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

PurposeThe purpose of this study was to assess the psychosocial status of people with diabetes and their perceived quality of received health care services in a local outpatient center in Santo Domingo, Dominican Republic.MethodsCross-sectional study that included 385 Dominican adults with diabetes. Demographic and clinical information was collected. Key psychometric indicators were collected by using the WHO-5 Well-Being Index, EuroQol-5D Visual Analogue Scale (EQ-VAS), Problem Areas in Diabetes Scale, Summary of Diabetes Self-Care Activities, and Patient Assessment of Chronic Illness Care.ResultsThe mean EQ-VAS score was 77.6 (SD 18). Of all the participants, 18.7% exhibited symptoms of depression, with higher rates among women and younger age groups. Diabetes-related distress was present in 22.6% of participants, particularly among younger individuals and those employed. Physical activity was the self-care activity with the lowest reported adherence. Perceptions of received health care services aligned moderately with the chronic care model (CCM), with a higher perceived alignment in patients that were enrolled in a chronic disease management program.ConclusionsPatients with diabetes report having a reduced quality of life and significant psychological burdens, with a high rate of depressive symptoms and diabetes-related distress and a low adherence to self-care behaviors. The enrollment in chronic disease management programs improved patients' perception of received health care services, reporting a more coordinated care and experiencing more patient activation, which could improve health outcomes. These findings underline the need for psychological screening, patient-centered care, and broader implementation of the CCM to improve health outcomes in this population.

PurposeThe purpose of this study was to introduce and validate a minimally time-consuming method for regular, ongoing assessments of practice- and individual-level outcomes in a rural diabetes self-management education and support (DSMES) program.MethodsThe method involves a report developed within an electronic health record system to capture the initial A1C data of patients in the program and their most recent A1C data at the time the report is run. To validate the method's ability to continuously assess outcomes, 3 retrospective pre-post studies were conducted over 3 consecutive months: October, November, and December 2023. The subjects were individuals with type 2 or type 1 diabetes who completed their initial visits in the program during these months. A1C changes in patient cohorts and their statistical significance were analyzed as practice-level outcomes, and individual-level outcomes were monitored by plotting and analyzing patient data.ResultsThe report accurately captured data, enabling minimally time-consuming analyses. The method allowed both continuous assessment of program effectiveness based on A1C changes and monitoring of individual patient progress. Statistically significant reductions in average A1C were observed for subjects seen in October and December 2023 (but not in November) and across the combined data from all 3 months. Data plotting helped identify individual subjects who may benefit from follow-up.ConclusionsThe method is feasible and accurate for ongoing outcome assessments, providing timely feedback to clinicians and promoting practice changes to improve patient outcomes. It is also flexible and adaptable to other DSMES programs.

PurposeThe purpose of this study was to explore the barriers and facilitators to taking medication in newly diagnosed patients with type 2 diabetes (T2DM) at each stage of change from the perspective of the Transtheoretical model.MethodsThis qualitative descriptive study used purposive sampling to select 32 newly diagnosed patients with T2DM, with 8 representing each of the 4 stages of change (precontemplation, contemplation, preparation, and action). Participants were recruited at a community health service center in Sichuan Province, China. Semistructured interviews were conducted, and data were transcribed and analyzed using qualitative content analysis.ResultsThis study identified barriers and facilitators related to the patient, medication, health care service, and sociocultural dimensions. At the precontemplation and contemplation stages, various barriers across different domains predominated (e.g., incomplete comprehension of the disease; gaps in medication knowledge regarding importance, benefits, and indications; limited access to care; preferred traditional and alternative medication approaches). At the preparation and action stages, although patient, medication, health care service, and sociocultural facilitators were more reported (e.g., awareness of medication benefits, health system financial support, peer medication experiences), medication-related barriers persisted (e.g., medication knowledge gaps regarding side effects, adverse reactions, administration procedures, and missed dose management).ConclusionsThe primary barriers to taking medication in newly diagnosed patients with T2DM are medication-related factors, with barriers and facilitators dynamically evolving across the stages of change. Future research should focus on developing and evaluating stage-matched interventions to promote medication-taking behavior and patient well-being.

