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

Purpose: The purpose of this research is to develop a set of continuous glucose monitoring (CGM)-related measure concepts to be tested in a health care system. Existing measures assessing the quality of diabetes care do not include modern approaches to diabetes management, such as CGM. Continuous glucose monitors rival traditional methods of measuring diabetes management by providing real-time, longitudinal data and demonstrating glucose variability over time. The Improving Diabetes Quality Initiative seeks to address this gap in diabetes quality measurement.

Methods: A Technical Expert Panel (TEP) was convened to curate a diabetes quality measures portfolio and conceptualize three new CGM-related quality measures within the portfolio. From the additional measure concepts identified in the portfolio, the TEP prioritized three for conceptualization. High-level measure concept specifications were made available during a public comment period.

Results: The measure concepts prioritized by the TEP included a shared decision-making measure to assess the value of initiating CGM for disease management, a utilization measure to address disparities in access and use of CGM, and a patient-provider review of CGM data to promote routine consideration of these assessments in treatment and ongoing management. Clinical literature, public comments, and TEP feedback informed full measure specifications.

Conclusions: The evolution of diabetes technology reflects the need to shift diabetes quality of care. The measure concepts will be tested in a flexible pilot setting to understand the future of diabetes care and communicate the value of CGM to people with diabetes, providers, and payers.

Purpose: The purpose of this study is to examine the extent to which perceived support and depressive symptoms might interfere with Hispanic patients' ability to manage their diabetes and whether these effects vary by gender.

Methods: Data were collected from a cohort of 232 Hispanic men and women with type 2 diabetes mellitus (T2DM). Conditional process analysis was used to test a moderated mediation model of the time-lagged processes associating gender, diabetes support, and depressive symptoms with reported self-efficacy after 3 months.

Results: Increased depressive symptoms were associated with lower self-efficacy, but the conditional effects varied among men and women. The index of moderated mediation was significant, indicating that among women, the indirect effect of depressive symptoms on self-efficacy was contingent on lower levels of perceived support. Among men, increased depressive symptoms were directly associated with declines in self-efficacy and were not conditional on perceived support.

Conclusions: Results of the study have important implications for gender health equity. Mental health screening and an assessment of support needs may be important for determining appropriate complementary therapies when treating Hispanic women with chronic conditions such as diabetes. Attention to possible differences in gender-specific mental health needs could lead to improved self-management, better glycemic control, and more equitable health outcomes.

Purpose: The purpose of this study was to explore how treatment adherence and lifestyle changes required for glycemic control in type 2 diabetes (T2D) are related to quality of life (QoL) among predominantly ethnic minority and socioeconomically disadvantaged adults engaged in making changes to improve T2D self-management.

Methods: Adults with T2D in New York City were recruited for the parent study based on recent A1C (≥7.5%) and randomly assigned to 1 of 2 arms, receiving educational materials and additional self-management support calls, respectively. Substudy participants were recruited from both arms after study completion. Participants (N = 50; 62% Spanish speaking) were interviewed by phone using a semistructured guide and were asked to define QoL and share ways that T2D, treatment, self-management, and study participation influenced their QoL. Interviews were analyzed using thematic analysis.

Results: QoL was described as a multidimensional health-related construct with detracting and enhancing factors related to T2D. Detracting factors included financial strain, symptom progression and burden, perceived necessity to change cultural and lifestyle traditions, and dietary and medical limitations. Enhancing factors included social support, diabetes education, health behavior change, sociocultural connection.

Conclusion: QoL for diverse and socioeconomically disadvantaged adults with T2D is multifaceted and includes aspects of health, independence, social support, culture, and lifestyle, which may not be captured by existing QoL measures. Findings may inform the development of a novel QoL measure for T2D.

Purpose: The purpose of this study is to explore the experiences of parents of children with type 1 diabetes mellitus (T1DM) who are living in rural areas. Individuals living in rural areas face barriers to accessing health care that lead to significant health disparities with increased morbidity and mortality. There is a need to understand the unique experiences of those living in rural communities to support their health needs.

Methods: In this qualitative study, a convenience sample of 11 parents of children who were diagnosed with T1DM in the last 10 years living in Vermont were recruited through connections with local health professionals and family support networks and interviewed about their experiences. Interviews were transcribed verbatim and analyzed using Braun and Clarke's 6-step approach to reflexive thematic analysis.

Results: Five themes were identified to capture the experience of parenting a child with T1DM in a rural community, including enduring emotional traumas, living life on call, adapting to everyday challenges, lacking a safety net for support, and finding a rhythm.

Conclusions: Although findings echo many themes found in previous studies on experiences of parents of children with T1DM, participants also identified unique barriers such as physical distance from formal and informal support systems, unreliable and/or insufficient technological resources, and lack of understanding of T1DM by their communities, including among child care and schools. Diabetes care and education specialists working with families living in rural areas must explore ways to educate key supports to these families to minimize isolation, stigma, and burnout among parents.

Purpose: The purpose of the study was to describe differences in non-Hispanic Black (NHB) and non-Hispanic White (NHW) parents' perceptions of factors that influence the use of diabetes technology.

Methods: Focus groups were conducted with parents of NHB and NHW children at a pediatric diabetes center in the Northeast United States. Kilbourne's health disparities framework informed the focus group guide and a priori coding for directed content analysis. Further analysis allowed subcategories to emerge inductively.

Results: Twenty-one parents participated. Five subcategories emerged, describing differences in NHB and NHW parent decisions regarding diabetes technology: (1) child's choice, (2) shame versus pride, (3) pros and cons of technology, (4) time frame, and (5) blood glucose indications of readiness. NHB parents feared technology malfunction, worried that visible devices could worsen experienced stigma of diabetes diagnosis, and described the diabetes team as gatekeepers, who changed eligibility criteria for diabetes technology use for their research purposes. In contrast, NHW parents reported diabetes team expectation of diabetes technology use and did not report provider-related barriers.

