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Laranjo L, Neves AL, Costa A, Ribeiro RT, Couto L, Sá AB. Facilitators, barriers and expectations in the self-management of type 2 diabetes--a qualitative study from Portugal. Eur J Gen Pract 2015; 21:103-10. [PMID: 25698085 DOI: 10.3109/13814788.2014.1000855] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with type 2 diabetes mellitus (DM) have a central role in managing their disease, but the effective adoption of self-management behaviours is often challenging. OBJECTIVES The main objective of this study was to assess the facilitators, barriers and expectations in the self-management of type 2 DM, as perceived by patients. METHODS Patients with type 2 DM were recruited at the Portuguese Diabetes Association outpatient clinic, using a convenient sampling technique. Qualitative data was obtained using video-recorded focus groups. Each session had a moderator and an observer, and followed a pre-tested questioning route. Two independent researchers transcribed and analysed the focus groups. RESULTS Three major themes were identified: diet, physical exercise, and glycaemic control. Difficulties in changing dietary habits were grouped in four main categories: decisional, food quality, food quantity, and dietary schedule. Barriers related to physical exercise also included decisional aspects, as well as fatigue, muscle and joint pain, and other co-morbidities. Information and knowledge translation, as well as family and social ties, were commonly explored aspects across the three themes and were regarded as facilitators in some situations and as barriers in others. CONCLUSION This study provided new insight on the barriers, facilitators and expectations in type 2 DM self-management, pointing out the importance of tailored guidance. Future research should explore interventions designed to promote and facilitate behaviour change in this population.
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Affiliation(s)
- Liliana Laranjo
- Portuguese School of Public Health, Universidade Nova de Lisboa , Lisboa , Portugal
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102
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Ravert RD, Boren SA, Wiebke E. Transitioning through college with diabetes: themes found in online forums. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2015; 63:258-267. [PMID: 25693002 DOI: 10.1080/07448481.2015.1015026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Content analysis of Internet-based diabetes forum text was used to examine the experiences encountered by students with diabetes transitioning into and through college. PARTICIPANTS Forum posts (N = 238) regarding attending college with diabetes were collected and analyzed. METHODS Thematic coding was used to identify prominent topics, followed by analysis of theme distribution across college transitional stages. Three students with diabetes were recruited to review results and corroborate findings. RESULTS Twenty thematic categories were identified. Preparation for college involved efforts to move toward autonomous diabetes management. Transitioning in was marked by adjusting to a college lifestyle, then working to manage issues such as busy schedules and alcohol use as continuing students, and turning attention toward future career options and finances while transitioning out. CONCLUSIONS As they move into and through college, students with diabetes negotiate developmental and diabetes-specific tasks within an environment that presents unique logistical, lifestyle, and psychological challenges.
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103
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Li R, Shrestha SS, Lipman R, Burrows NR, Kolb LE, Rutledge S. Diabetes self-management education and training among privately insured persons with newly diagnosed diabetes--United States, 2011-2012. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2014; 63:1045-9. [PMID: 25412060 PMCID: PMC5779508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diabetes is a complex chronic disease that requires active involvement of patients in its management. Diabetes self-management education and training (DSMT), "the ongoing process of facilitating the knowledge, skill, and ability necessary for prediabetes and diabetes self-care," is an important component of integrated diabetes care. It is an intervention in which patients learn about diabetes and how to implement the self-management that is imperative to control the disease. The curriculum of DSMT often includes the diabetes disease process and treatment options; healthy lifestyle; blood glucose monitoring; preventing, detecting and treating diabetes complications; and developing personalized strategies for decision making. The American Diabetes Association recommends providing DSMT to those with newly diagnosed diabetes, because data suggest that when diabetes is first diagnosed is the time when patients are most receptive to such engagement. However, little is known about the proportion of persons with newly diagnosed diabetes participating in DSMT. CDC analyzed data from the Marketscan Commercial Claims and Encounters database (Truven Health Analytics) for the period 2009-2012 to estimate the claim-based proportion of privately insured adults (aged 18-64 years) with newly diagnosed diabetes who participated in DSMT during the first year after diagnosis. During 2011-2012, an estimated 6.8% of privately insured, newly diagnosed adults participated in DSMT during the first year after diagnosis of diabetes. These data suggest that there is a large gap between the recommended guideline and current practice, and that there is both an opportunity and a need to enhance rates of DSMT participation among persons newly diagnosed with diabetes.
