From coast to coast, nurses are participating in or conducting research that may change the way they and their colleagues care for patients with diabetes. "[My job] is fantastic," said Terry Zierenberg, RN, CDE, a diabetes nurse educator at the Diabetes & Metabolism Research Institute at City of Hope in Duarte, Calif. "We can see the difference we make in the lives of people with diabetes." Zierenberg works on the islet cell transplant program, evaluating candidates' self-management skills and qualifications to participate in the study and helping coordinate blood glucose management after transplant. "My role is to assess that we have exhausted all measures in attempting to control [the candidates]," Zierenberg said. Trial participants, who have severe type 1 diabetes and frequent hypoglycemia or hypoglycemia unawareness, receive islet cells from the pancreas of a deceased donor through the hepatic circulation and the anti-rejection medication anti-thymocyte globulin. Participants can receive up to three transplants. Patients continue to self-manage their disease and will initially receive small doses of insulin and then are weaned off of it. City of Hope will follow them for five years. Some participants in prior islet cell trials at the institute have been followed for 10 years, including one woman whose islets are becoming exhausted. She is now waiting to start the new trial. While Fouad Kandeel, MD, PhD, said in a release that islet cells may provide a cure for type 1 diabetes, Zierenberg said, "the goal of islet transplantation is to get rid of the dangerously and potentially life-threatening hypoglycemic events that occur." She also indicated a goal is to manage patients with islet cells but no immunosuppression. Zierenberg also is working on a misinformation study in collaboration with the University of California Riverside to assess the diabetes information on websites and blogs. With that data, nurses will be able to refer patients to reliable sites.
Prevention studies
At the Kovler Diabetes Center at The University of Chicago Medicine, Gail Gannon, APN, FNP-C, manager of clinical trials, is working on the Type 1 Diabetes TrialNet, an international initiative investigating ways to prevent, delay the onset of and reverse the progression of type 1 diabetes. Immediate family members of type 1 diabetics are screened for autoantibodies predictive of the disease up to 10 years prior to development with up to 85% accuracy. With that knowledge, someone could participate in a prevention trial, such as an oral insulin trial, also at Kovler. "It's pretty exciting," Gannon said. "We watch them more closely if they have the autoantibodies. We know patients have a softer landing when diagnosed and their outcomes are a lot better." TrialNet participants making antibodies to insulin and other positive antibodies are eligible to participate in the oral insulin study. The trial aims to determine if oral insulin can delay or prevent the development of the disease in this population. Nurses can educate their families about the trials and possibilities for prevention, Gannon said.
Education studies
While such trials are exciting and make headlines, Katie Weinger, EdD, RN, FAADE, an investigator and director of the Center for Innovation in Diabetes Education at the Joslin Diabetes Center in Boston, has taken a different approach, researching how people learn about the disease. "It's important to know what works for patients, the problems patients face and how they can be supported," Weinger said. "We don't know enough about human behavior, how people learn and integrate information and skill sets into their lifestyle." Weinger is working on a project about how patients perceive conversations about complications, and how the information was perceived and how it affects their self-care. "We don't know the best way to explain complications to patients," she said. "We have to know how patients respond to something very threatening." Based on the findings, nurses might change how they educate patients. Additionally, Weinger has studied using a cognitive-restructuring approach to help patients solve problems, such as high A1c or blood glucose levels, and found it successful, while her research into the use of conversation maps determined the maps, a type of educational tool, were not more successful than traditional care in the long term. These are just a sampling of the research nurses are involved with that will affect patient care of people living with diabetes in the years ahead. "Nurses need to be up-to-date on all of the research coming down the pike," Weinger said. "They also need to know the things that affect their everyday practice."
