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Funnell MM. What is new in diabetes care and self-management? Nursing 2023; 53:10-11. [PMID: 37856291 DOI: 10.1097/01.nurse.0000978884.53092.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Affiliation(s)
- Martha M Funnell
- Martha M. Funnell is a Research Scientist Emerita with the Department of Learning Health Sciences at the University of Michigan Medical School in Ann Arbor, Mich
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Feldhacker DR, Ikiugu MN, Fritz H, Schweinle WE, Wang H. Habit Formation Intervention to Improve Type 2 Diabetes Self-Management Behaviors: A Feasibility Study. Am J Occup Ther 2023; 77:7706205100. [PMID: 37994806 DOI: 10.5014/ajot.2023.050351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
IMPORTANCE Self-management of lifestyle behaviors is the recommended focus for interventions to address Type 2 diabetes. Habit formation is an effective approach to changing personal behaviors, but evidence of success for Type 2 diabetes is limited. OBJECTIVE To examine the feasibility and preliminary effectiveness of occupation-based habit formation interventions for improving diabetes self-management behaviors. DESIGN Single-subject design with multiple participants providing 4 wk of baseline data followed by 10 wk of intervention data. SETTING Individual telehealth sessions. PARTICIPANTS Eight adults (ages 29-75 yr) with Type 2 diabetes, who had access to a telephone and who were not involved in other diabetes-related education or interventions voluntarily, enrolled into the study. INTERVENTION Participants engaged in 10 wk of habit formation intervention focused on four diabetes self-management domains: nutrition, blood glucose monitoring, medication management, and physical activity. OUTCOMES AND MEASURES Data gathered included findings on measures of diabetes self-care behaviors and habit formation. RESULTS There was a significant change in self-care behaviors for 6 of the 8 participants (p < .05 for 1 participant, and p < .01 for 5 participants). Group changes were statistically significant (p < .001). Habit strength significantly improved for all areas of diabetes self-management (p < .001 for nutrition, blood glucose monitoring, and medication management and p = .001 for physical activity). CONCLUSIONS AND RELEVANCE Findings suggest that the occupation-based intervention was feasible and showed promise for developing self-management behaviors. What This Article Adds: Habits are considered foundational to occupations, yet application of the science of habit formation is often not well understood by occupational therapists. This study considered the theoretical components of habit formation that have been neglected by prior studies and demonstrates the feasibility and preliminary effect estimates of a habit formation intervention when used with people with Type 2 diabetes.
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Affiliation(s)
- Diana R Feldhacker
- Diana R. Feldhacker, PhD, OTD, OTR/L, BCPR, is Founding Program Director and Chair, Department of Occupational Therapy, Des Moines University, Des Moines, IA;
| | - Moses N Ikiugu
- Moses N. Ikiugu, PhD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, University of South Dakota, Vermillion
| | - Heather Fritz
- Heather Fritz, PhD, OTR/L, CHC, is Founding Program Director, School of Occupational Therapy, Pacific Northwest University, Yakima, WA
| | - William E Schweinle
- William E. Schweinle, PhD, is Professor, Department of Physician Assistant Studies, University of South Dakota, Vermillion
| | - Hongmei Wang
- Hongmei Wang, PhD, is Associate Professor, Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha
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Salunkhe VA, Sinha N, Ahlqvist E, Prasad RB, Johansson S, Abrahamsson B, Rosengren AH. Digital lifestyle treatment improves long-term metabolic control in type 2 diabetes with different effects in pathophysiological and genetic subgroups. NPJ Digit Med 2023; 6:199. [PMID: 37884680 PMCID: PMC10603160 DOI: 10.1038/s41746-023-00946-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
To address the unmet need for scalable solutions for lifestyle treatment, we developed a new digital method to promote behavioral change. Here we report that patients with type-2 diabetes in Sweden (n = 331) exposed to the intervention have significantly improved HbA1c during a median follow-up of 1038 days (4 mmol/mol compared with matched controls; P = 0.009). This is paralleled by reduced body weight, ameliorated insulin secretion, increased physical activity, and cognitive eating restraints. Participants with high BMI and insulin resistance have an even larger response, as have non-risk allele carriers for the FTO gene. The findings open a new avenue for scalable lifestyle management with sustained efficacy and highlight a previously unrecognized opportunity for digital precision treatment based on genetics and individual pathophysiology. ClinicalTrials.gov NCT04624321.
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Affiliation(s)
- Vishal A Salunkhe
- Department of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Neha Sinha
- Department of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Emma Ahlqvist
- Lund University Diabetes Centre, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Rashmi B Prasad
- Lund University Diabetes Centre, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | | | - Birgitta Abrahamsson
- Department of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Anders H Rosengren
- Department of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
- Region Skåne, Kristianstad, Sweden.
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Pettersson S, Klompstra L, Jirwe M, Jaarsma T. Developing a Culturally Appropriate Tool to Support Self-Care in Migrants with Type 2 Diabetes - A Co-Design Study. Patient Prefer Adherence 2023; 17:2557-2567. [PMID: 37854029 PMCID: PMC10581012 DOI: 10.2147/ppa.s426908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/08/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Migrants, especially from the Middle East, experience poorer health outcomes and face greater difficulties in accessing healthcare compared to native populations and there is a need for culturally appropriate education for this vulnerable group. The purpose of this study is to describe the process of developing a culturally appropriate tool to support self-care in migrants with type 2 diabetes. Methods In this Co-design study, a tool for supporting self-care in migrants with type 2 diabetes was developed. Migrant patients with type 2 diabetes, healthcare providers and researchers participated in the process, which was based on six elements; engage, plan, explore, develop, decide and change. From February 2021 to December 2022, idea groups were conducted, and a tool was developed through brainstorming, prioritizing and prototyping. Results In total, 14 migrant patients, ten health care providers and four researchers participated in the Co-design process. The patients wished to receive information about type 2 diabetes self-care behaviour in their own languages. The healthcare providers asked for clear instructions on where to guide their patients regarding reliable information about diabetes in the patient's own language. All participants agreed that information can be presented in different formats, either: text (paper or online), audio-visual via recorded videos and/or lectures and pictures. Discussion The Co-design process led to several important insights and experiences related to the importance of diverse cultural backgrounds. When conducting a Co-design study with end-users as stakeholders, it is significant that the stakeholders have a diverse background in experiences, both as patients as well as those who deliver or implement the health service. In this study it was of great importance to include patients with diverse backgrounds regarding; gender, age, health literacy, occupation, years living in Sweden and duration of diabetes.
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Affiliation(s)
- Sara Pettersson
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
| | - Leonie Klompstra
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
| | - Maria Jirwe
- Red Cross University College, Department of Health Sciences, Huddinge, Sweden
| | - Tiny Jaarsma
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
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Tokunaga-Nakawatase Y, Aomori M, Watabe S. Lifestyle behaviors that reduce food and fat intake in patients with type 2 diabetes within 3 months of diagnosis lead to a reduction in the HbA1c level after 12 months. Diabetol Int 2023; 14:413-421. [PMID: 37781461 PMCID: PMC10533453 DOI: 10.1007/s13340-023-00650-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/05/2023] [Indexed: 10/03/2023]
Abstract
It is important to provide "Diabetes Self-Management Education and Support," the ongoing process of facilitating the knowledge, skills, and ability necessary for diabetes self-care, immediately after diagnosis. In this 12-month (12 M) longitudinal observational study, outpatients within 3 months of their first diagnosis of type 2 diabetes mellitus (T2DM) were surveyed at baseline (BL) and 12 M using a self-administered questionnaire used in the "Lifestyle Intervention Support Software for Diabetes Prevention" and medical record survey. To explore factors associated with the change extent in HbA1c level during the 12 M post-diagnosis, hierarchical multiple regression analysis was performed with sex, age, HbA1c level at BL, medication in the first 12 M post-diagnosis, and lifestyle behaviors related to diet and exercise therapy as independent variables. The HbA1c level of the 89 participants was 8.4% ± 2.2% at BL and 6.7% ± 1.0% at 12 M. "ND06 I add milk to coffee or tea (reverse item)" (β = -0.110, p = 0.015), "RD15 I eat vegetable dishes such as a vegetable side dish and/or a vinegar or pickle dish" (β = 0.151, p = 0.003), "ND02 I eat until I feel full (reverse item)" (β = -0.115, p = 0.024), and "RD14 I select udon or soba instead of Chinese noodles in soups" (β = -0.113, p = 0.007) were associated with the change extent in the HbA1c level during the 12 M post-diagnosis. Overall, it may be useful to support patients with T2DM early post-diagnosis to improve lifestyle behaviors associated with the extent of change in HbA1c level during the 12 M post-diagnosis.
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Affiliation(s)
- Yuri Tokunaga-Nakawatase
- Department of Nursing, Faculty of Health Sciences, Kyorin University, 5-4-1Shimorenjyuku, Mitaka, 181-8612 Tokyo, Japan
- Department of Adult Nursing, Nursing Course, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-Ku, 236-0004 Yokohama, Japan
| | - Maki Aomori
- Department of Adult Nursing, Nursing Course, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-Ku, 236-0004 Yokohama, Japan
| | - Setsuko Watabe
- Department of Adult Nursing, Nursing Course, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-Ku, 236-0004 Yokohama, Japan
- Department of Nursing, Faculty of Medical Sciences, Shonan University of Medical Sciences, 3-9 Kamishinano, Totsuka-Ku, Yokohama, 244-0806 Japan
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Thomas OW, McManus CR, Badaracco C, MacLaren J, Mason A, McWhorter JW. Registered Dietitian Nutritionists Taking the Lead in Teaching Kitchens. J Acad Nutr Diet 2023; 123:1393-1405. [PMID: 37453534 DOI: 10.1016/j.jand.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/21/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Olivia W Thomas
- Department of Food and Nutrition, Boston Medical Center, Boston, Massachusetts
| | | | | | - Julia MacLaren
- Wellness Centre, South Health Campus, Alberta Health Services, Calgary, Alberta, Canada; Community Health Sciences, University of Calgary, Calgary Alberta, Canada
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Todd S, Reagan L, Laguerre R. Health Literacy, Cognitive Impairment, and Diabetes Knowledge Among Incarcerated Persons Transitioning to the Community: Considerations for Intervention Development. JOURNAL OF FORENSIC NURSING 2023; 19:262-270. [PMID: 35482339 DOI: 10.1097/jfn.0000000000000396] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the relationships of health literacy (HL; Short Test of Functional Health Literacy), cognitive impairment (CI), and diabetes knowledge (DK) among incarcerated persons transitioning to the community. METHODS Using preintervention data from a quasi-experimental nonequivalent control group study evaluating the feasibility of a six-session literacy-tailored Diabetes Survival Skills intervention for incarcerated men transitioning to the community, we conducted correlational analyses among the Short Test of Functional Health Literacy, Montreal Cognitive Assessment, and Spoken Knowledge in Low Literacy in Diabetes Scale using the SPSS PROCESS macro and bias-corrected bootstrapping to test the meditational hypothesis: HL mediates the relationship between CI and DK. RESULTS Participants ( N = 73) were incarcerated for 1-30 years with a mean age of 47 (9.9) years, 40% Black, 19% White, and 30% Hispanic, with 78% having high school/GED or less education. Most (70%) screened positive for CI and had low DK, and 20% had marginal or inadequate HL. HL, CI, and DK were positively associated with each other. Controlling for race, age, and group (control/experimental), cognitive function had a significant direct effect on HL ( b = 0.866, p = 0.0003) but not on DK ( b = 0.119, p = 0.076). Results indicated a significant indirect effect of cognitive functioning on DK via HL, 95% confidence interval [0.300, 0.1882]. CONCLUSION Intervention approaches aimed at increasing HL or tailored to low HL in the presence of CI may be effective in increasing DK in this population. IMPLICATIONS Given the low risk to high benefit of implementing literacy-tailored approaches to persons in prison and the population demographics from studies supporting a high degree of CI, nurses should consider implementing literacy-tailored approaches and screening for CI before participation in all educational programs.
