The Knowledge Acquired from the Diabetes Education Clinic Class at the Pembroke Regional Hospital

1
The Knowledge Acquired from the Diabetes
Education Clinic Class at the Pembroke Regional
Hospital

• Dietetic Intern Qiuhong Han (Catherine)
• Advisor Mary Ann Carroll, RD CDE

2
Acknowledgements

• Many thanks to all mentors and advisors
• Pembroke Regional Hospital
• Mary Ann Carroll, RD CDE, Judy Hill, RD CDE,
  Manager of Clinical Nutrition and Diabetes
  Education, Becky Campbell, Dietitians Assistant
• The Ottawa Hospital Dietetic Internship Program
• Barbara Khouzam, RD, MPA, Josee Bertrand, RD,
  Coordinator of the Dietetic Internship, Renée
  Crompton, RD, Louise Gariepy, Statistician, Lynne
  Lewis, Clerk of the internship,

3
Overview

• Introduction
• Procedures and Methods
• Results and Discussion
• Conclusion

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Diabetes

• Chronic degenerative illness with great negative
  effects on health
• Prevalence in Canada gt 2 million people1
• Cost of diabetes and its complications
• 13.2 million / year2

5
Diabetes Education

• Most complications are preventable by correct
• self-management3
• Significant knowledge deficit among those with
  diabetes3
• Diabetes education was introduced in the 1930s.
• Diabetes education enhances positive lifestyle
  changes
• Diabetes education programs are clinically
  worthwhile and cost-effective4

6
DEC at the PRH

• PRH one of five sites of Renfrew County Diabetes
  Education Program
• DEC is multidisciplinary RDs, RNs, Dietitians
  Assistant
• 1 hour group class
• Individual appointment with RD and RN

DEC Diabetes Education Clinic PRHPembroke
Regional Hospital RD Registered Dietitian
RN Registered Nurse
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Study Objective and Goal

• Determine the knowledge acquired by clients who
  attend the DEC group class
• Appropriately revise the presentation or material
  presented in the DEC group class

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Inclusion Criteria

• gt 18 years old
• Pre-diabetes, type 1 or type 2 diabetes
• Signed consent
• Attended DEC group class between February 28th,
  2008 and March 13th, 2008
• Completed pre-class, post-class and
  one-week-follow-up tests
• 20 qualified participants

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The Questionnaire

• Identical for all three tests
• Based on DEC group class
• Validated by 5 RDs and 2 RNs
• (Diabetes Educators)
• Two parts
• demographic section and knowledge section

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Procedure

• Pre-class test immediately before attending class
• Post-class test immediately after class
• One-week-follow-up test
• investigator by telephone

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Data Analysis

• SPSS 16.0 Graduate Student Version
• Whether clients diabetes-related knowledge
  improved after attending class
• Whether knowledge improvement associated with
  demographic characteristics
• Pre-existing knowledge gaps

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Results knowledge improvementpaired samples
t-test plus Bonferroni Correction (plt0.017)
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Discussion

• Diabetes-related knowledge improved
• Retained knowledge for one week
• Consistent with results from other similar
  studies5-9

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Results Demographics

• Independent sample t-test plus Bonferroni
  Correction (plt0.017)
• Pre-class test plt0.017
• Males 7.79 2.359
• Females 4.17 2.137
• One-week-follow-up test plt0.017
• Males 10.00 1.414
• Females 7.83 1.472
• No statistically significant difference between
• males and females on post-class test

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Results - Demographics

• No significant differences associated with
• age
• type of diabetes
• duration of diabetes
• previously attended a diabetes class
• having seen an RD / RN for diabetes
• level of schooling
• Previous studies knowledge improvement not
• related to demographic characteristics10

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Discussion - demographics
Continue
17

• 12 clients used more than one method to manage
  their diabetes

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Results Knowledge Gaps
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DiscussionQuestion 4. A1C target

• 4. Your A1C should be
• a. less than 5 b. less than 6
  
• c. less than 7 d. I dont know

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DiscussionQuestion 4. A1C target

