Pub Date : 2019-10-01Epub Date: 2019-06-27DOI: 10.1177/0145721719860491
Alissa J Roberts, Connor Mitrovich, Joyce P Yi-Frazier, Craig E Taplin
Purpose: This pilot study assessed the feasibility and satisfaction of an electronic clinical tool to survey management of exercise in youth with type 1 diabetes (T1DM) for use in an outpatient diabetes clinic setting.
Methods: Fifty youth with T1DM were recruited (ages, 10-18 years; mean ± SD, 14.8 ± 2.4) and 11 diabetes providers. Prior to a clinic visit and with an electronic tablet, participants completed the Type 1 Diabetes Report of Exercise Practices Survey, which included 9 primary exercise management guidelines. Responses were flagged if contrary to guidelines, and automated individualized reports with personalized evidence-based recommendations were produced for providers prior to seeing the patient. Postclinic assessment surveys were completed by patients and providers.
Results: Out of the 9 guidelines, a mean of 4 ± 0.9 responses per patient were flagged as potentially unsafe. Ninety-one percent of providers took <10 minutes to review and discuss the report with their patients. Ninety-one percent of providers rated the tool as highly useful in facilitating patient education regarding exercise guidelines at that clinic visit. Fifty-six percent of youth rated the tool highly when asked whether its use altered their planned behavior around exercise. When participants were asked if such a tool should be used routinely in diabetes clinic, 64% of provider responses and 60% of patient responses were highly positive.
Conclusions: This electronic tool identified deficits in exercise management in youth with T1DM and improved education in the clinic visit regarding exercise, and a majority felt it feasible and desirable to include in routine outpatient diabetes care.
{"title":"Feasibility of Routine Assessment of Exercise Knowledge and Safety in Youth With Type 1 Diabetes.","authors":"Alissa J Roberts, Connor Mitrovich, Joyce P Yi-Frazier, Craig E Taplin","doi":"10.1177/0145721719860491","DOIUrl":"https://doi.org/10.1177/0145721719860491","url":null,"abstract":"<p><strong>Purpose: </strong>This pilot study assessed the feasibility and satisfaction of an electronic clinical tool to survey management of exercise in youth with type 1 diabetes (T1DM) for use in an outpatient diabetes clinic setting.</p><p><strong>Methods: </strong>Fifty youth with T1DM were recruited (ages, 10-18 years; mean ± SD, 14.8 ± 2.4) and 11 diabetes providers. Prior to a clinic visit and with an electronic tablet, participants completed the Type 1 Diabetes Report of Exercise Practices Survey, which included 9 primary exercise management guidelines. Responses were flagged if contrary to guidelines, and automated individualized reports with personalized evidence-based recommendations were produced for providers prior to seeing the patient. Postclinic assessment surveys were completed by patients and providers.</p><p><strong>Results: </strong>Out of the 9 guidelines, a mean of 4 ± 0.9 responses per patient were flagged as potentially unsafe. Ninety-one percent of providers took <10 minutes to review and discuss the report with their patients. Ninety-one percent of providers rated the tool as highly useful in facilitating patient education regarding exercise guidelines at that clinic visit. Fifty-six percent of youth rated the tool highly when asked whether its use altered their planned behavior around exercise. When participants were asked if such a tool should be used routinely in diabetes clinic, 64% of provider responses and 60% of patient responses were highly positive.</p><p><strong>Conclusions: </strong>This electronic tool identified deficits in exercise management in youth with T1DM and improved education in the clinic visit regarding exercise, and a majority felt it feasible and desirable to include in routine outpatient diabetes care.</p>","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":"45 5","pages":"469-476"},"PeriodicalIF":3.9,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721719860491","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37093150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-01Epub Date: 2019-07-13DOI: 10.1177/0145721719861349
Neesha Ramchandani, Niobe Way, Gail D'Eramo Melkus, Susan Sullivan-Bolyai
Purpose: The purpose of this qualitative descriptive study undergirded by Meleis's Transition Framework was to explore developmental, situational, and organizational challenges experienced by a diverse group of emerging adults (18-29 years old) with type 1 diabetes (T1DM). Their perspectives on creating a developmentally informed diabetes self-management (DSM) program that supports transitional care were also explored.
