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

Purpose: The purpose of this study was to explore the educational experiences of youth with type 1 diabetes (T1D), their parents, and clinicians when initiating continuous glucose monitoring (CGM) and insulin pumps.

Methods: Twenty parent-child dyads with T1D ≥6 months and ≥1 month CGM and insulin pump use were eligible to participate in semistructured dyadic interviews. Purposive sampling was used to recruit youth with a range of A1C levels and to overrepresent dyads from minoritized backgrounds. Eight diabetes clinicians with ≥1 year of experience participated in individual interviews using a parallel interview guide. A subset of interviews was double-coded, and thematic analysis was used to generate themes.

Results: Poor internet connections, distractions in the home, and small screens made in-person education the preferred modality for dyads and clinicians due to the physical skills required when learning to use these devices. Structured education addressing essential topics was constrained by allotted appointment times and thus (1) often overlooked cognitive and emotional burdens of diabetes technology education and (2) insufficiently accounted for individual learning pace and capacity. Real-world experiential learning supported by the clinical team through telemedicine, phone calls, and electronic medical record messaging was often used to fill the gaps of structured education.

Conclusions: Both clinicians and parent-child dyads initiating CGM and automated insulin delivery expressed a preference for in-person education. Although experiential learning can supplement important concepts not adequately addressed during structured education, relying solely on this approach may unintentionally omit crucial concepts. Educational strategies are needed to overcome information overload and support families in diabetes self-management.

PurposeThe purpose of this study was to collect data from surveys and focus groups to describe the overall experiences and perceptions of racism of parents of non-Hispanic Black (NHB) children with diabetes.MethodsA concurrent mixed-methods research design was utilized. Surveys (General Intake, Brief Hypervigilance Scale) were obtained, and 5 focus groups (4 type 1 diabetes, 1 type 2 diabetes) were conducted with parents of NHB children followed at an urban pediatric diabetes center. A focus group guide was developed, and transcripts were coded and analyzed by the research team.ResultsForty-seven parents consented to participate in the study; 22 parents (47%) participated in 1 of 5 focus groups. Focus group participants were generally in good health and had higher education and income levels than nonparticipants. Hypervigilance (a heightened awareness to threat) was reported in parents, especially of those children with type 2 diabetes. Focus group themes related to experiences with diabetes management, including (1) communication with the diabetes team, (2) coping mechanisms, and (3) perceptions of medical racism.ConclusionsKey insights that emerged from the study included the importance of communicating openly with the diabetes team, the inequitable provision of diabetes technology, a desire for NHB role models, and high levels of hypervigilance in the participants. Innovative approaches, including trauma-informed care focused on patient/caregiver and parent voice, can help to address the racial disparities in the treatment and outcomes of youth with diabetes.

BackgroundPharmacist-led multidisciplinary care may enhance diabetes self-management, yet evidence from Taiwan is limited. This study evaluates the impact of such interventions on health literacy, medication adherence, and clinical outcomes in patients with type 2 diabetes.MethodsA quasi-experimental pretest-posttest study was conducted at Taipei City Hospital (April to December 2021) with 70 adults allocated into a pharmacist-led care group or standard care group. The intervention included medication management, diabetes education, and structured follow-ups. Generalized estimating equations analyzed changes in health literacy, medication adherence, weight, low-density lipoprotein cholesterol (LDL-C), A1C, fasting glucose, and total cholesterol (TC).ResultsThe intervention group achieved a 21.1% increase in health literacy and a 20.4% improvement in medication adherence (P < .01). Significant reductions were observed in weight (B = -0.16, P < .01) and LDL-C (B = -12.83, P = .02). Differences in A1C, fasting glucose, and TC were not statistically significant, although time effects suggested overall improvement.ConclusionsPharmacist-led care significantly improved health literacy, adherence, and some clinical outcomes in patients with type 2 diabetes. These findings highlight the value of integrating pharmacists into multidisciplinary teams to enhance chronic disease management.

PurposeThe purpose of this systematic review was to evaluate the effectiveness of mHealth-based self-management interventions on self-efficacy among patients with type 2 diabetes.MethodsFollowing PRISMA guidelines, a systematic search was conducted across Medline, CINAHL, the Cochrane Library, and OVID databases. Analyses were performed using the meta and metafor packages in R programming. The restricted maximum likelihood (REML) method and Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment were applied to rigorously estimate random effects.Results:The analysis included 9 high-quality randomized controlled trials published between 2014 and 2022, with a total of 1,116 participants. The standardized mean difference was 0.97 (95% CI, 0.16-1.78, t = 2.75, P = .02), indicating a significant effect.ConclusionThe findings suggest that mHealth-based self-management interventions significantly enhance self-efficacy in patients with type 2 diabetes. Improved self-efficacy fosters better self-management, ultimately leading to enhanced health outcomes in patients with diabetes. These interventions provide a valuable tool for patients, particularly those who are unable to attend in-person sessions, to effectively manage their condition and potentially reduce complications associated with diabetes. The integration of mHealth into routine diabetes care can play a critical role in supporting ongoing self-management and improving overall health.

