European Diabetes Nursing最新文献

Productive interactions are necessary to prevent serious complications from occurring, as is a shared vision on how to meet the obvious targets. Doesn't this look common to what we are trying to achieve in diabetes care? One way of getting there is by sharing information in order to learn from each other. This is exactly what EDN aims to achieve. Not to solve the euro crisis, but to strengthen diabetes nursing across Europe. Then again, with over 60 million people who live with diabetes in Europe, evidence-based care does have significant economic and other implications.

This issue of EDN presents very interesting pieces of evidence. Huber et al. shed light on the views held and problems encountered by nurses working in home health care and nursing homes. Clarke reports on associations between personal characteristics and benefits of attendance at CODE, a structured diabetes education programme. Interim results of a study on the contribution of participant-driven patient education to a reduction of new ulceration are presented by Annersten Gershater et al. Diabetes specialist nursing in the UK is systematically reviewed by James. Zhang and Ho report on a case of severe hypoglycaemia in an individual with insulin treated type 2 diabetes, secondary to panhypopituitarism from a Rathke's cyst. Finally, highlights of this year's annual conference of FEND are reported by Rita Forde.

Another, special way of visualising the societal value of diabetes care is by awarding people for their contributions. It is with great pleasure to mention that Brigitte Osterbrink, member of FEND since its foundation, has been given the German Cross of Merit Award. Congratulations to Brigitte!

This study aimed to explore nurses' perspectives on diabetes care for dependent older adults in home health care and nursing homes in Switzerland.

Growing numbers of old and very old adults with diabetes need professional care. In home health care older adults are usually in their 70s and in nursing homes they are about 10 years older. Inadequate diabetes care in older people leads to higher complication rates. Little is known about the views held and problems encountered by nurses working in home health care and nursing homes. Empirical information is lacking concerning perceptions of nurses caring for this dependent group.

A descriptive qualitative study of nurses' perspectives on diabetes care was conducted with a purposive sample of 23 nurses caring for dependent older adults with diabetes in one region of Switzerland in 2008–2009. Semi-structured focus group interview data were analysed using thematic content analysis.

Qualitative data analysis of nurses' transcripts elicited four themes: (a) actual situation in diabetes care – concerns about complications, inter-professional dependency, communication and continuity; (b) nurses' experiences – apprehension about varied interest in diabetes, suitability of assessments, and current knowledge of disease and its influence on patient outcomes; (c) barriers to diabetes care – patient isolation, co-morbidities, lack of understanding; and (d) resources for diabetes care – patients' social support, maintaining regular physical activities, adapting care to individuals' needs.

It was concluded that level of communication, continuity of care and professional roles need clarification. Regular exposure to training through different methods would encourage professional and interpersonal skills and possibly will lead to better patient outcomes. Introducing consulting roles for advanced nurse practitioners specialised in diabetes care within home health care and nursing homes may advance diabetes care within these settings. Copyright © 2011 FEND. Published by John Wiley & Sons, Ltd.

This study was designed to explore whether participant-driven patient education in group sessions, compared to provision of standard information, will contribute to a statistically significant reduction in new ulceration during 24 months in patients with diabetes and high risk of ulceration. This is an interim analysis after six months.

A randomised controlled study was designed in accordance with CONSORT criteria. Inclusion criteria were: age 35–79 years old, diabetes mellitus, sensory neuropathy, and healed foot ulcer below the ankle; 657 patients (both male and female) were consecutively screened.

A total of 131 patients (35 women) were included in the study. Interim analysis of 98 patients after six months was done due to concerns about the patients' ability to fulfil the study per protocol. After a six-month follow up, 42% had developed a new foot ulcer and there was no statistical difference between the two groups. The number of patients was too small to draw any statistical conclusion regarding the effect of the intervention. At six months, five patients had died, and 21 had declined further participation or were lost to follow up. The main reasons for ulcer development were plantar stress ulcer and external trauma.

It was concluded that patients with diabetes and a healed foot ulcer develop foot ulcers in spite of participant-driven group education as this high risk patient group has external risk factors that are beyond this form of education. The educational method should be evaluated in patients with lower risk of ulceration. Copyright © 2011 FEND. Published by John Wiley & Sons, Ltd.

Hypoglycaemia in a type 2 diabetes patient can be due to oral hypoglycaemic agent(s), in particular sulphonylureas, or insulin therapy. Pituitary dysfunction is a less common, yet important, cause of severe hypoglycaemia. Associated features include nausea, dizziness, hypotension, and hyponatraemia.

