Monday, November 3, 2003

This presentation is part of : Patients with Diabetes

Twelve- and Eighteen-Month Evaluation of a Self-Awareness Intervention for Adults with Type 1 Diabetes and Hypoglycemia Unawareness

Cheri Ann Hernandez, RN, PhD, CDE, Faculty of Nursing, University of Windsor, Windsor, ON, Canada, Margaret Hume, RN, MScN, CDE, University Health Network, Toronto, ON, Canada, and N. Wilson Rodger, MD, FRCPC, CDE, Endocrinology, Faculty of Medicine, University of Western Ontario, London, ON, Canada.
Learning Objective #1: Define the terms hypoglycemia unawareness and self-awareness in diabetes
Learning Objective #2: Describe three outcomes (physiological or psychosocial) that can be impacted with a self-awareness intervention in adults with Type 1 diabetes and hypoglycemia unawareness

Objectives: Hypoglycemia unawareness (HU) affects about 50% of those with Type 1 diabetes and often has devastating physical, psychological, and social ramifications. The purpose of this pilot study was to evaluate the effectiveness of a self-awareness intervention (SAI) in promoting increased awareness of body cues associated with various levels of glycemia and in enhancing physiological and psychosocial well-being, in adults with Type 1 diabetes and HU. Design: The conceptual framework for this study was Hernandez’ theory of integration. This intervention study had a pre- (baseline) and post- (X3) measurement design. Population, Sample, Setting: Twenty-four subjects (12 males, 12 females) between the ages of 24 and 73 years, and with diabetes duration of 7 to 45 years completed the SAI. Concept or Variables Studied Together: Outcomes measured were both physiological (hemoglobin A1c, hypoglycemia unawareness related events, number of glucose cues) and psychological (integration, diabetes quality of life). Methods: The SAI consisted of eight 3-hour sessions held biweekly and conducted using a collaborative alliance educational method. The focus of the SAI was enhancing self-awareness sensitivity, body cue detection, and development of self-awareness strategies. Baseline measures of the study variables were taken pre-intervention and at 6, 12 and 18 month post-intervention. Findings: Study results indicated that subjects could identify more cues of normal and low blood glucose, had increased integration, and had better glycemic control as measured by hemoglobin A1c (p < .05). Conclusions: This innovative, theory-based educational intervention does have the potential to improve physiological parameters and psychosocial well-being in adults with Type 1 diabetes and HU. Implications: The results point to the need for major changes in the focus, content, development and delivery of diabetes education programs for adults with Type 1 diabetes.

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