Using the Concept of Being Safe as a Positive Motivator In Diabetes Education

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1 Inova Health System Using the Concept of Being Safe as a Positive Motivator In Diabetes Education Ann Carnes MN RN CDE Sally Guise RD CDE AADE Annual Meeting August 6, 2009

2 Why Safety?

3 67% of Americans with Type 2 diabetes have an A1C > 6.5% American Association of Clinical Endocrinologists, 2007

4

5 64.2% of Americans with Type 2 diabetes have blood pressure > 130/80 mm Hg 51.8% of Americans have total cholesterol levels >200mg/dL An Uncompromising Approach to Achieving Good Glycemic Goals, Gavin, JR, The Diabetes Educator, Mar 2007; vol. 33: pp. 52S-59S

6 POLLING QUESTION # 1 What percentage of Type 2 Americans achieved all three recommended clinical outcomes (A1C, blood pressure, and LDL-C) in 2007? a. 40% b. 10% c. 7%

7 POLLING QUESTION #1 The percentage of Type 2 Americans achieving all three recommended clinical outcomes (A1C, blood pressure, and LDL-C) in 2007 a. 40% b. 10% c. 7% An Uncompromising Approach to Achieving Good Glycemic Goals, Gavin, JR, The Diabetes Educator, Mar 2007; vol. 33: pp. 52S-59S

8 Barriers to Good Self-care What is the problem? Where is the solution?

9 Uninformed The Problem Unconvinced Unmotivated Higher priorities

10 Barriers to Good Self-care What is the problem? Where is the solution?

11 Why is being Safe important?

12 SAFE The premise is that nobody wants to be unsafe William Polonsky PhD CDE

13 Analogies Personal Airplane Car Home: carbon monoxide detector smoke alarm

14 Analogies Professional Oil and gas industries Aviation Auto makers

15 Medicine has traditionally had a defective culture of safety (Hellman)

16 Literature Review Databases searched: 4 articles with safety mentioned, related to patient empowerment, not safety as a motivator Safety profiles based on possible adverse events to medications

17 Safety net Literature Review Safe to go home (mastery of survival skills) Safety based on hypoglycemia events and treatment

18 Literature Review Nothing published on using safety as a positive motivator to improve glycemic control

19 We can t motivate patients They must see diabetes management as important enough to incorporate into their lives

20 POLLING QUESTION # 2 If you were presented health information as a safety issue, would it increase the level of importance? Yes No

21 Our Study Evaluation of an Education Intervention Using Being Safe as a Positive Motivator To Improve Diabetes Self-Care

22 Purpose Evaluate if the concept of being safe improved patient outcomes Clinical outcomes Psychosocial outcomes

23 Measurements Systolic/diastolic B/P A1C Frequency of SBGM Exercise Treatment:medication Yucky feelings: hypo

24 Measurements Stress, size (BMI) Aspirin Foot problems Eye (retinal) exams Tobacco use Yucky feeling: (hyper)

25 Measurements Silent comorbidities Apnea (sleep) Food intake, feelings Encourage vaccines Treatment phase Yucky feeling: (neuro)

26 Measurements Responses from Living with Diabetes questionnaire - Confidence in diabetes management - Social support - Diabetes as a lifestyle interference - Psychological concerns - Fear of complications

27 Eligibility Criteria Persons with Type 2 diabetes Adults (> 18 years) Completed the Basics education classes

28 Study Design Retrospective chart review one year before and immediately after implementing the SPM intervention Matched intervention based on diabetes-related criteria

29 Hypothesis There will be detectable improvements in self-care behaviors for those hearing the safety message compared to those who did not hear the safety message

30 Inova s Basics Diabetes Education Program Outpatient-only program Type 2 patients Series of four classes spread over 2-3 months

31 POLLING QUESTION # 3 How do you define being Safe?

32 Before hearing the safety message, our patients defined being Safe as No threat Secure Not in danger Comfortable Not hurt Free from worry No loss Protected from harm 3 Videos

33 Our Presentation On Being Safe With Diabetes

34

35 TODAY S AGENDA 1. THREE important facts about diabetes 2. Find out how you are doing 3. Provide tools to help you be SAFE 4. Feel more confident and in control of your diabetes

36 What is Diabetes A chronic disease that causes high blood sugar (glucose) levels It can be managed but not cured It does not go away Requires the following treatments: Nutrition Exercise Medications Self-management education

37

38 Types of Diabetes Type 1 cells stop making insulin Type 2 insulin resistance insulin deficiency Gestational Diabetes insulin resistance identified during pregnancy

39 THE TRUTH ABOUT DIABETES Diabetes is the leading cause of adult blindness, non-traumatic amputation and kidney failure. True or false?

40 False Poorly controlled diabetes is the leading cause of adult blindness, amputation and kidney failure.

41 Well-Controlled Diabetes is the Cause of NOTHING! William Polonsky, PhD, CDE

42 Diabetes and Your Health To live a long and healthy life, develop a chronic disease and take care of it. -- Sir William Osler

43 THE TRUTH ABOUT DIABETES 2. Managing diabetes means you don t have any more choices. 3. True or false?

44 False With good diabetes care, you will have plenty of choices AND know your blood sugars are SAFE.

45 THE TRUTH ABOUT DIABETES 3. You can tell how well you are doing with your diabetes by: a. how well you are eating b. how much medication you take c. how you are feeling d. all of the above e. none of the above All are FALSE.. The best way to tell is by keeping your A1C, blood pressure, and cholesterol in the normal range.

