فصلنامه پرستاری دیابت
سال هشتم شماره 4 (پاییز 1399)

Patients with diabetic foot ulcers are at the risk of limb amputation. One of the most common treatments to prevent limb amputation is the use of dressings or other appropriate treatments. This study was conducted to compare the effect of two methods of vacuum-assisted closure therapy and modern dressing on wound healing in patients with diabetic foot ulcers.

This descriptive cross-sectional study (n=140) was performed on patients with grade 2 and 3 diabetic foot ulcers referring to selected hospitals affiliated with the Isfahan University of Medical Sciences, Isfahan, Iran, in 2019. The necessary data were collected using a two-part questionnaire of demographic characteristics and wound condition checklist distributed at the baseline and once a week up to 4 weeks. The Wagner ulcer classification system was used to measure the degree of the wound. Different types of new dressings, including foam, hydrocolloid, hydrogel, alginate, and hydrofilm, were used in the present study depending on the patientchr('39')s needs and wound conditions. In this study, vacuum therapy is performed by a vacuum device made in Iran. Finally, the changes in depth, discharge, shape, size, and degree of the wound were compared in the two groups. The collected data were analyzed in SPSS software (version 22) using descriptive and inferential statistics.

The results showed that the mean scores of changes in the area, discharge, depth, and degree of the wound were significant in the two groups after the intervention (P-value<0.05). It was also found that it was found that the vacuum-assisted closure therapy method was more effective in wound healing than the new dressing method.

The results indicated that both vacuum-assisted closure therapy and modern dressing methods were effective in healing diabetic foot ulcers. However, vacuum therapy-assisted closure therapy could accelerate and improve the healing process of diabetic foot ulcers, compared to the modern dressing method. Patients with diabetes, as a vulnerable group, need educational planning and counseling services regarding treatment and recovery. Since nurses are the main individuals who can provide the required services in the field of planning and caring for a patient with diabetes, they can play a key role in guiding the patient to choose the appropriate treatment for the type of wound at the onset of the treatment process.

Since diabetic type1 is a chronic and without definitive treatment disease, one of the main goals of health system is increasing of patients’ self-empowerment to control blood sugar and manage the disease. According to doing rare study in this age group, this study aimed to investigate the effect of team self-management training on blood sugar control in children and adolescents with type1 diabetes.

In this quasi-experimental study, 32 patients with type1 diabetes aged 6-18 years old were included. Initially, HbA1c was measured and self-management education was delivered by treatment team. Patients were asked to record the cause of increasing and decreasing of blood sugar and its’ level. This program lasted for three months in six sessions. Finally, HbA1c level, fluctuations in blood sugar, frequency of hypoglycemia and hospitalization, and daily insulin dose were compared pre and post of the study. Data were analyzed by SPSS18.

The mean age of participants was 12.59±0.5 years. Mean of HbA1c was 10.96±0.40 mg/dl and 9.85±0.35 mg/dl pre and post of the study, respectively that this mean difference was significant(P<0.05). After study, short-acting insulin dose had significantly decreased(P<0.05) and long-acting insulin dose had increased(P<0.05). The frequency of hospitalizations and hypoglycemia showed no significant difference between before and after the study (P>0.05).

Since self-management program had an effective role in decreasing of HbA1c and insulin dose, it is suggested to implement it in care programs of type1 diabetic patients in order to better control blood sugar and reduce insulin requirement.

One of the behavioral problems among diabetic patients in Ahvaz is found to be their infrequent referral to diabetes units. Therefore, this qualitative research aimed to identify barriers and incentives for patients with type II diabetes referring to healthcare centers.

The present qualitative content analysis research was conducted in Ahvaz in 2017. The population of this study consisted of 69 patients with type II diabetes referring to diabetes units of healthcare centers in Ahvaz. The necessary data were collected through performing interviews until and was continued until data saturation was achieved. All interviews were transcribed verbatim and finally analyzed by the researchers.

