The Journal of Japan Academy of Diabetes Education and Nursing
Online ISSN : 2432-3713
Print ISSN : 1342-8497
ISSN-L : 1342-8497
Volume 28, Issue 2
Displaying 1-9 of 9 articles from this issue
  • Masako Shimizu, Makoto Motegi, Shun Itou
    2024Volume 28Issue 2 Pages 77-84
    Published: September 30, 2024
    Released on J-STAGE: October 25, 2024
    JOURNAL FREE ACCESS

    The present study aimed to determine the factors that contribute to the delivery of overweight babies by pregnant women who have not been diagnosed with an abnormal glucose metabolism. From 273 delivery cases in fiscal year 2021 at one acute care hospital, the pregnant women of group A (24 cases who delivered a baby weighing 3,500 g or more) and group B (192 cases who delivered a baby weighing 2,500–3,499 g) were compared, excluding the pregnant women who delivered stillbirth, multiple births, a baby weighing less than 2,500 g, and those with an abnormal glucose metabolism. Group A had a later delivery week (p < 0.001),a higher nongestational BMI (p = 0.028),and higher initial blood glucose (p = 0.037) than group B. The neonatal weight correlated with the week of delivery and the non-pregnancy BMI. A multivariate analysis revealed the factors contributing to the delivery of overweight babies to include a delay in the number of weeks of delivery, a high non-gestational BMI, a high initial blood glucose level, and a history of infertility treatment (odds ratio [95%CI]:2.46 [1.46-4.15], 1.20 [1.07-1.35], 1.06 [1.00-1.12], 5.91 [1.26-27.60]).

    The necessity to develop preventive intervention strategies while considering the various risk factors of overweight babies was indicated, even when the mother has not been diagnosed to have any glucose metabolism abnormality.

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Original Article
  • Hatsue Hamano, Nozomu Takada, Yuta Mori
    2024Volume 28Issue 2 Pages 93-104
    Published: September 30, 2024
    Released on J-STAGE: October 25, 2024
    JOURNAL FREE ACCESS

    Background

    Diabetes mellitus is a common metabolic disease with various complications. Among them, diabetic foot ulcer (DFU) has intractable and serious effects. However, with appropriate care and education, lower-limb amputation can be avoided. Therefore, preventive intervention by nurses is particularly important to avoid lower-limb amputation due to diabetic foot lesions.

    Purpose

    The purpose of this study was to identify the nursing practice competencies required for diabetic foot care as perceived by advanced practice nurses.

    Methods

    This study included eight certified nurse specialists and certified nurses who had completed an advanced practice nurse education program in Japan. The subjects underwent individual semi-structured interviews regarding the nursing practice competencies required in foot care for patients with diabetes. Data were analyzed qualitatively inductively.

    Results

    A total of 136 codes were obtained from which 19 subcategories and six major categories were extracted. These were as follows: ability to assess patients from multiple perspectives, such as assessment using kinematic factors and predicting the patient's future; passion for foot care; direct foot care techniques; building relationships with patients to facilitate foot care, such as techniques to promote patient self-care; ability to enhance teamwork by involving multiple professions, such as human resource development and building a smooth collaborative system; and ability to manage the foot care environment in the organization. Particularly, assessment techniques using kinematic components were considered to encompass areas that are fundamental to physical therapy and are not adequately included in current foot care training programs.

    Conclusions

    In addition to the ability to care for patients while analyzing and evaluating varied information, including kinematic factors, practical skills of nurses involved in foot care for patients with diabetes were characterized by management skills, including leadership and negotiation skills.

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  • Mariko Fukuda, Keiko Tasaki, Tomomi Horiguchi, Yuya Asada, Michiko Ina ...
    2024Volume 28Issue 2 Pages 105-113
    Published: September 30, 2024
    Released on J-STAGE: October 25, 2024
    JOURNAL FREE ACCESS

    This study aimed to clarify aspects of setting blood glucose targets for older adult patients with diabetes using insulin. We conducted semi-structured interviews with 10 patients and analyzed data using the Modified Grounded Theory Approach (M-GTA).

    As a result, the structure was described using seven categories and four concepts, generated from 23 initial concepts. Based on the idea of [a life of medical treatment in which one makes daily efforts based on own will], <initially, a low HbA1c target value was set>. Moreover, because the <medical treatment was carried out together with the attending physician based on a trusting relationship>, as patients aged, [although confused, patients thought of substituting their HbA1c target value for a more relaxed, age-appropriate one]. However, this was antagonized by [the optimal HbA1c target value that cannot be abandoned], and this antagonism was influenced by <changes in HbA1c target values, which were not fully understood>. Furthermore, [the fear of hypoglycemia, which patients seemed to know but not understand], influenced the optimal target values that they could not abandon.

    The findings highlight the need for medical professionals to endeavor to understand how patients perceive their target blood glucose values. The results suggest they must collaboratively consider and support setting safe blood glucose targets in older adult patients with diabetes requiring insulin therapy.