Methods: A purposive sample of emerging adults with T1DM was recruited from the pediatric and adult diabetes clinics of an urban academic medical center. Those who consented participated in either a single focus group or a single interview. Self-reported demographic and clinical information was also collected.
Results: The sample was comprised of 21 emerging adults, with an average age of 23.6 ± 2.6 years, diabetes duration of 14.7 ± 5.0 years, and 71% female. Four main themes emerged: (1) finding a balance between diabetes and life, (2) the desire to be in control of their diabetes, (3) the hidden burden of diabetes, and (4) the desire to have a connection with their diabetes provider. Use of insulin pumps and continuous glucose monitors and attendance at diabetes camp decreased some of the DSM challenges. Different groups of individuals had different perspectives on living with diabetes and different approaches to DSM.
Conclusions: The emerging adults in this study had a strong desire to be in good glycemic control. However, all participants described having a hard time balancing DSM with other competing life priorities. They also desired personalized patient-provider interactions with their diabetes care provider in clinical follow-up services. Even though the study sample was small, important themes emerged that warrant further exploration.
{"title":"Challenges to Diabetes Self-Management in Emerging Adults With Type 1 Diabetes.","authors":"Neesha Ramchandani, Niobe Way, Gail D'Eramo Melkus, Susan Sullivan-Bolyai","doi":"10.1177/0145721719861349","DOIUrl":"https://doi.org/10.1177/0145721719861349","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this qualitative descriptive study undergirded by Meleis's Transition Framework was to explore developmental, situational, and organizational challenges experienced by a diverse group of emerging adults (18-29 years old) with type 1 diabetes (T1DM). Their perspectives on creating a developmentally informed diabetes self-management (DSM) program that supports transitional care were also explored.</p><p><strong>Methods: </strong>A purposive sample of emerging adults with T1DM was recruited from the pediatric and adult diabetes clinics of an urban academic medical center. Those who consented participated in either a single focus group or a single interview. Self-reported demographic and clinical information was also collected.</p><p><strong>Results: </strong>The sample was comprised of 21 emerging adults, with an average age of 23.6 ± 2.6 years, diabetes duration of 14.7 ± 5.0 years, and 71% female. Four main themes emerged: (1) finding a balance between diabetes and life, (2) the desire to be in control of their diabetes, (3) the hidden burden of diabetes, and (4) the desire to have a connection with their diabetes provider. Use of insulin pumps and continuous glucose monitors and attendance at diabetes camp decreased some of the DSM challenges. Different groups of individuals had different perspectives on living with diabetes and different approaches to DSM.</p><p><strong>Conclusions: </strong>The emerging adults in this study had a strong desire to be in good glycemic control. However, all participants described having a hard time balancing DSM with other competing life priorities. They also desired personalized patient-provider interactions with their diabetes care provider in clinical follow-up services. Even though the study sample was small, important themes emerged that warrant further exploration.</p>","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":"45 5","pages":"484-497"},"PeriodicalIF":3.9,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721719861349","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37145396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-06DOI: 10.1177/0145721719873640
Loretta Hsueh, Juan M Peña, A. Hirsh, M. de Groot, Jesse C. Stewart
Purpose The purpose of the study was to examine associations of immigrant and racial/ethnic status with diabetes risk perception among a population-based sample of US adults without diabetes. Racial/ethnic minorities are at increased risk of developing diabetes. Emerging research shows that immigrant (foreign born) individuals are also at increased risk, but less is understood about risk perception in this group. Methods Respondents were 11,569 adults from the NHANES (2011-2016; National Health and Nutrition Examination Survey) reporting no diabetes or prediabetes. Immigrant status was coded as foreign born or US born and analyses used NHANES racial/ethnic categories: white, black, Mexican American, other Hispanic, Asian, and other/multiracial. Immigrant status and variables comparing each minority group with whites were simultaneously entered into models predicting risk perception (yes/no), adjusting for demographic and diabetes risk factors. Results Being foreign born was associated with decreased odds of perceived risk, while being Mexican American, Asian, and other/multiracial were associated with increased odds of perceived risk. Discussion Foreign-born adults are less likely than US-born adults to report perceived risk for diabetes. Lower diabetes risk perception among immigrants could result in poorer preventative behaviors and later diabetes detection.