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Affiliation(s)
| | | | - Rick Laguerre
- Department of Psychological Sciences, University of Connecticut
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Harris K, Jackson J, Webster H, Farrow J, Zhao Y, Hohmann L. Mindfulness-Based Stress Reduction (MBSR) for Chronic Pain Management in the Community Pharmacy Setting: A Cross-Sectional Survey of the General Public's Knowledge and Perceptions. PHARMACY 2023; 11:150. [PMID: 37736922 PMCID: PMC10514835 DOI: 10.3390/pharmacy11050150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023] Open
Abstract
Patient access to mindfulness-based stress reduction (MBSR), a complementary and integrative health approach that is proven to reduce chronic pain, can be increased via community pharmacy-based implementation. However, the general public's awareness and preferences regarding MBSR as a treatment option for chronic pain, including provider roles (pharmacist vs. non-pharmacist), are unclear. Therefore, the purpose of this study was to assess the U.S. general public's knowledge, attitudes, barriers, and programmatic preferences regarding MBSR for chronic pain management, particularly in the community pharmacy setting. A cross-sectional, anonymous online survey was distributed to U.S. adults ≥18 years via the Amazon Mechanical Turk (MTurk) online survey platform. The survey instrument was informed by Anderson's framework for health service utilization. Measures were assessed using multiple-choice and 5-point Likert-type scales (1 = strongly disagree, 5 = strongly agree). Primary outcome measures included: (1) knowledge and awareness of MBSR (12-items); (2) confidence in seeking out MBSR for pain (5-items); (3) barriers to receiving MBSR (11-items); (4) beliefs about MBSR in general (12-items); (5) beliefs about community pharmacy-delivered MBSR (15-items); and (6) preferences for MBSR classes/programs (6-items). Outcomes were analyzed using descriptive statistics, and influential factors associated with mean beliefs regarding community pharmacy-delivered MBSR for chronic pain management were assessed via multiple linear regression. Of the 302 survey respondents, the majority were white (79.1%) and female (50.7%), with a mean age of 44.65 years. Respondents' self-rated MBSR knowledge (mean [SD] scale score: 2.30 [0.68]) and confidence (2.65 [0.87]) were low, although perceived barriers to access were low overall (2.22 [0.53]). Beliefs regarding the use of MBSR for treatment of chronic pain were positive in general (3.67 [0.71]), but more negative regarding community pharmacy-delivered MBSR (2.38 [0.56]). Confidence in seeking out MBSR (β = 0.297, 95% CI = 0.219 to 0.375; p < 0.001) and current opioid use (β = 0.419, 95% CI = 0.147 to 0.690; p = 0.003) were positively associated with beliefs regarding pharmacy-delivered MBSR, while annual household income (β = -0.124, 95% CI = -0.244 to -0.004; p = 0.043) and level of bodily pain (β = -0.149, 95% CI = -0.291 to -0.008; p = 0.039) exerted statistically significant negative influences. Respondents preferred a hybrid MBSR class format including both online and in-person components (29.7%) as well as both group and individual session options (43.7%). In conclusion, further education is necessary to increase the public's perception of community pharmacies as a resource for complementary and integrative health.
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Affiliation(s)
- Klaudia Harris
- Department of Pharmacy Practice, Auburn University Harrison College of Pharmacy, 1330 Walker Building, Auburn, AL 36849, USA
| | - Jazmyne Jackson
- Department of Pharmacy Practice, Auburn University Harrison College of Pharmacy, 1330 Walker Building, Auburn, AL 36849, USA
| | - Holly Webster
- Department of Pharmacy Practice, Auburn University Harrison College of Pharmacy, 1330 Walker Building, Auburn, AL 36849, USA
| | - Jillian Farrow
- Department of Pharmacy Practice, Auburn University Harrison College of Pharmacy, 1330 Walker Building, Auburn, AL 36849, USA
| | - Yi Zhao
- Department of Health Outcomes Research and Policy, Auburn University Harrison College of Pharmacy, 4306 Walker Building, Auburn, AL 36849, USA
| | - Lindsey Hohmann
- Department of Pharmacy Practice, Auburn University Harrison College of Pharmacy, 1330 Walker Building, Auburn, AL 36849, USA
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Litchfield I, Barrett T, Hamilton-Shield J, Moore T, Narendran P, Redwood S, Searle A, Uday S, Wheeler J, Greenfield S. Current evidence for designing self-management support for underserved populations: an integrative review using the example of diabetes. Int J Equity Health 2023; 22:188. [PMID: 37697302 PMCID: PMC10496394 DOI: 10.1186/s12939-023-01976-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/26/2023] [Indexed: 09/13/2023] Open
Abstract
AIMS With numerous and continuing attempts at adapting diabetes self-management support programmes to better account for underserved populations, its important that the lessons being learned are understood and shared. The work we present here reviews the latest evidence and best practice in designing and embedding culturally and socially sensitive, self-management support programmes. METHODS We explored the literature with regard to four key design considerations of diabetes self-management support programmes: Composition - the design and content of written materials and digital tools and interfaces; Structure - the combination of individual and group sessions, their frequency, and the overall duration of programmes; Facilitators - the combination of individuals used to deliver the programme; and Context - the influence and mitigation of a range of individual, socio-cultural, and environmental factors. RESULTS We found useful and recent examples of design innovation within a variety of countries and models of health care delivery including Brazil, Mexico, Netherlands, Spain, United Kingdom, and United States of America. Within Composition we confirmed the importance of retaining best practice in creating readily understood written information and intuitive digital interfaces; Structure the need to offer group, individual, and remote learning options in programmes of flexible duration and frequency; Facilitators where the benefits of using culturally concordant peers and community-based providers were described; and finally in Context the need to integrate self-management support programmes within existing health systems, and tailor their various constituent elements according to the language, resources, and beliefs of individuals and their communities. CONCLUSIONS A number of design principles across the four design considerations were identified that together offer a promising means of creating the next generation of self-management support programme more readily accessible for underserved communities. Ultimately, we recommend that the precise configuration should be co-produced by all relevant service and patient stakeholders and its delivery embedded in local health systems.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Tim Barrett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK
| | - Julian Hamilton-Shield
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 2NT, UK
- The Royal Hospital for Children in Bristol, Bristol, BS2 8BJ, UK
- NIHR Bristol BRC Nutrition Theme, University Hospitals Bristol and Weston Foundation Trust, Bristol, B52 8AE, UK
| | - Theresa Moore
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
- Queen Elizabeth Hospital, Birmingham, B15 2GW, UK
| | - Sabi Redwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Aidan Searle
- NIHR Bristol BRC Nutrition Theme, University Hospitals Bristol and Weston Foundation Trust, Bristol, B52 8AE, UK
| | - Suma Uday
- Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jess Wheeler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
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Ritchie ND, Gurfinkel D, Sajatovic M, Carter M, Glasgow RE, Holtrop JS, Waxmonsky JA, Kwan BM. A Multi-Method Study of Patient Reach and Attendance in a Pragmatic Trial of Diabetes Shared Medical Appointments. Clin Diabetes 2023; 41:526-538. [PMID: 37849523 PMCID: PMC10577507 DOI: 10.2337/cd23-0015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Shared medical appointments (SMAs) are an evidence-based approach to diabetes care in primary care settings, yet practices can struggle to ensure participation, especially among racial and ethnic minority and low-income patients. We conducted a multimethod evaluation of reach and attendance in the Invested in Diabetes study of the comparative effectiveness of two SMA delivery models (standardized and patient-driven) in two practice settings (federally qualified health centers [FQHCs] and clinics serving more commercially insured patients). Through this study, 22 practices reached 6.2% of patients with diabetes through SMAs over 3 years, with good attendance for both practice types and both SMA delivery models. FQHCs were especially successful at enrolling underserved populations and improved attendance with virtual SMAs.
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Affiliation(s)
- Natalie D. Ritchie
- Center for Health Systems Research, Denver Health & Hospital Authority, Denver, CO
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Dennis Gurfinkel
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Martha Sajatovic
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Madelaine Carter
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Russell E. Glasgow
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
- Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jodi Summers Holtrop
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jeanette A. Waxmonsky
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Bethany M. Kwan
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Thielen SC, Reusch JEB, Regensteiner JG. A narrative review of exercise participation among adults with prediabetes or type 2 diabetes: barriers and solutions. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1218692. [PMID: 37711232 PMCID: PMC10499496 DOI: 10.3389/fcdhc.2023.1218692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/02/2023] [Indexed: 09/16/2023]
Abstract
Type 2 diabetes (T2D) has been rising in prevalence over the past few decades in the US and worldwide. T2D contributes to significant morbidity and premature mortality, primarily due to cardiovascular disease (CVD). Exercise is a major cornerstone of therapy for T2D as a result of its positive effects on glycemic control, blood pressure, weight loss and cardiovascular risk as well as other measures of health. However, studies show that a majority of people with T2D do not exercise regularly. The reasons given as to why exercise goals are not met are varied and include physiological, psychological, social, cultural and environmental barriers to exercise. One potential cause of inactivity in people with T2D is impaired cardiorespiratory fitness, even in the absence of clinically evident complications. The exercise impairment, although present in both sexes, is greater in women than men with T2D. Women with T2D also experience greater perceived exertion with exercise than their counterparts without diabetes. These physiological barriers are in addition to constructed societal barriers including cultural expectations of bearing the burden of childrearing for women and in some cultures, having limited access to exercise because of additional cultural expectations. People at risk for and with diabetes more commonly experience unfavorable social determinants of health (SDOH) than people without diabetes, represented by neighborhood deprivation. Neighborhood deprivation measures lack of resources in an area influencing socioeconomic status including many SDOH such as income, housing conditions, living environment, education and employment. Higher indices of neighborhood deprivation have been associated with increased risk of all-cause, cardiovascular and cancer related mortality. Unfavorable SDOH is also associated with obesity and lower levels of physical activity. Ideally regular physical activity should be incorporated into all communities as part of a productive and healthy lifestyle. One potential solution to improve access to physical activity is designing and building environments with increased walkability, greenspace and safe recreational areas. Other potential solutions include the use of continuous glucose monitors as real-time feedback tools aimed to increase motivation for physical activity, counseling aimed at improving self-efficacy towards exercise and even acquiring a dog to increase walking time. In this narrative review, we aim to examine some traditional and novel barriers to exercise, as well as present evidence on novel interventions or solutions to overcome barriers to increase exercise and physical activity in all people with prediabetes and T2D.
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Affiliation(s)
- Samantha C. Thielen
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jane E. B. Reusch
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Ludeman Family Center for Women’s Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Rocky Mountain Regional Department of Veterans Affairs Medical Center (VAMC), Aurora, CO, United States
| | - Judith G. Regensteiner
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Ludeman Family Center for Women’s Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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Dening J, Mohebbi M, Abbott G, George ES, Ball K, Islam SMS. A web-based low carbohydrate diet intervention significantly improves glycaemic control in adults with type 2 diabetes: results of the T2Diet Study randomised controlled trial. Nutr Diabetes 2023; 13:12. [PMID: 37633959 PMCID: PMC10460437 DOI: 10.1038/s41387-023-00240-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/14/2023] [Accepted: 06/29/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND/OBJECTIVES In people with type 2 diabetes mellitus (T2DM), low carbohydrate diets (LCD), defined as 10-<26% total energy intake from carbohydrate, have indicated improved glycaemic control and clinical outcomes. Web-based interventions can help overcome significant challenges of accessibility and availability of dietary education and support for T2DM. No previous study had evaluated a web-based LCD intervention using a randomised controlled trial (RCT) design. The objective of this study was to assess whether a web-based LCD programme provided in conjunction with standard care improves glycaemic control in adults with T2DM. SUBJECTS/METHODS A 16-week parallel RCT was conducted remotely during Covid-19 among the general community, recruiting adults with T2DM not on insulin aged 40-89 years. Participants were randomly assigned (1:1) to standard care plus the web-based T2Diet healthy LCD education programme (intervention) or standard care only (control). The primary outcome was haemoglobin A1c (HbA1c). Secondary outcomes were weight, body mass index (BMI), anti-glycaemic medication, dietary intake, and self-efficacy. Blinded data analysis was conducted by intention-to-treat. RESULTS Ninety-eight participants were enrolled, assigning 49 to each group, with 87 participants (n = 40 intervention; n = 47 control) included in outcome analysis. At 16 weeks, there was a statistically significant between-group difference favouring the intervention group, with reductions in HbA1c -0.65% (95% CI: -0.99 to -0.30; p < 0.0001), weight -3.26 kg (p < 0.0001), BMI -1.11 kg/m2 (p < 0.0001), and anti-glycaemic medication requirements -0.40 (p < 0.0001), with large effect sizes Cohen's d > 0.8. CONCLUSION This study demonstrated that as an adjunct to standard care, the web-based T2Diet programme significantly improved glycaemic control and clinical outcomes in adults with T2DM. In addition, the results highlight the potential to improve access and availability for people with T2DM to achieve glycaemic control and improved health through web-based dietary education and support.
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Affiliation(s)
- Jedha Dening
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia.
