Diabetes Educator最新文献

Purpose: The purpose of this study was to understand barriers and facilitators to engagement in a diabetes prevention program for young women at an urban safety-net health care system.

Methods: Individual semistructured interviews (N = 29) explored motivations, challenges, and successes regarding participation and suggestions for improvement among women aged 18 to 39 years who enrolled in the National Diabetes Prevention Program in the past 2 years. Participants were classified as nonattendees (n = 10), early-withdrawers (n = 9), or completers (n = 10). Interview transcriptions were analyzed using a grounded hermeneutic editing approach.

Results: Qualitative analysis revealed 4 main themes (enrollment, attendance, experience, and suggestions) with multiple subthemes. Most women were motivated to enroll for health and family concerns. Early-withdrawers and nonattendees reported confusion about the program's aim and relevancy, logistical barriers, and lack of connection with fellow participants/coaches. Highly engaged women noted persistent motivation, perceived weight loss, and supportive program relationships.

Conclusions: Multiple barriers/facilitators for young women appear addressable in future adaptations. Additional research is needed to confirm these findings in other settings and explore implementation and effectiveness of adaptations, with a goal of reducing risks prior to conception.

Purpose: The purpose of this qualitative study was to examine perceived barriers to adoption of lifestyle changes for type 2 diabetes prevention among a diverse group of low-income women with a history of gestational diabetes mellitus (GDM).

Methods: A secondary data analysis of 10 semistructured focus group discussions was conducted. Participants were low-income African American, Hispanic, and Appalachian women ages 18 to 45 years who were diagnosed with GDM in the past 10 years. A qualitative content analysis was conducted to identify key themes that emerged within and between groups.

Results: Four key themes emerged on the role of knowledge, affordability, accessibility, and social support in type 2 diabetes prevention. Women discussed a lack of awareness of the benefits of breastfeeding and type 2 diabetes prevention, inaccessibility of resources in their local communities to help them engage in lifestyle change, and the desire for more culturally relevant education on healthful food options and proper portion sizes.

Discussion: Study findings suggests that to improve effectiveness of type 2 diabetes prevention efforts among low-income women with GDM history, health care providers and public health practitioners should avoid using "one-size-fits-all" approaches to lifestyle change and instead use tailored interventions that address the cultural and environmental factors that impact women's ability to engage in recommended behavior change.

Purpose: The purpose of the study was to describe experiences reported by diabetes care and education specialists caring for young adults with type 1 diabetes and to assess perceived deficiencies in clinical resources and barriers to care delivery.

Methods: A 60-item electronic survey was fielded through email to members of the Association of Diabetes Care and Education Specialists (ADCES). Respondents completed a survey consisting of: (1) clinical practice characteristics and respondents' demographics; (2) health care transition components (eg, referrals) and their perceived importance; (3) framework of current clinical diabetes care delivery and perceived need for additional support; and (4) perceived barriers regarding clinical care delivery. Statistical analyses included descriptive statistics, chi-square tests, and logistic regression.

Results: Respondents (N = 531, 96% female, median years in practice = 13; interquartile range = 7-20) represented 49 states plus the District of Columbia. Although 88% of respondents reported reviewing pediatric records as important/very important, only 22% often/always reviewed them. Although 58% of respondents noted easy access to mental health care providers for young adults, 50% stated a need for additional resources. Furthermore, diabetes care and education specialists without easy access to mental health professionals were significantly more likely to report barriers to diabetes management for young adults with depression, substance abuse, eating disorders, and developmental disabilities.

Conclusion: Study findings highlight modifiable factors that may improve diabetes care coordination for transitioning young adults. Uniform approaches and increased access to trained mental health professionals may help support diabetes care and education specialists in their care of young adults with type 1 diabetes.

Purpose: The purpose of this study was to identify factors influencing participant engagement in a community-based diabetes self-management program (DSMP), with a focus on the needs of underserved groups (eg, racial/ethnic minorities, low income).

Methods: Focus groups were conducted with participants (n = 22) from the YMCA of Greater Richmond's Diabetes Control Program, who were recruited using a purposeful sampling frame to capture a range of experiences. In-depth interviews were conducted with lay health coaches (n = 3). The RADaR qualitative analysis technique was used to identify themes related to factors across the continuum of engagement.

Results: Fear affected program enrollment and retention in complex ways. Peers and coaches were important for social support and accountability. The length of the program (12 weeks), accessible information, practical skill building, and emphasis on making small, feasible improvements in pursuit of larger goals were identified as critical for engagement and improving diabetes self-management. Health and outside obligations were the major barriers to program attendance.

Conclusions: Participant and coach perspectives provide important insight into existing strengths of community-based DSMPs that can be expanded on to promote engagement as well as potential opportunities for improvement. Actionable recommendations for increasing engagement of underserved groups in community-based DSMPs are provided.

Purpose: The purpose of the study is to test the longitudinal efficacy of a mHealth intervention (Intergenerational Mobile Technology Opportunities Program, IMTOP) for older type 2 diabetes mellitus (T2DM) patients in rural Taiwan. Few mHealth programs targeted rural older adults and the longitudinal effects are unknown.

Methods: Ninety-seven T2DM patients aged 55+ were recruited from an outpatient in Hualien, Taiwan. The intervention comprised 8-week technology and diabetes self-management training and 4-week technical support. College student tutors facilitated T2DM patients to learn technology. Participants used a diabetes self-management app to track health behaviors. Outcomes measured at baseline and at 4 and 8 months including patient-reported self-care behaviors, T2DM symptoms, clinical outcomes, health resource utilization, and medical expenditure. Linear mixed-effect regressions of repeated measures were conducted for each outcome.

