Insulin Pump Therapy In the Aboriginal Population

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Insulin Pump Therapy In the Aboriginal Population
Insulin Pump Therapy

• In the Aboriginal Population

Giota Athanasopoulos, Jenna Dickson, Bethany
DiGiacomo, Christine McCubbing, Kate Poper
Rachel Werkhoven
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Why We Chose this Topic

• There is an epidemic of type 2 diabetes amongst
  the aboriginal population (Reading, 2006).
• Aboriginals have a 3 to 5 times higher risk than
  any other ethnic group in Canada of developing
  type 2 diabetes.
• One in five aboriginals are diagnosed with
  diabetes (Health Canada, 2006).

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Insulin Pumps

• What is an Insulin Pump?
• Battery operated device worn 24 hours
• A small needle is inserted under the skin into
  the subcutaneous tissue which is attached by a
  flexible catheter to the pump.
• The pump slowly and consistently pushes insulin
  through the catheter.
• Every 2-3 days the insertion site is changed, and
  blood glucose levels are measured regularly.

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Literature Review

• Research Gaps
• Throughout our research we did not find any
  articles or journals which specifically referred
  to insulin pump use in the aboriginal population.
  

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Benefits of Insulin Pumps

• Provides greater glucose control than
  conventional daily multiple injection.
• One injection about every 3 days is given to
  insert the new cannula compared to multiple
  injections per day.
• Mimic the normal action of a healthy pancreas
• Blood sugars are generally more stable on pump
  therapy versus multiple injection regimens.
• Less fluctuation between blood glucose peaks and
  valleys and less risk of hypoglycemic episodes.
• This improved blood glucose control significantly
  reduces the risk of developing long term
  complications of diabetes (Frank, 2006)

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Benefits Contd

• Allows for increased flexibility in the users
  lifestyle, gives freedom to travel.
• When travelling, insulin delivery can be adjusted
  and programmed to destination time zone.
• Pump also helps with weight loss.
• Allows person to eat special occasion foods
  without the guilt because the pump manages
  delayed food absorption by adjusting or extending
  the meal bolus delivery to match the food
  absorption (Conway 2006).

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Disadvantages of Insulin Pumps

• This continuous in-situ catheter is a daily,
  24-hour reminder of the disease.
• Pump requires large lengths of infusion tubing,
  bulky carrying case, and there are restrictions
  on the type of physical activity the individual
  may participate in.
• Swimming and showering can not be accomplished
  while wearing the pump, so the individual has to
  enclose the pump in a plastic bag which hangs
  around the neck (Torrance, Franklin, Greene.
  2003).
• Approximately 30 percent of individuals develop
  an infection at the site of the cannula, which is
  a serious complication (Pardalis, 2005).

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Disadvantages Contd

• User must be knowledgeable in regards to use of
  pump and be extremely aware of the type and
  amount of food they ingest throughout the day.
• Pumps on occasion have become occluded, not able
  to deliver the necessary insulin into the body.
• Healthcare maintenance and education is needed at
  least monthly to maximize the benefits of insulin
  pump therapy (Schade Valentine, 2006).
• High Cost, 6000, with annual 1500 to 2000
  expense for supplies.

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Literature Review Analysis

• Contradictions found in the Literature.
• Insulin pumps can be both beneficial and
  controversial depending upon the individual.
• The insulin pump should at least be considered,
  and it is then up to the individual, health care
  team, and financial resources to determine its
  effectiveness for the client.

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Research Questions

• Would insulin pump therapy be beneficial for the
  aboriginal population?
• What are the barriers currently in place
  preventing the use of insulin pumps in the
  aboriginal population?

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Objectives

• Examine the cultural, political, social and
  unique factors that affect the choice to
  implement, or disregard the use of insulin-pump
  therapy in the Aboriginal population.
• The goal of this study is to gain a true and
  holistic emic perspective of this cultural group,
  and how insulin-pump therapy could influence
  their lifestyle.

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Variables

• Independent Variable
• Insulin Pump Use
• Dependent Variables
• Effect of Insulin Pump Use on Diabetic
  Aborigine's Health

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Hypothesis

• Through increased information, education and
  awareness in the Aboriginal communities provided
  by nurses through various services, individuals
  would be capable of making an informed decision
  on whether insulin-pump therapy is beneficial for
  their diabetic management

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Approach

• Combination of ethnographic, phenomenological,
  and grounded theories to fully comprehend the
  lifestyle, cultural factors, and lived
  experiences of this community.
• Focusing through an ethnographic lens provides a
  framework for studying the meaning, patterns and
  experiences of our defined cultural group, in a
  holistic fashion (Polit, Beck Hungler, 2001, P.
  211).
• Longitudinal study to be completed over the
  course of a year, allowing the researcher to
  observe the rituals, traditions and day to
  day activities that influence lifestyle choices.

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Design

• Qualitative
• in-depth observation and focus groups related to
  diabetes knowledge and the intervention of
  insulin pumps within four Aboriginal communities
  in Northern Ontario.
• Through focus group seminars, the nurse
  researchers will work in collaboration with
  individuals in the community to determine the
  cultural, political, social and unique factors
  that influence diabetic decisions for this group.

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Study Method

• Focus Group
• 6 8 participants involved with insulin
  dependent diabetes
• Hosted by the same two facilitators, one led
  discussion while other recorded notes.
• Two hour limit and would consist of 5 minutes
  summary of our studys purpose, ten minute
  introduction of facilitator and focus group
  members, 5 minute description of the focus group
  procedure and plan for member participation, 45
  minutes allotted for discussion of the open
  ended questions, and 10 minutes for summary and
  conclusion (Verner Gilbert, 2006).
• ).

