Complete Nurse's Guide to Diabetes Care, 3rd Edition

DIABETES KNOWLEDGE IS POWER: WHAT THIS GUIDE HOLDS FOR YOU

The first edition of the Complete Nurse’s Guide to Diabetes Care was published in 2004. Not only do more people have prediabetes and diabetes today than they did in 2004, but there are also three new classes of diabetes medication and major advances in technology, including continuous glucose monitoring systems and hybrid closed loop insulin delivery systems, have emerged. These changes demonstrate the importance of nurses to diabetes care. How individuals with diabetes and their care providers obtain information continues to change with many using smartphone technology, social media, podcasts, apps, and other online tools. Models of care continue to evolve with the advent of the patient-centered medical home, increasing workplace and insurance-driven wellness programs, and use of telehealth services. The third edition of the Complete Nurse’s Guide to Diabetes Carebrings forth the most up-to-date information in 2017.

The incidence of diabetes is increasing, with 9.3% of the population having diabetes, representing 29.1 million Americans. More than 8 million people have undiagnosed diabetes. The majority of people have type 2 diabetes (T2D), but more than 5% have type 1 diabetes (T1D). It is estimated that 18,436 children have T1D, and some 5,089 have T2D.1,2 The incidence of both T1D and T2D is increasing.3 Uncontrolled diabetes remains the seventh leading cause of death.1

Eighty-six million Americans have prediabetes, and approximately 90% of them are unaware that they have it. People with prediabetes have an increased risk of T2D, heart disease, and stroke. Structured lifestyle change programs can help people with prediabetes cut this risk sharply. Many communities now offer these programs at local community centers, workplaces, churches, and health centers that are low cost and accessible to those who are in high-risk populations.

Uncontrolled diabetes is the leading cause of cardiovascular disease, kidney disease, amputations, and blindness and occurs more often in Latinos, Native Americans, and African Americans. Diabetes care costs $245 billion annually, an increase from $174 billion in 2007.4

My passion for diabetes has been spurred by my family history, including my aunt; my father-in-law, as well as four of his six siblings; my brother, who has T1D; and his daughter, who was diagnosed in her 20s. I also have been inspired by the individuals for whom I care in my practice. I now have been in practice long enough to see the children and parents of my patients develop diabetes. Recently, I was called on to guide a 7-year-old girl who had been newly diagnosed with T1D. I was privileged to share the journey with her uncle who has had diabetes since he was 1 year old as well as his sister who was diagnosed at 4 years of age. This young girl has great role models, and her life with diabetes will be very different, and even better than, her uncle and aunt who remain complication free more than three decades since diagnosis. She will benefit immediately from the use of a continuous glucose monitor and newer insulins.

Diabetes creates daily challenges and obstacles that must be navigated. For many people, uncontrolled diabetes does lead to complications. We are seeing increasing numbers of individuals, especially with T1D, living more than 50 years with diabetes—complication free. This success is dependent on many things: genes; the individual’s knowledge; education tools and resources; support systems, including family; diabetes care providers; and financial resources, including insurance availability and affordability. Perhaps more concerning is the number of children who are at risk for, or who already have been diagnosed with, T2D related to obesity and the sedentary pastimes prevalent in today’s society. Although the Diabetes Control and Complications Trial and other important diabetes trials taught us the importance of glucose and blood pressure control in preventing or reducing microvascular complications, the tools and therapies to reduce macrovascular complications, particularly cardiovascular disease, in T2D have been much harder to identify. What does the future hold for these children with T2D? How can we promote the necessary healthy lifestyle to reduce the prevalence of diabetes in our younger populations? Certainly nurses have a role to play in helping our youth face these challenges. As advocates for patients, nurses are front and center in helping to promote and improve health for families and individuals.

Nurses play an invaluable role in supporting people with diabetes in every setting. Nurses knowledgeable in diabetes care can improve outcomes and reduce complications. Whether in the hospital, outpatient clinics, community health settings, schools, long-term care facilities, or one of the many other workplace settings, nurses always have played an important role in the care of people with diabetes, and they will continue to be an essential part of the health-care system. Nurses bring not only the knowledge of science to their practice but also the art of nursing.

