Diabetes Outcomes and High Fructose Corn Syrup

Education Laura McIntosh, Sheila Estelle Neira, Antonio Padilla

Azusa Pacific UniversityFor Dr. Najood Azar | GNRS 508A

July 30, 2014

HealthyPeople.gov: Diabetes

● 70,000 annual deaths● 16.4% Hispanic

prevalence● $116 billion direct

cost estimate in 2007● Ave. cost for hospital

inpatient day due to diabetes: ○ $1,853-$2,281

● Diabetes-related hospitalizations○ 24.3 million days

in 2007 up from 16.9 million days in 2002

USDA

Research Question

Research Hypothesis ● A Certified Diabetes Educator (CDE) nurse led

educational intervention that includes avoiding high fructose corn syrup and reading labels, will result in improved health outcomes of Hemoglobin A1C (A1c), Body Mass Index (BMI), and Blood Pressure (BP), in Hispanic adults with T2DM over 18 years of age.

Literature Review: Comparison and Analysis

● Culturally Appropriate Interventions○ Reductions in A1C were greater and longer lasting in those

studies that implemented a culturally tailored intervention

● Diabetes Education○ All literature shows positive effects on A1C when participants

received specific diabetes education

● Gaps○ Hispanic population○ Anti-fructose education

Theoretical Framework● Health Promotion Model by Nola Pender● Our intervention is targeted at: Behavior-

specific Interventions (Category 2)

○ DSME Education that includes Healthy eating,○ Avoiding fructose○ Goal: affect healthy choices and outcomes

manifested by a decrease in: ■ A1C■ BMI■ BP

Research Design

● Pre/ Post Test longitudinal design● Subjects randomly assigned to two brackets

○ Bracket A: AF-DSME + support + diet monitoring○ Bracket B: DSME alone

Research Design

● Study Location: Community center classroom● Study Length: 8 months

○ BP measurement weekly○ A1C and BMI measurement every other month○ Rationale for length of study

Research Variables● Independent Variables

•Education

•Support

•Dietary monitoring

(Burke & Vannice, 2011)

● Dependent Variables•A1c

•BMI

•Blood pressure

Operational Definitions● Education: Diabetes Self Management (DMSE)

○ pre and post test● Dietary monitoring

○ Food worksheet diet “worksheet” to be collected each week

● Support○ Did you receive your weekly call? yes or no

○ Attendance measured by CDE

Conceptual Definitions●Education: Diabetes Self Management Education (DMSE)

●SupportoWeekly phone call and diabetes support group (after education portion ends)

●Dietary MonitoringoModified Idaho Plate Model

Sampling PlanInclusion Criteria ● Diagnosed with TDM2 for

at least one year ● Hispanic● Over 18 years old ● English speaking, ● Cognitively able to sign

consent form

Exclusion Criteria● Comorbid conditions● More than two

hypoglycemic meds

Sampling Plan● Target population: Hispanic adults with TDM2● Accessible Population: those adults living in LA county● Convenience Sampling

○ Effect size 0.41○ Recruiting from restaurants, community centers, churches, flea

markets ○ Subjects randomly assigned to two brackets

■ AF-DSME + support + diet monitoring■ DSME alone

(Janson et al., 2012)

Data Collection● Education: ordinal

○ Measured via improvement in pre/post test scores○ A: 90-100%○ B: 80-89%○ C: 70-79%○ D: 60-69%○ F: 59% or below

● Support: nominal○ Did you receive a support phone call?

■ No: 0 ■ Yes: 1

Data Collection

Data Analysis

● Independent t-test○ To determine whether there is a statistically

significant difference in health outcomes between group A (support+education+diet monitoring) and group B (education alone)

Ethical Considerations

● Informed Consent● IRB approval● Only imposed action is education there is no

real threat to participants. ○ Able to personally choose whether or not to

implement intervention

Implications● Nurses at all levels are in a key position to

effect positive change and improve health outcomes

● Educational efforts may include:○ Avoid HFCS○ Healthy eating○ Setting goals○ DSME - a life-long endeavor working with a team

Resources● Burke, S. D. & Vannice, A., (2011). Diabetes self-management education: The art and science of disease management. In C. Mensing, S. McLaughlin & C. Halstenson (Eds.), The Art

and Science of Diabetes Self-Management Education Desk Reference (pp. 3-20). Chicago, IL: American Association of Diabetes Educators.● Diabetes in the US. Retrieved from: Diabetes in the US retrieved from: http://visual.ly/diabetes-in-the-us● HealthyPeople.gov 2020 Topics and Objectives: Diabetes. Retrieved from: http://www.healthypeople. gov/2020/topicsobjectives 2020/overview.aspx?topicid=8

●Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2011). Health promotion manual (6th Edition). Retrieved from: http://research2vrpractice.org/wp-

content/uploads/2013/02/HEALTH_PROMOTION_MANUAL_Rev_5-2011.pdf

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Questions