{"title":"Diabetes Risk Perception Among Immigrant and Racial/Ethnic Minority Adults in the United States","authors":"Loretta Hsueh, Juan M Peña, A. Hirsh, M. de Groot, Jesse C. Stewart","doi":"10.1177/0145721719873640","DOIUrl":"https://doi.org/10.1177/0145721719873640","url":null,"abstract":"Purpose The purpose of the study was to examine associations of immigrant and racial/ethnic status with diabetes risk perception among a population-based sample of US adults without diabetes. Racial/ethnic minorities are at increased risk of developing diabetes. Emerging research shows that immigrant (foreign born) individuals are also at increased risk, but less is understood about risk perception in this group. Methods Respondents were 11,569 adults from the NHANES (2011-2016; National Health and Nutrition Examination Survey) reporting no diabetes or prediabetes. Immigrant status was coded as foreign born or US born and analyses used NHANES racial/ethnic categories: white, black, Mexican American, other Hispanic, Asian, and other/multiracial. Immigrant status and variables comparing each minority group with whites were simultaneously entered into models predicting risk perception (yes/no), adjusting for demographic and diabetes risk factors. Results Being foreign born was associated with decreased odds of perceived risk, while being Mexican American, Asian, and other/multiracial were associated with increased odds of perceived risk. Discussion Foreign-born adults are less likely than US-born adults to report perceived risk for diabetes. Lower diabetes risk perception among immigrants could result in poorer preventative behaviors and later diabetes detection.","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":"45 1","pages":"642 - 651"},"PeriodicalIF":3.9,"publicationDate":"2019-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721719873640","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42003540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-05DOI: 10.1177/0145721719872558
Y. Yang, W. Chee, E. Im
Purpose The purpose of this study was to describe the association between type 2 diabetes and musculoskeletal symptoms among midlife women from 4 major racial/ethnic groups in the United States. Methods This is a secondary data analysis using the data from 164 participants aged 40 to 60 years of 2 larger survey studies (62 with type 2 diabetes and 102 without type 2 diabetes). In the original studies, the participants completed multiple questionnaires on background characteristics, health status, menopausal status, and musculoskeletal symptoms. The Musculoskeletal Symptom Index for Midlife Women was used to determine the number and severity of musculoskeletal symptoms. For data analysis, independent t tests, Mann-Whitney U tests, and multiple regression analyses were used. Results The mean number of musculoskeletal symptoms was significantly higher in women with vs without type 2 diabetes as was the mean severity score. In subgroup analyses, among each menopausal stage and non-Hispanic white women, there were significant differences in the numbers and total severity scores between those with type 2 diabetes and without type 2 diabetes. When background characteristics, health status, and menopausal status were controlled, having diagnosis of type 2 diabetes was positively associated with the numbers and total severity scores of musculoskeletal symptoms. Conclusion Study findings supported significant associations of type 2 diabetes with musculoskeletal symptoms among midlife women. Further studies are recommended to confirm relationships in larger populations.