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Affiliation(s)
- Rui Li
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC,Corresponding author: Rui Li, , 770-488-1070
| | - Sundar S. Shrestha
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | | | - Nilka R. Burrows
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | | | - Stephanie Rutledge
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC
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104
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Fico G, Fioravanti A, Arredondo MT, Gorman J, Diazzi C, Arcuri G, Conti C, Pirini G. Integration of Personalized Healthcare Pathways in an ICT Platform for Diabetes Managements: A Small-Scale Exploratory Study. IEEE J Biomed Health Inform 2014; 20:29-38. [PMID: 25389246 DOI: 10.1109/jbhi.2014.2367863] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The availability of new tools able to support patient monitoring and personalized care may substantially improve the quality of chronic disease management. A personalized healthcare pathway (PHP) has been developed for diabetes disease management and integrated into an information and communication technology system to accomplish a shift from organization-centered care to patient-centered care. A small-scale exploratory study was conducted to test the platform. Preliminary results are presented that shed light on how the PHP influences system usage and performance outcomes.
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105
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Choi EJ. Focused on Diabetes Education Practice of Community Health Centers in Korea. ACTA ACUST UNITED AC 2014. [DOI: 10.14367/kjhep.2014.31.4.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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106
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Mulvaney SA, Jaser SS, Rothman RL, Russell WE, Pittel EJ, Lybarger C, Wallston KA. Development and validation of the diabetes adolescent problem solving questionnaire. PATIENT EDUCATION AND COUNSELING 2014; 97:96-100. [PMID: 25063715 PMCID: PMC4162751 DOI: 10.1016/j.pec.2014.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 06/10/2014] [Accepted: 07/03/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Problem solving is a critical diabetes self-management skill. Because of a lack of clinically feasible measures, our aim was to develop and validate a self-report self-management problem solving questionnaire for adolescents with type 1 diabetes (T1D). METHODS A multidisciplinary team of diabetes experts generated questionnaire items that addressed diabetes self-management problem solving. Iterative feedback from parents and adolescents resulted in 27 items. Adolescents from two studies (N=156) aged 13-17 were recruited through a pediatric diabetes clinic and completed measures through an online survey. Glycemic control was measured by HbA1c recorded in the medical record. RESULTS Empirical elimination of items using principal components analyses resulted in a 13-item unidimensional measure, the diabetes adolescent problem solving questionnaire (DAPSQ) that explained 56% of the variance. The DAPSQ demonstrated internal consistency (Cronbach's alpha=0.92) and was correlated with diabetes self-management (r=0.53, p<.001), self-efficacy (r=0.54, p<.001), and glycemic control (r=-0.24, p<.01). CONCLUSION The DAPSQ is a brief instrument for assessment of diabetes self-management problem solving in youth with T1D and is associated with better self-management behaviors and glycemic control. PRACTICE IMPLICATIONS The DAPSQ is a clinically feasible self-report measure that can provide valuable information regarding level of self-management problem solving and guide patient education.
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Affiliation(s)
- Shelagh A Mulvaney
- School of Nursing, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Russell L Rothman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William E Russell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric J Pittel
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cindy Lybarger
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth A Wallston
- School of Nursing, Vanderbilt University Medical Center, Nashville, TN, USA
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107
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Siminerio L, Ruppert K, Huber K, Toledo FGS. Telemedicine for Reach, Education, Access, and Treatment (TREAT): linking telemedicine with diabetes self-management education to improve care in rural communities. DIABETES EDUCATOR 2014; 40:797-805. [PMID: 25253624 DOI: 10.1177/0145721714551993] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to examine diabetes-related behavioral and psychosocial outcomes as well as patient satisfaction with the Telemedicine for Reach, Education, Access, and Treatment (TREAT) model. METHODS TREAT employs telemedicine services provided by an endocrinologist at an urban area in partnership with a diabetes educator in a rural area, working together with patients and primary care providers (PCPs). Thirty-five patients with type 2 diabetes were referred by PCPs and received glycemic management and education in the TREAT model. A diabetes educator operated the videoconferencing equipment, remained with the patient to receive and review plan communicated by the endocrinologist during the visit, coordinated services, administered surveys, and provided self-management education and support. Empowerment, self-care, diabetes distress, adherence to monitoring, and patient satisfaction were assessed by survey at baseline and follow-up. RESULTS There was significant improvement in empowerment, self-care (adherence to diet and monitoring), and reduction in diabetes distress. Patients reported high levels of satisfaction. CONCLUSIONS In rural areas, the TREAT model delivers improvements in behavioral and psychosocial outcomes and high patient satisfaction. The TREAT model may be a viable option for rural communities that suffer from a shortage of team-based diabetes specialist and self-management support services.
