A nurse-led conceptual model to inform patient-centred, type 2 diabetes mellitus management in public clinical settings

Background Globally, there is an increased need to provide patient-centred care for people diagnosed with type 2 diabetes mellitus. In Nigeria, a poorly financed health system has worsened the difficulties associated with managing type 2 diabetes mellitus in clinical settings, causing a detrimental effect on patient-centred care. Aims We aimed to develop a conceptual model to promote patient-centred type 2 diabetes mellitus care in clinical settings. We explored nurses’ contextual perceptions of clinical practices and operations in light of type 2 diabetes mellitus management across public hospitals in Lagos, Nigeria. Identifying a nurse-led intervention is critical to care optimisation for people diagnosed with type 2 diabetes mellitus. Methods We adopted a qualitative approach. Using the constant comparison method and semi-structured questions and interviewed practice nurses, with over one year’s experience and who were working in public hospitals across Lagos, Nigeria. The framework method was used to analyse the data obtained. Results Nurses provided insight into four areas of patient-centred type 2 diabetes mellitus management in clinical settings: empowering collaboration; empowering flexibility; empowering approach; and empowering practice. Nurses discussed an empowering pathway through which health settings could provide patient-centred care to individuals diagnosed with type 2 diabetes mellitus. The pathway entailed the integration of macro, meso and micro levels for patient management. Nurses’ accounts have informed the development of a conceptual model for the optimisation of patient care. Conclusions The model developed from this research sits within the patient-centred care model of healthcare delivery. The research sits within the patient-centred care model of healthcare delivery. inform patient-centred care, not only in countries with poorly financed healthcare systems, but in developed countries with comparatively better healthcare.

Effect of Ramadan Fasting on Patients With Type Ii Diabetes Mellitus (A Literature Review)

Diabetes Mellitus (DM) or commonly known as diabetes is a disease caused by impaired carbohydrate metabolism due to the pancreas cannot produce insulin or can produce insulin but the body is not able to use insulin effectively and also produces less insulin, so the body is unable to metabolize carbohydrates, fats, and proteins due to insulin deficiency. Insulin is a hormone that regulates the balance of blood glucose in the body. The writing of this article uses a method of literature review or review literature by reviewing several journals and articles about the relationship between fasting and control of diabetes mellitus management. Journals are downloaded or obtained through the journal portal of universities in Indonesia. The process of writing this article is carried out for two weeks. The results showed that Ramadan fasting is related to DM control through DM management. The conclusion is that there is a significant relationship between several journals studied.

HEALTHCARE PROVIDER PATIENT VERBAL LANGUAGE USE ON DIABETES MELLITUS MANAGEMENT PRACTICES IN SELECTED HOSPITALS IN KENYA

Purpose: To establish the effect of healthcare provider patient verbal language use on diabetes mellitus management practices in selected hospital in Kenya. Methodology: This was a causal comparative research study design with application of quantitative and qualitative methodology. The study was carried out at the outpatient diabetic clinics of Kenyatta National Hospital and MP Shah Hospital. 400 patient participants were involved in the study and comprised of 313 patients at Kenyatta National Hospital (KNH) and 87 patients at MP Shah respectively studied between the months of February 2019 and November 2019. A researcher administered questionnaire was used to collect data. The results were summarized using percentages and means or medians for categorical and continuous data respectively. Comparisons were done using chi square test of association of categorical variables and independent t-test for comparison of means. Linear regression and ANOVA were used to test for associations and hypothesis between healthcare provider patient verbal language use (VLU) and diabetes mellitus management practices (DMMPs). Results: Patients at MP Shah Hospital rated the verbal language use significantly higher than the patients at KNH (p< 0.001). However, linear regression analysis showed that verbal language use was not statistically significant overall in Kenya [β=0.04, (95% CI -0.09, 0.17), p=0.552], at KNH [β=0.05, (95% CI -0.10, 0.19), p=0.513] and MP Shah Hospital [β=0.09, (95% CI -0.21, 0.39), p=0.552]; (P > 0.05), hence the failure to reject the null hypothesis. Therefore, there was no significant effect of verbal language use by the healthcare provider and the patient on diabetes mellitus management practices in selected hospitals Kenya. Unique contribution to theory, practice and policy: Verbal language use though important in healthcare provider patient interactions was not responsible for improvement in the diabetes mellitus management practices among the patients. Therefore, verbal language use by the healthcare providers in their communication interaction with patients need to be reinforced in healthcare practice to ensure improved DMMPs. Strategies should be developed to enhance verbal language use through educational curriculum development and implementation at the medical training institutions.