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Study Participants

• Individuals in the community with insulin
  dependent diabetes
• The number of participants depends on how many it
  takes for the data to become repetitive and
  redundant, which is known as the saturation of
  data (Polit et al, 2001).

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Data Analysis

• Through the information gained from the multiple
  focus groups, commonalities will emerge between
  the 4 different research sites.
• Similar cultural practices, lifestyles, knowledge
  gaps, and emic ways will be analysed, in an
  attempt to comprehend this cultural group in
  regards to diabetes therapy.
• Clustering of the narratives will be essential in
  summarizing the research and will dictate the
  need and effectiveness of insulin-pump therapy.

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Budget

• Per month, per community
• Researchers Personal Expenses
• Living expenses (inclusive) 600
• Food expenditures 250
• Entertainment 200
• Transportation 150
• Additional (toiletries, clothing,
  etc.) 200
• Seminars/Focus group costs
• Advertisements 150
• Equipment and Facility rentals 200
• Total 1750
• 1750 x 4 communities 7000
• 1 month x 12 months 84 000
• We propose that this research study, which
  includes 6 nurse researchers, and which targets
  four communities for one full year would cost an
  approximate 84 000.

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Advancements in Nursing Knowledge

• Technology is ever changing, and it is nursing
  professional responsibility to educate clients
  regarding these new initiatives specifically
  insulin pumps in diabetes.
• This target population is in dire need of
  education therefore nursing has the professional
  responsibility to fulfil this pressing
  requirement at the communities level.
• It will further allow nurses to determine when
  insulin pumps are appropriate to use, and what
  factors need to be addressed for this therapy.
• By understanding this population, nurses will be
  further equipped to enhance nursing knowledge,
  and improve the quality of nursing intervention,
  all in an attempt to better diabetic management
  and therapy in the Aboriginal population.

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? Discussion Questions ?

• Do you think that the use of insulin pumps will
  be beneficial for Northern Ontario Aboriginals?
• Do you think the benefits outweigh the costs?

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References

• Anonymous. (2006). Can I get insurance for my
  insulin pump? Canadian Diabetes
• Association. Retrieved on November 22, 2006,
  from http//www.diabetes.ca/files/FAQ-CDA.pdf
• Canadian Diabetes Association. (2006). Stay
  Healthy. Preventing Diabetes and Its
  Complications. Retrieved on November 22, 2006,
  from http//www.diabetes.ca/files/STAYHEALTHYAbFin
  al.pdf
• Conway, R. (2006). Insulin pump therapy.
  Diabetes Clinic. Retreived from
• http//www.diabetesclinic.ca
• Deranarian, C., Wilcox, S., Abbott, J., Vrazel,
  J., et al. 2006. The Exercise Experience in
• Adults With Arthritis A Qualitative Approach.
  American Journal of Health Behaviour 30 (6), 731
  745. Retrieved on November 21, 2006, from
  ProQuest database.
• Fain, J.A. (2002). Photo Guide. Delivering
  Insulin Round the Clock. Nursing. 32(8)
• 54-56. Retrieved on November 21, 2006, from
  ProQuest database.
• Frank, M. (2006). Insulin pumps. About Kids
  Health. Retrieved on November 21, 2006,
• from http//www.aboutkidshealth.ca
• Health Canada. (2006). Aboriginal Diabetes
  Initiative. Retrieved on November 15, 2006, from
  http//www.hc-sc.gc.ca/dc-ma/diabete/aborig-autoch
  /index_e.html

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References Contd

• Pardalis, D. (2005) Insulin pump therapy gives
  patients flexibility. Pharmacy Post, 13(6), 11.
  Retrieved on November 21, 2006, from ProQuest
  database.
• Polit, D.F., Beck, C.T., Hungler, B.P. (2001).
  Essentials of Nursing Research (5th ed.).
  Philidelphia Lippincott. 43-45, 208-216.
• Reading, J,. (2006). The quest to improve
  Aboriginal health. Canadian Medical Association
  Journal, 174(9), 1233-1235. Retrieved on November
  20, 2006, from ProQuest database.
• Research Health Canada. (1999). Diabetes and
  Aboriginal People. Retrieved on November 23,
  2006, from http//www.phac-aspc.gc.ca/publicat/dic
  -dac99/d12_e.html.
• Schade, D., Valentine, V. (2006) Are insulin
  pumps underutilized in type 1
• diabetes? No. Diabetes Care, 29(6), 1453-1458.
  Retrieved on November 21, 2006, from ProQuest
  database.
• Simmons, D., Thompson, C.F., Conroy, C., Scott,
  D.J., (2001). Use of insulin pumps
• in pregnancies complicated by type 2 diabetes
  and gestational diabetes in a multiethnic
  community. Diabetes Care, 24(12), 2078-2082.
  Retrieved on November 21, 2006, from ProQuest
  database
• Torrance, T., Franklin, V., Greene, S. (2003).
  Insulin pumps. Archives of Disease in
• Childhood, 88(11), 949. Retrieved on November
  21, 2006, from ProQuest database.

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References Contd

• Verner, M., Gibert, J. (2006). Focus Groups
  Before Writing a Grant, Know Your
• Constituents Needs and Desires. Journal of
  Physical Education, Recreation Dance, 77 (9),
  4652. Retrieved on November 21, 2006, from
  ProQuest database.
• Weinzimer, S.S., Ahern, J.H., Doyle, E.A.,
  Vincent, M.R., Dziura, J., Steffen, A.T.,
• Tamborlane, W.V. (2004). Persistence of benefits
  of continuous subcutaneous insulin infusion in
  very young children with type 1 diabetes a
  follow-up report. Pediatric,114(6) 1601-1605.
  Retrieved on November 21, 2006, from ProQuest
  database.