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Affiliation(s)
- Linda Siminerio
- Department of Medicine, Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Siminerio, Dr Toledo)
| | - Kristine Ruppert
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Ruppert)
| | - Kimberly Huber
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Ms Huber)
| | - Fredrico G S Toledo
- Department of Medicine, Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Siminerio, Dr Toledo)
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108
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Basso PJ, Tazinafo LF, Silva MF, Rocha MJA. An alternative to the use of animals to teach diabetes mellitus. ADVANCES IN PHYSIOLOGY EDUCATION 2014; 38:235-8. [PMID: 25179613 PMCID: PMC4154263 DOI: 10.1152/advan.00051.2014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/02/2014] [Indexed: 05/30/2023]
Abstract
We developed an alternative approach to teach diabetes mellitus in our practical classes, replacing laboratory animals. We used custom rats made of cloth, which have a ventral zipper that allows stuffing with glass marbles to reach different weights. Three mock rats per group were placed into metabolic cages with real food and water and with test tubes containing artificial urine, simulating a sample collection of 24 h. For each cage, we also provided other test tubes with artificial blood and urine, simulating different levels of hyperglycemia. The artificial "diabetic" urine contained different amounts of anhydrous glucose and acetone to simulate two different levels of glycosuria and ketonuria. The simulated urine of a nondiabetic rat was prepared without the addition of glucose or acetone. An Accu-Chek system is used to analyze glycemia, and glycosuria and ketonuria intensity were analyzed by means of a Urocolor bioassay. In the laboratory classroom, students were told that they would receive three rats to find out which one has type 1 or type 2 diabetes mellitus. To do so, they had to weigh the animals, quantify the water and food ingestion, and analyze the artificial blood and urine for glycemia, glycosuria, and ketonuria. Only at the end of class did we reveal that the urine and blood were artificial. Students were instructed to plot the data in a table, discuss the results within their group, and write an individual report. We have already used this practical class with 300 students, without a single student refusing to participate.
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Affiliation(s)
- Paulo José Basso
- Department of Morphology, Physiology and Basic Pathology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Lucas Favaretto Tazinafo
- Department of Morphology, Physiology and Basic Pathology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Mauro Ferreira Silva
- Department of Morphology, Physiology and Basic Pathology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Maria José Alves Rocha
- Department of Morphology, Physiology and Basic Pathology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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109
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Kalra S, Baruah MP, Sahay R. Medication counselling with sodium glucose transporter 2 inhibitor therapy. Indian J Endocrinol Metab 2014; 18:597-599. [PMID: 25285273 PMCID: PMC4171879 DOI: 10.4103/2230-8210.139206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and Bharti Research Institute of Diabetes and Endocrinology, Karnal, Haryana, India
| | - Manash P. Baruah
- Department of Endocrinology, Excel Centre Hospitals, Guwahati, Assam, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, Andhra Pradesh, India
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110
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Strain WD, Cos X, Hirst M, Vencio S, Mohan V, Vokó Z, Yabe D, Blüher M, Paldánius PM. Time to do more: addressing clinical inertia in the management of type 2 diabetes mellitus. Diabetes Res Clin Pract 2014; 105:302-12. [PMID: 24956964 DOI: 10.1016/j.diabres.2014.05.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 05/16/2014] [Indexed: 01/13/2023]
Abstract
AIMS Clinical inertia, the tendency to maintain current treatment strategies despite results demanding escalation, is thought to substantially contribute to the disconnect between clinical aspirations for patients with diabetes and targets achieved. We wished to explore potential causes of clinical inertia among physicians and people with diabetes. METHODS A 20-min online survey of 652 adults with diabetes and 337 treating physicians in six countries explored opinions relating to clinical inertia from both perspectives, in order to correlate perceptions and expectations relating to diagnosis, treatment, diabetes complications and therapeutic escalation. RESULTS Physicians had low expectations for their patients, despite the belief that the importance of good glycaemic control through lifestyle and pharmacological interventions had been adequately conveyed. Conversely, people with diabetes had, at best, a rudimentary understanding of the risks of complications and the importance of good control; indeed, only a small proportion believed lifestyle changes were important and the majority did not intend to comply. CONCLUSIONS The principal findings of this survey suggest that impairments in communication are at the heart of clinical inertia. This manuscript lays out four key principles that we believe are achievable in all environments and can improve the lives of people with diabetes.