• 3 clients (15) correct on pre-class test
• 4 clients (20) correct on post-class test
• Improvement 1 clients (5)
• Rothman et al 8 of 217 participants knew the
• normal A1C range11
• Setter et al A1C value poorly understood12

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Discussion Question 7. TC/HDL cholesterol ratio

• 7. Your cholesterol ratio (TC/HDL) should
• be less than
• a. 2.0 b. 4.0
  
• c. 6.0 d. I dont know

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Discussion Question 7. TC/HDL cholesterol ratio

• 3 clients (15) correct on pre-class test
• 11 clients (55) correct on post-class test
• Improvement 8 clients (40)
• Cheng et al
• cholesterol knowledge poor among population
• cholesterol education needed to improve
  knowledge13

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Discussion Question 9. one aspect of healthy
eating

• 9. Which of the following is part of healthy
  eating?
• a. having 2-3 servings of vegetables and fruits
  each day
• b. eating 2 meals each day, when hungry
• c. having whole grains most of the time
• d. I dont know

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Discussion Question 9. one aspect of healthy
eating

• 2 clients (10) correctly on pre-class test
• 3 clients (15) correct on post-class test
• Improvement 1 client (5)
• Falk et al almost all of the 79 participants
• classified vegetable and fruit as healthy food14

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Study Limitations

• Small sample size
• Follow-up time line
• Larger sample size and a longer follow-up
• period needed to confirm findings

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Conclusion

• Improved diabetes knowledge
• knowledge retained for one week
• Consider revising class presentation regarding
• A1C and healthy eating concept

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References

• 1. Canadian Diabetes Association. The prevalence
  and costs of diabetes. http//www.diabetes.ca/Sec
  tion_About/prevalence.asp
• 2. American Diabetes Association 2000, statistics
  Canada 2000
• 3. Clement S. Diabetes self-management
  education. Diabetes Care 1995 18 1204-1214.
• 4. Ridgeway NA. Harvill DR. Harvill LM. et al.
  Improved control of type 2 diabetes
• mellitus a practical education/behavior
  modification program in a primary care clinic.
• Southern Medical Journal 1999 92(7)667-672.
• 5. Ridgeway NA. Harvill DR. Harvill LM. et al.
  Improved control of type 2 diabetes
• mellitus a practical education/behavior
  modification program in a primary care clinic.
• Southern Medical Journal 1999 92(7)667-672.
• 6. Leonard J. Outcomes of a Diabetes Education
  Program. Public Health Reports 1984
• 99 (6) 575-579.
• 7. Miller C K. Evaluation of a food label
  nutrition intervention for women with type 2
• diabetes mellitus. Journal of the American
  Dietetic Association 1999 99 323-328.

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References (continued)

• 9. Garrett N. Hageman CM. Sibley SD. et al. The
  effectiveness of an interactive small group
  diabetes intervention in improving knowledge,
  feeling of control, and behavior. Health
  Promotion Practice 2005 6(3)320-328.
• 10. UK Prospective Diabetes Study (UKPDS) Group.
  Intensive blood- glucose control with
  sulphonylureas or insulin compared with
  conventional treatment and risk of complications
  in patients with type 2 diabetes (UKPDS 33).
  Lancet 1998 352 837853.
• 11. Rothman RL. Malone R. Bryant B. et al. The
  Spoken Knowledge in Low Literacy in Diabetes
  scale a diabetes knowledge scale for vulnerable
  patients. Diabetes Educator 2005 31(2)215-224.
• 12. Setter SM. Corbett CF. Campbell RK. et al. A
  survey of the perceptions, knowledge, and use of
  A1C values by home care patients and nurses.
  Diabetes Educator 2003 29(1)144-152.
• 13. Cheng S. Lichtman JH. Amatruda JM. et.
  Knowledge of cholesterol levels and targets in
  patients with coronary artery disease. Preventive
  Cardiology 2005 8(1)11-17.
• 14. Falk LW. Sobal J. Bisogni CA. Connors M. et
  al. Managing healthy eating definitions,
  classifications, and strategies. Health Education
  Behavior 200128(4)425-439.

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• Thank You
• Comments and Questions