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Evaluation of a short course on diabetology for practising doctors
$20
Poster Session 1
Materials and Methods: The nursing education program consisted of 1) consulting an out-patient individually by a registered nurse for one hour, 2) taking information about lifestyle, psychological stress after diagnosis of diabetes and others from a patient, 2) providing programs for self-care based on the patient's information and 3) giving the information to physicians. We consulted 62 patients (age: 574-13 years-old, 40 males and 22 females) who had irregular lifestyle, poor self-management, obesity (BMI>_26), poor glycemic control (HbAlc_>8.0%) a n d / o r new out-patients with diabetes. The effectiveness of the program were evaluated by determination of BMI and H b A l c before and 3-months after consultation. Results: (1) Three months after consultation, H b A l c level improved significantly compared with that before it (7.054-1.25% vs 8.344-1.81%, p_<0.05), although BMI did not change. (2) The change in H b A l c level reciprocally related to the duration of diabetes. (3) In patients treated with diet and exercise, BMI and/or H b A l c markedly improved. Conclusion: Individualized nursing consultation is effective on the treatment for diabetic patients who have poor life-style and obesity, especially for patients treated with diet and exercise, and short-duration of the disease. Also, it is indicated that nurses who had well understood the patient's lifestyle problems could provide effective information on the patients to physicians.
P158 Evaluating the Use of the Novopen 3 Insulin Delivery System in Singaporean Diabetes Subjects Grace CHANG, Joan Chia, Sri Rahayu, Wendy Teo, Chung Horn Lee.
Changi General Hospital We conducted a study to evaluate the clinical use of the NovoPen 3 insulin delivery system in a group of Singaporean diabetic patients enrolled in the diabetes center of our hospital. Diabetes nurse specialists gathered data using a questionnaire tool by telephoning study subjects. A total of 16 multiple-choice questions were asked. All patients were encouraged to give comments and report adverse events related to the use of NovoPen 3. Results: Seventy-six patients were recruited. There were 44 males and 32 females. The mean age was 52 years and body mass index was 23.7kg/m 2. Thirty seven percent were patients with type 1 diabetes and 63% were patients with type 2 diabetes. The mean duration of diabetes was 12 years & the mean duration of insulin therapy was 6 years. Only 4 out of 76 patients used oral agents in addition to insulin. Forty-four patients had experience using the NovoPen2 insulin delivery system. Ninety-one percent of patients were injecting the insulin by themselves and were on two daily injections. The mean insulin dose was 42 units at the first post-initiation visit and 44 units at the second visit. The following responses were obtained regarding the use of NovoPen 3: 1. NovoPen 3 was very easy to learn to use (87%) 2. It is easy to see if the insulin is correctly shaken (84%) 3. NovoPen 3 is durable (99%) 4. It is easy to change the penfill cartridge (92%) 5. It is easy to change the needle (89%) 6. It is quicker to use than the syringe method (84%) 7. Subject felt more independent (64%) 8. NovoPen 3 allowed easier dosing of insulin (82%) 9. NovoPen 3 injection was comfortable (96%) 10. NovoPen 3's size and weight is acceptable (85%) 11. Subject wanted to continue using NovoPen 3 (94%) 12. NovoPen 3 and insulin cartridge were affordable (75%) 13. Subject found no technical faults (96%) Glycated hemoglobin (HbAlc) fell from 9.2 to 8.5% (p=0.04) after conversion to NovoPen 3. The number of hypoglycaemic attacks before and after introduction of NovoPen 3 was not different. There were no adverse events related to the use of NovoPen 3. When NovoPen 3 was compared to the subject's previous injection device, and analysed separately for patients with and without previous NovoPen 2 experience, there was a
higher acceptance of Nova Pen 3 from patients who were using syringes previously. Contusion: Nova Pen 3 was readily accepted by most insulin requiring diabetic patients. It is also a safe device to use.
