The science of diabetes self-management and care最新文献

Purpose: The purpose of the study was to determine whether sociodemographic characteristics were associated with access to digital resources among Medicare beneficiaries ages ≥65 years with reported diabetes and no prior diabetes self-management training (DSMT).

Methods: The 2022 nationally representative Medicare Current Beneficiary Survey was analyzed. A 3-level categorical dependent variable was created (n = 1783): (1) has a computer/laptop/tablet and internet access, (2) has a computer/laptop/tablet or internet access, and (3) has no access to either (reference group). A survey-weighted multinomial logit model was conducted to examine associations between sociodemographics and the dependent variable.

Results: Among study beneficiaries, 15.7% had no computer/laptop/tablet and no internet access, 15.8% had a computer/laptop/tablet or internet access, and 68.5% had a computer/laptop/tablet and internet access. Hispanic, non-Hispanic Black (NHB), and other minority beneficiaries were less likely than non-Hispanic White beneficiaries to have a computer/laptop/tablet and internet access (for NHB, odds ratio [OR] = 0.40, 95% CI, 0.23-0.71). Beneficiaries with less than high school (HS) or HS education were less likely to have a computer/laptop/tablet and internet access (for < HS, OR = 0.07, 95% CI, 0.04-0.12) or to have a computer/laptop/tablet or internet access (for < HS, OR = 0.41, 95% CI, 0.21-0.79). Beneficiaries with lower incomes (< $25,000) were less likely to have a computer/laptop/tablet and internet access (OR = 0.25, 95% CI, 0.15-0.41) or to have a computer/laptop/tablet or internet access (OR = 0.51, 95% CI, 0.32-0.81).

Conclusions: Approximately one-third (or 3.4 million) of potential DSMT-eligible beneficiaries lacked the digital resources necessary to receive a full-service virtual DSMT. Efforts to promote enrollment in virtual DSMT must address the complexities of the digital divide for at-risk beneficiaries.

Purpose: The purpose of the study was to explore perceptions of using continuous glucose monitor (CGM) use and how it affects diabetes self-management behaviors in adult patients with diabetes.

Methods: Individual qualitative interviews following a structured script were conducted with 10 adult patients (mean age 31.2, ±14.5 SD) with type 1 or type 2 diabetes seen in an endocrine specialty clinic in the United States.

Results: Multiple themes related to diabetes self-management were reported, including nutrition choices, exercise engagement, medication management, endocrine provider communication, and managing hypoglycemia. Furthermore, themes of diabetes distress, including financial concerns over health insurance coverage of CGM supplies and provider communication over supply refills, emerged.

Conclusion: Study interviews highlight several areas of focus that may help providers incorporate CGM use into diabetes self-management education and management plans. To validate these findings, future quantitative research is needed to better understand how to incorporate CGM use into diabetes self-management education interventions to support healthy behavior change in adults with diabetes.

Purpose: This article reports the results of the 2025 National Practice Survey (NPS), documenting professional engagement in the diabetes care and education specialist (DCES) specialty, conducted by the Association of Diabetes Care & Education Specialists (ADCES).

Methods: The quantitative NPS survey was administered online using email addresses compiled from ADCES and Certification Board for Diabetes Care and Education. Data were collected over a 4-week period in 2025. Descriptive and correlative statistics were used to identify relationships between variables and are discussed in the context of existing literature and previous NPS surveys.

Results: The responses from the 2479 respondents to this NPS find those serving as DCESs to be a diverse group of professionals, working within the context of both an expanding diabetes care team and population with diabetes. While serving disparate populations, they appear, as a group, to actively seek out training opportunities to further their understanding of those they work with and professional credentialing and other educational advancement. DCESs appear to have an expanded role in patient care and increased responsibility in providing colleagues and people with diabetes with guidance on diabetes-related technology.

Conclusions: Given the advances in the care and treatment of diabetes, DCESs are an important conduit for patient-centered care. Understanding the current practice of the DCES provides insights to address the evolving needs of diabetes prevention, diabetes and cardiometabolic syndrome care, treatment, and education with a workforce prepared to integrate technology and best practices for people living with diabetes.

PurposeThe purpose of the current study was to explore family members' experiences of how to support an adult person with type 1 diabetes (T1D).MethodsA qualitative descriptive study with thematic analysis was conducted in Sweden between 2020 and 2021. Interview transcripts were analyzed from 13 people who are a family member (≥18 years) of an adult with T1D, and inductive coding identified salient themes. Family members were recruited via social media, and their length of time as a family member to an individual with the T1D ranged between 3 and 38 years (median 24).ResultsThe analysis and coding identified 4 salient themes: (1) searching for knowledge in unfamiliar situations, (2) applying new knowledge in everyday life, (3) balancing support to fit need and situation, and (4) over time, the support role matures.ConclusionsFamilies with members with T1D are complex, with relational and behavioral challenges arising as the members live their lives. Routines, habits, and unexpected events become especially challenging for families with a member with T1D. Because most self-care activities for adults are carried out within the family, directly involving family members in educational interventions is important. These interventions should include providing information about the symptoms and treatment for T1D, developing knowledge about how families can be affected, but also providing strategies for how families optimally implement necessary daily changes.