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Elena S George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
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Lamptey R, Amoakoh-Coleman M, Djobalar B, Grobbee DE, Adjei GO, Klipstein-Grobusch K. Diabetes self-management education interventions and self-management in low-resource settings; a mixed methods study. PLoS One 2023; 18:e0286974. [PMID: 37450431 PMCID: PMC10348576 DOI: 10.1371/journal.pone.0286974] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/27/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Diabetes is largely a self-managed disease; thus, care outcomes are closely linked to self-management behaviours. Structured self-management education (DSME) interventions are, however, largely unavailable in Africa. AIM We sought to characterise DSME interventions in two urban low-resource primary settings; and to explore diabetes self-management knowledge and behaviours, of persons living with diabetes (PLD). RESEARCH DESIGN AND METHODS A convergent parallel mixed-methods study was conducted between January and February 2021 in Accra, Ghana. The sampling methods used for selecting participants were total enumeration, consecutive sampling, purposive and judgemental sampling. Multivariable regression models were used to study the association between diabetes self-management knowledge and behaviours. We employed inductive content analysis of informants' experiences and context, to complement the quantitative findings. RESULTS In total, 425 PLD (70.1% (n = 298) females, mean age 58 years (SD 12), with a mean blood glucose of 9.4 mmol/l (SD 6.4)) participated in the quantitative study. Two managers, five professionals, two diabetes experts and 16 PLD participated in in-depth interviews. Finally, 24 PLD were involved in four focus group discussions. The median diabetes self-management knowledge score was 40% ((IQR 20-60). For every one unit increase in diabetes self-management knowledge, there were corresponding increases in the diet (5%;[95% CI: 2%-9%, p<0.05]), exercise (5%; [95% CI:2%-8%, p<0.05]) and glucose monitoring (4%;[95% CI:2%-5%, p<0.05]) domains of the diabetes self-care activities scale respectively. The DSME interventions studied, were unstructured and limited by resources. Financial constraints, conflicting messages, beliefs, and stigma were the themes underpinning self-management behaviour. CONCLUSIONS The DSME interventions studied were under-resourced, and unstructured. Diabetes self-management knowledge though limited, was associated with self-management behaviour. DSME interventions in low resource settings should be culturally tailored and should incorporate sessions on mitigating financial constraints. Future studies should focus on creating structured DSME interventions suited to resource-constrained settings.
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Affiliation(s)
- Roberta Lamptey
- Polyclinic/ Family Medicine Department, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mary Amoakoh-Coleman
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Babbel Djobalar
- Internal Medicine Department, Korle Bu Teaching Hospital, Accra, Ghana
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - George Obeng Adjei
- Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Office of Research Innovation and Development, University of Ghana, Legon, Ghana
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Tatum WO, Glauser T, Peters JM, Verma A, Weatherspoon S, Benbadis S, Becker DA, Puri V, Smith M, Misra SN, Rabinowicz AL, Carrazana E. Acute seizure therapies in people with epilepsy: Fact or fiction? A U.S. Perspective. Epilepsy Behav Rep 2023; 23:100612. [PMID: 37520180 PMCID: PMC10372156 DOI: 10.1016/j.ebr.2023.100612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/20/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023] Open
Abstract
Patients with epilepsy (PWE) may experience seizure emergencies including acute repetitive seizures despite chronic treatment with daily antiseizure medications. Seizures may adversely impact routine daily activities and/or healthcare utilization and may impair the quality of life of patients with epilepsy and their caregivers. Seizures often occur at home, school, or work in a community setting. Appropriate treatment that is readily accessible for patients with seizure urgencies and emergencies is essential outside the hospital setting. When determining the best acute antiseizure therapy for PWE, clinicians need to consider all of the available rescue medications and their routes of administration including the safety and efficacy profiles. Benzodiazepines are a standard of care as a rescue therapy, yet there are several misconceptions about their use and safety. Reevaluating potential misconceptions and formulating best practices are necessary to maximize usage for each available option of acute therapy. We examine common beliefs associated with traditional use of acute seizure therapies to refute or support them based on the current level of evidence in the published literature.
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Affiliation(s)
- William O. Tatum
- Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224-1865, USA
| | - Tracy Glauser
- Comprehensive Epilepsy Center, Cincinnati Children’s Hospital, 3333 Burnet Ave., Cincinnati, OH 45229, USA
| | - Jurriaan M. Peters
- Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
| | - Amit Verma
- Stanley H. Appel Department of Neurology, Houston Methodist Hospital, 6560 Fannin St., Ste 802, Houston, TX 77030, USA
| | - Sarah Weatherspoon
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 848 Adams Ave., Memphis, TN 38103, USA
| | - Selim Benbadis
- Comprehensive Epilepsy Program, University of South Florida & Tampa General Hospital, 2 Tampa General Cir., Tampa, FL 33606, USA
| | - Danielle A. Becker
- Department of Neurology, Case Western Reserve University School of Medicine, 10900 Euclid Ave., Cleveland, OH 44106, USA
| | - Vinay Puri
- Norton Children’s Neuroscience Institute, affiliated with University of Louisville, 411 E. Chestnut St., Suite 645, Louisville, KY 40202, USA
| | - Michael Smith
- Department of Neurology, Rush University, 1725 W. Harrison St., Ste 885, Chicago, IL 60612, USA
| | - Sunita N. Misra
- Neurelis Inc., 3430 Carmel Mountain Rd., Ste 300, San Diego, CA 92121, USA
| | | | - Enrique Carrazana
- Neurelis Inc., 3430 Carmel Mountain Rd., Ste 300, San Diego, CA 92121, USA
- John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St., Honolulu, HI 96813, USA
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Nassar CM, Dunlea R, Montero A, Tweedt A, Magee MF. Feasibility and Preliminary Behavioral and Clinical Efficacy of a Diabetes Education Chatbot Pilot Among Adults With Type 2 Diabetes. J Diabetes Sci Technol 2023:19322968231178020. [PMID: 37278191 DOI: 10.1177/19322968231178020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Diabetes self-management education and support (DSMES) improves diabetes outcomes yet remains consistently underutilized. Chatbot technology offers the potential to increase access to and engagement in DSMES. Evidence supporting the case for chatbot uptake and efficacy in people with diabetes (PWD) is needed. METHOD A diabetes education and support chatbot was deployed in a regional health care system. Adults with type 2 diabetes with an A1C of 8.0% to 8.9% and/or having recently completed a 12-week diabetes care management program were enrolled in a pilot program. Weekly chats included three elements: knowledge assessment, limited self-reporting of blood glucose data and medication taking behaviors, and education content (short videos and printable materials). A clinician facing dashboard identified need for escalation via flags based on participant responses. Data were collected to assess satisfaction, engagement, and preliminary glycemic outcomes. RESULTS Over 16 months, 150 PWD (majority above 50 years of age, female, and African American) were enrolled. The unenrollment rate was 5%. Most escalation flags (N = 128) were for hypoglycemia (41%), hyperglycemia (32%), and medication issues (11%). Overall satisfaction was high for chat content, length, and frequency, and 87% reported increased self-care confidence. Enrollees completing more than one chat had a mean drop in A1C of -1.04%, whereas those completing one chat or less had a mean increase in A1C of +0.09% (P = .008). CONCLUSION This diabetes education chatbot pilot demonstrated PWD acceptability, satisfaction, and engagement plus preliminary evidence of self-care confidence and A1C improvement. Further efforts are needed to validate these promising early findings.
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Affiliation(s)
- Carine M Nassar
- MedStar Health Research and Diabetes Institutes, Washington, DC, USA
| | | | - Alex Montero
- MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Michelle F Magee
- MedStar Health Research and Diabetes Institutes, Washington, DC, USA
- Georgetown University School of Medicine, Washington, DC, USA
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Mirzazadeh-Qashqaei F, Zarea K, Rashidi H, Haghighizadeh MH. The relationship between self-care, spiritual well-being and coping strategies in patients with type 2 diabetes mellitus. J Res Nurs 2023; 28:259-269. [PMID: 37534270 PMCID: PMC10392715 DOI: 10.1177/17449871231172401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
Background Diabetes is one of the most common diseases in the world. The most important underlying cause of death in diabetic patients is the lack of self-care and management. However, there is little known about the influence of coping strategies and spiritual well-being (SWB) on self-care in diabetic patients. Aims This study aimed to investigate the relationship between self-care activities with coping strategies and spiritual well-being (SWB) in patients with type 2 diabetes mellitus (T2DM). Methods In this descriptive-analytical study, we selected 236 patients with T2DM referred to the diabetes hospital clinics in the southwest of Iran. Inclusion criteria were patients diagnosed with T2DM, with the age group ranging 20-80 years, literate, not suffering from severe and debilitating complications of diabetes and lacking acute psychological illness. Exclusion criteria included refusing to complete questionnaires and cognitive or emotional impairment. Instruments include the demographic questionnaire, Summary of Diabetes Self-Care Activities, Lazarus and Folkman's Coping Strategies Questionnaire and the Spiritual Well-Being Scale (SWBS; developed by Paloutzian and Ellison). To examine the relationship between variables, the Pearson correlation and multiple stepwise regression analysis were used. Results The findings of this study on 236 patients with T2DM (53.25 ± 10.91) including 76 (32.2%) males and 160 (67.8%) females showed the majority of participants were female, the age group was between 41 and 60 years (68.22%), had a Diploma (63.98%), were insured (63.55%) and had a moderate economic situation (55.93%). There was a direct and significant correlation between self-care activities and coping strategies (r = 0.163, p < 0.05), and only a problem-focused coping strategy was considered as a predictor variable of self-care (p < 0.01). There was a direct and significant correlation between self-care and SWB (r = 0.385, p < 0.01). Conclusion The results of this study showed that there is a significant relationship between self-care and the problem-focused dimension of coping strategies and SWB in patients with T2DM.
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Affiliation(s)
- Firouzeh Mirzazadeh-Qashqaei
- Master’s Student, Student Research Committee, School of Nursing & Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kourosh Zarea
- Associate Professor, Nursing Care Research Center in Chronic Diseases, School of Nursing & Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Homeira Rashidi
- Associate Professor, Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences. Ahvaz, Iran
| | - Mohammad Hosein Haghighizadeh
- Senior Lecturer, Department of Biostatistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Uchida T, Ueno H, Konagata A, Nakamura T, Taniguchi N, Nabekura H, Kogo F, Nagatomo Y, Tanaka Y, Shimizu K, Shiiya T, Yamaguchi H, Shimoda K. Association between personality traits and glycemic control after inpatient diabetes education. Metabol Open 2023; 18:100244. [PMID: 37396672 PMCID: PMC10313504 DOI: 10.1016/j.metop.2023.100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 07/04/2023] Open
Abstract
Aims The longitudinal effect of personality traits on glycemic control is unclear. This prospective observational study explored the relationship between personality traits and glycemic control in patients with uncontrolled diabetes after inpatient diabetes education. Methods Patients with diabetes mellitus (HbA1c ≥ 7.5%, measured by high-performance liquid chromatography) who received inpatient diabetes education were scored on the Big Five personality traits: neuroticism, extraversion, openness, agreeableness, and conscientiousness. Multiple linear analysis was used to determine whether any personality traits were independently associated with HbA1c on admission and HbA1c change from admission to 1, 3, and 6 months after discharge. Results One hundred seventeen participants (mean age 60.4 ± 14.5 years; 59.0% male) were enrolled. HbA1c values on admission and 1, 3, and 6 months after discharge were 10.2 ± 2.1%, 8.3 ± 1.4%, 7.6 ± 1.4%, and 7.7 ± 1.5%, respectively. Multiple linear analysis showed that no personality traits were associated with HbA1c on admission. Neuroticism was negatively associated with the HbA1c change from admission to 3 months (β = -0.192, P = 0.025) and 6 months after discharge (β = -0.164, P = 0.043). Conclusions Neuroticism was associated with good long-term glycemic control after inpatient diabetes education.
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Affiliation(s)
- Taisuke Uchida
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hiroaki Ueno
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Ayaka Konagata
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Takayuki Nakamura
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
- Koga General Hospital, 1749-1 Sudaki, Ikeuchi, Miyazaki, 880-0041, Japan
| | - Norifumi Taniguchi
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Hiroki Nabekura
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Fumiko Kogo
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Yuma Nagatomo
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Yuri Tanaka
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Koichiro Shimizu
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Tomomi Shiiya
- Koga General Hospital, 1749-1 Sudaki, Ikeuchi, Miyazaki, 880-0041, Japan
| | - Hideki Yamaguchi
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Kazuya Shimoda
- Division of Hematology, Diabetes, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan
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Salvia MG, Quatromoni PA. Behavioral approaches to nutrition and eating patterns for managing type 2 diabetes: A review. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 9:100034. [PMID: 39035058 PMCID: PMC11256231 DOI: 10.1016/j.ajmo.2023.100034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/15/2023] [Indexed: 07/23/2024]
Abstract
Nutritional interventions are a key component of type 2 diabetes management; making health-supporting changes in eating patterns can improve postprandial glycemic excursions and lower HbA1c to reduce diabetes-related morbidity and mortality. Research around implementing calorie-restricted and/or low-carbohydrate diets is plentiful, though the ability to sustain physiologic and behavioral changes for longer than 12 months is a concern. An understanding of intervention goals and adherence is needed to apply this research to patient care and translate expectations to real-world living contexts. Diverse dietary patterns including a Mediterranean eating pattern, vegetarian or plant-based eating pattern, or others that emphasize high-quality carbohydrates (e.g., whole grains), vegetables, whole fruits, legumes, and fish can support achievement of glycemic targets. Counseling strategies like motivational interviewing can be used to build eating competence. These approaches prioritize collaborative decision-making with the goal of increasing patient empowerment and self-efficacy. Strategies for incorporating these tools and frameworks in a clinical setting are highlighted. Providing ongoing diabetes and nutrition education, paired with appropriate support to address the challenges in implementing and sustaining behavior changes, is warranted. Further, social determinants of health including environmental context, education, socioeconomic status, access to healthcare, and experiences of systemic stigma (e.g., racism or weight bias) can interfere with individuals' diabetes self-care and nutrition behaviors. Providing medical nutrition therapy and tailoring nutrition interventions to individual needs and circumstances can be an important way physicians, dietitians, and diabetes providers can support individuals with type 2 diabetes.