We describe a case of severe hypoglycaemia in an individual with insulin treated type 2 diabetes, secondary to panhypopituitarism from a Rathke's cyst. A brief overview on Rathke's cysts is provided. Copyright © 2011 FEND. Published by John Wiley & Sons, Ltd.

In the three round table discussions, the statements read by government representatives recognised the magnitude and impact of the NCD global challenge. There was no opportunity given to discuss possible solutions among those participating in these round tables. It was an opportunity lost and in fact a number of government representatives expressed this disappointment. In my view, the title ‘round table discussion’ was misleading.

Each government representative was permitted to make a three-minute statement and, because of the large number of statements, this consumed valuable time which might have been spent in a more worthwhile way in discussion regarding solutions but this appears to be the way in which UN ‘round tables’ are conducted. It was also the experience of FEND representatives at the informal civil society meeting at the UN in June.

Dr Margaret Chan, Director General of WHO, called the meeting a ‘watershed event’ during her plenary address at the opening of the summit. Many of the government representatives who spoke indicated their awareness of the impact of NCDs in their own countries, and in some cases committed to additional funding and action plans to specific programmes relating to NCD prevention and control. WHO will be the central agency co-ordinating action post following on from this summit in preparation for a formal report by the end of 2012.

It follows that civil society organisations including FEND should now engage with their national governments because it is there that the responsibility lies. So the work of advocacy must continue. The International Diabetes Federation, as a member of the NCD group, will be addressing the key issues in relation to the deficits in the political declaration as well as ensuring that governments who have made commitments during the UN HLM are held to account.

FEND will engage with WHO through the offices of Dr Ala Alwan, Assistant Director General of WHO with special responsibility for NCDs. FEND aims to offer its expertise in the field of diabetes nursing in addressing this major disease of the NCD group. We will keep you informed with regard to the response of WHO to this offer.

The full political declaration can be viewed in six languages at: www.un.org/Docs/journal/asp/ws.asp?m=A/66/L.1. Other documents can be found at: www.un.org/en/ga/ncdmeeting2011/documents.shtml.

Furthermore, you can also view the webcasts of the plenary and round tables at: www.unmultimedia.org/tv/webcast/c/ncdmeeting2011.html.

FEND was the only nursing organisation represented in the civil society groups.

At the time of writing, World Diabetes Day approaches on 14 November. I wish you all a successful day in promoting awareness of the burden of diabetes in your respective countries, and continued success in your advocacy for people with diabetes.

The opening address given by the Chairperson, Deirdre Kyne-Grzebalski, welcomed those present to a programme representing a cross-section of diabetes topics and speakers. The President of FEND, Anne-Marie Felton, emphasised the role of diabetes nursing as not solely clinical and research but also having an advocacy responsibility for all people living with diabetes.

The co-ordinator of the Portuguese Diabetes Association, Dr Boavida, gave a review of the impact diabetes has on the Portuguese population. He also outlined the National Diabetes Prevention programme which began in 2008 and which is aiming to reduce the incidence of diabetes in the Portuguese population. According to Lurdes Serrabulho, diabetes nursing in Portugal was recognised in the 1970s; however, a dedicated course for this specialty did not commence until more than two decades later. Patient education has been a focal aspect of care in Portugal with the world's first Diabetes Association being established in Lisbon in 1929 under the guidance of Dr Ernesto Roma.

The Leuven model of diabetes care in the ICU setting was presented by Koen Vanhonsebrouck. This model was the basis of the first randomised controlled trial on the management of glycaemia in the intensive care setting and confirmed the positive impact of maintaining near normal blood glucose levels on mortality and morbidity. While other studies have argued against tight glycaemic control in this patient cohort, fundamental differences were identified in these studies, such as technology and education of staff.

Dr Peter Adolfsson from Sweden presented on the effects and benefits of exercise in people with diabetes. In general, people living with diabetes tend to be less active than their non-diabetes counterparts. It is thought that fear of hypoglycaemia is a contributing factor. While glucose values are dependent on the intensity and the duration of the exercise, several other factors come into play such as the person's insulin sensitivity and dietary intake prior to, during and after the exercise. He explained the complex hormonal adaptation that occurs during exercise. The use of technology such as insulin pumps and glucose sensors have a place; however, when used he encouraged the trends to be analysed and the patients to be coached in the interpretation.

