Via Research Recognition Day 2024 VCOM-Carolinas

Educational Reports

Diabetes Danger: Reducing Diabetic Consequences by Way of Education Breanna Dobberpuhl, OMS-IV; Anna-Taylor Harbin, OMS-IV; Robert Atkinson, OMS-IV; Matthew Cannon, DO; Alexis Stoner, PhD VCOM South Carolina, Spartanburg, SC. Context

Results Continued

A total of 26 participants were randomly placed in the control or experimental group. Comparison of mean HbA1c values are found in Table 1. The experimental group had a mean reduction of HbA1c by 0.2067. The control group had a mean reduction of HbA1c by 0.025. Using an unpaired t test, these findings were not statistically significant due to a P value of 0.3762 (P < 0.05). Higher heiQ values indicate improvement in patient's outlook of their own health. The mean difference of each group is illustrated in Table 2. The experimental group had a mean increase of 0.1925 compared to a mean of 0.0400 for the control group, compared by an unpaired t test. These findings were statistically significant with a P value of 0.0136 (P < 0.05). Table 3 shows a positive change in heiQ over 3 months between the experimental vs control group. The difference between the groups was statistically significant with a P value of < 0.0001 (P < 0.05). The experimental group had statistically significant improvement in their outlook of their health compared to the control group over 3 months. Methods Participants were recruited through chart review and from office visits conducted at St. Luke's Free Medical Clinic. Inclusion criteria for eligibility include: 1. Having a known diagnosis of Type 2 Diabetes 2. 18+ years old with the ability to comprehend English 3. Have access to a smartphone or computer to conduct telemedicine calls Participants were excluded if inclusion criteria could not be upheld, if hemoglobin A1c was <6.5 or >10.5, or if they preferred to undergo medication alterations within the 3-month study. Informed consent was obtained. By way of a randomized controlled trial, variables of interest include HbA1c and Health Education Impact Questionnaire (heiQ) results. Both values were collected at day 0 and 3 months. No medication adjustments were permitted for patients unless the participant's physician deemed necessary. If medical intervention was chosen, the individual was excluded. The heiQ survey is a 40-question tool to evaluate disease education programs 8 . This standardized reliable tool assesses health education impact. HbA1c is a measurable, objective outcome that is sampled from skin prick with HbA1c ≥ 6.5% constituting diabetes. Participants were randomly allocated to either control or experimental group. The experimental group received diabetic education & 3 telemedicine phone visits throughout 3 months. Control participants received no diabetic education or telemedicine visits. Hypothesis testing with a p value of 0.05 contrasted with day 0 was conducted for HbA1c as well as for each heiQ question. Null hypotheses for this specific aspect include that the following eight measurements will not improve: 1. Skill and technique acquisition 2. Constructive attitudes and approaches 3. Health services navigation 4. Self-monitoring and insight 5. Positive and active engagement in life 6. Emotional distress 7. Health directed activity 8. Social integration and support. Hypothesis 1: Diabetes Danger program improves patients’ diabetic self -management. Hypothesis 2: Diabetes Danger program improves patients’ health outcomes. Hypothesis 3: By incorporating frequent communication check-ins with each patient using telemedicine, patient health outcomes will be improved by the 3-month visit compared to their initial baseline and additionally in comparison to the control group not receiving telemedicine check ins. Results

Type 2 diabetes affects 11.3% of the United States population, not including an estimated 3.4% of undiagnosed individuals 1 . By aiding participants in lowering their hemoglobin A1c (HbA1c) strictly by way of education, taking control of one's health and preventing future health consequences becomes possible. o Objective: To determine if educating Type 2 diabetics along with frequent telemedicine check instead of medication changes results in a statistically significant improvement in hemoglobin A1c compared to those who receive no education/telemedicine check ins. Utilizing a randomized controlled trial, HbA1c and Health Education Impact Questionnaire (heiQ) results assessed effectiveness. Participants were randomly assigned to either the experimental or control group. Both groups had initial HbA1c and heiQ taken and compared to values obtained at 3 months. Participants were recruited by St. Luke's Free Medical Clinic record review and through office visits. In a healthy individual, blood glucose is maintained between 70-100 mg/dL 2 . Glycated hemoglobin (HbA1c) in the blood demonstrates average blood glucose levels during the past 3 months, a biomarker for monitoring diabetes severity 2 . Glycation occurs by a nonenzymatic reaction between hemoglobin and glucose. Chronically increased plasma glucose increases glycated hemoglobin of plasma 3 . Beta cells released from the pancreas secrete insulin, a key factor in blood glucose homeostasis. In Type 2 diabetes, however, the body cannot efficiently use the insulin that is present 2 . Hyperglycemia results and has debilitating consequences if not corrected. Various consequences include diabetic ketoacidosis, microangiopathy, retinopathy, nephropathy, neuropathy, and ulcers 4 . Health literacy is defined as the degree to which an individual understands basic health information and services needed to make appropriate health decisions 5 . Low health literacy is associated with poor health outcomes and improving these aids in disease management and self-efficacy. Literature evidence suggests that educational programs for chronic diseases improve health literacy and health outcomes 5 . Furthermore, programs supported by medical personnel are especially effective for underserved populations 6 . While much of diabetic literature focuses on medication efficacy, minimal research has been conducted regarding the effectsof diabetic education without medication adjustments. Diabetic education takes time, and with the average primary care physician spending 15 minutes with their patient, this is not adequate time to educate 7 . In the pilot study The Other 45, medical students investigated the impact of education on the patient’s health outcomes for diabetes, COPD, and hypertension. This study aims to narrow its focus to diabetes alone, focusing on objective laboratory values and seeking to improve hemoglobin A1C values in patients via education that leads to lifestyle changes instead of adjusting medications. Introduction

Table 2. This estimation plot compares mean change from day 0 to 3 months regarding heiQ. The changes for each of the 8 domains were tested versus each group.

Table 1. This estimation plot compares the A1c value changes from day 0 to 3 months for the control versus experimental.

Table 3. This graph shows the percent of positive improvement in outlook on their health between day 0 and 3 months between the groups regarding the 8 domains.

Conclusion

This study aimed at finding the impact of patient education on lowering A1c values and improving patient’s outlook on their own health in Type 2 Diabetics. The A1c value was found to not be statistically significantly changed between the groups. The Health Education Impact Questionnaire showed a statistically significant change between the groups. Patient’s outlook on their own health can be improved with thorough patient education and medical support through a life-changing diagnosis. Continued recruitment into study is needed to increase statistical power and further stratify trends in results seen to date.

References

Acknowledgments

Research study reviewed and approved by Edward Via College of Osteopathic Medicine Institutional Review Board, Blacksburg, VA. Board reference number 2022-066. IRBNet ID for this project is 1836232-5. Initially approved 11/30/2022. Project is active and open to enrollment currently.

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2024 Research Recognition Day