P159 Evaluation of a Short Course on Diabetology for Practising Doctors H.B. CHANDALIA, S. Purohit, P.S. Lamba. Diabetes, Endocrine, Nutrition Management & research Center, Mumbai, India A short three-day course on Diabetology, attended by 83 doctors was evaluated by using a well-structnred, multiple choice questionnaire, before and after the course. The doctors were divided into three groups. (Group I: basic qualification, MBBS, Group II: MD in Internal Medicine or an allied subject, Group III: Diploma in Diabetes Mellitus). The mean ages of all three groups were comparable. Pre-course evaluation of their knowledge of diabetes showed the best performance in Group III and poorest in Group I. Post-course evaluation showed significant improvement only in Group I and II (P<0.002 and < 0.001 respectively). Maximal improvement in performance was seen in Group II. 14.5% of doctcrs were from rural or semi-urban setting. The pre-course performance of rural doctors in the MD group was significantly poorer (P<0.05), but their post-course performance was as good as others. All doctors from rural or semi-urban areas improved their performance post-course, compared to 84% in the urban group. Thus, MD (Internal Medicine) group from rural or semi-urban areas appeared to be the best target. 75% of doctors had not attented any post-graduate course after their basic degree. Their performance did not differ significantly from those who had attended such courses. 44.6% were Consultants, 26.5% were general practitioners, 12.1% were attached to institutions, 10.8% were in Government service or Armed Forces and 6% were attached to teaching hospitals. The performance of the doctors was not linked to the type of practice. The doctors attending the course felt that the audiovisual presentation needed improvement.
P160 Identifying Strategies To Address Diabetes in Asian American and Pacific Islander Communities in the United States NINA L. AGBAYANI, Karen Yanagisako. BALANCE Programfor Diabetes, Association of Asian Pacific Community Health Organizations, Oakland, CA, United States of America Purpose: To gather information on diabetes as it relates to Asian American and Pacific Islanders (AAPIs), assess their current level of understanding regarding the disease, and to ensure that the diverse needs of AAPIs are included in implementing diabetes awareness activities in AAPI communities. Methods: The Association of Asian Pacific Community Health Organizations (AAPCHO), in collaboration with our member centers and partnering community organizations, has conducted needs assessment activities with Asian American and Pacific Islander (AAPI) communities in California, Hawaii Massachusetts, New York and Washington. Ten sites were selected to conduct community discussion groups with AAPIs living with diabetes and key informant interviews with community leaders and health care professionals serving these communities. The needs assessment activities were conducted with the following ethnicities: Native Hawaiian, Samoan, Micronesian, Chinese, Korean, South Asian, Vietnamese, Cambodian and Filipino. To ensure consistency in questions and procedures at each site, a standard instrument was utilized for community discussion groups and key informant interviews. In addition, AAPCHO staff provided technical assistance and a half-day training for participating member centers and community organizations. Results: A total of 13 community discussion groups and 33 key informant interviews were conducted. The results will provide information regarding culturally appropriate messages and approaches for preventing and managing
Poster Session 1
Materials and Methods: The nursing education program consisted of 1) consulting an out-patient individually by a registered nurse for one hour, 2) taking information about lifestyle, psychological stress after diagnosis of diabetes and others from a patient, 2) providing programs for self-care based on the patient's information and 3) giving the information to physicians. We consulted 62 patients (age: 574-13 years-old, 40 males and 22 females) who had irregular lifestyle, poor self-management, obesity (BMI>_26), poor glycemic control (HbAlc_>8.0%) a n d / o r new out-patients with diabetes. The effectiveness of the program were evaluated by determination of BMI and H b A l c before and 3-months after consultation. Results: (1) Three months after consultation, H b A l c level improved significantly compared with that before it (7.054-1.25% vs 8.344-1.81%, p_<0.05), although BMI did not change. (2) The change in H b A l c level reciprocally related to the duration of diabetes. (3) In patients treated with diet and exercise, BMI and/or H b A l c markedly improved. Conclusion: Individualized nursing consultation is effective on the treatment for diabetic patients who have poor life-style and obesity, especially for patients treated with diet and exercise, and short-duration of the disease. Also, it is indicated that nurses who had well understood the patient's lifestyle problems could provide effective information on the patients to physicians.
P158 Evaluating the Use of the Novopen 3 Insulin Delivery System in Singaporean Diabetes Subjects Grace CHANG, Joan Chia, Sri Rahayu, Wendy Teo, Chung Horn Lee.