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Affiliation(s)
- Meg G. Salvia
- Department of Health Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Paula A. Quatromoni
- Department of Health Sciences, Boston University, 635 Commonwealth Avenue, Boston, MA 02215, USA
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de Groot M. Diabetes and Depression: Strategies to Address a Common Comorbidity Within the Primary Care Context. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 9:100039. [PMID: 39035059 PMCID: PMC11256228 DOI: 10.1016/j.ajmo.2023.100039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/19/2023] [Indexed: 07/23/2024]
Abstract
Diabetes and depression represent a prevalent, bidirectional, and impactful comorbidity that affects patient and family quality of life, glycemic self-management, long-term diabetes complications, usage of medical services, medical costs, and early mortality. Primary care providers (PCPs) are frequently the first medical providers to observe changes in mood and diabetes management, as well as the primary point of contact for making referrals to specialty providers (e.g. endocrinology, psychiatry). PCPs play a critical role in screening, evaluating, and treating these conditions. Critical to fostering and maintaining a position of trust and patient engagement in medication recommendations is the use of person-centered, nonjudgmental language used by the provider within the clinical encounter. Key strategies for the management of these conditions include the following: routine screening for depressive symptoms, securing access to behavioral health professionals, either within or beyond the primary care setting, collaboration with diabetes care and education specialists to support problem-solving of diabetes self-management, and monitoring the use and effectiveness of antidepressant medications.
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Affiliation(s)
- Mary de Groot
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Indiana University School of Medicine, Indianapolis
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Johnson CM, D'Eramo Melkus G, Reagan L, Pan W, Amarasekara S, Pereira K, Hassell N, Nowlin S, Vorderstrasse A. Learning in a Virtual Environment to Improve Type 2 Diabetes Outcomes: Randomized Controlled Trial. JMIR Form Res 2023; 7:e40359. [PMID: 36962700 PMCID: PMC10160930 DOI: 10.2196/40359] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/17/2022] [Accepted: 03/23/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Given the importance of self-management in type 2 diabetes mellitus (T2DM), a major aspect of health is providing diabetes self-management education and support. Known barriers include access, availability, and the lack of follow through on referral to education programs. Virtual education and support have increased in use over the last few years. OBJECTIVE The purpose of the Diabetes Learning in a Virtual Environment (LIVE) study was to compare the effects of the LIVE intervention (educational 3D world) to a diabetes self-management education and support control website on diet and physical activity behaviors and behavioral and metabolic outcomes in adults with T2DM over 12 months. METHODS The LIVE study was a 52-week multisite randomized controlled trial with longitudinal repeated measures. Participants were randomized to LIVE (n=102) or a control website (n=109). Both contained the same educational materials, but the virtual environment was synchronous and interactive, whereas the control was a flat website. Data were collected at baseline and 3, 6, and 12 months using surveys and clinical, laboratory, and Fitbit measures. Descriptive statistics included baseline characteristics and demographics. The effects of the intervention were initially examined by comparing the means and SDs of the outcomes across the 4 time points between study arms, followed by multilevel modeling on trajectories of the outcomes over the 12 months. RESULTS This trial included 211 participants who consented. The mean age was 58.85 (SD 10.1) years, and a majority were White (127/211, 60.2%), non-Hispanic (198/211, 93.8%), married (107/190, 56.3%), and female (125/211, 59.2%). Mean hemoglobin A1c (HbA1c) level at baseline was 7.64% (SD 1.79%) and mean BMI was 33.51 (SD 7.25). We examined weight loss status versus randomized group, where data with no weight change were eliminated, and the LIVE group experienced significantly more weight loss than the control group (P=.04). There were no significant differences between groups in changes in physical activity and dietary outcomes (all P>.05), but each group showed an increase in physical activity. Both groups experienced a decrease in mean HbA1c level, systolic and diastolic blood pressure, cholesterol, and triglycerides over the course of 12 months of study participation, including those participants whose baseline HbA1c level was 8.6% or higher. CONCLUSIONS This study confirmed that there were minor positive changes on glycemic targets in both groups over the 12-month study period; however, the majority of the participants began with optimal HbA1c levels. We did find clinically relevant metabolic changes in those who began with an HbA1c level >8.6% in both groups. This study provided a variety of resources to our participants in both study groups, and we conclude that a toolkit with a variety of services would be helpful to improving self-care in the future for persons with T2DM. TRIAL REGISTRATION ClinicalTrials.gov NCT02040038; https://clinicaltrials.gov/ct2/show/NCT02040038.
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Affiliation(s)
- Constance M Johnson
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
- School of Nursing, Duke University, Durham, NC, United States
| | - Gail D'Eramo Melkus
- Rory Myers College of Nursing, New York University, New York, NY, United States
| | - Louise Reagan
- Rory Myers College of Nursing, New York University, New York, NY, United States
- School of Nursing, University of Connecticut, Storrs, CT, United States
| | - Wei Pan
- School of Nursing, Duke University, Durham, NC, United States
| | | | | | - Nancy Hassell
- School of Nursing, Duke University, Durham, NC, United States
| | - Sarah Nowlin
- Rory Myers College of Nursing, New York University, New York, NY, United States
- Department of Nursing, Mount Sinai Hospital, New York, NY, United States
| | - Allison Vorderstrasse
- School of Nursing, Duke University, Durham, NC, United States
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, United States
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Clark CN, Eby EL, Lensing CJ, Fultz E, Hart B, Lingcaro L, Hoffner R, Schloot NC, Benneyworth BD. Characterizing Diabetes Empowerment and Motivation for Changing Health Behaviors Among People with Type 2 Diabetes: A Cross-Sectional Survey. Diabetes Ther 2023; 14:869-882. [PMID: 37010793 PMCID: PMC10126189 DOI: 10.1007/s13300-023-01397-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/14/2023] [Indexed: 04/04/2023] Open
Abstract
INTRODUCTION Effectively engaging people with type 2 diabetes (T2D) earlier in their health journeys is critical to prevent downstream complications. Digitally based diabetes programs are a growing component of care delivery that have the potential to engage individuals outside of traditional clinic-based settings and use personalized data to pair people to tailored diabetes self-management interventions. Knowing an individuals' diabetes empowerment and health-related motivation can help drive appropriate recommendations for personalized interventions. We aimed to characterize diabetes empowerment and motivation towards changing health behaviors among participants in Level2, a T2D specialty care organization in the USA that combines wearable technology with personalized clinical support. METHODS A cross-sectional online survey was conducted among people enrolled in Level2 (February-March 2021). Distributions of respondent-reported diabetes empowerment and health motivation were analyzed using Motivation and Attitudes Toward Changing Health (MATCH) and Diabetes Empowerment Scale Short Form (DES-SF) scales, respectively. Associations between MATCH and DES-SF scores with Level2 engagement measures and glycemic control were analyzed. RESULTS The final analysis included 1258 respondents with T2D (mean age 55.7 ± 8.4 years). Respondents had high average MATCH (4.19/5) and DES-SF (4.02/5) scores. The average MATCH subscores for willingness (4.43/5) and worthwhileness (4.39/5) were higher than the average ability subscore (3.73/5). Both MATCH and DES-SF scores showed very weak correlations with Level2 engagement measures and glycemic control (ρ = - 0.18-0.19). CONCLUSIONS Level2 survey respondents had high average motivation and diabetes empowerment scores. Further research is needed to validate sensitivity of these scales to detect changes in motivation and empowerment over time and to determine whether differences in scores can be used to pair people to personalized interventions.
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Affiliation(s)
| | - Elizabeth L Eby
- Eli Lilly and Company, 1 Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | | | | | - Brian Hart
- Optum Labs, Eden Prairie, MN, 55344, USA
| | | | | | | | - Brian D Benneyworth
- Eli Lilly and Company, 1 Lilly Corporate Center, Indianapolis, IN, 46285, USA.
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72
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Owusu BA, Ofori-Boateng P, Forbes A, Doku DT. Knowledge of young people living with type 1 diabetes and their caregivers about its management. Nurs Open 2023; 10:2426-2438. [PMID: 36448367 PMCID: PMC10006669 DOI: 10.1002/nop2.1498] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/23/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
AIMS AND OBJECTIVE We sought to investigate knowledge and skills of type 1 diabetes (T1D) management among young people living with the disease and their caregivers. Our aim is to provide baseline evidence to inform T1D self-management education for young people living with the disease and their caregivers. BACKGROUND Both local and international guidelines recommend ongoing T1D self-management education for people living with the disease. This is because T1D often develops among young people who rarely have the competencies to adequately manage their condition. However, the extent to which young people living with T1D and their caregivers can self-manage this chronic disease in a low-resource country like Ghana is unknown. METHODS Using a phenomenological study design, semi-structured interviews were conducted with 28 young people living with type 1 diabetes, 12 caregivers and 6 healthcare providers in southern Ghana. Data were collected at homes, hospitals and support group centres of participants via face-to-face interviews, photovoice and video-conferencing. The data were analysed thematically using QSR NVivo 11. RESULTS The young people living with T1D and their caregivers demonstrated knowledge and skills in the self-monitoring of blood glucose, and the treatment of hyperglycaemia. Areas of more marginal or lack of knowledge were concerning carbohydrate counting, severe hypoglycaemia and the management of intercurrent illnesses. Young persons living with T1D and their caregivers received their management information from healthcare and non-healthcare providers. Access to diabetes self-management education influenced T1D management knowledge and practices. CONCLUSION Young people living with type 1 diabetes and their caregivers possessed limited scope of knowledge on type 1 diabetes self-management. Multiple sources of T1D knowledge were found, some of which may not be helpful to patients. The knowledge gaps identified compromises transitional independence and self-management capacity. RELEVANCE TO CLINICAL PRACTICE It is important for clinicians and organizations that provide T1D education to provide diabetes self-management education also on managing hypoglycaemia, carbohydrate counting and managing T1D during intercurrent life events among young people living with T1D. NO PATIENT OR PUBLIC CONTRIBUTION Patients and their caregivers were interviewed as research participants. They did not conceptualize, analyse, interpret or prepare the manuscript.
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Affiliation(s)
| | - Prince Ofori-Boateng
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.,Cape Coast Teaching Hospital, Central Region, Cape Coast, Ghana
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, London, UK
| | - David Teye Doku
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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73
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Boakye MD, Miyamoto S, Greenwood D, Kraschnewski J, Van Haitsma K, Boltz M. Pathway From Type 2 Diabetes Diagnosis to Action: How to Move People Forward. Diabetes Spectr 2023; 36:264-274. [PMID: 37583554 PMCID: PMC10425228 DOI: 10.2337/ds22-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Seven self-care behaviors-healthy coping, healthy eating, being active, taking medication, monitoring, reducing risk, and problem-solving-are recommended for individuals with diabetes to achieve optimal health and quality of life. People newly diagnosed with type 2 diabetes may find it challenging to learn and properly incorporate all of these self-care behaviors into their life. This qualitative study explored the experiences and perceived immediate self-management and psychosocial support needs in individuals newly diagnosed with type 2 diabetes. Data analysis revealed the significant challenges individuals encounter after a type 2 diabetes diagnosis. Five main themes were identified: 1) type 2 diabetes diagnosis competes with other complex life challenges, 2) difficulty in performing behavior modification actions, 3) lack of support, 4) emergence of emotional and psychological issues, and 5) need for planned individualized follow-up support after a type 2 diabetes diagnosis. This study revealed a gap in care after type 2 diabetes diagnosis. Individualized support is needed to assist people in moving successfully from diagnosis to being well equipped with the knowledge and skills necessary to properly manage the condition.