PurposeThe purpose of this study was to evaluate the impact of a novel diabetes self-management education (DSME) intervention on self-reported behavioral and clinical outcomes.MethodsAdults over the age of 35 with type 2 diabetes mellitus (T2DM) were recruited to participate in a 3-month study to assess the impact of the Live in Control intervention, a 4-week care supporter-integrated DSME program. Forty-nine participants and their care supporters participated in the program in a community setting. A prospective, repeated measure, pretest and posttest research design was employed with assessments at week 0 (W0; baseline), 4 weeks (W4), and 3 months (W12). The primary measures were diabetes-related self-management behaviors, self-efficacy, autonomy support, social support, distress, and A1C.ResultsPaired t-test analyses revealed significant changes in study variables across different time points. The self-management scores significantly improved from W0 to W4 and from W0 to W12. Self-efficacy significantly increased from W0 to W4 and from W0 to W12. Autonomy support significantly increased from W0 to W12, and social support scores significantly improved over the same period. Findings indicate that participants experienced enhanced support for themselves and from their social networks throughout the study. Diabetes-related distress significantly decreased from W0 to W12. Although decreases in A1C were not significant for the total study sample, those with A1C ≥8 had significant decreases from W0 to W12.ConclusionsA care supporter-integrated DSME intervention can favorably impact diabetes self-care, perceived social support, and A1C, especially for those with higher A1C values, suggesting the positive impact of program participation.

ObjectiveThe purpose of the study was to describe the collaborative process of a deaf-hearing research team developing diabetes education videos in American Sign Language (ASL) for deaf and hard of hearing (DHH) populations.MethodsDiabetes education videos were guided by a DHH community advisory board (CAB) who were living with diabetes (N = 10), DHH video production team (N = 9), DHH research team members (N = 3), hearing clinical experts and research team members (N = 3), and a hearing designer (N = 1). Over 10 meetings, the CAB provided ongoing feedback to enhance video content and design. Videos were then developed using a rigorous 5-step process that involved script development, design of visual supports, script translation into ASL by native signers, video recording, and video editing. Interviews with individual CAB members were obtained to understand future video needs.ResultsUsing a design thinking and collaborative approach between deaf-hearing team members, 20 diabetes education videos were designed to prioritize ASL and DHH culture while still being inclusive for hearing family members who may not know ASL. The videos met the WebAIM guidelines for accessibility. CAB members rated the videos positively.ConclusionsThe diabetes education videos in ASL fill an existing void in diabetes education for DHH populations and are still being evaluated in the Deaf Diabetes Can Together intervention and will be placed on a future diabetes education website in ASL. This article highlights key details of developing diabetes education videos using a deaf-hearing team that future studies could learn from.

Purpose: The purpose of this study was to investigate adolescent perspectives of parent-adolescent communication, type 1 diabetes mellitus (T1DM)-specific family conflict, self-efficacy, and their relationship to adolescent self-management of T1DM.

Methods: A cross-sectional survey design was employed. Adolescents completed measures of parent-adolescent communication, T1DM-specific family conflict, self-efficacy, and self-management, which included activation and division of responsibility for management tasks.

Results: Surveys were completed by 113 adolescents ages 11 to 17 years (mean age 13.85 years, SD 1.78) and living with T1DM for 6 months and longer. Hierarchical multiple regression sought to determine what variables make the most unique contribution to self-management of T1DM, division of family responsibility for management tasks, and activation. Self-efficacy was a significant predictor of division of family responsibility for T1DM management, patient activation, and all self-management subscales except collaboration with parents. Openness in parent-adolescent communication was a significant predictor of the diabetes communication and goals subscale of the self-management measure and activation. Problems in communication was a significant predictor of collaboration with parents and self-management goals.

Conclusions: These findings suggest that family context characteristics, particularly parent-adolescent communication, and self-efficacy are important for engagement with self-management for adolescents living with T1DM. Findings can inform future family-focused self-management interventions to improve T1DM outcomes for adolescents living with T1DM.

Purpose: The purpose of this study was to explore experiences with an interdisciplinary micro-choice-based concentrated group intervention for people with type 2 diabetes.

Methods: A qualitative study with individual semistructured interviews were conducted with 14 adults (8 women, ages 45-74 years) with type 2 diabetes. Purposive sampling was used, and participants from 3 different intervention groups in the micro-choice-based concentrated group intervention were recruited. Thematic analysis was used for the data analysis.