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Affiliation(s)
- W D Strain
- Diabetes and Vascular Research Centre, University of Exeter Medical School, Barrack Road, Exeter EX25AX, UK.
| | - X Cos
- Sant Marti de Provençals Primary Health Care Centre, Institut Català de la Salut, Generalitat de Catalunya, C/ Fluvià 211, 08020 Barcelona, Spain
| | - M Hirst
- International Diabetes Federation, Glentirran House, Kippen, Stirlingshire FK8 3DY, Scotland, UK
| | - S Vencio
- Catholic University of Goiás, Goiânia, Avenida T4 number 313, Setor Bueno, Goiania CEP 74230-030, Brazil
| | - V Mohan
- Dr. Mohan's Diabetes Specialities Centre, Madras Diabetes Research Foundation, Conran Smith Road, Gopalapuram, Chennai 600086, India
| | - Z Vokó
- Department of Health Policy & Health Economics, Faculty of Social Sciences, Eötvös Loránd University, Syreon Research Institute, Thökölly út 119, 1146 Budapest, Hungary
| | - D Yabe
- Center for Diabetes, Endocrinology and Metabolism and Center for Metabolism and Clinical Nutrition, Kansai Electric Power Hospital, 2-1-7 Fukushima-ku, Osaka 553-0003, Japan
| | - M Blüher
- University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - P M Paldánius
- Novartis Pharma AG, Postfach CH-4002, Basel, Switzerland
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111
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Wai Leng C, Jundong J, Li Wei C, Joo Pin F, Kwong Ming F, Chen R. Telehealth for improved glycaemic control in patients with poorly controlled diabetes after acute hospitalization – a preliminary study in Singapore. J Telemed Telecare 2014; 20:317-23. [DOI: 10.1177/1357633x14544441] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated a disease management and education programme delivered via telephone support (TS) to patients with poorly controlled diabetes (HbA1c >7%). All eligible patients were invited to participate in the programme, which involved education on lifestyle modification and disease management delivered via three scheduled monthly calls by trained nurses. Patients who declined or could not be contacted acted as the controls (usual care, UC). A per protocol analysis was conducted using a mixed effect model for two subgroups with different baseline HbA1c levels (i.e. baseline HbA1c <8.0% and HbA1c ≥8.0%). A total of 2646 patients with diabetes were eligible for enrolment. Of these, 1391 participants had HbA1c measurements available. The study comprised 633 patients (46%) who completed the programme (TS), 598 (43%) who were not contactable or refused to participate at the first telephone call (UC) and 160 patients who dropped out. In the patients with HbA1c ≥8%, TS reduced the adjusted mean HbA1c by 0.38% ( P = 0.022) but the reduction in diabetes-related admissions (4.2% lower adjusted mean admission rate) was not significant. In patients with HbA1c <8%, TS had no additional effect on glycaemic control or diabetes-related admission. Telephone support appeared effective in improving glycaemic control in patients with poor diabetes control.
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Affiliation(s)
- Chow Wai Leng
- Health Services Research, Eastern Health Alliance, Singapore
| | - Jiang Jundong
- Health Services Research, Eastern Health Alliance, Singapore
| | - Cho Li Wei
- Endocrinology, Changi General Hospital, Singapore
| | - Foo Joo Pin
- Endocrinology, Changi General Hospital, Singapore
| | | | - Richard Chen
- Endocrinology, Changi General Hospital, Singapore
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112
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Stacciarini TSG, Pace AE. Tradução, adaptação e validação de uma escala para o autocuidado de portadores de diabetes mellitus tipo 2 em uso de insulina. ACTA PAUL ENFERM 2014. [DOI: 10.1590/1982-0194201400038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objetivo Traduzir, adaptar e validar a escala Appraisal of Self Care Agency Scale-Revised (ASAS-R) para o Brasil.Métodos Utilizou-se o método descritivo de adaptação de instrumentos de medidas, em 150 portadores de diabetes mellitus. As etapas foram: tradução, síntese das traduções independentes, avaliação pelo Comitê de Juízes, retrotradução, submissão das versões retrotraduzidas aos autores da versão original, validação semântica, submissão da versão adaptada aos autores da versão original e pré-teste.Resultados ASAS-R manteve as equivalências semântica, cultural e conceitual. O alfa de Cronbach foi de 0,74, e o coeficiente de correlação intraclasse, no teste e reteste, foi de 0,81, e na análise interobservadores, de 0,84.Conclusão A versão manteve as equivalências conceitual, semântica e cultural. Confirmou-se a correlação entre os construtos capacidade de autocuidado, depressão e percepção do estado de saúde, exceto apoio social. Na validade discriminante, observaram-se diferenças significantes entre grupos, quanto à idade, escolaridade e autoaplicação de insulina.