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Affiliation(s)
- Michelle D.S. Boakye
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
| | - Sheridan Miyamoto
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
| | | | | | - Kimberly Van Haitsma
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
| | - Marie Boltz
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
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74
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Herman ST, Detyniecki K, O'Hara K, Penovich P, Rao VR, Tatum W, Long L, Stern JM, Carrazana E, Rabinowicz AL. Written seizure action plans for adult patients with epilepsy: Distilling insights from emergency action plans for other chronic conditions. Epilepsy Behav 2023; 140:109002. [PMID: 36822041 DOI: 10.1016/j.yebeh.2022.109002] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/31/2022] [Accepted: 11/15/2022] [Indexed: 02/25/2023]
Abstract
Seizure emergencies and potential emergencies, ranging from seizure clusters to prolonged seizure and status epilepticus, may affect adults with epilepsy despite stable antiseizure therapy. Seizure action plans (SAPs) are designed for patients and their caregivers/care partners to provide guidance on the individualized treatment plan, including response to potential seizure emergencies and appropriate use of rescue therapy. The use of pediatric SAPs is common (typically required by schools), however, most adults with epilepsy do not have a plan. Patient-centered action plans are integral to care for other chronic conditions and may offer insights applicable to the care of adults with epilepsy. This review analyzes the potential benefits of action plans for medical conditions by exploring their utility in conditions such as asthma, diabetes, chronic obstructive pulmonary disease, heart disease, and opioid overdose. Evidence across these conditions substantiates the value of action plans for patients, and the benefits of adult SAPs in epilepsy are emerging. Because wide implementation of SAPs has faced barriers, other conditions may provide insights that are relevant to implementing SAPs in epilepsy. Based on these analyses, we propose concrete steps to improve the use of SAPs among adults. A recent consensus statement promoting the use of formal SAPs in epilepsy and advances in rescue therapy delivery methods provides support to engage patients around the value of SAPs. The precedent for use of SAPs for pediatric epilepsy patients serves as the foundation to support increased usage in adults. Seizure action plans in the context of improved clinical outcomes are expected to reduce healthcare utilization, improve patient quality of life, and optimize epilepsy management.
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Affiliation(s)
- Susan T Herman
- Barrow Neurological Institute, Phoenix, AZ, United States.
| | | | | | | | - Vikram R Rao
- University of California San Francisco, San Francisco, CA, United States
| | | | | | - John M Stern
- University of California Los Angeles, Los Angeles, CA, United States
| | - Enrique Carrazana
- University of Hawaii John A. Burns School of Medicine, Honolulu, HI, United States; Neurelis, Inc, San Diego, CA, United States
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75
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Polonsky WH, Fortmann AL, Soriano EC, Guzman SJ, Funnell MM. The AH-HA! Project: Transforming Group Diabetes Self-Management Education Through the Addition of Flash Glucose Monitoring. Diabetes Technol Ther 2023; 25:194-200. [PMID: 36409486 DOI: 10.1089/dia.2022.0419] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: The majority of individuals referred to diabetes self-management education and support (DSMES) programs do not access this resource. Of those who do, attrition is high, with anecdotal reports pointing to the didactic and impersonal nature of these programs contributing to low utilization and completion rates. In an effort to develop a more engaging form of DSMES for adults with type 2 diabetes (T2D), we constructed a nondidactic "discovery learning"-based DSMES program centered on real-time flash glucose monitoring (FGM). Methods: In this single-arm pilot study, 35 adults with T2D duration 1-5 years, ages 21-75 years, not using insulin and HbA1c ≥8.0% were introduced to FGM and participated in five weekly group sessions. DSMES content was personalized, emerging from the concerns and questions arising from participants' FGM discoveries. The primary outcome was glycemic change as assessed by blinded FGM at baseline and month 3. Secondary outcomes included psychosocial and behavioral measures. Results: There was a significant gain in percentage time in range (% TIR) 70-180 mg/dL from baseline (55%) to month 3 (74%), and a parallel drop-in percentage time above range (TAR) >180 mg/dL from 44% to 25% (Ps = 0.01). Overall well-being rose significantly (P = 0.04), whereas diabetes distress showed a nonsignificant drop. Participants reported improvements in healthy eating (P < 0.001) and physical activity, although the latter did not reach statistical significance. Conclusions: These findings support a new approach to DSMES, a method that integrates FGM with a highly interactive and engaging patient-driven "discovery learning" approach to education.
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Affiliation(s)
- William H Polonsky
- Behavioral Diabetes Institute, San Diego, California, USA
- University of California, San Diego, California, USA
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, California, USA
| | - Emily C Soriano
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, California, USA
| | - Susan J Guzman
- Behavioral Diabetes Institute, San Diego, California, USA
| | - Martha M Funnell
- Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
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76
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Jalilian H, Javanshir E, Torkzadeh L, Fehresti S, Mir N, Heidari‐Jamebozorgi M, Heydari S. Prevalence of type 2 diabetes complications and its association with diet knowledge and skills and self-care barriers in Tabriz, Iran: A cross-sectional study. Health Sci Rep 2023; 6:e1096. [PMID: 36761031 PMCID: PMC9895320 DOI: 10.1002/hsr2.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Background and Aims Diabetes can lead to multiple complications that can reduce the quality of life, impose additional costs on the healthcare systems and ultimately lead to premature death. Proper self-care in diabetic patients can impede or delay the onset of diabetes complications. This study aimed to investigate diabetes complications and their association with diet knowledge, skills, and self-care barriers. Methods This was a cross-sectional study. A total of 1139 patients with Type 2 Diabetes Mellitus (T2DM) referring to health centers in Tabriz, Iran, were included from January to July 2019. Data were collected using two questionnaires: (1) a sociodemographic questionnaire and (2) a Personal Diabetes Questionnaire (PDQ). Data were analyzed using SPSS software version 22. χ 2 test was used to examine the association between the socioeconomic and disease-related variables and the prevalence of diabetes complications. T-test was used to examine the association between diet knowledge and skills, self-care barriers, and the incidence of diabetes complications. Results In this study, 76.1% of patients had at least one complication, and 30.2% had a history of hospitalization due to diabetes complications during the past year. Approximately 49% and 43% were diagnosed with high blood pressure and hyperlipidemia, respectively. Cardiovascular disease was the most common diabetes complication (15.9%) and the cause of hospitalization (11.01%) in patients with diabetes. Barriers to diet adherence, blood glucose monitoring, and exercise were significantly associated with self-reported diabetes complications (p < 0.001). Our results showed no significant association between the number of complications and diet knowledge and skills (p = 0.44). Conclusion This study indicated that the prevalence of diabetes complications was higher among patients with more barriers to self-care. In light of these findings, taking appropriate measures to reduce barriers to self-care can prevent or delay the onset of diabetes complications.
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Affiliation(s)
- Habib Jalilian
- Department of Health Services Management, School of HealthAhvaz Jundishapur University of Medical SciencesAhvazIran,Social Determinants of Health Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Elnaz Javanshir
- Cardiovascular Research CentreTabriz University of Medical SciencesTabrizIran
| | - Leila Torkzadeh
- Department of Health Policy and Management, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Saeedeh Fehresti
- Department of Health Economics and Management, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Nazanin Mir
- Health Management and Economics Research CenterIran University of Medical SciencesTehranIran
| | | | - Somayeh Heydari
- Social Determinants of Health Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran
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77
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Greenlee MC, Bolen S, Chong W, Dokun A, Gonzalvo J, Hawkins M, Herman WH, Leake E, Linder B, Conlin PR. The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs to Improve Diabetes Treatment and Reduce Complications. Diabetes Care 2023; 46:e51-e59. [PMID: 36701593 PMCID: PMC9887628 DOI: 10.2337/dc22-0621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/08/2022] [Indexed: 01/27/2023]
Abstract
The Treatment and Complications subcommittee of the National Clinical Care Commission focused on factors likely to improve the delivery of high-quality care to all people with diabetes. The gap between available resources and the needs of people living with diabetes adversely impacts both treatment and outcomes. The Commission's recommendations are designed to bridge this gap. At the patient level, the Commission recommends reducing barriers and streamlining administrative processes to improve access to diabetes self-management training, diabetes devices, virtual care, and insulin. At the practice level, we recommend enhancing programs that support team-based care and developing capacity to support technology-enabled mentoring interventions. At the health system level, we recommend that the Department of Health and Human Services routinely assess the needs of the health care workforce and ensure funding of training programs directed to meet those needs. At the health policy level, we recommend establishing a process to identify and ensure pre-deductible insurance coverage for high-value diabetes treatments and services and developing a quality measure that reduces risk of hypoglycemia and enhances patient safety. We also identified several areas that need additional research, such as studying the barriers to uptake of diabetes self-management education and support, exploring methods to implement team-based care, and evaluating the importance of digital connectivity as a social determinant of health. The Commission strongly encourages Congress, the Department of Health and Human Services, and other federal departments and agencies to take swift action to implement these recommendations to improve health outcomes and quality of life among people living with diabetes.
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Affiliation(s)
| | - Shari Bolen
- Population Health Research Institute and Center for Health Care Research and Policy, Case Western Reserve at The MetroHealth System, Cleveland, OH
| | - William Chong
- Office of Generic Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Rockville, MD
| | - Ayotunde Dokun
- Division of Endocrinology and Metabolism, Carver School of Medicine, University of Iowa, Iowa City, IA
| | - Jasmine Gonzalvo
- Center for Health Equity and Innovation, Purdue University, Indianapolis, IN
| | - Meredith Hawkins
- Global Diabetes Institute, Albert Einstein College of Medicine, Bronx, NY
| | | | - Ellen Leake
- Juvenile Diabetes Research Foundation, Jackson, MS
| | - Barbara Linder
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Paul R. Conlin
- Department of Veterans Affairs Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
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78
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Teng CL, Lee VKM, Malanashita G, Sulaiman LH, Bujang MA. Gender and Ethnic Differences in Diabetes Self Care in Malaysia: An Individual Participant Meta-Analysis of Summary of Diabetes Self Care Activities Studies. Malays J Med Sci 2023; 30:162-171. [PMID: 36875195 PMCID: PMC9984106 DOI: 10.21315/mjms2023.30.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/03/2022] [Indexed: 03/05/2023] Open
Abstract
Background Many published studies in Malaysia have examined and assessed self care among type 2 diabetes mellitus (T2DM) patients using the Summary of Diabetes Self Care Activities (SDSCA) scale. The current paper is a meta-analysis of related studies that also examines how gender and ethnicity influence and shape T2DM self care practices in Malaysia. Methods We undertook a bibliographic search for studies conducted and published in Malaysia on T2DM adults using the SDSCA scale. This is a two-stage individual participant meta-analysis of SDSCA which synthesised the overall and subscale score based on gender and ethnic groups as well as the correlation between SDSCA and HbA1c. Results We examined 11 studies that utilised SDSCA to analyse 3,720 T2DM patients. The overall SDSCA score was 33.46 (47.8% of the 7-day week). The subscale score for general diet, specific diet, exercise, blood glucose self-monitoring and foot care were 4.80, 4.09, 2.87, 1.80 and 3.21, respectively. A small but statistically significant better self care in some gender or ethnic groups was noted. The SDSCA diet subscale and HbA1c showed statistically significant correlation. Conclusion The finding suggested Malaysian T2DM patients were deficient in exercise and blood glucose self-monitoring. In fact, overall self care among Malaysian adult T2DM patients appears to be suboptimal across gender and the three main ethnic groups. Greater efforts are therefore needed to educate Malaysian adult T2DM patients to improve their self care practices.