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  • Mayumi Hokari, Kimiko Uehara, Naoko Hara, Keiko Nakamura
    2024Volume 28Issue 2 Pages 123-131
    Published: December 31, 2024
    Released on J-STAGE: February 07, 2025
    JOURNAL FREE ACCESS

    The purpose of this study was to clarify the structure of obstacle factors and challenges for elderly people with diabetes living in semi-mountainous areas to ongoing home-care and to obtain suggestions for support methods. The following are the results of a qualitative synthesis method (KJ method) analysis with a pulse discussion of public health nurses, visiting nurses, and care managers: "Self-care issues due to the patients' age: a lack of awareness of their own condition, the uncharacteristic nature of their diabetes symptoms, and an inability to change established patterns of exercise and eating"; "Self-care issues due to living in semi-mountainous regions: unbalanced eating patterns based on locally-available food, and an unwillingness to let others find out about their condition"; "Difficulty of receiving care due to living in these regions: geographical disadvantages, and a lack of trained caregivers and care-giving family members"; "Support-system issues: lack of goal-uniformity among public health, medical and welfare workers, and an absence of information-sharing systems"; "Limits on the services provided by visiting nurses and public health nurses: the difficulty of focusing on the diabetes, due to the wide range of care services required"; and "Relationship issues between elderly people with diabetes and their families: home visits and cooperation done in order to avoid stress-relationships between the patients and their families." It is important to be aware of the connection between the elderly with diabetes and the people living in the community, including their families.

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Original Article
  • Seiko Sakane, Ken Kato, Sonyun Hata, Erika Nishimura, Rika Araki, Kuni ...
    2024Volume 28Issue 2 Pages 133-139
    Published: December 31, 2024
    Released on J-STAGE: March 29, 2025
    JOURNAL FREE ACCESS

    Background: Hypoglycemia is a serious health concern in older adults(OA)with type 1 diabetes(T1D)and can lead to an increased risk of mortality and morbidity. This study aimed to investigate hypoglycemic symptoms and problem-solving abilities related to hypoglycemia in OA with T1D.

    Methods: We conducted cross-sectional study of 268 adults with T1D, with a mean age of 52.3±13.4 years, males accounted for 37.3%, diabetes duration of 18.4±11.1 years, and mean hemoglobin A1c(HbA1c)level of 7.7±0.9%. The participants were divided into two groups: an OA group(aged ≥60 years, N=82)and an adult control group(CG)(<60 years, N=186). Data on diabetes history, complications, diabetes distress, hypoglycemia problem-solving abilities, and treatment were collected.

    Results: The OA group had a lower body mass index but higher HbA1c levels than the CG. There was no difference in the male percentage, retinopathy ratio, severe hypoglycemia history, problem areas in diabetes scores between the two groups. The OA group had lower autonomic and most of neuroglycopenic hypoglycemic symptom scores than the CG;however, there was no significant difference in general malaise symptom scores between the groups. The “Seeking preventive strategies” hypoglycemia score was lower in the OA group compared to the CG.

    Conclusions: Autonomic and neuroglycopenic symptoms frequently manifest in OA with T1D, and their ability to implement hypoglycemic prevention strategies is weak. To prevent hypoglycemia in OA with T1D, families and nurses should discuss and plan appropriate preventive strategies.

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  • Mizuyo Okura, Natsuko Seto, Chisono Ohara, Yasuko Shimizu
    2024Volume 28Issue 2 Pages 141-149
    Published: December 31, 2024
    Released on J-STAGE: February 07, 2025
    JOURNAL FREE ACCESS

    [Purpose]

    Self-care for patients with diabetes (PWD) includes monitoring, such as blood glucose self-monitoring. Understanding the meaning of blood glucose level as an objective value is important. However, monitoring poses a psychological burden; thus, nursing care is essential. This study aimed to clarify objective self-awareness of PWD and its nursing care perceived by certified nurses in diabetes (CN).

    [Methods]

    This study used the qualitative synthesis method, KJ method, to analyze transcript data from semi-structured interviews with 10 CN.

    [Results]

    CN had a perceived "Difficulty in understanding objective self-awareness of PWD." The attitude of CN was based on "Trying to understand the difficulties and struggles that the patients experience." And CN provided advocacy and created "Nonintrusive supportive relationship" with PWD. Then, CN provide "Approval for PWD to calm down and understand themselves" and "Reflect to recognize PDW's positive qualities themselves and to ensure that they have time to think about themselves." Finaly, nursing care shared an "Understanding of the PWD's changing self-determination throughout the past, present, and future" and "PWD's established personal goals."

    [Conclusion]

    CN perceived difficulty in understanding objective self-awareness of PWD. The objective self-awareness of PWD is supported by providing an environment in which the patients feel safe and approved and ensuring that they have time for self-reflection and to engage themselves in interactive communication with CN to deepen self-understanding. This care is considered to respect and acceptance of the changes in the patient's decision making.

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  • Hatsumi Katayama, Satoshi Ugi
    2024Volume 28Issue 2 Pages 151-157
    Published: December 31, 2024
    Released on J-STAGE: February 07, 2025
    JOURNAL FREE ACCESS

    To determine the factors that influence the sense of burden among patients with diabetes receiving insulin, a questionnaire-based survey was conducted among patients attending an outpatient clinic. The subjects were 284 patients. The questions included age, sex, HbA1c, body mass index (BMI), disease type, method of measuring blood glucose, work status, number of people living together, and self-care behavior. The diabetes burden was assessed using the problem areas in diabetes survey (PAID). Multiple regression analysis was performed on the association between the diabetes burden and each of the questionnaire items. Results showed that the factor that most influenced the sense of diabetes burden was sex (female) (β=0.191, p=0.002). Women who were not working and those who lived with their spouses and do not live with their parents had a greater sense of burden. Men and women differ biologically, psychologically, and socially. It is important for medical care providers to consider sex differences in patient involvement. Support for women with diabetes should be provided to reduce their sense of burden.

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