Cognitive-Educative Model for Mexican Adults with Type 2 Diabetes

Thursday, 16 July 2009: 1:45 PM

Esther C. Gallegos, PhD
Secretaria de Doctorado, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
Bertha Cecilia Salazar, PhD
Secretaria de Investigacion, Nursing College, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
Marco Vinicio Gomez, PhD
Economics School, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
Eduardo Garza, MD
Secretaria de Doctorado FAEN, Universidad Autónoma de Nuevo León FAEN, Monterrey, Mexico

Learning Objective 1: Learn about complex nursing interventions focusing diabetes self-care to better control the disease.

Learning Objective 2: understand how diferent variables (cognitive, organic, psychosocial) can affect the diabetic patients' behavior.

Purpose: Describe the effect of intervening variables upon the effectiveness of a controlled intervention as reflected on diabetes knowledge. Describe the predictive capacity of empowerment and self-care on a measure of glycaemic control on adults w DMT2. Methods: A two group quasi experimental repeated measures design was applied. Participants were recruited from two underserved communities in Monterrey, México, age 20-60 yrs (16 M-96 W), assigning each community group to the experimental and control conditions. Subjects w renal failure, less than 19 in MMSE were excluded. Type 2 Diabetes BASICS curriculum was the intervention fundament, delivered in four sessions distributed within a six months period. Content included, 1) symptoms, complications and carbohydrates management; 2) glucose self-monitoring and decision making, 3) self-management, 4) problem solving strategies. Measurements included four instruments and biochemical variables. Measures were performed at basal, 6, 12, and 18 months. Results: Participants were similar (p .06) in age, gender, education, BMI, and psychosocial variables, except in HbA1c where the control group had a lower value than the experimental (6.75 VS 7.71%). 1. Effect of the intervening variables upon diabetes knowledge was significant at the 18 months measurement (F 2,41 = 4.26, p = .021; adjusted R2 = .132. A backward regression model showed urine protein and Trail Making A test as the contributors to significance. 2. On the 18 months measurement self-care, empowerment and its interaction, were significant predictors of HbA1c (F 3, 41 = 3.58,  p = .026; adjusted R2 = .15). Covariates were evaluated at Self-care 47.48, and empowerment 80.25, mean values. Conclusion: Diabetes knowledge is affected by disease complications as well as by cognitive factors. Intervention was effective improving diabetes knowledge, self-care and empowerment which at the time improved HbA1c values; however the self-care scores were much lower than the empowerment ones, suggesting patients overestimate their power.