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Affiliation(s)
- Cheong Lieng Teng
- Department of Family Medicine, International Medical University, Negeri Sembilan, Malaysia
| | - Verna Kar Mun Lee
- Department of Family Medicine, International Medical University, Negeri Sembilan, Malaysia
| | - Ganeson Malanashita
- Department of Family Medicine, International Medical University, Negeri Sembilan, Malaysia
| | - Lokman Hakim Sulaiman
- Department of Community Medicine, International Medical University, Kuala Lumpur, Malaysia
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79
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Improved prognosis with integrated care management including early rhythm control and healthy lifestyle modification in patients with concurrent atrial fibrillation and diabetes mellitus: a nationwide cohort study. Cardiovasc Diabetol 2023; 22:18. [PMID: 36717853 PMCID: PMC9887851 DOI: 10.1186/s12933-023-01749-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/21/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Patients with concurrent atrial fibrillation (AF) and diabetes mellitus (DM) [AF-DM] have a high risk of cardiovascular and diabetes-related complications, but are less engaged in a comprehensive treatment approach. We evaluated the association of early rhythm control (ERC), lifestyle modification (LSM), and a combination of ERC and LSM with cardiovascular or diabetes-related complication risk in patients with AF-DM (type 2). METHODS From the National Health Information Database, 47,940 patients diagnosed with AF-DM in 2009-2016 were included. We defined ERC as rhythm control therapy within two years of AF diagnosis and LSM as adherence to ≥ 2 of the healthy behaviors among non-current smoking, non-drinking, and regular exercise. We compared the primary (ischemic stroke) and secondary (macro- and microvascular complications, glycemic emergency, and all-cause death) outcomes in four groups: non-ERC and non-LSM (group 1), LSM only (group 2), ERC only (group 3), and both ERC and LSM (group 4). RESULTS Of total, 10,617 (22%), 26,730 (55.8%), 2,903 (6.1%), and 7,690 (16.0%) were classified into groups 1 to 4, in sequence. The mean duration from AF diagnosis to ERC was 25.6 ± 75.5 days. During 4.0 (interquartile range: 2.5-6.2) years' follow-up, groups 2 and 3 were associated with 23% and 33% lower risks of stroke than group 1, respectively. Group 4 was associated with the lowest risk of stroke: hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.51-0.67, p < 0.001. Regarding secondary outcomes, the lowest risks were also observed in group 4; macro- and microvascular complications, glycemic emergency, and all-cause death had HRs (95% CIs) of 0.63 (0.56-0.70), 0.88 (0.82-0.94), 0.72 (0.62-0.84), and 0.80 (0.73-0.87), respectively, all p < 0.001. CONCLUSIONS For AF-DM patients, ERC and LSM exert a synergistic effect in preventing cardiovascular and diabetes-related complications with the greatest lowered risk of stroke. A comprehensive treatment approach should be pursued in AF-DM patients.
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80
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Long-Term Tailor-Made Exercise Intervention Reduces the Risk of Developing Cardiovascular Diseases and All-Cause Mortality in Patients with Diabetic Kidney Disease. J Clin Med 2023; 12:jcm12020691. [PMID: 36675619 PMCID: PMC9864356 DOI: 10.3390/jcm12020691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/28/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
This study aimed to determine the effect of long-term exercise on the risk of developing cardiovascular diseases (CVD) and all-cause mortality in patients with diabetic kidney disease (DKD). A single-center, prospective intervention study using propensity score matching was performed over 24 months. The intervention group (n = 67) received six months of individual exercise instruction from a physical therapist, who performed aerobic and muscle-strengthening exercises under unsupervised conditions. New events were defined as the composite endpoint of stroke or CVD requiring hospitalization, initiation of hemodialysis or peritoneal dialysis, or all-cause mortality. The cumulative survival rate without new events at 24 months was significantly higher in the intervention group (0.881, p = 0.016) than in the control group (n = 67, 0.715). Two-way analysis of variance revealed a significant effect of the group factor on high density lipoprotein-cholesterol (HDL-C) which was higher in the intervention group than in the control group (p = 0.004); eGFRcr showed a significant effect of the time factor, which was lower at 24 months than before intervention (p = 0.043). No interactions were observed for all items. In conclusion, aerobic exercises combined with upper and lower limb muscle strengthening for six months reduce the risk of developing CVD and all-cause mortality in patients with DKD.
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81
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Young-Hyman D, Gabbay RA, on behalf of the American Diabetes Association. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S68-S96. [PMID: 36507648 PMCID: PMC9810478 DOI: 10.2337/dc23-s005] [Citation(s) in RCA: 136] [Impact Index Per Article: 136.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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82
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Blythin AM, Elkes J, van Lindholm T, Bhogal A, Wilkinson TMA, Saville C, Kirk A. Can digital health apps provide patients with support to promote structured diabetes education and ongoing self-management? A real-world evaluation of myDiabetes usage. Digit Health 2023; 9:20552076221147109. [PMID: 36923369 PMCID: PMC10009031 DOI: 10.1177/20552076221147109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 12/06/2022] [Indexed: 03/16/2023] Open
Abstract
Objective Structured diabetes education has evidenced benefits yet reported uptake rates for those referred to traditional in-person programmes within 12 months of diagnosis were suboptimal. Digital health interventions provide a potential solution to improve diabetes education delivery at population scale, overcoming barriers identified with traditional approaches. myDiabetes is a cloud-based interactive digital health self-management app. This evaluation analysed usage data for people with type 2 diabetes focusing on digital structured diabetes education. Methods Descriptive quantitative analyses were conducted on existing anonymised user data over 12 months (November 2019-2020) to evaluate whether digital health can provide additional support to deliver diabetes education. Data was divided into two equal 6-month periods. As this overlapped the onset of COVID-19, analyses of its effect on usage were included as a secondary outcome. All data was reported via myDiabetes. Users were prescribed myDiabetes by National Health Service healthcare primary care teams. Those who registered for app use within the study period (n = 2783) were assessed for eligibility (n = 2512) and included if activated. Results Within the study period, n = 1245/2512 (49.6%) registered users activated myDiabetes. No statistically significant differences were observed between gender (p = 0.721), or age (p = 0.072) for those who activated (59.2 years, SD 12.93) and those who did not activate myDiabetes (57.6 years, SD 13.77). Activated users (n = 1119/1245 (89.8%)) viewed 11,572 education videos. No statistically significant differences were observed in education video views across age groups (p = 0.384), gender (p = 0.400), diabetes treatment type (p = 0.839) or smoking status (p = 0.655). Comparison of usage pre-COVID-19 and post-COVID-19 showed statistically significant increases in app activity (p ≤0.001). Conclusion Digital health is rapidly evolving in its role of supporting patients to self-manage. Since COVID-19 the benefits of digital technology have become increasingly recognised. There is potential for increasing diabetes education rates by offering patients a digital option in combination with traditional service delivery which should be substantiated through future research.
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Affiliation(s)
- A M Blythin
- Department of Research & Innovation, my mhealth Limited, Bournemouth, UK
| | - J Elkes
- School of Public Health, Imperial College Clinical Trials Unit, London, UK
| | - T van Lindholm
- Department of Research & Innovation, my mhealth Limited, Bournemouth, UK
| | - A Bhogal
- Department of Research & Innovation, my mhealth Limited, Bournemouth, UK
| | - T M A Wilkinson
- Department of Research & Innovation, my mhealth Limited, Bournemouth, UK.,Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - C Saville
- Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - A Kirk
- Department of Research & Innovation, my mhealth Limited, Bournemouth, UK
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83
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Changsieng P, Pichayapinyo P, Lagampan S, Lapvongwatana P. Implementation of Self-Care Deficits Assessment and a Nurse-Led Supportive Education Program in Community Hospitals for Behavior Change and HbA1c Reduction: A Cluster Randomized Controlled Trial. J Prim Care Community Health 2023; 14:21501319231181106. [PMID: 37335030 DOI: 10.1177/21501319231181106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND The prevalence of uncontrolled type 2 diabetes has been increasing, and the nurse is a primary healthcare provider to patients when health professionals are scarce in the community setting. A feasible intervention delivered by nurses is necessary to fulfill patients' needs to help them achieve glycemic control. AIM To investigate whether Thai adults with uncontrolled diabetes in community hospitals lack self-care competency and whether a nurse-led supportive education program can enhance their self-care skills, change behavior, and control HbA1C levels. METHODS We employed a multi-community hospital cluster randomized controlled trial design. Participants were randomly selected in the experimental group (2 hospitals) and control group (2 hospitals), with 30 patients from each hospital. One hundred twenty adults with HbA1c 7-10% treated by oral glycemic medication were recruited. Using Orem's Theory as a framework, nurses implemented self-care deficit assessments and supportive-educative nursing programs into their work. Participants in the control group received usual care, and those in the experimental group underwent a nurse assessment and supportive education measures. Data were collected at baseline, with 4-week and 12-week follow-ups. Data analysis were a repeated measures ANOVA with post hoc analysis, and Independent t-test. RESULTS One hundred three patients completed the trial (51 in the experimental group and 52 in the control group). At 12 weeks, there were statistically significant improvements in HbA1c (P < .001), fasting plasma glucose (P = .03), knowledge (P < .001), diabetes self-care agency (P < .001), diet consumption (P < .001), physical activity (P < .001), and medical adherence (P = .03) in the experimental group significantly greater than those in the control group. Also, the between-group effect sizes were 0.49 or greater. CONCLUSION The self-care deficit assessment and supportive education program were essential to the nursing intervention that effectively improved knowledge, changed behavior, and HbA1c levels among adults with uncontrolled blood glucose.
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Affiliation(s)
- Piyanat Changsieng
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
| | - Panan Pichayapinyo
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
| | - Sunee Lagampan
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
| | - Punyarat Lapvongwatana
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Thailand
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84
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Osunde RN, Olorunfemi O. Knowledge, practice, and challenges of diabetes foot care among patients at the University of Benin Teaching Hospital, Benin City: A cross-sectional study. Ayu 2023; 44:1-8. [PMID: 38505106 PMCID: PMC10946662 DOI: 10.4103/ayu.ayu_282_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 08/22/2023] [Accepted: 12/25/2023] [Indexed: 03/21/2024] Open
Abstract
Background Foot ulcer is a common complication of diabetes and the most devastating component of diabetes progression that is associated with high morbidity and mortality. Aims The aim of this study was to assess the knowledge, practice, and challenges of diabetes foot care among patients with diabetes mellitus. Materials and methods This descriptive cross-sectional study assessed knowledge and practice of foot care among type I and type II patients with diabetes attending the University of Benin Teaching Hospital, Benin City. The instrument for data collection was a structured questionnaire with a reliability of 0.880. SPSS version 22 was used to analyze the data. Results The findings revealed that there is good knowledge of foot care, among 110 (50.0%) of the diabetic patients, while the practice of foot care was found to be poor among diabetic patients. It also shows the factor that statistically predicts the development of foot ulcers to include combined diet + oral medications + insulin treatment regimen (adjusted odds ratio [AOR] = 0.181, P = 0.016, confidence interval [CI] = 0.045-0.728), history of renal conditions (AOR = 0.115, P = 0.036, CI = 0.015-0.871), not receiving foot care education (AOR = 116.098, P < 0.001, CI = 12.497-1078.554), and receiving foot care education from nurses (AOR = 0.022, P = 0.001, CI = 0.002-0.216). Furthermore, 201 (91.4%) diabetes patients reported fatigue from completing the same task repeatedly, and 198 (90.0%) reported forgetfulness as obstacles to practicing foot care. Conclusion When creating DM Patients future care plans, nurses and other health-care administrators must take into account the difficulties and predicting factors related to the practice of diabetes foot care.
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Affiliation(s)
- Rosemary Ngozi Osunde
- Department of Nursing Science, Wellspring University, Benin-City, Edo State, Nigeria
| | - Olaolorunpo Olorunfemi
- Department of Medical Surgical Nursing, Faculty of Nursing Science, Achievers University, Owo, Ondo State Nigeria
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85
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 3. Prevention or Delay of Type 2 Diabetes and Associated Comorbidities: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S41-S48. [PMID: 36507633 PMCID: PMC9810464 DOI: 10.2337/dc23-s003] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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86
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Iregbu S, Spiers J, Duggleby W, Salami B, Schick-Makaroff K. Nigerian Health Care Providers and Diabetes Self-Management Support: Their Perspectives and Practices. QUALITATIVE HEALTH RESEARCH 2023; 33:92-105. [PMID: 36519805 PMCID: PMC9827480 DOI: 10.1177/10497323221143889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Nigeria struggles to reframe its traditional acute-care disease approach to health care to accommodate rising needs for chronic disease care. This interpretive descriptive study explored Nigerian healthcare providers' (HCPs) perspectives, experiences, and practices related to self-management support (SMS). Observational and experiential data were gathered from 19 HCPs at two urban hospitals in Southeastern Nigeria (seven physicians, four nurses, five dietitians/nutritionists, and three health educators). There were four themes: (a) compliance-oriented medical model, (b) SMS as advice, informal counseling, and education, (c) navigating the sociocultural terrain, and (d) workarounds. Nigerian HCPs perspectives and SMS practices were characterized by attempts to foster compliance with healthcare instructions within a traditional biomedical model. Participants enhanced patient support using specific strategies to bypass structural system obstacles. These findings demonstrate the need to reevaluate the current understanding of SMS in Nigeria and its practice.