{"title":"Type 2 Diabetes and Musculoskeletal Symptoms Among Midlife Women","authors":"Y. Yang, W. Chee, E. Im","doi":"10.1177/0145721719872558","DOIUrl":"https://doi.org/10.1177/0145721719872558","url":null,"abstract":"Purpose The purpose of this study was to describe the association between type 2 diabetes and musculoskeletal symptoms among midlife women from 4 major racial/ethnic groups in the United States. Methods This is a secondary data analysis using the data from 164 participants aged 40 to 60 years of 2 larger survey studies (62 with type 2 diabetes and 102 without type 2 diabetes). In the original studies, the participants completed multiple questionnaires on background characteristics, health status, menopausal status, and musculoskeletal symptoms. The Musculoskeletal Symptom Index for Midlife Women was used to determine the number and severity of musculoskeletal symptoms. For data analysis, independent t tests, Mann-Whitney U tests, and multiple regression analyses were used. Results The mean number of musculoskeletal symptoms was significantly higher in women with vs without type 2 diabetes as was the mean severity score. In subgroup analyses, among each menopausal stage and non-Hispanic white women, there were significant differences in the numbers and total severity scores between those with type 2 diabetes and without type 2 diabetes. When background characteristics, health status, and menopausal status were controlled, having diagnosis of type 2 diabetes was positively associated with the numbers and total severity scores of musculoskeletal symptoms. Conclusion Study findings supported significant associations of type 2 diabetes with musculoskeletal symptoms among midlife women. Further studies are recommended to confirm relationships in larger populations.","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":"45 1","pages":"520 - 528"},"PeriodicalIF":3.9,"publicationDate":"2019-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721719872558","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45035063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-05DOI: 10.1177/0145721719873066
A. Bzowyckyj, C. Aquilante, An-Lin Cheng, B. Drees
Purpose The purpose of this study is to identify patient-specific factors, easily obtainable from the electronic medical record (EMR), that are associated with nonattendance to a group Diabetes Self-Management Education and Support (DSMES) program among an adult population with type 2 diabetes. Methods This study used a retrospective cohort design, with attendance to a group DSMES session as the primary outcome. The study included adult patients with diagnosed type 2 diabetes who were scheduled for a group DSMES session between March 1, 2013, and June 30, 2017. Patients who were pregnant or who had other types of diabetes (eg, type 1 diabetes, prediabetes, gestational diabetes) were excluded. Results A higher A1C, required copay for DSMES, low socioeconomic status, increased number of diabetes medications prescribed, the presence of a prescription for any insulin, and a higher calculated total daily dose of insulin were all associated with a decreased likelihood of attendance. Only older age was associated with an increased likelihood of attendance. Conclusion Using the EMR to identify patients who need more intensive intervention strategies can help programs direct resources to those who need them most. Having identified these at-risk individuals, a targeted communication and outreach strategy can be developed to assist these individuals with overcoming barriers to attending DSMES.
{"title":"Leveraging the Electronic Medical Record to Identify Predictors of Nonattendance to a Diabetes Self-Management Education and Support Program","authors":"A. Bzowyckyj, C. Aquilante, An-Lin Cheng, B. Drees","doi":"10.1177/0145721719873066","DOIUrl":"https://doi.org/10.1177/0145721719873066","url":null,"abstract":"Purpose The purpose of this study is to identify patient-specific factors, easily obtainable from the electronic medical record (EMR), that are associated with nonattendance to a group Diabetes Self-Management Education and Support (DSMES) program among an adult population with type 2 diabetes. Methods This study used a retrospective cohort design, with attendance to a group DSMES session as the primary outcome. The study included adult patients with diagnosed type 2 diabetes who were scheduled for a group DSMES session between March 1, 2013, and June 30, 2017. Patients who were pregnant or who had other types of diabetes (eg, type 1 diabetes, prediabetes, gestational diabetes) were excluded. Results A higher A1C, required copay for DSMES, low socioeconomic status, increased number of diabetes medications prescribed, the presence of a prescription for any insulin, and a higher calculated total daily dose of insulin were all associated with a decreased likelihood of attendance. Only older age was associated with an increased likelihood of attendance. Conclusion Using the EMR to identify patients who need more intensive intervention strategies can help programs direct resources to those who need them most. Having identified these at-risk individuals, a targeted communication and outreach strategy can be developed to assist these individuals with overcoming barriers to attending DSMES.","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":"45 1","pages":"544 - 552"},"PeriodicalIF":3.9,"publicationDate":"2019-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721719873066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43582689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-03DOI: 10.1177/0145721719872553
R. Romanelli, Hsiao-Ching Huang, Vidita Chopra, Jun Ma, E. Venditti, S. Sudat, Deborah A. Greenwood, A. Pressman, K. Azar
Purpose The purpose of this electronic health record (EHR)–based retrospective cohort study was to characterize a population of patients participating in a 12-month, lifestyle change program in a community-based health system and to examine longitudinal weight outcomes. Methods Program participants were identified in the EHRs of a health care delivery system across 18 sites between 2010 and 2017. Outcomes were mean weight change and proportion of patients with ≥5% weight loss through 24 months from program initiation. Results Among 4463 program participants, 3156 met study eligibility criteria, with a mean ± SD age of 53.5 ± 13.1 years; 77.7% were women. Mean baseline weight ± SD was 101.3 ± 23.8 kg. Three main cardiometabolic risk groups were identified: prediabetes/high risk for diabetes (47.3%), overweight/obese in the absence of elevated diabetes risk (27.2%), and existing diabetes (23.9%). Maximal mean weight loss was 3.9% at 6 months from baseline. At 12 and 24 months from baseline, mean weight loss was 3.2% and 2.3%, respectively, with 31% and 29% of participants attaining ≥5% weight loss. Long-term weight outcomes were similar across risk groups. Conclusions A lifestyle change program in a clinical practice setting is associated with modest weight loss, sustained through 24 months, among participants with a range of cardiometabolic risk factors. More than one-quarter of participants achieve ≥5% weight loss, regardless of cardiometabolic risk.