PurposeThe purpose of the study was to examine the association between the level of oral health knowledge (OHK), the risk of periodontitis, and diabetes management self-efficacy (DMSE) among individuals with type 2 diabetes (T2DM).MethodsA cross-sectional survey of 93 adults with T2DM in central Texas was used to examine OHK levels with descriptive analyses; 5 hierarchical regression analyses were conducted to explore the impact of OHK and periodontitis risk on DMSE.ResultsParticipants' mean age was 59.60 ± 12.76 years, 54.8% were female, and 54.8% were White. Their average duration of having diabetes was 12.17 ± 11.27 years, and 77.4% took oral medications. Their average A1C was 6.75 ± 1.56; nearly half (47.3%) had more than 1 comorbidity. The risk of periodontitis was high, and the level of OHK was low. On average, 65% of the OHK questions were answered correctly; the 2 questions with the lowest rates of being answered correctly were related to dry mouth risks. Forty-two percent of participants were at risk of periodontitis. Hierarchical regression analyses showed that only the risk of periodontitis significantly predicted DMSE in managing diet, DMSE in managing exercise and weight, and overall DMSE after controlling for age, gender, number of comorbidities, duration of diabetes, and treatment types.ConclusionsHealth care providers should proactively assess OHK and periodontitis risk, especially when patients indicate low efficacy concerning diet and body weight management.

PurposeThe purpose of this integrative literature review was to assess barriers and facilitators to diabetes technology use among underrepresented racial and ethnic adolescents and young adults with type 1 diabetes mellitus (T1DM) in the United States.MethodsThis integrative review followed Whittemore and Knafl's methodology. A systematic database search was conducted in PubMed, CINAHL, EMBASE, PsycINFO, Scopus, and Web of Science from inception through December 2024. The inclusion criteria were English-language primary studies on diabetes technology targeting adolescents and young adults with T1DM from underrepresented racial and ethnic groups. Two independent reviewers identified articles for inclusion, extracted data, and assessed quality with the mixed-methods appraisal tool. The social ecological model guided thematic coding and deductive synthesis.ResultsOut of 1704 references, 8 articles met inclusion criteria. The most prevalent barriers to technology use were financial limitations, inadequate knowledge, limited patient-provider communication, insurance restrictions, lack of peer and family support, and cultural and psychosocial barriers. Facilitators included increased familiarity and support, positive experiences and involvement, effective communication, community-based education initiatives, and insurance and systemic advocacy.ConclusionThe review highlights persistent inequities in technology use among underrepresented racial-ethnic adolescents and young adults with T1DM. Actions should aim at preventing and reforming barriers, including racism and inequitable access, support for community-based interventions, and incentivize technological innovations for underrepresented individuals.

PurposeThe purpose of the study was to understand challenges to optimal diabetes management for African American (AA) youth and willingness to use advanced diabetes technologies.MethodsTwenty AA youth with type 1 diabetes mellitus (mean age 13.81 ± 2.10 years; 8 girls and 12 boys) and their parents participated in focus groups or individual interviews addressing adherence barriers and attitudes about new technologies, such as the advanced hybrid closed loop (AHCL) insulin pump. Sessions were video recorded, and based on verbatim transcripts, 2 independent raters coded responses into themes, and a third rater resolved discrepancies; thematic analysis was conducted using NVivo.ResultsQualitative analyses revealed 6 main themes encompassing current regimens, life with diabetes, parenting, culture, willingness to try new technologies, and hesitancy to try an AHCL system. Most families (65%) reported being very willing to try the AHCL system, and a third were open but not ready to commit, citing concerns about reliance on technology and need for more information.ConclusionsInnovative technology, such as the AHCL insulin pump system, may help to improve glycemic outcomes and reduce health disparities for AA youth. Many AA youth with type 1 diabetes mellitus and their parents are ready to try advanced technologies but may require additional individualized support from the health care team to achieve optimal outcomes.

PurposeThe purpose of the study was to explore the motivators and barriers influencing health behavior change and perceptions of public hospital services among mothers living with cardiometabolic diseases (CMDs) in Thailand.MethodsA qualitative descriptive approach was employed using in-depth interviews with 30 mothers diagnosed with CMDs, including hypertension, type 2 diabetes mellitus, and cardiovascular conditions. Participants were recruited from public hospitals in Thailand between April and June 2025. Data were analyzed thematically using QCAmap software to identify recurring patterns and themes.ResultsFive major categories of motivators emerged: concern for family and children, awareness of health risks, support from health care providers, peer and social support, and personal beliefs and self-motivation. Key barriers included time and role constraints, financial limitations, limited knowledge and misconceptions, and emotional and psychological challenges.ConclusionsMothers with CMDs are motivated by family responsibility and personal health goals but face significant structural and emotional barriers. For collectivistic culture, family-centered interventions and strengthened public health services are essential to support sustainable health behavioral change.