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

Purpose: The purpose of the study was to explore patient-reported challenges influencing type 2 diabetes self-management in a diabetes center in Ethiopia.

Methods: Exploratory qualitative interviews were conducted with purposively sampled patients with type 2 diabetes. Thematic data analysis was performed to identify challenges to diabetes self-management, and the themes were interpreted using Leininger's sunrise model.

Results: Thirty patients with type 2 diabetes participated. Four themes were identified regarding challenges to type 2 diabetes self-management: (1) cultural values and beliefs, (2) kinship and social factors, (3) educational factors, and (4) economic conditions. Sociocultural factors and low income intersected to significantly impede effective diabetes self-management. Sociocultural contexts strongly influenced patient beliefs and interpretations related to diabetes self-care. Misconceptions and limited awareness of diabetes, reliance on herbal remedies, ritual fasting, and prioritization of family needs over individual needs also involved challenges for diabetes self-care. Poverty influenced access to diabetes care. Many patients faced difficulties in adhering to healthy diets for diabetes due to limited income and food costs, and some patients reduced medication doses, including insulin, to manage costs effectively.

Conclusion: The study highlighted the pressing need for comprehensive and culturally appropriate patient education and empowerment interventions involving various stakeholders to enhance knowledge, understanding, and self-efficacy in diabetes self-management. Urgent attention is needed to ensure patients have access to affordable and sustainable diabetes medications and healthy diets for diabetes through financial incentives. These findings can be considered in designing tailored strategies for improving self-management practice in diabetes care in Ethiopia.

Purpose: The purpose of the study was to translate and cross-culturally adapt the 24-item Diabetes Knowledge Questionnaire (DKQ) for Indonesian patients with type 2 diabetes (T2D) and evaluate its psychometric properties.

Methods: Forward-backward translation, adaptation involving 7 experts, and pretesting to develop the Indonesian version of DKQ were conducted. Psychometric analysis was carried out among T2D patients from 40 primary health care centers in Indonesia. Known-group, convergent and discriminant validity, internal consistency and test-retest reliability were assessed. Additionally, a descriptive item analysis was conducted.

Results: In total, 39 patients participated in the pretesting and 304 patients in the validation process and descriptive analysis. Of the 24 items, 2 were adjusted during the adaptation process, and 1 item was deleted because it did not adequately reflect the original item. Known-group validity was demonstrated because patients with younger ages, higher educational levels, and longer diabetes duration had significantly higher DKQ scores. Convergent validity was demonstrated by a significant positive correlation of the DKQ scores with overall treatment satisfaction. The 23-item DKQ Bahasa Indonesia showed satisfactory internal consistency (Cronbach's α = 0.73; omega total = 0.72) and good test-retest reliability (intraclass correlation coefficient = 0.87 in a sample of 27 patients). No floor and ceiling effects were found in the item analysis.

Conclusion: The study demonstrates adequate validity and reliability of the 23-item DKQ Bahasa Indonesia for assessing diabetes knowledge in Indonesian primary care patients with T2D. This instrument can be used to identify room for improvement and develop diabetes education programs.

Purpose: The purpose of this study was to examine the relationships between symptom burden and sleep problems and the role of depressive symptoms on these relationships in middle-aged and older adults with type 2 diabetes.

Methods: The study employed a cross-sectional, correlational design with secondary analysis. De-identified data sets from three original studies were combined. A total of 189 men and women with type 2 diabetes were recruited using convenience sampling in midwestern United States. Symptom burden, sleep impairment and sleep disturbance, depressive symptoms, demographics, and diabetes-related variables were assessed. The participants were grouped into glucose-controlled and -uncontrolled groups to examine a multigroup effect. Multigroup path analyses were conducted.

Results: The results indicated that symptom burden had direct and indirect effects through depressive symptoms on sleep disturbance in the controlled group, whereas only a direct effect was found in the uncontrolled group. For sleep-related impairment, significant direct and indirect effects of symptom burden were found via depressive symptoms in both groups, and the strength of the effects on each path differed between the groups.

Conclusions: Diabetes symptom burden was associated with sleep disturbance and sleep-related impairment in middle-aged and older adults with diabetes. A different approach should be considered for sleep management according to their A1C levels, and depressive symptoms can be a therapeutic target to treat sleep problems in the population.