{"title":"Longitudinal Weight Outcomes From a Behavioral Lifestyle Intervention in Clinical Practice","authors":"R. Romanelli, Hsiao-Ching Huang, Vidita Chopra, Jun Ma, E. Venditti, S. Sudat, Deborah A. Greenwood, A. Pressman, K. Azar","doi":"10.1177/0145721719872553","DOIUrl":"https://doi.org/10.1177/0145721719872553","url":null,"abstract":"Purpose The purpose of this electronic health record (EHR)–based retrospective cohort study was to characterize a population of patients participating in a 12-month, lifestyle change program in a community-based health system and to examine longitudinal weight outcomes. Methods Program participants were identified in the EHRs of a health care delivery system across 18 sites between 2010 and 2017. Outcomes were mean weight change and proportion of patients with ≥5% weight loss through 24 months from program initiation. Results Among 4463 program participants, 3156 met study eligibility criteria, with a mean ± SD age of 53.5 ± 13.1 years; 77.7% were women. Mean baseline weight ± SD was 101.3 ± 23.8 kg. Three main cardiometabolic risk groups were identified: prediabetes/high risk for diabetes (47.3%), overweight/obese in the absence of elevated diabetes risk (27.2%), and existing diabetes (23.9%). Maximal mean weight loss was 3.9% at 6 months from baseline. At 12 and 24 months from baseline, mean weight loss was 3.2% and 2.3%, respectively, with 31% and 29% of participants attaining ≥5% weight loss. Long-term weight outcomes were similar across risk groups. Conclusions A lifestyle change program in a clinical practice setting is associated with modest weight loss, sustained through 24 months, among participants with a range of cardiometabolic risk factors. More than one-quarter of participants achieve ≥5% weight loss, regardless of cardiometabolic risk.","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":"45 1","pages":"529 - 543"},"PeriodicalIF":3.9,"publicationDate":"2019-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721719872553","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47324990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-21DOI: 10.1177/0145721719866619
Carolyn A. Mendez-Luck, J. Miranda, C. Mangione, Jangho Yoon, Aurora VanGarde
Purpose The purpose of this study was to design a culturally sensitive dyad-level diabetes intervention to improve glycemic control for older Latino adults with type 2 diabetes. Methods This study used a pretest-posttest noncontrol group design. The intervention was developed from formative research with Mexican-origin caregiving dyads. The curriculum was adapted from 2 randomized trials of community interventions specifically designed for Latino older adults with type 2 diabetes. The curriculum consisted of communication skill-building exercises and dyad decision making on lifestyle changes to improve the older adult’s blood glucose levels. Thirty-two community-dwelling dyads completed a 6-week program of one-on-one sessions with a trained program facilitator. Main outcomes were feasibility and acceptability of the Juntos program. The authors assessed feasibility by examining participant burden and retention and acceptability by participant exit interviews. Although underpowered for outcomes, A1C, health status, and dyadic communication were also assessed to evaluate whether trends suggested the effectiveness of the intervention. Results Most participants viewed Juntos as an acceptable program and wanted the program expanded in terms of length and scope. All outcomes showed improvement from baseline through 6 months postintervention. Conclusions Results show that Juntos is acceptable to Mexican-origin caregiving dyads and is a promising approach for effectively controlling type 2 diabetes among older Latino adults who have a family caregiver.