Prof Angus Forbes gave his overview of training of diabetes nurse specialists utilising the FEND ENDCUP model. He acknowledged that the training of diabetes health care professionals (HCPs) is variable across Europe; however, some fundamental aspects should be universal such as analysing the learning in order to achieve clinical competence and clinical performance. The FEND ENDCUP model strives for not only clinical excellence but also education and research excellence.

The management of severe obesity, which is at the extreme end of the spectrum of obesity, requires a dedicated multidisciplinary team approach. Dr O'Connell outlined t

Our Professor in Diabetes Nursing, Angus Forbes, has been busy this year with the successful launch of the new ENDCUP Programme, which comprised a summer school completed in July and an ongoing e-learning programme. A number of students from Europe and other countries in the world took part in the programme, and on completion will receive a postgraduate certificate in clinical diabetes management.

The conference, held in Lisbon this year, was once again well attended (>650 delegates) and highly evaluated. The programme was very well received with exceptional speakers who delivered highly appropriate and stimulating presentations. Rita Forde, a former committee member of FEND, has written an excellent report outlining the main points from the meeting (see page 117).

The journal continues to go from strength to strength with three issues published each year. I hope you are continuing to think of the journal first for any original work or innovations in practice you may wish to share. The editors are working hard to obtain index submission for the journal.

FEND, through you the members, continues to promote World Diabetes Day, and we trust that this year it will be another successful day highlighting the important issues of education and prevention.

FEND continues to work in collaboration with other European organisations to make up the European Coalition for Diabetes (ECD). The objective of this group is to improve prevention of diabetes, as well as the health and quality of life of European citizens living with diabetes, by influencing European Union policy. There is further information in this issue from your President, with regard to the recent United Nations Summit on Non-Communicable Diseases.

We look forward to hearing from you, whether online, through the journal or at our next annual conference. The conference next year will take place on 28 and 29 September 2012 in Berlin.

Frequently doctors, specialist nurses and patients are unaware of the interaction between different insulins. We reviewed a needle phobic patient using a subcutaneous cannula device. The patient was using insulin glargine (Lantus) and insulin aspart (Novorapid). He had been advised to use two separate devices to keep the insulins apart. However, he was using the one device to give both insulin types and had experienced no problems.

Unlike most other insulins which are soluble at a neutral pH, insulin glargine is soluble at a pH of 4. The slightly acidic nature of glargine is the reason it can sting when injected. The manufacturer (Sanofi-Aventis) advises that it is never diluted or mixed with other insulins and that it should only be used if it is clear and colourless with no particles visible.

We demonstrate the effects of mixing insulin glargine with short acting insulin analogues. In each of six 1ml syringes we mixed 50 units of a long acting insulin analogue, either glargine (Lantus) or detemir (Levemir), with 50 units of a short acting analogue: aspart (Novorapid), lispro (Humalog) or glulisine (Apidra).

All of the short acting insulins mixed with insulin glargine immediately formed a cloudy white precipitate which gradually settled at the bottom of the syringe. In contrast, no precipitate was seen with the same short acting analogues mixed with detemir (see Figure 1).

Adding an insulin with a slightly acidic pH on to an insulin with a neutral pH results in a solution with a pH part-way between the two (depending on the proportions of the two insulins). At the new pH, neither insulin will now be soluble. The insulin molecules form crystals which precipitate out of solution. This reduces the effectiveness of the insulin dose.

Subcutaneous cannulae can be useful devices where patients might otherwise omit insulin doses because of needle phobia. Available brands include the Insuflon (Applied Medical Technology Ltd, Cambridge, UK) and the i-port (Patton Medical Devices, Austin, Texas, USA). These can be used for insulin but also for other repeated subcutaneous injections such as growth hormone, heparin, analgesics or G-CSF.

These injection ports reduce pain and anxiety around repeated injections.1 Studies in children show that their use can improve glycaemic control. In one study, HbA_1c dropped from 9.4% (79mmol/mol) to 8.5% (69mmol/mol) over six months.2 They are designed to be changed every three to five days. They are not available on prescription on the National Health Service but patients can purchase them. They are not widely used, either because of the cost or because doctors and specialist nurses are unfamiliar with them.

We demonstrate why patients should be advised to use a separate injection port for the two different insulin types, especially if the long acting insulin is glargine. This advice is also relevant to patients injecting the two insulins