Conclusion: This study adds to existing literature advancing our understanding of the patient and provider mechanisms underlying racial disparities in diabetes technology use. This understanding may guide development of interventions focused on patients, providers, and structural factors to improve equity in use of diabetes technology by youth with type 1 diabetes.

Purpose: The purpose of the study was to explore the perspectives and experiences of adults with type 1 diabetes (T1DM) who are currently using the closed-loop insulin delivery system (CLIDS).

Methods: Eleven adults with T1DM who used closed-loop insulin pumps for at least 6 months participated in this qualitative descriptive study.

Results: Four themes emerged from the rich descriptions: (1) striving for improvement, (2) missing a magic wand effect, (3) seeking support, and (4) barriers to adaptation. These themes represent both process-based and psychosocial implications for nursing practice and patient education.

Conclusions: To optimize CLIDS use and outcome, the antecedent conditions that contribute to patients' decision to adopt it must be understood. Then, interventions that focus on setting realistic expectations must be created. Patients need support as they incorporate CLIDS into their T1DM self-management. Training health care providers on the idiosyncrasies of adapting to CLIDS is critical. Patients must learn to relinquish control and trust the machine and manage the anxiety the system's intrusive alarms cause them so they can be better supported cognitively and psychosocially.

Purpose: The purpose of the study was to examine the influences of sex and acculturation on dietary behaviors, macronutrient intake, and dietary quality in participants enrolled in a diabetes prevention initiative in Starr County, Texas.

Methods: Baseline data from the Starr County diabetes prevention study (N = 300) were analyzed-acculturation (country of origin, years in Starr County, language and food preferences), depressive symptoms (Patient Health Questionnaire-9), healthy eating self-efficacy (Weight Efficacy Lifestyle Questionnaire-Short Form), diet quality (USDA Healthy Eating Index), fat avoidance (Fat Avoidance Scale, Spanish version), and macronutrients. Descriptive statistics and univariate analysis of covariance were used to examine differences based on acculturation, controlling for sex.

Results: Participants were predominantly female (73%) and, on average, 51 years of age. Language and food preferences favored Spanish language and Hispanic foods, respectively. The majority (71%) was born in Mexico but had resided in Starr County for 33 years, on average. Depressive symptoms were moderate, and eating self-efficacy scores suggested low confidence in making healthy food choices, particularly for saturated fats. Spanish language preference was associated with worse dietary habits. The mean dietary quality score was lower than the national average (54 vs 59 nationally); females had slightly higher dietary quality than males and a higher mean fat avoidance score, although differences were not clinically significant. Intakes of carbohydrate, saturated fats, and cholesterol were higher than recommended daily allowances.

Conclusions: The overall preference for speaking Spanish and the influence of language on dietary intake should inform future dietary interventions. Accommodating cultural norms and food preferences remain major challenges to improving dietary quality among the diverse Hispanic ethnic groups.

Purpose: The purpose of this study is to discern the mechanisms that impact diabetes self-management from the perspective of individuals living with diabetes.

Methods: Using a critical realist perspective, this qualitative descriptive study enrolled 54 individuals living with diabetes who had been exposed to diabetes self-management education and support within the previous 3 years. Focus groups were conducted between January and March 2021. Reflexive thematic analysis was used to develop themes and subthemes.

Results: The overarching theme was wrangling diabetes: getting in control. Enablers to getting in control included professional and informal support and constant reassurance that they were on the right track. Individual-level barriers to getting in control included competing priorities, difficult emotions, and financial concerns. Health system barriers included inconsistent messaging from providers, lack of care coordination, and insurance driving treatment decisions. The latent force underlying these barriers was the limited agency individuals with diabetes had in reference to self-management behaviors.

Conclusions: Although the health care system ostensibly wants individuals to be in control of and responsible for managing their diabetes, system-level structures and processes do not allow for some people living with diabetes to effectively self-manage.

Purpose: The purpose of this study was to evaluate the feasibility and acceptability of a technology-assisted behavioral sleep intervention (Sleep-Opt-In) and to examine the effects of Sleep-Opt-In on sleep duration and regularity, glucose indices, and patient-reported outcomes. Short sleep duration and irregular sleep schedules are associated with reduced glycemic control and greater glycemic variability.

Methods: A randomized controlled parallel-arm pilot study was employed. Adults with type 1 diabetes (n = 14) were recruited from the Midwest and randomized 3:2 to the sleep-optimization (Sleep-Opt-In) or Healthy Living attention control group. Sleep-Opt-In was an 8-week, remotely delivered intervention consisting of digital lessons, sleep tracker, and weekly coaching phone calls by a trained sleep coach. Assessments of sleep (actigraphy), glucose (A1C, continuous glucose monitoring), and patient-reported outcomes (questionnaires for daytime sleepiness, fatigue, diabetes distress, and depressive mood) were completed at baseline and at completion of the intervention.

Results: Sleep-Opt-In was feasible and acceptable. Those in Sleep-Opt-In with objectively confirmed short or irregular sleep demonstrated an improvement in sleep regularity (25 minutes), reduced glycemic variability (3.2%), and improved time in range (6.9%) compared to the Healthy Living attention control group. Patient-reported outcomes improved only for the Sleep-Opt-In group. Fatigue and depressive mood improved compared to the control.

Conclusions: Sleep-Opt-In is feasible, acceptable, and promising for further evaluation as a means to improve sleep duration or regularity in the population of people with type 1 diabetes.