Purpose: The purpose of this study was to determine the effectiveness of pharmacist-led interventions on diabetes distress and glucose management among people with type 2 diabetes (T2DM) in a community care clinic.

Methods: Adults with T2DM were recruited during routine visits at the pharmacist-run clinic. Participants completed a baseline A1C, demographic survey, Diabetes Distress Scale (DDS), and Patient Health Questionnaire-2 (PHQ-2). Depending on DDS subscale-specific responses, participants qualified for pharmacist-led educational interventions based on the ADCES7 Self-Care Behaviors™. After 6 months, participants completed another A1C, satisfaction survey, DDS, and PHQ-2. Data analysis included descriptive statistics and paired t tests.

Results: Among 53 participants at baseline, diabetes distress was present in 77.4%; emotional burden was most common in 64.2%, followed by regimen distress in 45.3%, interpersonal distress in 34.0%, and physician distress in 20.8%. After the intervention, significant reductions occurred in mean overall DDS score (2.0 to 1.7), emotional burden (2.4 to 1.8), regimen distress (2.3 to 1.7), A1C (7.0% to 6.5%; 53.0 to 47.5 mmol/mol), and PHQ-2 score (1.6 to 1.0). Participants were highly satisfied with the service, their knowledge, and self-management skills following completion of the study.

Conclusions: Diabetes distress was present in most participants despite glucose management that was largely achieving treatment goals. Pharmacist-led educational interventions significantly reduced overall DDS score, emotional burden, regimen distress, A1C, and PHQ-2 score. The results of this study suggest that people with T2DM should receive routine screening for diabetes distress and that pharmacists can positively affect diabetes management and emotional well-being through tailored education.

Purpose: The purpose of this study was to examine the relationship between self-management behaviors (eg, healthy eating, being active, medication taking, glucose monitoring, feet check), sociodemographic factors, disease-related characteristics, and health literacy among patients with type 2 diabetes in Singapore.

Methods: Data were analyzed from a nationwide survey conducted between 2019 and 2020 (n = 387). Self-management behaviors were assessed using the Dietary Approaches to Stop Hypertension questionnaire, the Global Physical Activity Questionnaire, and a diabetes care questionnaire. A linear regression model was generated to examine the association of healthy eating with the variables of interest (sociodemographic factors, disease-related characteristics, and health literacy), and logistic regression models were generated to investigate the significant correlates of the remaining self-care behaviors.

Results: Regression models showed that the 5 self-care behaviors have different correlates. Nonetheless, compared to individuals aged 50 to 64 years, those aged 65 years and above were less likely to be active, adhere to their medication prescription, and check their feet. Individuals with a higher number of diabetes-related complications were less likely to be sufficiently active but more likely to monitor their glucose level and check their feet. Moreover, individuals with poor health literacy were more likely to eat healthily and be sufficiently active.

Conclusions: Programs related to self-care behaviors can be tailored to specific demographics to improve their uptake in the population. Furthermore, encouraging comprehensive self-care behaviors in those aged 65 years and above is crucial for effective diabetes management.

Purpose: The purpose of this study was to identify the independent factors associated with intertemporal decision-making and to examine its relationship with diabetes self-management behaviors, glucose variability, and diabetes complications in patients with diabetes.

Methods: A cross-sectional study using convenience sampling (n = 368) was conducted in patients with type 2 diabetes (T2DM) between November 2021 and April 2023. Data were collected using self-reported questionnaires and retrieval of clinical information from medical records. Intertemporal decision-making was operationalized using delay discounting. The outcome variables included diabetes self-management behaviors, A1C, diabetic retinopathy, and carotid artery disease. Hierarchical regression and binary logistic regression models were used to explore the relationships among intertemporal decision-making, self-management, A1C, and carotid artery disease.

Results: The analyses showed that intertemporal decision-making was negatively associated with physical activity and carotid artery disease, in which individuals with lower delay discounting tended to have healthier physical activity; when the delay discounting rate increased 1 unit, the risk of the carotid artery disease increased by 39.8%.