Endocrine disorders

Diabetes mellitus, Management of diabetes mellitus, Diabetes in children and adolescents, Hypothyroidism, Hyperthyroidism, Enlarged Thyroid Gland (Goitre), Pituitary dysfunction, Endocrine hypertension, Pheochromocytoma and paraganglioma, Cushing's syndrome, Gynaecomastia, Hypoadrenalism, Hypercalcaemia, Hypocalcaemia, Hyperkalaemia, Hypokalaemia, Hyponatraemia, Hypernatraemia

HEALTHCARE PROVIDER PATIENT NONVERBAL COMMUNICATIVE BEHAVIOUR ON DIABETES MELLITUS MANAGEMENT PRACTICES IN SELECTED HOSPITALS IN KENYA

Purpose: To examine the effect of healthcare provider patient communication nonverbal communicative behaviour on diabetes mellitus management practices in selected hospital in Kenya. Methodology: This was a causal comparative research design study with application of quantitative methodology. The study was carried out at Kenyatta National Hospital (KNH) and MP Shah Hospital. Systematic random sampling was used to sample patients. 400 participants were involved in the study and comprised 313 patients at KNH and 87 patients at MP Shah Hospital studied between the months of February 2019 and November 2019. The researcher administered questionnaire was used to collect data. The results were summarized using percentages and means or medians for categorical and continuous data respectively. Comparisons were done using chi square test of association of categorical variables and independent t-test for comparison of means. Linear regression and ANOVA were used to test for associations and hypothesis between healthcare provider patient nonverbal communicative behaviour (NVCB) and diabetes mellitus management practices (DMMPs). Findings: The rating of nonverbal communicative behavior was significantly higher at MP Shah Hospital than at KNH, p=0.010. Nonverbal communicative behavior had positive significant effect on diabetes mellitus management practices in Kenya [β=0.15, (95% CI 0.03, 0.27), p=0.016] with similar outcome at KNH [β=0.20, (95% CI 0.08, 0.33), p=0.002] and not at MP Shah Hospital [β=0.03, (95% CI 0.37, 0.42), p=0.899]. Thus, the null hypothesis was rejected in Kenya; the null hypothesis was rejected at KNH; the null hypothesis was not rejected at MP Shah Hospital. Therefore, there was significant effect of NVCB on DMMPs in Kenya, at KNH and not at MP Shah Hospital. Unique contribution to theory, practice and policy: Nonverbal communicative behaviour was responsible for improved performance in diabetes mellitus management practices among patients in Kenya and at KNH. At MP Shah Hospital, NVCB was not responsible for improvement in the DMMPs. The findings reinforce uncertainty reduction and communication accommodation theories basis in the dyadic interaction between patients and healthcare providers. Therefore, NVCB needs to be well conceptualized and incorporated at the health ministry and medical training institutions to equip medical workers with the required communication skills.

The promising future of insulin therapy in diabetes mellitus

The first therapeutic use of insulin by Frederick Banting and Charles Best in 1921 revolutionized the management of type 1 diabetes and considerably changed the lives of many patients with other types of diabetes. In the past 100 years, significant pharmacological advances took place in the field of insulin therapy, bringing closer the goal of optimal glycemic control along with decreased diabetes-related complications. Despite these developments, several challenges remain, such as increasing treatment flexibility, reducing iatrogenic hypoglycemia, and optimizing patient quality of life. Ongoing innovations in insulin therapy (e.g., new insulin analogs, alternative routes of insulin administration, and closed-loop technology) endeavor to overcome these hurdles and change the landscape of diabetes mellitus management. This report highlights recent advances made in the field of insulin therapy and discusses future perspectives.