فصلنامه پرستاری دیابت
سال سوم شماره 2 (تابستان 1394)

Diabetes mellitus is one of the most common and critical diseases, worldwide. Various studies have been conducted to improve diabetes management. However, given the inadequacy of common methods for improving diabetes control, this qualitative study was performed to determine the effects of training optimization in adolescents for promoting diabetes control. In this cooperative, action study, 10 personnel from the diabetes clinic and 74 adolescents with diabetes mellitus and their families were enrolled. Overall, in-depth interviews (65-120 min) were conducted with seven personnel and 14 adolescents (and their families) in order to determine the prevalent problems. After identifying the problems, discussion meetings were held to design programs and decisions regarding educational programs, prioritized by the participants, were implemented in guided meetings. After the implementation of the program, 21 interviews were conducted and the differences before and after program implementation were evaluated. Furthermore, blood glucose and HbA1c levels were measured by paired t-test and qualitative analysis. By optimizing the training program, incorrect insulin injection, lack of knowledge about dietary habits, infrequent referral to hospital and lack of attention to blood sugar and HbA1c were corrected. Furthermore, changes in fasting blood glucose were measured in this study. In addition to qualitative changes, fasting glucose and HbA1C levels changed from 189±65.69 to 141.08±59.42 (P=0.002) and from 8.45±1.35 to 6.98±0.89 (P=0.0001), respectively. According to the obtained findings, training program optimization resulted in improvements in diabetes management in adolescents.

Generalized anxiety disorder (GAD) and depression are common among patients with type II diabetes. Type II diabetes is one of the most common chronic conditions, causing various limitations for the patients. Therefore, meta-cognitive therapy can be applied to reduce GAD and depression among these patients. This study aimed to investigate the effects of meta-cognitive therapy on reducing GAD and depression among patients with type II diabetes, referring to healthcare centers of Qarchak, Iran. In this quasi-experimental study, a pre-test, post-test, control-group design was applied. The study population consisted of patients with type II diabetes, referring to healthcare centers of Qarchak in 2015. Overall, 30 patients were selected via simple random sampling and were assigned to experimental and control groups (n=15 per group). The experimental group received 10 sessions of training via meta-cognitive therapy, while the control group did not receive any treatments. The groups completed the Generalized Anxiety Questionnaire (GAQ) and Depression Questionnaire (DQ) for pre-test and post-test assessments. For data analysis, multivariate analysis of covariance (MANCOVA) was performed, using SPSS version 19. The findings showed a significant difference between the experimental and control groups. In other words, meta-cognitive therapy led to a significant decline in GAD and depression among patients with type II diabetes (P<0.01). The results of this study showed that meta-cognitive therapy could reduce GAD and depression among patients with type II diabetes. Therefore, counselors, clinical psychologists and therapists can apply meta-cognitive therapy as a means to decrease GAD and depression among these patients.

Diabetes is one of the most common chronic metabolic diseases. Health literacy is beyond one’s reading and writing knowledge and refers to making appropriate health decisions by patients. Self-efficacy is one’s understanding of his/her ability to control his/her behaviors and behavioral outcomes. The aim of this study was to determine the relationship between health literacy and self-efficacy in patients with type II diabetes, referring to the diabetes clinic of Gorgan, Iran. In this descriptive, correlational study, 100 diabetic patients were selected via convenience random sampling in 2014. Data were collected using questionnaires on demographic characteristics, health literacy and self-efficacy. Data were analyzed by descriptive (e.g., mean and standard deviation) and inferential statistical tests (e.g., linear regression analysis, multiple regression and analysis of variance). Health literacy and self-efficacy scores of the participants were 86.7±21.9 (borderline) and 18.7±6.139 (moderate), respectively. There was a significant relationship between health literacy and educational level (P=0.01), occupational status (P= 0.02) and access to information (P=0.01). Moreover, there was a significant relationship between self-efficacy and educational level (P=0.01), occupational status (P=0.001) and access to information (P=0.04). Also, health literacy and self-efficacy were significantly associated (r=0.72 and P<0.01). Health literacy and self-efficacy in diabetic patients contribute to health prediction in these individuals. The importance and necessity of health literacy and self-efficacy in educational interventions for diabetic patients have highlighted the need for attention to these issues for promoting self-care in patients.