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113
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Towards a conceptual model of diabetes self-management among Chinese immigrants in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:6727-42. [PMID: 24978878 PMCID: PMC4113840 DOI: 10.3390/ijerph110706727] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 11/29/2022]
Abstract
Background: Chinese immigrants have been disproportionally affected by type 2 diabetes. This paper presents the state of science regarding the factors that may influence diabetes self-management among Chinese immigrants in the US and the potential health outcomes. Design: Using Walker and Avant’s techniques, a search of the literature was conducted from CINAHL, PubMed, OVID, and Web of Science. Findings: Factors most relevant to diabetes self-management were grouped under five categories: socio-demographic characteristics, behavioral and psychological characteristics, social support, linguistic barriers, and cultural characteristics. Potential outcomes derived from improved diabetes self-management include quality of life, glycosylated hemoglobin, and blood pressure and other cardiovascular risk factors. Discussion: A conceptual model was provided to guide future research. Based on the review of the literature, specific research topics that need to fill the gaps in the literature were provided, including family-focused interventions for Chinese immigrant patients with diabetes and the effectiveness of these interventions to improve family functioning.
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114
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Abstract
BACKGROUND Health systems increasingly look to mobile health tools to monitor patients cost-effectively between visits. The frequency of assessment services such as interactive voice response (IVR) calls is typically arbitrary, and no approaches have been proposed to tailor assessment schedules based on evidence regarding which measures actually provide new information about patients' status. METHODS We analyzed longitudinal data from over 5000 weekly IVR monitoring calls to 298 diabetes patients using logistic models to determine the predictability of IVR-reported physiological results, perceived health indicators, and self-care behaviors. We also determined the implications for assessment burden and problem detection of omitting assessment items that had no more than a 5% predicted probability of a problem report. RESULTS Assuming weekly IVR assessments, episodes of hyperglycemia were difficult to predict [area under the curve (AUC)=69.7; 95% confidence interval (CI), 50.2-89.2] based on patients' prior assessment responses. Hypoglycemic symptoms and fair/poor perceived health were more predictable, and self-care behaviors such as problems with medication adherence (AUC=92.1; 95% CI, 89.6-94.6) and foot care (AUC=98.4; 95% CI, 97.0-99.8) were highly predictable. Even if patients were only asked about foot inspection behavior when they had >5% chance of a problem report, 94% of foot inspection assessments could be omitted while still identifying 91% of reported problems. CONCLUSIONS Mobile health monitoring systems could be made more efficient by taking patients' reporting history into account. Avoiding redundant information requests could make services more patient centered and might increase engagement. Time saved by decreasing redundancy could be better spent educating patients or assessing other clinical problems.
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115
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Bailey SC, Brega AG, Crutchfield TM, Elasy T, Herr H, Kaphingst K, Karter AJ, Moreland-Russell S, Osborn CY, Pignone M, Rothman R, Schillinger D. Update on health literacy and diabetes. DIABETES EDUCATOR 2014; 40:581-604. [PMID: 24947871 DOI: 10.1177/0145721714540220] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Inadequate literacy is common among patients with diabetes and may lead to adverse outcomes. The authors reviewed the relationship between literacy and health outcomes in patients with diabetes and potential interventions to improve outcomes. METHODS We reviewed 79 articles covering 3 key domains: (1) evaluation of screening tools to identify inadequate literacy and numeracy, (2) the relationships of a range of diabetes-related health outcomes with literacy and numeracy, and (3) interventions to reduce literacy-related differences in health outcomes. RESULTS Several screening tools are available to assess patients' print literacy and numeracy skills, some specifically addressing diabetes. Literacy and numeracy are consistently associated with diabetes-related knowledge. Some studies suggest literacy and numeracy are associated with intermediate outcomes, including self-efficacy, communication, and self-care (including adherence), but the relationship between literacy and glycemic control is mixed. Few studies have assessed more distal health outcomes, including diabetes-related complications, health care utilization, safety, or quality of life, but available studies suggest low literacy may be associated with increased risk of complications, including hypoglycemia. Several interventions appear to be effective in improving diabetes-related outcomes regardless of literacy status, but it is unclear if these interventions can reduce literacy-related differences in outcomes. CONCLUSIONS Low literacy is associated with less diabetes-related knowledge and may be related to other important health outcomes. Further studies are needed to better elucidate pathways by which literacy skills affect health outcomes. Promising interventions are available to improve diabetes outcomes for patients with low literacy; more research is needed to determine their effectiveness outside of research settings.