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Affiliation(s)
- Sandra Iregbu
- Faculty of Nursing,
University
of Alberta, Ave Edmonton, AB,
Canada
| | - Jude Spiers
- Faculty of Nursing,
University
of Alberta, Ave Edmonton, AB,
Canada
| | - Wendy Duggleby
- Faculty of Nursing,
University
of Alberta, Ave Edmonton, AB,
Canada
| | - Bukola Salami
- Faculty of Nursing,
University
of Alberta, Ave Edmonton, AB,
Canada
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87
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Moverley JA, Novak L, Shubrook JH. Conquering diabetes therapeutic inertia: practical tips for primary care. J Osteopath Med 2023; 123:113-120. [PMID: 36121937 DOI: 10.1515/jom-2022-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/23/2022] [Indexed: 01/27/2023]
Abstract
Diabetes is a complex condition that is largely self-managed. Decades of scientific evidence has proved that early glycemic control leads to improved microvascular and macrovascular outcomes in people with diabetes mellitus. Despite well-established management guidelines, only about half of the patients with diabetes achieve glycemic targets, and only one in five patients achieve metabolic control (blood pressure, lipid, and glucose targets), and both patients and physicians find themselves stuck in a rut called therapeutic inertia (TI). The authors present several practical strategies that can be tailored to different practice settings and facilitate reducing TI.
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Affiliation(s)
- Joy A Moverley
- Joint MSPAS/MPH Program, Touro University California, Vallejo, CA, USA
| | - Lucia Novak
- Diabetes Consulting Services, North Bethesda, MD, USA
| | - Jay H Shubrook
- College of Osteopathic Medicine, Touro University California, Vallejo, CA, USA
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88
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Exploring barriers and facilitators to pharmacist-provided diabetes self-management education and support. J Am Pharm Assoc (2003) 2023; 63:74-79. [PMID: 36114100 PMCID: PMC10405629 DOI: 10.1016/j.japh.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Pharmacists have the necessary clinical experience and medication knowledge to effectively provide diabetes self-management education and support (DSMES); however, barriers exist to DSMES implementation by community pharmacists. OBJECTIVE The aim of this study is to explore DSMES from the community pharmacists' perspectives, identify barriers and facilitators to pharmacist DSMES implementation, and guide development of pharmacist-provided DSMES programs in Idaho. METHODS Implementation climate, the theoretical framework for this project, is focused on how community pharmacists in Idaho perceive they will be supported by patients, health care providers, and insurers in DSMES implementation. Pharmacist investigators with qualitative research experience conducted semistructured interviews with 6 licensed community pharmacists from Idaho via Zoom between March and June 2020. Recordings were transcribed verbatim and analyzed using HyperRESEARCH 4.5.1. Themes, patterns, and dominant concepts that emerged from respondents' about DSMES were explored, labeled, and categorized into modifiable and nonmodifiable barriers and facilitators. This study was granted expedited approval by the Idaho State University Investigational Review Board. RESULTS Relevant themes included current scope of practice, barriers, and facilitators. Subthemes related to the current scope of pharmacy practice included unclear roles and responsibilities and legislative constraints to practice. For barriers, subthemes included cost of set-up, billing and coding education, and the sustainability of services based on current reimbursement models. For facilitators, subthemes included the need for additional collaborations (external and internal), technology access, and trained pharmacy staff. CONCLUSION Pharmacists are underutilized health care providers, capable of providing DSMES services if provided the necessary resources. This work identifies barriers and facilitators to pharmacist-led DSMES that can be considered by others when implementing DSMES or other disease management services.
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Dietz CJ, Sherrill WW, Stancil M, Rennert L, Parisi M, McFall D. Health Extension for Diabetes: Impact of a Community-Based Diabetes Self-Management Support Program on Older Adults' Activation. Diabetes Spectr 2023; 36:59-68. [PMID: 36818413 PMCID: PMC9935283 DOI: 10.2337/ds21-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The goals of this study were to determine whether completion of a community-based diabetes self-management support (DSMS) program delivered through a university Cooperative Extension network increased Patient Activation Measure (PAM) scores and to examine predictors of improvement in PAM score in individuals participating in the DSMS. METHODS The Health Extension for Diabetes (HED) is a 4-month program delivered via a paraprofessional extension agent in partnership with an established diabetes self-management education and support program. The study population included 148 adults (median age 69 years; interquartile range 60-74 years) with diabetes recruited from local community organizations. Data for the analysis were collected before and after participation in the intervention as part of a longitudinal study, using the PAM and Self-Efficacy for Diabetes instruments. Descriptive statistics were gathered, and hypothesis tests and simple and multivariable regression analyses were conducted. RESULTS The mean PAM score increased by 6.58 points, with a 5-point change considered clinically significant. From pre- to post-intervention, PAM scores significantly decreased for 23 participants, decreased for 6, did not change for 14, increased for 21, and significantly increased for 84. Higher pre-intervention PAM scores, younger age, greater educational attainment, and higher baseline self-efficacy scores were associated with increased post-intervention PAM scores when not controlling for potential covariates. Age was no longer associated with higher PAM scores after controlling for covariates. CONCLUSION Community-based DSMS interventions can be effective in generating positive change in individuals' activation. HED provides a feasible and accessible DSMS option that addresses key diabetes self-management components while effectively improving individuals' activation. It is recommended that people living with diabetes attend a DSMS program such as HED to increase their ability to effectively self-manage various components of their chronic condition.
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Affiliation(s)
- Christina J. Dietz
- Department of Public Health Sciences, Clemson University, Clemson, SC
- Corresponding author: Christina J. Dietz,
| | | | - Michelle Stancil
- Diabetes Self-Management Program, Prisma Health–Upstate, Greenville, SC
| | - Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC
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90
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Selen F, Polat Ü. The effect of web based type 2 diabetes education on diabetes self management. Digit Health 2023; 9:20552076231205739. [PMID: 37822962 PMCID: PMC10563455 DOI: 10.1177/20552076231205739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
Objective This study is a control group intervention study to determine the effect of web-based education on diabetes self-management in individuals with type 2 diabetes. Methods The study was conducted in the Training and Research Hospital Diabetes Education Unit of Hitit University. The study was completed with 75 people (intervention 38, control 37). The data were obtained in the web site through patient identification form, self-management perception scale in diabetes, diabetes attitude, self-care scale and HbA1c, HDL, LDL values were followed by providing training and counseling. The values followed were viewed at the third and sixth months. Written permission was obtained from ethics committee and participants. The data of the study were evaluated with number, percentage, mean, pearson chi-square, independent t-test, repetitive analysis and variance analysis. Results Statistically significant decrease in HbA1c and LDL values, diabetes self-management scale, diabetes attitude scale and self-care scale scores were found to be significantly different between the intervention and control groups. Conclusion Web-based education and follow-up studies are effective in decreasing HbA1c values in increasing diabetes self-management skills of individuals with type 2 diabetes. It is recommended to use as a complementary tool in health care services for type 2 diabetes management.
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Affiliation(s)
- Filiz Selen
- Department of Internal Medicine Nursing, Hitit University Faculty of Health Sciences, Corum, Turkey
| | - Ülkü Polat
- Department of Internal Medicine Nursing, Gazi University, Faculty of Health Sciences, Ankara, Turkey
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91
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Rabeea Banoon S, Younis Alfathi M, Shokouhi Mostafavi SK, Ghasemian A. Predominant genetic mutations leading to or predisposing diabetes progress: A Review. BIONATURA 2022. [DOI: 10.21931/rb/2022.07.04.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Diabetes mellitus (DM) arises following poor capacity to generate or secrete insulin or insulin resistance; hence insulin production impairment creates the illness. Individuals can control their weight, impulsivity, blood pressure, and blood lipids at the commencement of the disease. A single genetic mutation affects nearly 3% of people with diabetes. Surprisingly, beta cell function is regulated by more than 20 genes. Benefits of genetic diagnosis include improved therapy, better prediction of illness prognosis and progression, genetic counseling, and possibly prevention.
Alpha HNF1 mutations in the early stages may respond to the regimen. Still, most patients need it because they control their blood glucose and will be subject to microvascular or macrovascular complications. In cases where insulin does not control sugar, using low-dose sulfonylureas would be beneficial and lower four times the glucose metabolism of metformin. These patients are susceptible to sulfonylureas and may be treated for years in case of no blood glucose attack complications. The drug will start at one-fourth of the adult dose: MODY1. It is caused by a mutation in the alpha-HNF 4 gene and is relatively uncommon. The same is true, but the threshold for renal excretion is not low, and the incidence of upward alpha-HNF 4 mutations in cases where there is a robust clinical panel for alpha HNF 1 but not confirmed by genetic sequencing should be considered. The disease is also susceptible to sulfonylureas: MODY4 with a mutation in the MODY6 gene, IPF1, with a mutation in MODY7, NeuroD1 is characterized by a carboxy sterilise mutation, which is not common: MODY2. In children and adolescents, an increment in fasting blood glucose of 100 to 150 mg/dl is not typical. The incidence of this condition is usually considered to be type 1 or 2 diabetes, but a large percentage of the above patients are heterozygote individuals, the glucokinase mutations. Specific mutations, including those rare variants in WFS1 and ABCC8 genes, insulin receptor (IR), fructose 6-phosphate aminotransferase (GFPT2), and nitric oxide synthase (eNOS), as well as mouse pancreatic β‐cell lines (Min6 and SJ cells), showed that the HDAC4 variant (p. His227Arg) had been directly linked with T2DM.
Keywords: type-2 diabetes, genetic mutations, risk factors
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Affiliation(s)
| | - Mohammed Younis Alfathi
- Department of Biology, College of Education for Pure Science, University of Mosul, Mosul, Iraq
| | | | - Abdolmajid Ghasemian
- Noncommunicable diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
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Seixas MB, Ghisi GLDM, Oh P, Pereira DS, Moreira APB, Jansen AK, Batalha APDB, Cândido GDN, de Almeida JA, Pereira DAG, da Silva LP. Feasibility of Remote Delivering an Exercise and Lifestyle Education Program for Individuals Living with Prediabetes and Diabetes in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16697. [PMID: 36554577 PMCID: PMC9779705 DOI: 10.3390/ijerph192416697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
This study aimed to test the feasibility of remote delivering a 12-week exercise and lifestyle education program (ExLE) or a 12-week exercise program (Ex) for individuals with prediabetes and diabetes in terms of acceptability, implementation, practicality, and limited efficacy. The programs were internet- or telephone-based delivered, depending on the participants' internet access and technology literacy. Of the 196 individuals screened, 15 were included in the study (internet-based delivery (n = 13); telephone-based delivery (n = 2)). Twelve participants completed the program they were randomized to, and most reported being satisfied with the study interventions (acceptability). Data collection procedures, weekly follow-up, study website visits, and educational materials were proper (implementation), and the adherence rate to study interventions ranged from 24% to 58% (practicality). Additionally, both programs (ExLE and Ex) seemed to promote beneficial changes in functional capacity (limited efficacy). The internet-based remote delivery of the interventions showed feasibility. Therefore, in future trials, exercise and educational interventions can be internet-based remote delivered to individuals with prediabetes and diabetes with internet access and technology literacy. In addition, some adjustments to eligibility criteria, study websites, more accessible ways of recording exercise sessions and using educational materials, and an initial supervised exercise session are recommended.