There has been a growing interest in spirituality, considering the role of this human dimension in the process of patient recovery. This study aimed to determine the relationship between spiritual health and glycemic control in type II diabetic patients. In this descriptive, correlational study, 50 diabetic patients, admitted to Imam Musa Ibn Jafar Hospital, were recruited via convenience sampling in Quchan, Iran in 2014. Data were collected, using the spiritual well-being scale by Ellison & Levin. Venous blood samples were obtained for measuring the patient's fasting blood sugar level. For data analysis, descriptive statistics, t-test and Pearson's correlation test were performed, using SPSS version 18. The mean score of spiritual health was 169.160, which indicates the high level of spirituality among patients. The results of Pearson's correlation test demonstrated a significant relationship between spiritual health and type II diabetes. In this study, the scores of spiritual health were not significantly different among patients with controlled and uncontrolled blood glucose. It is suggested that nurses consider cultural, spiritual and religious factors, which may affect glycemic control in the treatment of diabetic patients. Further case-control studies with a larger sample size are required to evaluate the effects of other factors such as educational level and age on glycemic control.

The quality of life of patients with type 2 diabetes is affected by several variables that from most important can be noted perceived social support, psychological hardiness and family communication patterns. This research aimed to investigate the relationship between perceived social support, psychological hardiness and family communication patterns with quality of life among patients with type II diabetes. This is a descriptive analytical study of correlation type. The statistical population included all patients with type 2 diabetic that referred to health care center of Varamin city in 2015 year. Totally 190 patient were selected by simple randomly sampling method. All of them completed the questionnaires include perceived social support (PSS), psychological hardiness (PH), family communication patterns (FCP) and quality of life (QL). Data was analyzed using Pearson correlation and multivariate regression and with using of SPSS-19 software. The findings showed a positive and significant relationship between perceived social support, psychological hardiness and conversation communication pattern with quality of life among patients with type 2 diabetes and a negative and significant relationship between conformity communication pattern with quality of life among patients with type 2 diabetes. In a one predicted model, perceived social support, conversation communication pattern, psychological hardiness and conformity communication pattern predicted 54/7 percent of variance of quality of life among patients with type 2 diabetes (P≤0/01). Regarded to results of this study suggest that therapists, counselors and clinical psychologist consider the symptoms of these variables and design appropriate programs to improve the quality of life of patients with type 2 diabetes.

Similar to many other complications, patients with diabetes play a significant role in the treatment and management of their condition. Therefore, evaluation of compliance with therapeutic regimens among these patients is of pivotalimportance. Identification of factors affecting patient's compliance with therapeutic regimens is the first step in designing therapeutic interventions. The aim of this studywas to investigate the association between therapeutic regimen compliance and demographic and social factors in type II diabetic patients, referring to Tamin EjtemaeiDiabetes Center of Isfahan, Iran. In this qualitative, correlational study, 106 patients (≥ 40 years of age) with confirmed type II diabetes, referring to Tamin Ejtemaei Diabetes Center, were selected via census sampling. The subjects had no diabetes-induced complications and received continuous nutritional consultation. A researcher-made questionnaire was used for data collection. For data analysis, inferential statistics were calculated, using SPSS. Based on the findings, compliance with therapeutic regimens had a significant positive association with educational level, frequency of referral to diabetes centers, patient's perceptions and beliefs, level of knowledge, social factors and family support. However, compliance with therapeutic regimens had a significant negative association with income level and time of diagnosis. Also, no significant association was observed between regimen compliance and age, marital status, residential status, history of using herbal medicines or the time spent on travelling from home to diabetes centers. Based on the findings, some demographic and social factors can affect patient's compliance with therapeutic regimens.

Diabetes mellitus is one of the most common non-communicable metabolic disorders. Proper diet can enhance glycemic control in diabetic patients by approximately 80%. This study aimed to determine the effects of nutritional education on the prevention of diabetes. In this review study, online databases including Science Direct, Scopus, Google Scholar, PubMed, Biomed Central, EMBASE, MagIran, SID and Iran Medex were searched to identify articles published during May 1995-January 2014. The effectiveness of nutritional education has been assessed, using different patterns and models including the Health Belief Model (HBM) and BASNEF educational model. According to different studies, diabetes is associated with different factors such as family history, environmental factors, immunocompromised status, nutritional status, overweight, lack of physical activity, age, high blood pressure, threatening cholesterol level, high triglyceride level, expanded urbanization and lifestyle changes. According to the obtained results, some foodstuffs play an important role in preventing the development of type II diabetes. Prevention of diabetes is synonymous with the management and prevention of this disease. Therefore, adherence to a balanced diet is effective in the treatment and prevention of this condition.