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Affiliation(s)
- Stacy Cooper Bailey
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Dr Bailey)
| | - Angela G Brega
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA (Dr Brega)
| | - Trisha M Crutchfield
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Ms Crutchfield)
| | - Tom Elasy
- Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN, USA (Drs Elasy, Osborn, and Rothman)
| | - Haley Herr
- Brown School of Social Work, Washington University in St Louis, St Louis, MO, USA (Ms Herr and Dr Moreland-Russell)
| | - Kimberly Kaphingst
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St Louis, St Louis, MO, USA (Dr Kaphingst)
| | - Andrew J Karter
- Kaiser Permanente Division of Research, Oakland, CA, USA (Dr Karter)
| | - Sarah Moreland-Russell
- Brown School of Social Work, Washington University in St Louis, St Louis, MO, USA (Ms Herr and Dr Moreland-Russell)
| | - Chandra Y Osborn
- Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN, USA (Drs Elasy, Osborn, and Rothman)
| | - Michael Pignone
- Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Dr Pignone)
| | - Russell Rothman
- Vanderbilt Center for Health Services Research, Nashville, TN, USA (Dr Rothman)
| | - Dean Schillinger
- Division of General Internal Medicine, University of California San Francisco, and Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA, USA (Dr Schillinger)
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116
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Wiley J, Westbrook M, Long J, Greenfield JR, Day RO, Braithwaite J. Diabetes education: the experiences of young adults with type 1 diabetes. Diabetes Ther 2014; 5:299-321. [PMID: 24519150 PMCID: PMC4065294 DOI: 10.1007/s13300-014-0056-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Clinician-led diabetes education is a fundamental component of care to assist people with Type 1 diabetes (T1D) self-manage their disease. Recent initiatives to incorporate a more patient-centered approach to diabetes education have included recommendations to make such education more individualized. Yet there is a dearth of research that identifies patients' perceptions of clinician-led diabetes education. We aimed to describe the experience of diabetes education from the perspective of young adults with T1D. METHODS We designed a self-reported survey for Australian adults, aged 18-35 years, with T1D. Participants (n = 150) were recruited by advertisements through diabetes consumer-organizations. Respondents were asked to rate aspects of clinician-led diabetes education and identify sources of self-education. To expand on the results of the survey we interviewed 33 respondents in focus groups. RESULTS SURVEY The majority of respondents (56.0%) were satisfied with the amount of continuing clinician-led diabetes education; 96.7% sought further self-education; 73.3% sourced more diabetes education themselves than that provided by their clinicians; 80.7% referred to diabetes organization websites for further education; and 30.0% used online chat-rooms and blogs for education. Focus groups: The three key themes that emerged from the interview data were deficiencies related to the pedagogy of diabetes education; knowledge deficiencies arising from the gap between theoretical diabetes education and practical reality; and the need for and problems associated with autonomous and peer-led diabetes education. CONCLUSION Our findings indicate that there are opportunities to improve clinician led-diabetes education to improve patient outcomes by enhancing autonomous health-literacy skills and to incorporate peer-led diabetes education and support with clinician-led education. The results provide evidence for the potential value of patient engagement in quality improvement and health-service redesign.
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Affiliation(s)
- Janice Wiley
- Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia,
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Greenwood DA, Hankins AI, Parise CA, Spier V, Olveda J, Buss KA. A Comparison of In-person, Telephone, and Secure Messaging for Type 2 Diabetes Self-Management Support. DIABETES EDUCATOR 2014; 40:516-525. [DOI: 10.1177/0145721714531337] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ongoing interaction between diabetes educators and patients is necessary for making and sustaining behavior changes essential for glycemic control and subsequently reducing the complications of diabetes. Purpose The purpose of this study was to determine the feasibility of diabetes self-management support (DSMS) delivered via telephone or secure message and to compare clinical outcomes (A1C, LDL), behavioral goal achievement, and health maintenance task completion. Methods In sum, 150 persons with type 2 diabetes who completed diabetes self-management education self-selected DSMS methods: 1 in-person visit (n = 47), 3 brief visits by phone (n = 44), or 3 by secure message (n = 59) through electronic health record. DSMS included evaluation of goal achievement, barriers and facilitators, problem solving, and review of health maintenance exams. Self-reported data were collected at 9 months. Results There were no significant differences among groups in main outcomes between baseline and 9-month follow-up. Behavioral goals were achieved by 59% of in-person participants, 73% phone, and 77% secure message. Sixty-two completed the intervention per protocol: fewer online than in-person or phone groups. Mean attempts to contact participants was significantly greater in the secure message group. Phone contact was significantly longer than secure message. Conclusions Telephone and secure message was feasible for providing DSMS. Three brief contacts by phone or secure message resulted in similar outcomes when compared to an in-person visit. Secure messaging required less staff time, but increased patient engagement is needed.
