Browsing Doctor of Nursing Practice (DNP) Projects by Subject "Veterans--United States"
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Behavioral Factors Associated with Glycemic Control in Diabetic VeteransBackground: Veterans have a higher prevalence of Type 2 diabetes than the general population, and experience more problems with glycemic control, placing them at greater risk for complications. The primary purpose of this study was to examine two self-management behaviors in a sample of diabetic veterans, and to evaluate indicators of adherence to diabetes treatment regimes and glycemic control. Our hypothesis was that veterans who maintained logs and refilled medications on time would have better glycemic control than those who did not perform these specific behaviors. Methods: We examined a convenience sample of 261 adult Type 2 diabetic veterans seen in Vet Fitness Clinic at VAMHCS from 2006-2009. All subjects were treated with prescribed medications as part of their routine diabetes care. Based on related studies, we identified Self-Monitoring of Blood Glucose (SMBG) and medication refill procurement as behavioral predictors of Hemoglobin A1c outcomes. Results: Using a dependent samples t test, improvements in HbA1c from first to final contact in clinic were evaluated. As an expected clinical outcome related to treatment, statistically significant improvements were seen in HgA1c from baseline to discharge (t 16.5,p=.000), however, 60% of the veterans were able to reach goal values (baseline mean 9.10%, ±2.1 0, discharge mean 7.40%, SD ± 1.21). The strongest behavioral predictor of glycemic control was medication refill (1= 3.11, p=.002). Maintenance of 5MBG logs did not produce significant improvements in HbAlc< (t= 0.33, p=.74). Conclusions: Despite timely medication refills, 40% of the subjects did not attain optimal HgA1c, values. Actual adherence to medications cannot be established using refills as an indicator. While 5MBG logs have been associated with improvements in some studies, we did not find the same relationship here. We believe that other unmeasured self-management behaviors may be vitally important in optimizing glycemic control in veterans. For example, health literacy, which is known to be lower in veterans, warrants further examination, as veterans need working knowledge in order to self-manage all aspects of their disease.