Deborah A Chyun

Abstract

The objective of this study was to determine the relationship of sociodemographics; diabetes-related factors, including diabetes-related microvascular complications; cardiac risk factors; and psychological factors with quality of life (QOL). Participants enrolled at three sites in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study were invited to participate in this ancillary study. Questionnaires assessing psychological factors were completed by participants, and the remainder of the data was obtained as part of the DIAD study. Many participants had elevated levels of anxiety (n = 91; 82%), depressive symptoms (n = 16; 14%), anger (n = 38; 34%), and hostility (n = 17; 17%). Results of multivariate analyses conducted for each of the eight domains on the Medical Outcomes Study Short Form-36 and two Diabetes Quality of Life domains demonstrated that in the majority of models (42% to 68% of the variance explained), female sex, peripheral or autonomic neuropathy, physical inactivity, higher body mass index, and the presence of depressive symptoms and anxiety were associated with poorer QOL (p =.0001). These findings demonstrate that anxiety, depressive symptoms, and neuropathy are prevalent in older adults with type 2 diabetes. In addition, potentially important correlations were demonstrated between psychological factors, neuropathy, body mass index, and physical inactivity.

Abstract

~

Abstract

~

Abstract

~

Abstract

Although short- and long-term outcomes in individuals with DM following ACS, PCI, and CABG have improved over the past decade, CVD continues to be an important cause of morbidity and mortality in this population. Nursing has a critical role in the prevention of CVD, and in the early detection of symptomatic and asymptomatic CHD. Following ACS, PCI, or CABG, ongoing assessment for new ischemia, HF, or renal insufficiency, and specific complications of ACS or revascularization is crucial. Long-term prevention of recurrent ischemia, ACS, HF, and death necessitates multifactorial CHD risk factor reduction, along with aggressive glucose control, in all individuals with DM.

Abstract

~

Abstract

Purpose: The purpose of this descriptive study was to describe attainment of glucose and coronary heart disease (CHD) risk factor goals and to identify factors that were associated with successful goal achievement. Methods: A cross-sectional survey enrolled 110 subjects with type 2 diabetes undergoing screening for asymptomatic myocardial ischemia. Results: Many participants had HbA1c levels ≥7% (45%), and 46% to 79% were not meeting goals for CHD risk reduction. Individual factors of age, gender, and anxiety; the illness-related factor of lipid-lowering therapy; and the family-related factor of living alone were independently associated with 1 of the 7 outcomes under study. Illness-related factors of a longer duration of diabetes were strongly associated with glucose and blood pressure control, insulin use with glucose control and waist circumference, and antihypertensive use with blood pressure, triglycerides, and body mass index. Family-related factors of higher income were significantly associated with poorer glucose control and higher body mass index, while higher levels of perceived support by family and friends were associated with a lower risk of not meeting lipid goals. However, individual factors, represented by several aspects of personal model beliefs (exercising regularly, testing glucose, and checking one's feet) and physical activity, were consistently related to lipid and weight control. Conclusions: A variety of factors were associated with control of blood glucose and CHD risk factors, suggesting that a one-size-fits-all approach to multiple risk factor reduction efforts may not result in goal attainment.

Abstract

Little is known about factors that contribute to either emotional or behavior outcomes following screening for coronary artery disease (CAD). The purpose of this prospective study was to explore these outcomes, along with potentially contributing factors in individuals enrolled in a screening trial for asymptomatic CAD. Included were 47 subjects with type 2 diabetes. Data were collected at study baseline and 3 and 6 months following entry by self-administered questionnaires and telephone follow-up. Emotional outcomes (quality of life and anxiety) tended to improve in those who underwent more aggressive screening with myocardial perfusion imaging, as well as in those who discussed the results of laboratory tests with their providers. Lower levels of diabetes competence and higher levels of controlled motivation for diet were associated with poorer emotional outcomes. Improvements in CAD risk factor behaviors were not observed.

Abstract

Background: Prevention of coronary heart disease (CHD) is a primary goal of diabetes management. Unfortunately, CHD risk knowledge is poor among people with diabetes. Purpose: The objective is to determine predictors of CHD risk knowledge in a community sample of people with diabetes. Methods: A total of 678 people with diabetes completed the Heart Disease Facts Questionnaire (HDFQ), a valid and reliable measure of knowledge about the relationship between diabetes and heart disease. Results: In regression analysis with demographics predicting HDFQ scores, sex, annual income, education, and health insurance status predicted HDFQ scores. In a separate regression analysis, having CHD risk factors did not predict HDFQ scores, however, taking medication for CHD risk factors did predict higher HDFQ scores. An analysis of variance showed significant differences between ethnic groups for HDFQ scores; Whites (M = 20.9) showed more CHD risk knowledge than African Americans (M = 19.6), who in turn showed more than Latinos (M = 18.2). Asians scored near Whites (M = 20.4) but did not differ significantly from any other group. Controlling for numerous demographic, socioeconomic, health care, diabetes, and cardiovascular health variables, the magnitude of ethnic differences was attenuated, but persisted. Conclusion: Education regarding modifiable risk factors must be delivered in a timely fashion so that lifestyle modification can be implemented and evaluated before pharmacotherapy is deemed necessary. African Americans and Latinos with diabetes are in the greatest need of education regarding CHD risk.

Abstract

The purpose of this study was to evaluate the relationship of recruitment methods to enrollment status in Black women with type 2 diabetes screened for entry into a randomized clinical trial (RCT). Using a cross-sectional study design with convenience sampling procedures, data were collected on recruitment methods to which the women responded (N=236). Results demonstrated that the RCT had a moderate overall recruitment rate of 46% and achieved only 84% of its projected accrual goal (N=109). Chi-square analysis demonstrated that enrollment outcomes varied significantly according to recruitment methods (P=.05). Recruitment methods such as community health fairs (77.8%), private practice referrals (75.0%), participant referrals (61.5%), community clinic referrals (44.6%), community advertising and marketing (40.9%), and chart review (40.4%) demonstrated variable enrollment yields. Results confirm previous findings that indicate that Black Americans may be successfully recruited into research studies at moderate rates when traditional recruitment methods are enhanced and integrated with more culturally sensitive methods. Lessons learned are considered.