{"title":"The Juntos Pilot Study: A Diabetes Management Intervention for Latino Caregiving Dyads","authors":"Carolyn A. Mendez-Luck, J. Miranda, C. Mangione, Jangho Yoon, Aurora VanGarde","doi":"10.1177/0145721719866619","DOIUrl":"https://doi.org/10.1177/0145721719866619","url":null,"abstract":"Purpose The purpose of this study was to design a culturally sensitive dyad-level diabetes intervention to improve glycemic control for older Latino adults with type 2 diabetes. Methods This study used a pretest-posttest noncontrol group design. The intervention was developed from formative research with Mexican-origin caregiving dyads. The curriculum was adapted from 2 randomized trials of community interventions specifically designed for Latino older adults with type 2 diabetes. The curriculum consisted of communication skill-building exercises and dyad decision making on lifestyle changes to improve the older adult’s blood glucose levels. Thirty-two community-dwelling dyads completed a 6-week program of one-on-one sessions with a trained program facilitator. Main outcomes were feasibility and acceptability of the Juntos program. The authors assessed feasibility by examining participant burden and retention and acceptability by participant exit interviews. Although underpowered for outcomes, A1C, health status, and dyadic communication were also assessed to evaluate whether trends suggested the effectiveness of the intervention. Results Most participants viewed Juntos as an acceptable program and wanted the program expanded in terms of length and scope. All outcomes showed improvement from baseline through 6 months postintervention. Conclusions Results show that Juntos is acceptable to Mexican-origin caregiving dyads and is a promising approach for effectively controlling type 2 diabetes among older Latino adults who have a family caregiver.","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":"45 1","pages":"507 - 519"},"PeriodicalIF":3.9,"publicationDate":"2019-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721719866619","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43091696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-02DOI: 10.1177/0145721719865181
L. Siminerio, M. Hamm, Justin Kanter, F. Cameron, J. Krall
Purpose The purpose of this qualitative study was to explore the effectiveness of Glucose to Goal (G2G), a diabetes self-management education and support (DSMES) model for primary care (PC). Methods PC providers and staff were recruited from 5 PC practices participating in the 18-month intervention to participate in focus groups and interviews, which were used to gain insights about their perspectives on DSMES and how G2G was implemented across the intervention. Data were collected by qualitative researchers at baseline, midpoint, and study completion. Results At baseline, PC participants held a favorable view of DSMES and welcomed having a diabetes educator (DE) in their practice. Most participants suggested DEs would be helpful in meeting patients’ nutrition needs but should give therapeutic advice only with a doctor’s oversight. Participants anticipated that having a DE onsite would mitigate transportation, scheduling, communication, and cost barriers. Participant viewpoints about G2G remained unchanged from midpoint to study end, while barriers regarding location and transportation were perceived as being reduced by having a DE in the practice. Despite referral rates remaining low in some practices, many concerns stated at earlier timepoints appeared to have been attenuated by G2G components (eg, bringing the DE onsite, preidentifying patients, and DE ability to communicate and make diabetes management recommendations). Conclusions This study demonstrates that G2G, providing DSMES in PC, appeared to be a welcome service where acceptance of and enthusiasm for the model grew over the course of the intervention.
