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

Purpose: The purpose of this study was to explore self-reported diabetes management strategies, social determinants of health (SDOH), and barriers to care among people with diabetes receiving care in a safety-net setting to identify factors contributing to disparities in outcomes for Black and Hispanic adults and inform future interventions.

Methods: Sequential, explanatory, mixed methods study comprised a survey of adults with diabetes seen in primary care at a safety-net hospital in New England, followed by qualitative semistructured interviews with a subset of the Black and Hispanic respondents. Descriptive statistics, chi-square and t tests were used to analyze quantitative data. The health equity implementation framework was used to guide qualitative data collection and directed content analysis.

Results: A total of 496 respondents completed the survey; 48 Black and Hispanic adults participated in interviews. Diabetes-related distress was significantly higher among Black and Hispanic participants compared to White participants. Nutrition management use was significantly lower among Black and Hispanic participants. Qualitative findings suggest that SDOH and lack of education and support, specifically, nutrition and access to self-management resources, contributed to diabetes-related distress and prevented optimal self-management.

Conclusions: High rates of diabetes-related distress and low rates of nutrition management were identified in Black and Hispanic adults in a safety-net setting. Qualitative interviews demonstrated a relationship between adverse SDOH and lack of nutrition education with diabetes distress and challenges to self-management, potentially contributing to disparities in outcomes. Findings suggest that increased uptake of nutrition therapy and self-management education and support may be critical for improving diabetes outcomes and promoting health equity.

Purpose: The purpose of the study was to identify the most common reasons for and timing of continuous glucose monitoring (CGM) attrition in youth with type 1 diabetes (T1DM).

Methods: This single center retrospective chart review included youth with T1DM <22 years seen between November 1, 2021, and October 31, 2022. Data were gathered from CGM cloud-based software and the electronic medical record.

Results: Among 2663 youth, 88.3% (n = 2351) actively used CGM, and 5.9% (n = 311) had CGM attrition. Those who discontinued CGM were older (17.0 vs 14.9 years, P = .0001), had a longer T1DM duration (7.4 vs 5.1 years), higher A1C (9% vs 7.4%), and were non-Hispanic Black (NHB; 34.0% vs 11.5%). The odds of CGM attrition were 5.0 and 2.8 times higher in NHB and Latine youth, respectively, compared to non-Hispanic White youth. Median time to CGM discontinuation was 4 months, 21 days after initiation; 57% of youth who discontinued did so in the first 6 months of use. The most common reasons for CGM attrition were problems with device adhesion (18.4%), dislike device on the body (10.8%), insurance problems (9.5%), pain with device use (8.3%), and system mistrust due to inaccurate readings (8.2%). NHB and Latine youth were more likely to discontinue CGM due to insurance problems (3.2% vs 15.1% vs 16.7%).

Conclusions: To support equitable, uninterrupted CGM use, education at CGM initiation should address practical approaches to improve adhesion and wearability and provide a clear pathway to obtaining supplies. Interventions to support sustained CGM use should occur within the first 6 months of initiation.

Purpose: The purpose of this study was to assess current knowledge, attitudes, and practices regarding hearing impairment and screening referrals in patients with diabetes among providers who have a Certified Diabetes Care and Education Specialist (CBDCE) Certification.

Methods: A cross-sectional survey created through Qualtrics was emailed to health care providers in the United States with CDCES certification. Providers responded regarding knowledge and importance of hearing impairment compared to other diabetes complications, when they would refer a patient to an audiologist, the percentage of patients referred, and awareness of over-the-counter hearing aids. Descriptive statistics were calculated for all questionnaire items.

Results: One thousand four hundred and ninety-five CDCES providers completed the survey. Participants selected the most common conditions associated with diabetes as kidney dysfunction (96.7%), retinopathy (96.5%), obesity (95.6%), and foot infection (94.5%); 44.5% chose hearing impairment. Over 60% of providers were not familiar with how to refer patients to an audiologist and acknowledged being unfamiliar with recommended screening frequency as the most common barrier. Most providers had referred fewer than 20% of patients to an audiologist. Over half of providers were not aware of over-the-counter hearing aids.