Changi General Hospital We conducted a study to evaluate the clinical use of the NovoPen 3 insulin delivery system in a group of Singaporean diabetic patients enrolled in the diabetes center of our hospital. Diabetes nurse specialists gathered data using a questionnaire tool by telephoning study subjects. A total of 16 multiple-choice questions were asked. All patients were encouraged to give comments and report adverse events related to the use of NovoPen 3. Results: Seventy-six patients were recruited. There were 44 males and 32 females. The mean age was 52 years and body mass index was 23.7kg/m 2. Thirty seven percent were patients with type 1 diabetes and 63% were patients with type 2 diabetes. The mean duration of diabetes was 12 years & the mean duration of insulin therapy was 6 years. Only 4 out of 76 patients used oral agents in addition to insulin. Forty-four patients had experience using the NovoPen2 insulin delivery system. Ninety-one percent of patients were injecting the insulin by themselves and were on two daily injections. The mean insulin dose was 42 units at the first post-initiation visit and 44 units at the second visit. The following responses were obtained regarding the use of NovoPen 3: 1. NovoPen 3 was very easy to learn to use (87%) 2. It is easy to see if the insulin is correctly shaken (84%) 3. NovoPen 3 is durable (99%) 4. It is easy to change the penfill cartridge (92%) 5. It is easy to change the needle (89%) 6. It is quicker to use than the syringe method (84%) 7. Subject felt more independent (64%) 8. NovoPen 3 allowed easier dosing of insulin (82%) 9. NovoPen 3 injection was comfortable (96%) 10. NovoPen 3's size and weight is acceptable (85%) 11. Subject wanted to continue using NovoPen 3 (94%) 12. NovoPen 3 and insulin cartridge were affordable (75%) 13. Subject found no technical faults (96%) Glycated hemoglobin (HbAlc) fell from 9.2 to 8.5% (p=0.04) after conversion to NovoPen 3. The number of hypoglycaemic attacks before and after introduction of NovoPen 3 was not different. There were no adverse events related to the use of NovoPen 3. When NovoPen 3 was compared to the subject's previous injection device, and analysed separately for patients with and without previous NovoPen 2 experience, there was a
higher acceptance of Nova Pen 3 from patients who were using syringes previously. Contusion: Nova Pen 3 was readily accepted by most insulin requiring diabetic patients. It is also a safe device to use.
P159 Evaluation of a Short Course on Diabetology for Practising Doctors H.B. CHANDALIA, S. Purohit, P.S. Lamba. Diabetes, Endocrine, Nutrition Management & research Center, Mumbai, India A short three-day course on Diabetology, attended by 83 doctors was evaluated by using a well-structnred, multiple choice questionnaire, before and after the course. The doctors were divided into three groups. (Group I: basic qualification, MBBS, Group II: MD in Internal Medicine or an allied subject, Group III: Diploma in Diabetes Mellitus). The mean ages of all three groups were comparable. Pre-course evaluation of their knowledge of diabetes showed the best performance in Group III and poorest in Group I. Post-course evaluation showed significant improvement only in Group I and II (P<0.002 and < 0.001 respectively). Maximal improvement in performance was seen in Group II. 14.5% of doctcrs were from rural or semi-urban setting. The pre-course performance of rural doctors in the MD group was significantly poorer (P<0.05), but their post-course performance was as good as others. All doctors from rural or semi-urban areas improved their performance post-course, compared to 84% in the urban group. Thus, MD (Internal Medicine) group from rural or semi-urban areas appeared to be the best target. 75% of doctors had not attented any post-graduate course after their basic degree. Their performance did not differ significantly from those who had attended such courses. 44.6% were Consultants, 26.5% were general practitioners, 12.1% were attached to institutions, 10.8% were in Government service or Armed Forces and 6% were attached to teaching hospitals. The performance of the doctors was not linked to the type of practice. The doctors attending the course felt that the audiovisual presentation needed improvement.
P160 Identifying Strategies To Address Diabetes in Asian American and Pacific Islander Communities in the United States NINA L. AGBAYANI, Karen Yanagisako. BALANCE Programfor Diabetes, Association of Asian Pacific Community Health Organizations, Oakland, CA, United States of America Purpose: To gather information on diabetes as it relates to Asian American and Pacific Islanders (AAPIs), assess their current level of understanding regarding the disease, and to ensure that the diverse needs of AAPIs are included in implementing diabetes awareness activities in AAPI communities. Methods: The Association of Asian Pacific Community Health Organizations (AAPCHO), in collaboration with our member centers and partnering community organizations, has conducted needs assessment activities with Asian American and Pacific Islander (AAPI) communities in California, Hawaii Massachusetts, New York and Washington. Ten sites were selected to conduct community discussion groups with AAPIs living with diabetes and key informant interviews with community leaders and health care professionals serving these communities. The needs assessment activities were conducted with the following ethnicities: Native Hawaiian, Samoan, Micronesian, Chinese, Korean, South Asian, Vietnamese, Cambodian and Filipino. To ensure consistency in questions and procedures at each site, a standard instrument was utilized for community discussion groups and key informant interviews. In addition, AAPCHO staff provided technical assistance and a half-day training for participating member centers and community organizations. Results: A total of 13 community discussion groups and 33 key informant interviews were conducted. The results will provide information regarding culturally appropriate messages and approaches for preventing and managing