{"title":"A Diabetes Education Model in Primary Care: Provider and Staff Perspectives","authors":"L. Siminerio, M. Hamm, Justin Kanter, F. Cameron, J. Krall","doi":"10.1177/0145721719865181","DOIUrl":"https://doi.org/10.1177/0145721719865181","url":null,"abstract":"Purpose The purpose of this qualitative study was to explore the effectiveness of Glucose to Goal (G2G), a diabetes self-management education and support (DSMES) model for primary care (PC). Methods PC providers and staff were recruited from 5 PC practices participating in the 18-month intervention to participate in focus groups and interviews, which were used to gain insights about their perspectives on DSMES and how G2G was implemented across the intervention. Data were collected by qualitative researchers at baseline, midpoint, and study completion. Results At baseline, PC participants held a favorable view of DSMES and welcomed having a diabetes educator (DE) in their practice. Most participants suggested DEs would be helpful in meeting patients’ nutrition needs but should give therapeutic advice only with a doctor’s oversight. Participants anticipated that having a DE onsite would mitigate transportation, scheduling, communication, and cost barriers. Participant viewpoints about G2G remained unchanged from midpoint to study end, while barriers regarding location and transportation were perceived as being reduced by having a DE in the practice. Despite referral rates remaining low in some practices, many concerns stated at earlier timepoints appeared to have been attenuated by G2G components (eg, bringing the DE onsite, preidentifying patients, and DE ability to communicate and make diabetes management recommendations). Conclusions This study demonstrates that G2G, providing DSMES in PC, appeared to be a welcome service where acceptance of and enthusiasm for the model grew over the course of the intervention.","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":"45 1","pages":"498 - 506"},"PeriodicalIF":3.9,"publicationDate":"2019-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721719865181","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43042716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose This study examined weight loss behavior and the prevalence of hyperglycemia unawareness (unknown high blood glucose) after gestational diabetes mellitus (GDM), within a nationally, representative sample. This study also examined social-demographic, psychosocial, provider communication, and health care access/utilization factors as predictors of A1C and health-protective behavior after GDM. Methods A secondary analysis of 2007-2014 National Health and Nutrition Examination Surveys (NHANES) data was conducted, including 205 women, aged 20 to 44 years, with a history of GDM, whose last live birth was in the past 10 years, excluding pregnant women and those with diabetes. Weighted bivariate, stepwise linear, and binary logistic regression analyses were conducted to examine correlates of A1C, weight change, weight loss attempt and behavior, diabetes screening, and physical activity. Results Hyperglycemia unawareness was associated with increased A1C and weight gain in the past year. Personal weight loss goal and perception of overweight increased the odds of weight loss attempt. Depressive symptoms were associated with weight gain over the past year. A third of the sample failed to have their glucose tested in the past 3 years. Two-thirds were never told about their personal risk for diabetes, but provider communication increased the odds of meeting weekly activity recommendations and glucose screening. Hispanic women and non-Hispanic black women were less likely to have had glucose screening than non-Hispanic white women. Conclusion Diabetes educators should address gaps in provider communication, while supporting psychosocial needs and reducing disparities to encourage health-protective behavior after GDM. The American Association of Diabetes Educators, 7 Self-Care Behaviors (AADE-7TM) provides an excellent framework for interventions to support health-protective behavior after GDM.
{"title":"Predictors of Health-Protective Behavior and Glycemia After Gestational Diabetes, NHANES 2007-2014.","authors":"Kerri Lynn Knippen, Jiunn-Jye Sheu, Reena Oza-Frank, Kimberly McBride, Joseph Dake","doi":"10.1177/0145721719848447","DOIUrl":"https://doi.org/10.1177/0145721719848447","url":null,"abstract":"Purpose This study examined weight loss behavior and the prevalence of hyperglycemia unawareness (unknown high blood glucose) after gestational diabetes mellitus (GDM), within a nationally, representative sample. This study also examined social-demographic, psychosocial, provider communication, and health care access/utilization factors as predictors of A1C and health-protective behavior after GDM. Methods A secondary analysis of 2007-2014 National Health and Nutrition Examination Surveys (NHANES) data was conducted, including 205 women, aged 20 to 44 years, with a history of GDM, whose last live birth was in the past 10 years, excluding pregnant women and those with diabetes. Weighted bivariate, stepwise linear, and binary logistic regression analyses were conducted to examine correlates of A1C, weight change, weight loss attempt and behavior, diabetes screening, and physical activity. Results Hyperglycemia unawareness was associated with increased A1C and weight gain in the past year. Personal weight loss goal and perception of overweight increased the odds of weight loss attempt. Depressive symptoms were associated with weight gain over the past year. A third of the sample failed to have their glucose tested in the past 3 years. Two-thirds were never told about their personal risk for diabetes, but provider communication increased the odds of meeting weekly activity recommendations and glucose screening. Hispanic women and non-Hispanic black women were less likely to have had glucose screening than non-Hispanic white women. Conclusion Diabetes educators should address gaps in provider communication, while supporting psychosocial needs and reducing disparities to encourage health-protective behavior after GDM. The American Association of Diabetes Educators, 7 Self-Care Behaviors (AADE-7TM) provides an excellent framework for interventions to support health-protective behavior after GDM.","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":"45 4","pages":"408-419"},"PeriodicalIF":3.9,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721719848447","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37224482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-01Epub Date: 2019-06-27DOI: 10.1177/0145721719858080
Marwan Bakhach, Mark W Reid, Elizabeth A Pyatak, Cari Berget, Cindy Cain, John Fred Thomas, Georgeanna J Klingensmith, Jennifer K Raymond
Purpose: To assess the impact of a home telemedicine clinic model (CoYoT1 Clinic) on psychosocial and behavioral outcomes designed for young adults (YAs) with type 1 diabetes (T1D).