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Affiliation(s)
- Mariana Balbi Seixas
- Cardiovascular Research Unit and Exercise Physiology, University Hospital, Federal University of Juiz de Fora, Avenida Eugênio do Nascimento S/N, Juiz de Fora 36038-330, MG, Brazil
- Graduate Program in Physical Education, Faculty of Physical Education and Sports, Federal University of Juiz de Fora, Rua José Lourenço Kelmer S/N, Juiz de Fora 36036-900, MG, Brazil
| | - Gabriela Lima de Melo Ghisi
- Cardiovascular Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, ON M4G 1R7, Canada
| | - Paul Oh
- Cardiovascular Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, ON M4G 1R7, Canada
| | - Daniele Sirineu Pereira
- Department of Physical Therapy, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte 31270-901, MG, Brazil
- Graduate Program in Rehabilitation Sciences, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte 31270-901, MG, Brazil
| | | | - Ann Kristine Jansen
- Department of Nutrition, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte 31270-901, MG, Brazil
| | - Ana Paula Delgado Bomtempo Batalha
- Cardiovascular Research Unit and Exercise Physiology, University Hospital, Federal University of Juiz de Fora, Avenida Eugênio do Nascimento S/N, Juiz de Fora 36038-330, MG, Brazil
- Graduate Program in Physical Education, Faculty of Physical Education and Sports, Federal University of Juiz de Fora, Rua José Lourenço Kelmer S/N, Juiz de Fora 36036-900, MG, Brazil
| | - Gabriela do Nascimento Cândido
- Graduate Program in Rehabilitation Sciences, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte 31270-901, MG, Brazil
| | - Josiane Aparecida de Almeida
- Cardiovascular Research Unit and Exercise Physiology, University Hospital, Federal University of Juiz de Fora, Avenida Eugênio do Nascimento S/N, Juiz de Fora 36038-330, MG, Brazil
- Graduate Program in Rehabilitation Sciences and Physical-Functional Performance, Faculty of Physical Therapy, Federal University of Juiz de Fora, Avenida Eugênio do Nascimento S/N, Juiz de Fora 36038-330, MG, Brazil
| | - Danielle Aparecida Gomes Pereira
- Department of Physical Therapy, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte 31270-901, MG, Brazil
- Graduate Program in Rehabilitation Sciences, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte 31270-901, MG, Brazil
| | - Lilian Pinto da Silva
- Cardiovascular Research Unit and Exercise Physiology, University Hospital, Federal University of Juiz de Fora, Avenida Eugênio do Nascimento S/N, Juiz de Fora 36038-330, MG, Brazil
- Graduate Program in Physical Education, Faculty of Physical Education and Sports, Federal University of Juiz de Fora, Rua José Lourenço Kelmer S/N, Juiz de Fora 36036-900, MG, Brazil
- Graduate Program in Rehabilitation Sciences and Physical-Functional Performance, Faculty of Physical Therapy, Federal University of Juiz de Fora, Avenida Eugênio do Nascimento S/N, Juiz de Fora 36038-330, MG, Brazil
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Looking at Diabetes-Related Distress through a New Lens: The Socio-Ecological Health Model. ENDOCRINES 2022. [DOI: 10.3390/endocrines3040064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Diabetes-related distress (DRD) is defined as an emotional state experienced by people with diabetes (PWD) who are worried about their disease management, the emotional burden from the condition, and/or potential difficulties accessing care or support. The psychosocial aspect of diabetes management is a factor that directly influences patients’ well-being as well as the chronic management of the condition yet is not a primary clinical problem being addressed within the healthcare setting. This review advocates for a re-evaluation and subsequent adjustment of the current DRD screening methodology by implementing the five primary components (Intrapersonal, Interpersonal, Organizational, Community, and Public Policy) of the Socio-Ecological Model of Health (SEMH), bridging the gaps from a public-health perspective. We searched two electronic databases for studies published in the United States from 1995 to 2020 reporting the effects of social determinants of health (SDOH) on DRD. Articles that contained at least one of the five elements of the SEMH and focused on adults aged 18 years or older were included. SDOH, which include circumstances where individuals grow, work, and age, are highly influenced by external factors, such as the distribution of wealth, power, and resources. Current DRD screening tools lack the capacity to account for all major components of SDOH in a comprehensive manner. By applying the SEMH as a theory-based framework, a novel DRD screening tool addressing sex, ethnicity, and socioeconomic background should be implemented to better improve diabetes management outcomes. By exploring the relationships between each level of the SEMH and DRD, healthcare professionals will be better equipped to recognize potential stress-inducing factors for individuals managing diabetes. Further efforts should be invested with the goal of developing a novel screening tool founded on the all-encompassing SEMH in order to perpetuate a more comprehensive diabetes treatment plan to address barriers within the SDOH framework.
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Davies MJ, Aroda VR, Collins BS, Gabbay RA, Green J, Maruthur NM, Rosas SE, Del Prato S, Mathieu C, Mingrone G, Rossing P, Tankova T, Tsapas A, Buse JB. Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2022; 65:1925-1966. [PMID: 36151309 PMCID: PMC9510507 DOI: 10.1007/s00125-022-05787-2] [Citation(s) in RCA: 293] [Impact Index Per Article: 146.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023]
Abstract
The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the previous consensus statements on the management of hyperglycaemia in type 2 diabetes in adults, published since 2006 and last updated in 2019. The target audience is the full spectrum of the professional healthcare team providing diabetes care in the USA and Europe. A systematic examination of publications since 2018 informed new recommendations. These include additional focus on social determinants of health, the healthcare system and physical activity behaviours including sleep. There is a greater emphasis on weight management as part of the holistic approach to diabetes management. The results of cardiovascular and kidney outcomes trials involving sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, including assessment of subgroups, inform broader recommendations for cardiorenal protection in people with diabetes at high risk of cardiorenal disease. After a summary listing of consensus recommendations, practical tips for implementation are provided.
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Affiliation(s)
- Melanie J Davies
- Leicester Diabetes Research Centre, University of Leicester, Leicester, UK.
- Leicester National Institute for Health Research (NIHR) Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Vanita R Aroda
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Billy S Collins
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | | | - Jennifer Green
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Nisa M Maruthur
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sylvia E Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Geltrude Mingrone
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Division of Diabetes and Nutritional Sciences, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tsvetalina Tankova
- Department of Endocrinology, Medical University - Sofia, Sofia, Bulgaria
| | - Apostolos Tsapas
- Diabetes Centre, Clinical Research and Evidence-based Medicine Unit, Aristotle University Thessaloniki, Thessaloniki, Greece
- Harris Manchester College, University of Oxford, Oxford, UK
| | - John B Buse
- University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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95
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Flood D, Edwards EW, Giovannini D, Ridley E, Rosende A, Herman WH, Jaffe MG, DiPette DJ. [Integrating hypertension and diabetes management in primary health care settings: HEARTS as a toolIntegrando o manejo da hipertensão e do diabetes na atenção primária à saúde: uso do HEARTS como instrumento]. Rev Panam Salud Publica 2022; 46:e213. [PMID: 36415785 PMCID: PMC9673610 DOI: 10.26633/rpsp.2022.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/01/2022] [Indexed: 11/19/2022] Open
Abstract
Hypertension and diabetes are modifiable cardiovascular disease (CVD) risk factors that contribute to nearly one-third of all deaths in the Americas Region each year (2.3 million deaths). Despite advances in the detection and clinical management of hypertension and diabetes, there are substantial gaps in their implementation globally and in the Region. The considerable overlap in risk factors, prognosis, and treatment of hypertension and diabetes creates a unique opportunity for a unified implementation model for management at the population level. This report highlights one such high-profile effort, the Pan American Health Organization's "HEARTS in the Americas" program, based on the World Health Organization's HEARTS Technical Package for Cardiovascular Disease Management in Primary Health Care. The HEARTS program aims to improve the implementation of preventive CVD care in primary health systems using six evidence-based, pragmatic components: Healthy-lifestyle counseling, Evidence-based protocols, Access to essential medicines and technology, Risk-based CVD management, Team-based care, and Systems for monitoring. To date, HEARTS implementation projects have focused primarily on hypertension given that it is the leading modifiable CVD risk factor and can be treated cost-effectively. The objective of this report is to describe opportunities for integration of diabetes clinical care and policy within the HEARTS hypertension framework. A substantial global burden of disease could be averted with integrated primary care management of these conditions. Thus, there is an urgency in applying lessons from HEARTS to close these implementation gaps and improve the integrated detection, treatment, and control of diabetes and hypertension.
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Affiliation(s)
- David Flood
- Departamento de Medicina InternaUniversidad de MichiganAnn ArborEstados Unidos de AméricaDepartamento de Medicina Interna, Universidad de Michigan, Ann Arbor, Estados Unidos de América.,David Flood,
| | - Elizabeth W. Edwards
- Departamento de Medicina InternaFacultad de Medicina de la Universidad de Carolina del SurColumbiaEstados Unidos de AméricaDepartamento de Medicina Interna, Facultad de Medicina de la Universidad de Carolina del Sur, Columbia, Estados Unidos de América
| | - David Giovannini
- Prisma Health-MidlandsColumbiaEstados Unidos de AméricaPrisma Health-Midlands, Columbia, Estados Unidos de América
| | - Emily Ridley
- Prisma Health-MidlandsColumbiaEstados Unidos de AméricaPrisma Health-Midlands, Columbia, Estados Unidos de América
| | - Andres Rosende
- Iniciativa HEARTS en las AméricasOrganización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaIniciativa HEARTS en las Américas, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América
| | - William H. Herman
- Departamento de EpidemiologíaUniversidad de MichiganAnn ArborEstados Unidos de AméricaDepartamento de Epidemiología, Universidad de Michigan, Ann Arbor, Estados Unidos de América
| | - Marc G. Jaffe
- The Permanente Medical GroupSan Francisco Medical CenterSan FranciscoEstados Unidos de AméricaThe Permanente Medical Group, San Francisco Medical Center, San Francisco, Estados Unidos de América
| | - Donald J. DiPette
- Departamento de Medicina InternaFacultad de Medicina de la Universidad de Carolina del SurColumbiaEstados Unidos de AméricaDepartamento de Medicina Interna, Facultad de Medicina de la Universidad de Carolina del Sur, Columbia, Estados Unidos de América
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96
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Boakye MD, Miyamoto S, Greenwood D, Van Haitsma K, Boltz M, Kraschnewski J. Remodeling Type 2 Diabetes Diagnosis: What Individuals Need for Success. Clin Diabetes 2022; 41:273-285. [PMID: 37092157 PMCID: PMC10115758 DOI: 10.2337/cd22-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The diagnosis of type 2 diabetes initiates a new health-illness transition. However, little is known about the immediate support that people need to successfully cope with this diagnosis. This qualitative study explored the experiences and immediate support needed at the point of diagnosis among individuals with type 2 diabetes. The findings suggest the need for health care professionals to render immediate emotional support in the form of reassurance and partnership to manage the condition together. Pre- and post-counseling sessions can minimize the emotional and psychological strain associated with the new diagnosis. Individuals should be given information on available resources, as well as an immediate connection with a health care partner who can provide guidance and help with the transition.
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Affiliation(s)
- Michelle D.S. Boakye
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
| | - Sheridan Miyamoto
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
| | | | - Kimberly Van Haitsma
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
| | - Marie Boltz
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
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97
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Mphasha MH, Skaal L, Mothiba TM, Ngoatle C, Hlahla LS. Primary health care–family partnership for better diabetes outcomes of patients: a systematic review. JOURNAL OF ENDOCRINOLOGY, METABOLISM AND DIABETES OF SOUTH AFRICA 2022. [DOI: 10.1080/16089677.2022.2140517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- MH Mphasha
- Department of Human Nutrition and Dietetics, University of Limpopo, South Africa
| | - L Skaal
- School of Health Sciences, University of Limpopo, South Africa
| | - TM Mothiba
- Faculty of Healthcare Sciences, University of Limpopo, South Africa
| | - C Ngoatle
- Faculty of Healthcare Sciences, University of Limpopo, South Africa
| | - LS Hlahla
- Faculty of Healthcare Sciences, University of Limpopo, South Africa
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98
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Chacko E. Minimizing Negative Effects on Glycemia of Pre- and Post-Meal Exercise for People With Diabetes: A Personal Case Report and Review of the Literature. Clin Diabetes 2022; 41:311-321. [PMID: 37092166 PMCID: PMC10115764 DOI: 10.2337/cd22-0076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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99
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Davies MJ, Aroda VR, Collins BS, Gabbay RA, Green J, Maruthur NM, Rosas SE, Del Prato S, Mathieu C, Mingrone G, Rossing P, Tankova T, Tsapas A, Buse JB. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2022; 45:2753-2786. [PMID: 36148880 PMCID: PMC10008140 DOI: 10.2337/dci22-0034] [Citation(s) in RCA: 472] [Impact Index Per Article: 236.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 02/07/2023]
Abstract
The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the previous consensus statements on the management of hyperglycemia in type 2 diabetes in adults, published since 2006 and last updated in 2019. The target audience is the full spectrum of the professional health care team providing diabetes care in the U.S. and Europe. A systematic examination of publications since 2018 informed new recommendations. These include additional focus on social determinants of health, the health care system, and physical activity behaviors, including sleep. There is a greater emphasis on weight management as part of the holistic approach to diabetes management. The results of cardiovascular and kidney outcomes trials involving sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists, including assessment of subgroups, inform broader recommendations for cardiorenal protection in people with diabetes at high risk of cardiorenal disease. After a summary listing of consensus recommendations, practical tips for implementation are provided.
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Affiliation(s)
- Melanie J. Davies
- Leicester Diabetes Research Centre, University of Leicester, Leicester, U.K
- Leicester National Institute for Health Research Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - Vanita R. Aroda
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | | | - Jennifer Green
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Nisa M. Maruthur
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sylvia E. Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Geltrude Mingrone
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Division of Diabetes and Nutritional Sciences, School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, London, U.K
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Apostolos Tsapas
- Diabetes Centre, Clinical Research and Evidence-Based Medicine Unit, Aristotle University Thessaloniki, Thessaloniki, Greece
- Harris Manchester College, University of Oxford, Oxford, U.K
| | - John B. Buse
- University of North Carolina School of Medicine, Chapel Hill, NC
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100
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Caring for people with diabetes: A fresh look at an old disease. Nursing 2022; 52:26-32. [PMID: 36259901 DOI: 10.1097/01.nurse.0000884536.18596.9e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT This article describes current evidence-based approaches to the care and education of adults living with diabetes. It also highlights revisions in the 2022 Standards of Care and evidence-based strategies nurses can use to be more effective.
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