience Sampling
○ Effect size 0.41○ Recruiting from restaurants, community centers, churches, flea
markets ○ Subjects randomly assigned to two brackets
■ AF-DSME + support + diet monitoring■ DSME alone
(Janson et al., 2012)
Data Collection● Education: ordinal
○ Measured via improvement in pre/post test scores○ A: 90-100%○ B: 80-89%○ C: 70-79%○ D: 60-69%○ F: 59% or below
● Support: nominal○ Did you receive a support phone call?
■ No: 0 ■ Yes: 1
Data Analysis
● Independent t-test○ To determine whether there is a statistically
significant difference in health outcomes between group A (support+education+diet monitoring) and group B (education alone)
Ethical Considerations
● Informed Consent● IRB approval● Only imposed action is education there is no
real threat to participants. ○ Able to personally choose whether or not to
implement intervention
Implications● Nurses at all levels are in a key position to
effect positive change and improve health outcomes
● Educational efforts may include:○ Avoid HFCS○ Healthy eating○ Setting goals○ DSME - a life-long endeavor working with a team
Resources● Burke, S. D. & Vannice, A., (2011). Diabetes self-management education: The art and science of disease management. In C. Mensing, S. McLaughlin & C. Halstenson (Eds.), The Art
and Science of Diabetes Self-Management Education Desk Reference (pp. 3-20). Chicago, IL: American Association of Diabetes Educators.● Diabetes in the US. Retrieved from: Diabetes in the US retrieved from: http://visual.ly/diabetes-in-the-us● HealthyPeople.gov 2020 Topics and Objectives: Diabetes. Retrieved from: http://www.healthypeople. gov/2020/topicsobjectives 2020/overview.aspx?topicid=8
●Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2011). Health promotion manual (6th Edition). Retrieved from: http://research2vrpractice.org/wp-
content/uploads/2013/02/HEALTH_PROMOTION_MANUAL_Rev_5-2011.pdf
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