Conclusion: Among a national sample of health care providers with comprehensive knowledge in diabetes care, many providers do not associate hearing impairment with diabetes and rate other microvascular complications of higher importance.

Purpose: The purpose of the study was to examine the extent to which adults with diabetes engage in self-management practices to lower their blood glucose levels and determine factors associated with these engagements.

Methods: The study analyzed data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). The sample included 1171 adults ages 20 and older with a laboratory A1C level of 6.5% or greater. The statistical analyses used included descriptive, chi-square, and logistic regression.

Results: The study revealed that 36% of participants used insulin, and 28% visited a diabetes specialist yearly. Additionally, 68% took medication to lower blood glucose, and 65% monitored their blood glucose daily. Although 86% checked their A1C level annually, only 14% adhered to a diabetes diet plan. A small percentage of respondents (11%) reported engaging in recreational activities at least 5 days a week. The engagement of American adults with diabetes in self-management practices is associated, to varying extents, with the type of diabetes diagnosis, diabetes status, and social determinants of health in adults with diabetes.

Conclusion: The recommended self-management practices among adults with diabetes in the United States are not fully embraced and are associated with several factors. Study findings also indicated that the numbers of undiagnosed and dated-diagnosed diabetes as prediabetes continue to be a problem.

Purpose: The purpose was to identify trajectories of medication taking among patients with diabetes and investigate correlates of these trajectories using the information-motivation-behavioral skills (IMB) model.

Methods: This study employed a descriptive correlational, longitudinal design using convenience sampling. The participants were 96 adults with diabetes from an outpatient diabetes clinic at a university-affiliated hospital. Medication taking was assessed at 3 time points: baseline, 6 months, and 12 months. At baseline, study variables based on the IMB model were measured: medication knowledge (information), motivational readiness and social support (motivation), and medication self-efficacy (behavioral skills). Group-based trajectory modeling was used to identify medication-taking trajectories, and multinomial logistic regression was used to assess factors associated with medication-taking trajectories.

Results: Three distinct medication-taking trajectory groups were identified: "high medication taking," "increasing medication taking," and "low medication taking." Higher medication knowledge was associated with the high and increasing medication-taking trajectory groups. Motivational readiness was associated with the high and increasing medication-taking groups. In contrast, higher medication self-efficacy was associated only with the high medication-taking group, not with the increasing and low medication-taking groups.

Conclusions: The findings suggest that knowledge, motivational readiness, and self-efficacy are essential in IMB model-based intervention strategies across dynamic medication-taking patterns to enhance medication taking. Health care providers can help patients with diabetes improve medication taking by understanding their medication-taking trajectories and their correlates. Strategies that enhance medication self-efficacy are essential for patients in the increasing and low medication-taking groups.

Purpose: The purpose of the study was to explore factors surrounding management of simultaneous dietary recommendations for heart failure and type 2 diabetes among patient-caregiver dyads.

Methods: Qualitative description was used to explore dyad experiences managing a dual diet. Semi-structured interviews were conducted with patients with a concurrent diagnosis of type 2 diabetes and heart failure and their family caregiver. Each 60-minute interview was conducted virtually. Interviews were audio recorded and transcribed verbatim. Thematic analysis was conducted with coding used for themes at dyadic-and individual levels.

Results: Twelve patient-caregiver dyads (N = 24) were interviewed. The mean age was 57 years (±15 years). Most participants were white (75%); patients were predominantly male, and caregivers were predominantly female (83.3% for both). Dyadic-level themes that emerged included factors that influence simultaneous management of dual diet recommendations. Themes included shared barriers, facilitators, motivators, and strategies for dual diet management. Individual-level themes discussed by patients were barriers and motivators to dual diet management, and caregivers discussed barriers to supporting dual diet management.

Conclusions: Findings from the study highlight that patients and caregivers often work together and share similar barriers, facilitators, motivators, and strategies for adhering to a dual diet. The results provide insight into chronic disease management at the family level and can guide health care providers' efforts to promote family involvement with dietary recommendations for patients with multiple comorbidities.

Purpose: The purpose of the study was to describe the development and feasibility of implementing the DM-BOOST program in support of an established diabetes self-management education and support (DSMES) program.