46 Diabetes Facts Complications are mostly invisible Many people don t see diabetes as a SAFETY issue There are tests to determine how you are doing AND lead you to better health

47

48 A1C Measures your average blood glucose level over the past 3 months Target is 6.5% or less: A1C Average BG 5% % % % % % % % % or greater

49 Metabolic Feedback Test Your score should be Your result At or better than goal Not yet at goal SO HOW ARE YOU A1C < 6.5 Blood Pressure Below 130/80 DOING?

50 How SAFE are you? Stay healthy and avoid complications by keeping: Blood glucose in a healthy range Blood pressure in a healthy range Lipids (e.g. cholesterol) in a healthy range

51 Rationale for monitoring your blood sugar Evaluate blood sugar control If your blood sugar is not SAFE, monitoring helps you make decisions about changes in your treatment plan Determine effectiveness of treatment changes

52 Testing Times Before Breakfast Before your main meal 2 Hours after start of main meal

53 Target Blood Glucose Ranges for Persons with Diabetes Before meals: After meals: < 160

54

55 Your feelings?

56 TODAY S S AGENDA Part 1. Make sure you know the THREE most important facts about diabetes Part 2. Find out if you are SAFE with your diabetes Part 3. Develop a personal plan for better diabetes management

57 Modified Eligibility Criteria Persons with Type 2 diabetes Adults (> 18 years) Attended at least one of the Basics education classes

58 Study Results

59 Demographics : Gender and Age CONTROL GROUP SAFE GROUP MALE 54 (54.00%) 42 (42.00%) FEMALE 46 (46.00%) 58 (58.00%) P = CONTROL GROUP SAFE GROUP AGE (13.72) (12.10) P=0.0212

60 Demographics: Race Control Group Safe Group Caucasian 67 (72.83%) 65 (65.66%) African American 11 (11.96%) 20 (20.20%) Asian Indian 5 (5.43%) 3 (3.03%) Hispanic 5 (5.43%) 3 (3.03%) Native American 0 (0.0%) 2 (2.02%) Middle Eastern 2 (2.17%) 2 (2.02%) Asian 1 (1.09%) 3 (3.03%) Other 1 (1.09%) 1 (1.01%)

61 Patient Outcomes: Exercise Percentage of patients who increased exercise: CONTROL GROUP Increased Exercise 55% 65% SAFE GROUP

62 Patient Outcomes: Medication Change Percentage of change in medication: CONTROL GROUP SAFE GROUP Change in Medication No Change in Medication 6 (6.0%) 11 (12.94%) 94 (94.0%) 74 (87.06%) P=

63 Patient Outcomes: Diet Changes Percentage of patients that made recommended diet changes: CONTROL GROUP SAFE GROUP Made Diet Changes 53% 75%

64 Patient Outcomes: SBGM Frequency Percentage of patients that increased SBGM: CONTROL GROUP SAFE GROUP Increased SBGM 46 (48.84%) 65 (77.38%) Non-increased P< SBGM 48 (51.06%) 19 (22.62%)

65 Patient Outcomes: A1C Percentages of Patients that showed decrease in AIC: Decreased HBA1c NO Decrease in HBA1c P = CONTROL SAFE GROUP 40 (61.54%) 32 (82.05%) 25 (38.46%) 7 (17.95%)

66 Patient outcomes: BMI Percentages of Patients that showed a decrease in BMI: CONTROL GROUP SAFE GROUP Decrease in BMI 54 (60.67%) 65 (79.27%) NO Decrease in BMI 35 (39.33%) 17 (20.73%) P=0.0122

67 Patient Outcomes: DEPRESSION Percentage of patients that showed a decrease in depression: CONTROL GROUP SAFE GROUP Decrease in Depression 19 (27.54%) 22 (26.83%) Increase in Depression 5 (7.25%) 7 (8.54%) No Change 45 (65.22%) 53 (64.63%) P=0.9573

68 Patient Outcomes: Lifestyle Interference Percentage of Patients that declared a decrease in amount that diabetes interferes in lifestyle: CONTROL GROUP SAFE GROUP Decrease in Interference No Decrease in Interference 14 (21.21%) 24 (32.43%) 52 (78.79) 50 (65.57%) P=0.1826

69 Patient Outcomes: Return Rate Percentage of patients who completed all four classes: CONTROL GROUP SAFE GROUP Completed all 4 classes 46% 60%

70 Lessons Learned Fostered an interactive environment When external pressures were removed, patients didn t worry about disappointing us A higher return rate: when patients believed they needed to learn how to be safe, more returned

71 Lessons Learned The safety concept helped patients develop personal motivation to accomplish the sometimes very difficult tasks we put before them

72 Future Applications Excited but cautious about our results Invite you to replicate our safety study to determine the value of incorporating the safety message in diabetes education

73 After hearing our safety message, our patients say Safety means No threat/not in danger of complications Secure that I am doing the right things to be healthy Comfortable knowing I can be just as healthy as my friends who don t have diabetes A lot of work, but no worries No losses I m protected from harm

74 In many ways my entire life was preparation for that moment on January 15. It all added up. Captain Sullenberger Airways Pilot Flight 1549 Skip Video

75 SPECIAL THANKS Bill Polonsky PhD CDE Karen Gabel-Speroni RN PhD Terry Lumber RN CNS CDE BC-ADM Traci Johnson MA RN CDE Skip Harkness Luther Guise PE CM Bill Carnes RN CNOR

76 Questions? Comments?

77 Contact us with questions: Ann Carnes MN RN CDE Sally Guise RD CDE

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