Results: Three main themes were identified: (1) group intervention tailored to individual needs through friendly and skilled professionals, (2) valuable social interactions and an experience of fellowship, and (3) commitment to change through goal setting and conscious micro-choices. The participants described a readiness for change that was met by important knowledge from skilled professionals in the concentrated intervention. They reported that new knowledge, particularly about micro-choices and the focus on how insulin works in the body, led to change in their awareness and self-management. The concentrated group intervention was a preferred setting that contained a sense of community without compromising on meeting individual needs. Participants described internalized changes after the intervention and a willingness to adhere to changes necessary for their self-management.

Conclusion: Study findings showed that a micro-choice-based concentrated group intervention for people with type 2 diabetes can be a valuable approach contributing to improved patient activation and diabetes self-management. The findings underpin the importance of increased diabetes knowledge and support from an interprofessional team to bring about significant changes in everyday life.

Purpose: The purpose of the study was to test the effectiveness of a nurse-led mobile phone intervention (NMPI) on glycemic variability and self-management among people living with type 2 diabetes (T2DM) in Ghana.

Methods: In this randomized controlled trial, the intervention group received a 3-month NMPI program plus standard care, and the control group received standard care alone in a tertiary health care setting. Ninety-eight participants (baseline A1C > 7%) were randomized 1:1 to either NMPI or standard care group. The primary study outcomes were changes in A1C testing and self-management assessed using the Summary of Diabetes Self-Care Activities tool at baseline and end of the study.

Results: The intervention group had statistically significant improvement in their mean A1C level from baseline to the end of the study. In comparison, the control group also had improvement in their mean A1C level but was not statistically significant. Consistently, the intervention participants had better statistically significant improvements in self-management behaviors than the control group. There was a medium, negative correlation between A1C changes and overall self-care changes for the intervention group, whereas that of the control group was smaller.

Conclusions: Study findings have shown that a tailored NMPI program in addition to standard care could improve glycemic variability and self-management among people living with poorly managed T2DM in Ghana better than standard care alone.

Purpose: The purpose of the study was to explore the facilitators and barriers of health behaviors in patients with type 2 diabetes (T2D), providing a reference for the development of health behavior interventions programs.

Methods: A qualitative descriptive research design was adopted, and interviews were conducted with 25 patients with T2D. The interview guide was developed based on the health action process approach theory. The interviews were audio-recorded and transcribed verbatim. Data analysis was performed using thematic analysis.

Results: Through the analysis of interview data, 2 main themes were identified: facilitators and barriers of health behaviors, comprising 18 subthemes. The facilitators included self-efficacy, outcome expectations, risk perception, intention, action planning, coping planning, emotional regulation, proactive and sustained sense of responsibility, and multidimensional social support. The barriers included insufficient disease awareness, insufficient self-control, impact of social activities, low self-efficacy, accessibility of personal conditions, lack of problem-solving skills, lack of disease management knowledge, lack of social support, and cognitive decline.

Conclusions: When designing health behavior intervention programs for patients with T2D, it is crucial to consider both facilitators and barriers to enhance the effectiveness of the interventions to encourage patients to adopt healthy lifestyles, improve their quality of life, and reduce the occurrence of complications.

Purpose: The purpose of this study is to examine whether food insecurity increases risk for depressive symptoms among adults with diabetes. Food insecurity is associated with depression in the general population. However, minimal research has examined this relationship among persons with diabetes.

Methods: Adults with diabetes were identified from the 2022 National Health Interview Survey. Depressive symptoms were assessed by the 8-item Patient Health Questionnaire. Food insecurity status was measured with the USDA 10-item food insecurity scale. Participants were categorized as food secure, low food security, and very low food security. The association between food insecurity and depressive symptoms was examined using weighted logistic regression, adjusting for potentially influential covariates (age, sex, ethnicity, poverty to income ratio, education, diabetes type, body mass index, region, and general health).

Results: Among 2595 persons with diabetes, nearly one third (29.8%) reported symptoms of depression. Over one tenth (11.7%) had low or very low food security. Persons who had low or very low food security were more than twice as likely to report depressive symptoms (adjusted odds ratio [AOR] = 2.15, 95% CI, 1.39-3.32; AOR = 3.84, 95% CI, 2.28-6.45, respectively). Persons who were older, had higher income, and better general health were less likely to report depressive symptoms.

Conclusions: Among adults with diabetes, low or very low food security was associated with increased risk for depressive symptoms. Further research is needed to evaluate the relationship between food insecurity and depressive symptoms among persons with diabetes.