The barriers and incentives for type 2 diabetic patients to refer to diabetes units were each divided into two categories of ‌individual and systemic. Individual barriers included two categories of economic barriers (3 codes) and occupation factors ‌(1 ‌code), and systemic barriers consisted of four ‌categories, namely information barriers ‌(2 codes), lack of facilities, equipment, and expertise required by patients (3 ‌codes), access limitations ‌(1 code), and long waiting queues (1 code). Individual incentives included one category of patientschr('39') awareness ‌(1 code) and systematic incentives consisted of 2 categories, namely financial factors ‌(1 ‌code) and proper educational and public relations ‌(2 ‌codes).

It seems that the use of e-learning and distance learning can greatly contribute to remove individual barriers and satisfy the patientschr('39') needs. Moreover,‌ in the systemic barriers section, the patientschr('39') referral problems can be solved by the cooperation of different organs with each other and the increase of inter-departmental coordination.

Quality of life is of special importance in patients with diabetes. This study aimed to investigate the quality of life model in patients with type II diabetes based on health and efficiency beliefs mediated by self-management behaviors.

This study was conducted based on a correlational design. Moreover, the structural equations were used to analyze the data. The statistical population of this study includeی all patients with type II diabetes referred to diabetes clinics in Abadan in 2018. The samples were selected using a purposeful sampling method, and a total of 254 patients with diabetes were selected based on the inclusion and exclusion criteria. The data were then collected using the Diabetes Patients Self-Efficacy Questionnaire, Health Beliefs Questionnaire, Self-Management Behaviors Questionnaire, and Quality of Life Questionnaire in Diabetic Patients.

The results of the analysis of the measurement confirmed the factor structure of the study scales. In addition, the test results of the structural model showed that the fit indices were in a good condition. Health beliefs also have a direct effect on the quality of life of patients with type II diabetes. Moreover, self-efficacy has direct and indirect effects on the quality of life (mediated by self-management behaviors).

The findings indicate the importance of the role of health beliefs and self-efficacy in the quality of life of patients with type II diabetes.

Diabetes is one of the most common, chronic, and deadly diseases caused by metabolic disorders. This disease can exert negative impacts on public health, well-being, and patientschr('39') quality of life. Therefore, the present study aimed to assess the effects of education on quality of life of diabetic patients in Zabol in 2018.

This quasi-experimental study was conducted on 144 patients with type II diabetes (two groups of 72) who were referred to the Diabetes Center and health centers in Zabol.  Participants were selected by simple random sampling method and assigned to two groups of case and control. The research instrument was a researcher-made questionnaire. Data were analyzed using SPSS software (version 20) using descriptive and inferential statistical tests.

Among the demographic variables in the case group, age, gender, education level, job, and marital status were significantly correlated  with quality of life, while there was no such relationship in the control group. The mean score of quality of life in the case group before and after training pointed to the effect of education on quality of life in diabetic patients (P˂0.05).

The results of the current study were indicative of the importance and role of health education in improving the quality of life of diabetic patients; therefore, the education and training of these patients should be expanded.

Adolescents often struggle with changes in blood sugar levels due to developing conditions. A major part of diabetes management is improving self-efficacy and increasing treatment-dependency. The education provided on theory-based approaches is considered one of the most basic methods of treatment and control of diseases. The extended parallel process model is also regarded as one of the healthcare training models. This study aimed to investigate the effect of the extended parallel process model on the self-efficacy of diabetic adolescents, Golestan Province, Iran, in 2019.

This classic interventional study with a pretest-posttest control group design was conducted on 50 diabetic adolescents in Golestan Province selected by simple random sampling method in 2019. The intervention group received an educational program based on the extended parallel process model in 5-6-people per group for 5 sessions of 45-60 min twice weekly. The required data were collected using a demographic form and the Self-Efficacy Questionnaire for Children. Data analysis was performed in SPSS software (version 23) using tables and mean scores for descriptive statistics and independent t-test, paired t-test, and ANOVA for inferential statistics.

The results of the ANOVA test, by removing the effect of the pretest, showed that teaching the extended parallel process model was effective on the self-efficacy of diabetic adolescents (Eta=0.63, P<0.01) predicting that 63% of posttest changes were attributed to the implementation of the intervention.

According to the findings, education based on the extended parallel process model and follow-ups after training sessions could increase the self-efficacy of adolescents with diabetes. Therefore, the findings of this study can be used to educate diabetic patients in clinics and medical centers.