Screening and Diabetes Type II Becky Ellis, RN, BSN.
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Transcript of Screening and Diabetes Type II Becky Ellis, RN, BSN.
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Screening and Diabetes Type II
Becky Ellis, RN, BSN
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Screening
The process of detecting unrecognized disease in otherwise
healthy populations
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4 Types of Screening
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Mass Screening
Applied to entire populations
– 1981 screening for elevated blood lead levels all adults within state– 1970 screening for cervical cancer
on women admitted to hospitals within state– PKU testing on all newborns
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Selective Screening
• Targets specific high-risk populations
−Mammograms recommended more frequently for women with a family history of breast cancer
− PPD for hospital personnel
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Multiphasic Screening
• A variety of screening tests applied to the same population on the same
occasion
− Includes a series of tests on a single vial of blood
– Pre-op work-ups, periodic health assessment and for monitoring the stage of an illness.
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Case-Finding Screening
• A Search for illness done during an individuals periodic health assessment
− Pap Smears and Breast Exams for women− Testicular Examinations for men− The Denver Developmental Screening
Test
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Appropriateness of Screening
• Health problem with serious consequences e.g. Diabetes
• Must be cost effective or have positive health outcomes• PAP Smears result in possible cure• PKU Screening can prevent mental
retardation
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To be Beneficial
• Screening should result in a better prognosis
• The screening process should be effective in reducing morbidity and mortality
• The prevalence of the health problem is high in the population
• Should be quick, easy and noninvasive when possible
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The Health Problem:
• Have a high prevalence in the population
• Be relatively serious• Be able to be detected in early stages• Have an effective treatment that
improves outcomes
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The Screened Group:
• Be identifiable• Be assessable• Accept the screening procedures• Be willing to seek treatment• Accept follow-up procedures
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The Screening Test:
• Cost effective• Simple, safe, and easy to administer• Of minimal discomfort• Sensitive enough to detect most cases• Specific to the health problem• Valid and reliable
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Sensitivity and Specificity
• Sensitivity• Populations who have the health problem
are correctly identified
• Specificity • Populations who do not have the health
problem are correctly identified
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Predictive Value
• Frequency with which the health problem is correctly identified among those screened
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Yield
• Previously unrecognized cases of the disease that is identified during the screening process
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CDC October 2003
Newly Diagnosed Cases of Diabetes by Year
• Steady Increase since 1997
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Screening Tests Type II Diabetes
• Fasting Plasma Glucose (FPG)• Two Hour post-load plasma
glucose (2 hour GTT)• Glycosylated hemoglobin A1c
(HbA1c)
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ADA Recommendations for Screening
• Fasting Plasma Glucose (FPG)• Faster to perform• More convenient • Acceptable to patients• Less expensive
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Other ADA Recommendations for
Diabetes Screening• Selective Screening based on risk
factors• Age>45• BMI>25• Family History • Habitual physical inactivity• Race/Ethnicity e.g. African Americans,
Hispanic-Americans, Native Americans, Asian-Americans, and Pacific Islanders
• Previously identified impaired fasting glucose or impaired glucose tolerance
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Selective Screening
• Recommended that Clinicians use the ADA’s guidelines for selective screening of at-risk individuals
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Nursing Implications: Diabetes Type 2
Tori L. Reid, RN BSN
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Learning From Listening: The Article
• Qualitative research from CDC, taped interviews, themes
• 235 Participants, 2002• Screened to have risk factors• Formal and informal community
leaders invited by recommendations
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Five Themes
• Attributions for Diabetes: “American lifestyle”, “don’t sweat”, biological risk factors, stress, poor eating habits, lack of physical exercise
• Reactions to findings confirming benefits of lifestyle interventions for diabetes prevention: encouraging and hopeful, common sense, modest recommendations, but wont be easy
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Five Themes Continued
• Awareness of the potential for preventing or delaying diabetes as a motivator for action: realistic fear can play a role, rewards must be connected to meaning, social support is critical, consistency with cultural or historical values, children need to be taught healthy lifestyles early
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Five Themes Continued
• Barriers to change: lack of time, fast food and sedentary entertainment, high cost of nutritional food, lack of family support, environmental constraints, lack of awareness about diabetes, diabetes not a priority in some communities
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Five Themes Continued
• How people want to be told if they have prediabetes: straightforward but with gentle, hopeful approach, simple explanations, knowing can be empowering, tied to hope
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What Can We Do?
• Social Support• Message design: use staging
and visual teaching tools• Gain exposure and attention:
“turn up the volume”• Identifying message appeal:
hope dispels fatalism
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What Can We Do?
• Accordance with values, belief and history: memories matter
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Historic/Current Approaches• Screenings: clinics, physician’s
office, work, mall, social groups• Follow-up: • Education: public, hospital,
physician’s office, formal education programs, internet,
• FOCUS ON SECONDARY/TERTIARY
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Current/Future Approaches• Division of Diabetes Translation (DDT):
“charged with developing and implementing a public health response to the rising burden of diabetes in the United States”
• Goal: “reduce the burden of diabetes through collaborations with diabetes prevention and control programs (DPCP)”
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Current/Future Approaches• Plans: strengthen public health
surveillance systems for diabetes, conduct applied translational research, implement the National Diabetes Control Program, implement the National Diabetes Education Program, and coordinate media strategies and provide public information
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Discussion
• What have you seen?• What are you doing?• Where can we improve?• Community programs in place
now?
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ReferencesJack, L; Narayan, K; Satterfield, D; Lanza, A. Public health
approaches in diabetes prevention and control, Journal of Public Health Management and Practice; Nov 2003; Proquest Medical Library pg. S5.
Satterfield, D; Lofton, T; May, J; Bowman, B; et al. Learning from listening: Common concerns and perceptions about diabetes prevention among diverse american populations. Journal of Public Health Management and Practice; Nov 2003; Proquest Medical Library pg. S56
Harkness, Gail A.; Epidemiology in Nursing Practice, Mosby Inc, 1995.
Zhang, P; Engelgau, M. M.; Valdez, R.; Benjamin, S.; Caldwell, B.; Venkat Narayan, K. M.; Costs of Screening for Pre-diabetes Among U.S. Adults, Diabetes Care; September 2003.
Screening for Type 2 Diabetes, Diabetic Care, January 2003