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Affiliation(s)
- Deborah A. Greenwood
- Sutter Medical Foundation, Sacramento, California, USA (Dr Greenwood, Dr Buss)
- Sutter Institute for Medical Research, Sacramento, California, USA (Ms Hankins, Dr Parise)
- Palo Alto Medical Foundation, Palo Alto, California, USA (Ms Spier)
- Sutter Health Diabetes Disease Management Program, Sacramento, California, USA (Ms Olveda)
| | - Andrea I. Hankins
- Sutter Medical Foundation, Sacramento, California, USA (Dr Greenwood, Dr Buss)
- Sutter Institute for Medical Research, Sacramento, California, USA (Ms Hankins, Dr Parise)
- Palo Alto Medical Foundation, Palo Alto, California, USA (Ms Spier)
- Sutter Health Diabetes Disease Management Program, Sacramento, California, USA (Ms Olveda)
| | - Carol A. Parise
- Sutter Medical Foundation, Sacramento, California, USA (Dr Greenwood, Dr Buss)
- Sutter Institute for Medical Research, Sacramento, California, USA (Ms Hankins, Dr Parise)
- Palo Alto Medical Foundation, Palo Alto, California, USA (Ms Spier)
- Sutter Health Diabetes Disease Management Program, Sacramento, California, USA (Ms Olveda)
| | - Valerie Spier
- Sutter Medical Foundation, Sacramento, California, USA (Dr Greenwood, Dr Buss)
- Sutter Institute for Medical Research, Sacramento, California, USA (Ms Hankins, Dr Parise)
- Palo Alto Medical Foundation, Palo Alto, California, USA (Ms Spier)
- Sutter Health Diabetes Disease Management Program, Sacramento, California, USA (Ms Olveda)
| | - Joan Olveda
- Sutter Medical Foundation, Sacramento, California, USA (Dr Greenwood, Dr Buss)
- Sutter Institute for Medical Research, Sacramento, California, USA (Ms Hankins, Dr Parise)
- Palo Alto Medical Foundation, Palo Alto, California, USA (Ms Spier)
- Sutter Health Diabetes Disease Management Program, Sacramento, California, USA (Ms Olveda)
| | - Kimberly A. Buss
- Sutter Medical Foundation, Sacramento, California, USA (Dr Greenwood, Dr Buss)
- Sutter Institute for Medical Research, Sacramento, California, USA (Ms Hankins, Dr Parise)
- Palo Alto Medical Foundation, Palo Alto, California, USA (Ms Spier)
- Sutter Health Diabetes Disease Management Program, Sacramento, California, USA (Ms Olveda)
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118
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Mallow JA, Theeke LA, Barnes ER, Whetsel T. Examining Dose of Diabetes Group Medical Visits and Characteristics of the Uninsured. West J Nurs Res 2014; 37:1033-61. [PMID: 24709853 DOI: 10.1177/0193945914529190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Type 2 diabetes is a significant problem for the uninsured. Diabetes Group Medical Visits (DGMVs) have been reported to improve outcomes. However, it is not known if the increased workload of the health care team to treat and educate patients at multiple visits has an impact on patient functioning and well-being. The aim of this study was to explore the impact of dose of DGMVs on biophysical outcomes of care in uninsured persons with diabetes. No significant correlations were found between number of DGMVs attended and biophysical outcomes of care. However, the majority of patients attended two or less DGMVs in 1 year. Dose of DGMVs did not impact outcomes and may not be enough to assure attendance. Involving patients to construct patient-centered interventions may decrease the treatment burden faced by both patients and providers. In addition, such interventions should be aimed at understanding reasons for low attendance, particularly in rural impoverished adults.
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120
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Hudson JL, Bundy C, Coventry PA, Dickens C. Exploring the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. A systematic review with meta-analysis. J Psychosom Res 2014; 76:265-74. [PMID: 24630175 DOI: 10.1016/j.jpsychores.2014.02.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Depression and anxiety are common in diabetes and are associated with lower diabetes self-care adherence. How this occurs is unclear. Our systematic review explored the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. METHODS Medline, Psycinfo, EMBASE, and CINAHL were searched from inception to June 2013. Data on associations between cognitive illness representations, poor emotional health, and diabetes self-care were extracted. Random effects meta-analysis was used to test the relationship between cognitive illness representations and poor emotional health. Their combined effect on diabetes self-care was narratively evaluated. RESULTS Nine cross-sectional studies were included. Increased timeline cyclical, consequences, and seriousness beliefs were associated with poorer emotional health symptoms. Lower perceived personal control was associated with increased depression and anxiety, but not mixed anxiety and depressive symptoms. Remaining cognitive illness representation domains had mixed statistically significant and non-significant relationships across emotional states or were measured only once. Effect sizes ranged from small to large (r=±0.20 to 0.51). Two studies explored the combined effects of cognitions and emotions on diabetes self-care. Both showed that cognitive illness representations have an independent effect on diabetes self-care, but only one study found that depression has an independent effect also. CONCLUSIONS Associations between cognitive illness representations and poor emotional health were in the expected direction - negative diabetes perceptions were associated with poorer emotional health. Few studies examined the relative effects of cognitions and emotions on diabetes self-care. Longitudinal studies are needed to clarify directional pathways.