Methods: A patient panel of 4 adults with type 2 diabetes (T2DM) codesigned DM-BOOST. DM-BOOST is a patient-focused program that includes peer-written text messages about diabetes self-management behaviors and digital health training to improve patient portal use and initiate goal setting prior to a scheduled DSMES appointment. Adults with T2DM and A1C ≥8.0% participated in a 6-month feasibility pilot. Participants were randomly assigned (1:1) to receive either DM-BOOST or usual care. Outcomes included DSMES engagement (scheduled and attended DSMES appointments) and changes in diabetes self-efficacy and treatment satisfaction.

Results: Pilot participants (n = 60) were 60.0% female with mean age 45.5 years (SD 8.3) and A1C 10.1% (SD 1.8%). All DM-BOOST participants (30/30, 100%) had DSMES appointments scheduled compared to 86.7% of usual care (26/30). DM-BOOST participants had fewer DSMES appointment no-shows/cancellations (3/30, 10%) compared to usual care (10/26, 35%). There was greater improvement in diabetes self-efficacy in the DM-BOOST group compared to usual care and no difference in treatment satisfaction.

Conclusions: DM-BOOST, leveraging peer-written text messaging and digital health training, increased DSMES engagement. Implementation of DM-BOOST was determined to be feasible, with several system-level barriers identified, including obtaining provider referrals and scheduling appointments. An effectiveness trial of DM-BOOST is needed to evaluate the impact on clinical outcomes.

Purpose: The purpose of the study was to determine the rate of diabetes self-management education and support (DSMES) utilization among Medicare fee-for-service (FFS) and Medicare Advantage (MA) populations with type 2 diabetes in Arkansas.

Methods: The Arkansas All-Payer Claims Database was used to identify Medicare FFS and MA beneficiaries diagnosed with type 2 diabetes from 2015 to 2018. Claims from 2013 to 2020 were analyzed to determine newly diagnosed individuals from 2015 to 2018. The criteria included 1 outpatient diabetes claim in the index year and at least 1 inpatient or outpatient claim in the 2 years following the initial claim. A total of 15 648 Medicare FFS individuals and 7520 MA individuals with newly diagnosed type 2 diabetes were identified. The use of DSMES 1 year following the diagnosis dates for both Medicare FFS and MA populations was assessed. Descriptive statistics and multiple logistic regression analyses were conducted to understand the factors associated with DSMES utilization.

Results: DSMES utilization consistently remained lower in the MA population compared to Medicare FFS (2.3% vs 4.9%). The adjusted analysis indicated that factors such as older age, living in a rural area, belonging to a racial group other than White, and MA enrollment were associated with a lower likelihood of receiving DSMES.

Conclusions: DSMES utilization in Arkansas, where the prevalence of diabetes is higher than the national average, is notably low. There is a need for coordinated efforts at various levels to enhance access to DSMES.

Purpose: The purpose of the study was to assess self-efficacy among adolescents with type 1 diabetes mellitus and to identify its contributing factors using a new measure based on the International Society for Pediatric and Adolescent Diabetes Guidelines: the Type 1 Diabetes Mellitus Self-Efficacy Scale (T1DM-SES).

Method: A descriptive, cross-sectional design was used to collect data from 161 adolescents ages between 12 and 18 via an online questionnaire survey, including demographic and management-related variables and the 21 items of T1DM-SES.

Results: Results demonstrated that adolescents had high self-efficacy levels regarding the basic needs to manage their diabetes and relatively moderate and low levels regarding more sophisticated needs, such as adjusting insulin dose to correct fluctuated glucose levels, covering carbohydrates, and managing ketoacidosis at home. Adolescent females and adolescents who have working mothers or caregivers demonstrated higher levels of self-efficacy, whereas adolescents who have another family member with T1DM reported lower levels.

Conclusion: Assessing adolescents' self-efficacy using evidence-based measures is crucial for informing health education plans. There should be a greater focus on acquiring the advanced knowledge and skills necessary for adolescents to manage the constantly evolving challenges of diabetes management. Access to health care and sufficient health insurance coverage that encompasses modern technology are fundamental for the effective management of T1DM.