PurposeThe purpose of the study was to evaluate the effectiveness of a nurse-led intervention via the LINE Official Account (OA) application on knowledge, self-care, and clinical outcomes in patients with type 2 diabetes and comorbidities in Thailand.MethodsA cluster 2-arm randomized controlled trial with assessments at baseline, 6 weeks, and 12 weeks was conducted in 2 noncommunicable disease clinics between October 2023 and March 2024. A total of 108 participants were recruited and randomly assigned to either the intervention group (n = 55) or control group (n = 53). Using Orem's Self-Care Deficit Nursing Theory as a conceptual framework, the 12-week intervention included knowledge and behavioral assessment, health education support, and practicing reminder via the LINE OA application. The control group received usual care. Outcomes included knowledge, self-care agency, self-care behaviors, A1C, blood pressure, and microalbuminuria (MAU). Data were analyzed using t-tests, repeated measures analysis of variance, and Cohen's d.ResultsCompared to the control group, at 6 and 12 weeks, participants in the intervention group demonstrated significant improvements in knowledge, self-care agency, and self-care. Clinically significant changes in A1C, blood pressure, and MAU were observed at 12 weeks in the intervention group.ConclusionThe study findings highlight the effectiveness of the nurse-led intervention via LINE OA application in knowledge, self-care, MAU, and A1C improvement. Extended study duration is recommended to assess sustainability for the future study.

PurposeThe purpose of the study was to examine the relationship between diabetes distress and various factors with patient activation among adults with type 2 diabetes.MethodsLinear and nonlinear relationships were evaluated using hierarchical polynomial regression models. Diabetes distress was measured using the Diabetes Distress Scale (DDS-17), with its 4 subscales, including emotional burden and regimen-, physician-, and interpersonal-related distress. Patient activation was measured using the Patient Activation Measure (PAM-13).ResultsThere was a weak linear association between total DDS-17 and PAM-13 scores (R² = 2.8%, P = .003). Across all subscales, results revealed robust quadratic trends that accounted for large increases in variance above and beyond linear trends (R²s = 8.6%-23.0%, Ps < .001).ConclusionsResults indicate a robust U-shaped relationship between diabetes distress and patient activation. These findings have the potential to inform treatment approaches for individuals with moderate to high diabetes distress and/or low patient activation.

Purpose: The purpose of the study was to examine the cross-lagged longitudinal associations between social isolation and cognitive function among older adults with diabetes and to investigate the mediating role of systemic inflammation in these associations.

Methods: Secondary data from the Health and Retirement Study were utilized across 3 waves (2006, 2010, and 2014). To examine the longitudinal relationships between social isolation and cognitive function, a cross-lagged panel modeling approach was employed, with particular attention to the mediating role of C-reactive protein. A sequential predictor procedure was used; initially, only social isolation and cognitive function were analyzed; subsequently, sociodemographic covariates were controlled for; and finally, health-related covariates were added.

Results: Data from 1336 older adults with diabetes in the United States were analyzed. In the partially adjusted model, reciprocal negative associations between social isolation and cognitive function were identified. However, these reciprocal negative associations were no longer statistically significant after accounting for health-related covariates. C-reactive protein did not serve as a mediator in the link between social isolation and cognitive function regardless of adjustments for covariates.

Conclusion: Given the reciprocal associations between social isolation and poorer cognitive function, a feedback loop may exist between these 2 factors. It is crucial to identify mediating mechanisms to disrupt this vicious cycle.

PurposeThe purpose of this study is to assess the effects of an intensive telehealth intervention on technology adoption and glycemic control in historically marginalized youth with diabetes mellitus on Medicaid.MethodsThis quality improvement project included youth (ages 12-18) with diabetes utilizing insulin therapy. Eligible participants were diagnosed at least 12 months prior to enrollment and had an A1C ≥9%, Medicaid insurance, and willingness to use a continuous glucose monitor (CGM) and an insulin pump. Participants received scheduled weekly contact (phone/video) with a certified diabetes care and education specialist and monthly video visits with a nurse practitioner.ResultsYouth (N = 18, 61% female, 78% non-White, diabetes duration 4.6±3 years) had baseline mean A1C of 11.4% ± 2.0%; 22% were on pump therapy. There was a sustained improvement between baseline A1C (mean 11.4% ± 2.0%) and 3 months (mean 10.5% ± 2.7%; P = .01) and 6 months (mean 9.8% ± 2.4%, 83.6 mmol/mol; P = .003). Significantly more participants used pump therapy by the end (n = 16) compared to baseline (n = 4; P < .0001). Participants wore CGMs more at 3 (P = .04) and 6 months (P = .0004) during the intervention compared to 3 and 6 months prior.ConclusionsThis telehealth intervention provided interim improvement in A1C and increased adoption of diabetes technology in a low socioeconomic status cohort from a historically marginalized population. Ongoing monitoring is needed to evaluate the durability of this intervention.