Methods: YAs self-selected to participate in the CoYoT1 Clinic or serve as a usual care control. CoYoT1 Clinic visits consisted of an individual appointment with a provider and a group appointment with other YAs with T1D using home telemedicine. Psychosocial and behavioral functioning was assessed by 4 measures: Diabetes Distress Scale, Self-Efficacy for Diabetes Scale, Self-Management of Type 1 Diabetes in Adolescence Scale, and Center for Epidemiologic Studies Depression Scale.
Results: Forty-two patients participated in the CoYoT1 Clinic and 39 patients served as controls. CoYoT1 participants reported lower levels of distress (P = .03), increased diabetes self-efficacy (P = .01), and improved ability to communicate with others about diabetes (P = .04) over the study period compared to controls. YA males in the control group reported increases in depressive symptoms (P = .03) during the study period, but CoYoT1 participants showed no changes.
Conclusion: Group home telemedicine for YAs with T1D positively affects diabetes distress, self-efficacy, and diabetes-specific communication. These positive findings have the potential to also affect the YAs' long-term diabetes outcomes. Further investigation of the model is needed.
{"title":"Home Telemedicine (CoYoT1 Clinic): A Novel Approach to Improve Psychosocial Outcomes in Young Adults With Diabetes.","authors":"Marwan Bakhach, Mark W Reid, Elizabeth A Pyatak, Cari Berget, Cindy Cain, John Fred Thomas, Georgeanna J Klingensmith, Jennifer K Raymond","doi":"10.1177/0145721719858080","DOIUrl":"https://doi.org/10.1177/0145721719858080","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the impact of a home telemedicine clinic model (CoYoT1 Clinic) on psychosocial and behavioral outcomes designed for young adults (YAs) with type 1 diabetes (T1D).</p><p><strong>Methods: </strong>YAs self-selected to participate in the CoYoT1 Clinic or serve as a usual care control. CoYoT1 Clinic visits consisted of an individual appointment with a provider and a group appointment with other YAs with T1D using home telemedicine. Psychosocial and behavioral functioning was assessed by 4 measures: Diabetes Distress Scale, Self-Efficacy for Diabetes Scale, Self-Management of Type 1 Diabetes in Adolescence Scale, and Center for Epidemiologic Studies Depression Scale.</p><p><strong>Results: </strong>Forty-two patients participated in the CoYoT1 Clinic and 39 patients served as controls. CoYoT1 participants reported lower levels of distress (<i>P</i> = .03), increased diabetes self-efficacy (<i>P</i> = .01), and improved ability to communicate with others about diabetes (<i>P</i> = .04) over the study period compared to controls. YA males in the control group reported increases in depressive symptoms (<i>P</i> = .03) during the study period, but CoYoT1 participants showed no changes.</p><p><strong>Conclusion: </strong>Group home telemedicine for YAs with T1D positively affects diabetes distress, self-efficacy, and diabetes-specific communication. These positive findings have the potential to also affect the YAs' long-term diabetes outcomes. Further investigation of the model is needed.</p>","PeriodicalId":50584,"journal":{"name":"Diabetes Educator","volume":"45 4","pages":"420-430"},"PeriodicalIF":3.9,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0145721719858080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37371581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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