Conclusions: The study reveals that a lower delay discounting can promote healthier physical activity and decrease the incidence of carotid artery disease. These results offer new knowledge for researchers and clinicians to consider intertemporal decision-making in developing interventional programs to improve physical activity and reduce carotid artery complication in patients with T2DM when providing care.

Purpose: The purpose of this study was to assess the combined effects of type 2 diabetes (T2D) and hearing loss on the level of distress in individuals with diabetes.

Methods: The 2021 National Health Interview Survey included 2633 adults (ages 18+) with T2D who reported perceived hearing loss, level of diabetes-related distress, household composition, and demographic characteristics. Logistic regressions evaluated these association between hearing loss and diabetes distress controlling for age, income, region of residence, marital status, rurality, educational attainment, insurance coverage, time since diabetes diagnosis, and household composition. Interaction effects examined differential associations between demographic groups.

Results: About 3.5% of adults with T2D in the sample reported hearing loss, and 70% reported diabetes-related distress. Results indicated that diabetes distress was significantly more likely among individuals with hearing loss (OR = 2.08) relative to their hearing counterparts. Additionally, females (OR = 1.50), low-income earners (OR = 1.84), middle-income earners (OR = 1.41), non-Hispanic Blacks (OR = 1.58), and Hispanics (OR = 1.75) with diabetes had higher odds of reporting diabetes distress. Interaction analyses indicated that non-Hispanic Blacks and Hispanics with hearing loss had a 37% and 19%, respectively, higher likelihood of diabetes distress relative to non-Hispanic Whites with hearing loss.

Conclusion: Diabetes distress was more likely among individuals with hearing loss. These findings suggest the communication challenges of individuals with hearing loss may explain the observed differences in distress.

Purpose: The purpose of this study was to explore symptom management experiences among college students with type 1 diabetes mellitus (T1DM). Limited qualitative data using a theoretical framework exist that explore the self-care behavior processes for symptom management.

Methods: A qualitative approach was used for this study. The middle-range theory of self care of chronic illness served as a framework for data collection and analysis procedures. Data collection included distributing a survey to collect participants' demographic and sociodemographic data and utilizing a semi-structured interview guide to conduct one-on-one interviews with 31 participants. Interviews occurred via Zoom (n = 28) and in person (n = 3). Interview transcripts were uploaded in NVivo for data management. The research team created a codebook using theoretical constructs to assist with thematic analysis. Data are representative of a sample whose characteristics include undergraduate students ages 18 to 23 living with T1DM for 2 years or more who attended large, public, 4-year universities located in the southeastern United States.

Results: Three main themes were created using theoretical constructs: symptom detection experiences, symptom interpretation experiences, and symptom response experiences. Two subthemes were identified for each theme. Participants engaged in symptom management for blood glucose regulation through detecting changes in their blood glucose physiologically and via technology. Additionally, symptom interpretation involved analyzing blood glucose trends and determining common causes of blood glucose changes. Symptom response included immediately addressing hypoglycemia but delayed responses addressing hyperglycemia.

Conclusions: Challenges were present responding to hypoglycemia; therefore, additional research is warranted to improve symptom response skills.

Purpose: The purpose of this study was to examine the impact of continuous blood glucose monitoring (CGM) on transitions of care as patients with diabetes are discharged from the hospital on insulin.

Methods: This is a descriptive study with 2 cohorts of patients (transition to home with CGM and transition to home without CGM) who were assessed prior to discharge (baseline) and 30 days post discharge (follow-up). The key outcome measures were satisfaction with diabetes management, diabetes-related quality of life, frequency of blood glucose monitoring, and 30-day readmission rates.

Results: Patients in the CGM group reported significantly higher levels of satisfaction with diabetes self-care management and higher levels of diabetes-related quality of life compared to those patients discharged without CGM.

Conclusion: The results of this study suggest that CGM enables a smoother transition from hospital to home for patients with diabetes placed on insulin at discharge. CGM was associated with higher satisfaction and diabetes-related quality of life, perhaps as a result of timely, ongoing information about glucose levels without the burden and pain of finger sticks. CGM may provide greater confidence in self-care decisions regarding insulin dosing, food intake, and exercise. Further research is needed to confirm our results and explore the additional factors associated with greater quality of life and satisfaction.