Despite the number of diabetes educators, advance practice diabetes nurse specialists, and diabetes education programs across the country, they are few in comparison to the number of people with diabetes and prediabetes. To improve outcomes for individual with diabetes, it is imperative that all nurses have a good understanding of diabetes risks, care, and education. The nurse must have up-to-date, accessible information when they are providing diabetes care to individuals with diabetes. My coeditors, Marjorie Cypress PhD, ANP-BC, CDE, and Geralyn R. Spollett, MSN, ANP-BC, CDE, and I bring more than 100 years of collective diabetes care, education, and advocacy experience to this book. We asked many of the leading experts in diabetes to contribute to this effort. It is our hope that through the knowledge and insight gained by the reader, patients may be diagnosed earlier, care may be improved in all settings, and diabetes may be prevented by the contribution of nurses. The first chapter of this book discusses the evolution of diabetes education and the role of nurses as diabetes educators.

Knowledge is a key to successfully managing diabetes whether you are a health professional, an individual with diabetes, or a caregiver for someone with diabetes. The advances in the understanding of diabetes and treatment strategies change almost daily. Even as this third edition is being published, new information is becoming available. Health professionals and individuals with diabetes alike will be challenged to stay abreast of the new treatment strategies and education tools and resources.

One way to stay abreast of new information is through the American Diabetes Association (ADA). The ADA’s mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. In addition to research, the ADA is committed to providing access to current information for health professionals and individuals with diabetes and their families. One way that the ADA carries out this mission is via the website (https://www.diabetes.org). This website provides access to the annually updated (every January) Standards of Medical Care in Diabetes, which is referred to extensively in this book (https://professional.diabetes.org). Another invaluable resources is the Consumer Guide published annually in Diabetes Forecast and available online at http://www.diabetesforecast.org/landing-pages/lp-consumer-guide.html. This guide covers such vital information as continuous glucose sensors, insulin infusion systems, glucose monitors, and other consumer products available for individuals with diabetes. The ADA provides an extensive list of publications for health professionals and individuals with diabetes and their families accessible online at https://store.diabetes.org or by calling 1-800-DIABETES. Many other organizations are listed in the “Resources” section of this book, including other nonprofit organizations.

A listing of professional journals and consumer-oriented magazines also is provided in the “Resources” section. In addition to Diabetes Forecast (an award-winning magazine for consumers), Diabetes SpectrumClinical DiabetesDiabetes Care, and Diabetes are professional publications of the ADA. Diabetes Spectrum translates diabetes research into practice, and its readership consists primarily of nurses, dietitians, pharmacists, mental health specialists, nurse practitioners, physician assistants, and other health professionals. Clinical Diabetes mainly is directed at primary care provides, including physicians, nurse practitioners, and physician assistants. Diabetes and Diabetes Care present the latest in basic and clinical diabetes research, respectively. DiabetesPro Smartbrief is a daily e-mail update on the latest in diabetes-related research and is an invaluable aid to keeping current in this rapidly evolving field.

Nursing can be challenging for many reasons, from long working hours and staffing issues to complexity of care. Geri, Marjorie, and I applaud you for your dedication and desire to assist individuals with diabetes live a healthier life with diabetes by learning more about diabetes. This book is designed and developed to be a resource guide. The sections are Fundamentals of Diabetes Care, Complications, Diabetes Care and Management, Special Populations, and Diseases and Treatments That Affect Diabetes. Each chapter features helpful Practical Points, implications for nursing practice that are interspersed throughout, and a summary at the end of each chapter.

Thank you for your interest in diabetes and in broadening your understanding about diabetes. It is my hope that the Complete Nurse’s Guide to Diabetes Care enhances your knowledge and passion for learning more about diabetes and supports you in your journey as a health-care provider and coach for those living with diabetes and their caregivers.

Belinda P. Childs, MN, APRN, BC-ADM, CDE, Editor

REFERENCES

1. American Diabetes Association. Statistics about diabetes. Available from http://www.diabetes.org/diabetes-basics/statistics/. Accessed 26 April 2017

2. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. National diabetes statistics report, 2014. Available from https://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf. Accessed 26 April 2017

3. Gale EA. The rise of childhood type 1 diabetes in the 20th century. Diabetes 2002;51:3353–3361

4. The Silver Book. National diabetes fact sheet, 2007. Available from http://www.silverbook.org/reference/national-diabetes-fact-sheet-2007-7. Accessed 26 April 2017


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