Results: At 4 months, improvements in self-care behaviors were reported in diet, exercise, smoking, and blood glucose testing. Patients paid less endocrinology clinic visits, spent less on endocrinology medications, and improvements in fasting blood glucose and total cholesterol were observed. At 8 months, the statistical significance of improvements in diet and smoking were maintained, and the averaged endocrinology clinic visits remained less than baseline. However, more frequent occurrence of diabetes symptoms were reported at both follow-ups.

Conclusions: IMTOP had lasting effects on diet and decreased smoking behavior, clinic visits, and medication costs over 8 months. Self-monitoring through an app increased awareness and may explain the increased reporting of diabetes symptoms. IMTOP is a promising model for promoting T2DM self-management in rural areas.

Purpose: The AADE7 Self-Care Behaviors^® (AADE7) is a robust framework for self-management of diabetes and other related conditions, such as prediabetes and cardiometabolic diseases. It is the position of the American Association of Diabetes Educators (AADE) that, at the cornerstone of diabetes self-management education and support, the AADE7 is the framework for achieving behavior change that leads to effective self-management through improved behavior and clinical outcome measures. The AADE7 model guides the health care team in effective person-centered collaboration and goal setting to achieve health-related outcomes and improved quality of life. Continued research and evidence are critical to expand this model and broaden its application to other chronic conditions. Given the advances in the science of diabetes management, as well as in diabetes self-management education and support, AADE has evaluated the AADE7 within the framework of these advances, including the digital and dynamic health care landscape.

Conclusion: This revised position statement blends the updates in research and AADE's vision and expansion beyond diabetes to refresh the AADE7 framework. This revision reflects the perspectives of all members of the health care team as they problem solve with individuals who are at risk for or who have diabetes and related conditions to achieve healthier outcomes.

Purpose: The purpose of the study was to evaluate the effectiveness of ALDEA (Latinos con Diabetes en Acción), a Shared Medical Appointment (SMA) intervention, compared to usual primary care (UPC) for the treatment of adults with type 2 diabetes over a 6-month period. It was hypothesized that participants in the SMA will have greater reductions in A1C at 6 months post-intervention compared to the control group.

Methods: This study was a quasi-experimental design with a non-randomized matched control group that followed participants prospectively for 6 months. All adults living with type-2 diabetes receiving primary care at a 2 FQHC clinics were eligible for inclusion. Participants in the control group were matched retrospectively on baseline A1C and age.

Results: The reductions in A1C were greater in the ALDEA SMA intervention group relative to the UPC control group at 6 months in both of the FQHC centers and in the combined sample.

Conclusions: This study demonstrated that patients in the ALDEA program had a significantly greater reduction in A1C at 6 months compared to the control group. Despite its limitations, the ALDEA SMA program was successful in empowering patients and improving glycemic control.

Purpose: The purpose of the study was to explore the needs of high-risk Latinx/Hispanic women with a history of gestational diabetes who were patients at a Federally Qualified Health Center (FQHC) in anticipation of a future family-based program.

Methods: Six focus group studies were conducted in partnership with El Rio Community Health Center, an FQHC in Tucson, Arizona. Thirty-nine women participated, each identified as Latinx/Hispanic, self-reported a history of gestational diabetes or prediabetes, and had at least 1 child aged 8 to 13. Three investigators independently reviewed transcripts from the focus groups to identify themes that reflected thematic saturation from participants' responses. Data coding and results were discussed as a group and any differences were collectively adjudicated.

Results: All participants had a family member with diabetes and worried about their and their immediate family members' risk for developing the disease. The possible benefits of participating in a lifestyle prevention program were universally recognized, but multiple barriers to participation were described, including scheduling conflicts, access to childcare, transportation, and the need to involve additional family members to reinforce program objectives.

Conclusions: There is a strong willingness to participate in a diabetes prevention program among respondents, but to be successful, interventions must be tailored to specific needs and challenges. Trying to apply existing prevention curricula with low-income Latinx/Hispanic populations may not be successful without adaptations.

Purpose: The purpose of the study was to explore the influences of the neighborhood environment on physical activity (PA) among people living with type 2 diabetes mellitus (T2DM) in a community with limited resources.

Methods: Participants were adults with T2DM and their family members or friends who help in the management of T2DM and who were living in a low-income African American (AA) community. Health care providers working in the neighborhood were also included. Using an emergent design, qualitative data were collected through 7 focus group discussions (N = 63) and 13 in-depth interviews. Verbatim transcriptions were analyzed via thematic coding to explore contextual factors that limit PA and meaning around neighborhood features that promote or discourage PA.

Results: Levels of PA were strongly limited by neighborhood insecurity and a lack of recreational facilities in the neighborhood. People with T2DM and physical/mobility disabilities were more affected by the neighborhood environment than those without disabilities, particularly due to perceived safety concerns and social stigma. Despite socioeconomic inequalities within neighborhoods, participants showed resilience and made efforts to overcome social-environmental barriers to PA, applied various coping strategies, and received social support.

Conclusions: Results suggested that in an underserved neighborhood, individual barriers to physical activity were amplified by neighborhood-level factors such as crime, especially among individuals who have T2DM and disabilities. Socioeconomic inequalities should be addressed further to improve management of T2DM and its complications.