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Affiliation(s)
- Joanna L Hudson
- Health Psychology Section, Psychology Department, Institute of Psychiatry, King's College London, UK; NIHR Collaboration for Leadership in Applied Health Research and Care for Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, UK.
| | - Chris Bundy
- NIHR Collaboration for Leadership in Applied Health Research and Care for Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, UK.
| | - Peter A Coventry
- NIHR Collaboration for Leadership in Applied Health Research and Care for Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, UK.
| | - Chris Dickens
- Mental Health Research Group, Institute of Health Research, University of Exeter Medical School, UK; The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula (PenCLAHRC), UK.
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Conley MP, Chim C, Magee CE, Sullivan DJ. A review of advances in collaborative pharmacy practice to improve adherence to standards of care in diabetes management. Curr Diab Rep 2014; 14:470. [PMID: 24496918 DOI: 10.1007/s11892-013-0470-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The prevalence of diabetes in the United States is increasing and so is the need to provide diabetes care. Given the time commitment and complexity of diabetes management, an interdisciplinary approach is recommended. Pharmacists are integral members of the diabetes care team because of their accessibility and expertise in medication management. Pharmacists are receiving specialized training and becoming more involved in direct patient care through collaborative practice opportunities such as medication therapy management and collaborative drug therapy management. These collaborative practice models increase patient access to care and allow pharmacists to optimize drug therapy and provide important education to promote diabetes self-management. Studies show pharmacists practicing in a variety of outpatient environments can reduce HbA1c, LDL and BP as well as improve adherence to recommended American Diabetes Association guidelines (yearly monofilament exams, dilated eye exams, microalbumin screening, etc). Pharmacists working as part of the health care team can ensure optimal diabetes management.
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Affiliation(s)
- Michael P Conley
- Bouvé College of Health Sciences, School of Pharmacy, Northeastern University, 360 Huntington Ave - R218 TF, Boston, MA, 02115, USA,
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122
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Integrated guidance on the care of familial hypercholesterolemia from the International FH Foundation. J Clin Lipidol 2014; 8:148-72. [DOI: 10.1016/j.jacl.2014.01.002] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 01/04/2014] [Indexed: 12/11/2022]
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Ross J, Stevenson F, Dack C, Pal K, May C, Michie S, Parrott S, Murray E. Evaluating the implementation of HeLP-Diabetes within NHS services: study protocol. BMC Health Serv Res 2014; 14:51. [PMID: 24495515 PMCID: PMC3915558 DOI: 10.1186/1472-6963-14-51] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 01/14/2014] [Indexed: 11/10/2022] Open
Abstract
Background Self-management by people with type 2 diabetes is central to good health outcomes and the prevention of associated complications. Structured education to teach self-management is recommended by the National Institute for Heath and Clinical Excellence; however, only a small proportion of patients report being offered this education and even fewer attend. This study aims to evaluate the implementation of a new internet-based self-management intervention: HeLP-Diabetes (Healthy Living for People with type 2 Diabetes) within the National Health Service. Specific objectives are to a) determine the uptake and use of HeLP-Diabetes by services and patients; b) identify the factors which inhibit or facilitate use; c) identify the resources needed for effective implementation; d) explore possible effects of HeLP-Diabetes use on self-reported patient outcome measures. Methods/Design This study will use an iterative design to implement HeLP-Diabetes into existing health services within the National Health Service. A two stage implementation process will be taken, whereby batches of General Practice surgeries and diabetes clinics will be offered HeLP-Diabetes and will subsequently be asked to participate in evaluating the implementation. We will collect data to describe the number of services and patients who sign up to HeLP-Diabetes, the types of services and patients who sign up and the implementation costs. Semi-structured interviews will be conducted with patients and health professionals and cohorts of patient participants will be asked to complete self-report measures at baseline, 3 months, and 12 months. Discussion This study will evaluate the implementation of a new online self-management intervention and describe what happens when it is made available to existing National Health Services and patients with type 2 diabetes. We will collect data to describe the uptake and use of the intervention and the resources needed for widespread implementation. We will report on patient benefits from using HeLP-Diabetes and the resources needed to achieve these in routine practice. Interviews with key stake holders will identify, define and explain factors that promote or inhibit the normalization of new patterns of patient and professional activity arising from HeLP-Diabetes.
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Affiliation(s)
- Jamie Ross
- 1e-Health Unit, UCL Research Department of Primary Care & Population Health, Upper 3rd Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF,m, UK.
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Watts GF, Gidding S, Wierzbicki AS, Toth PP, Alonso R, Brown WV, Bruckert E, Defesche J, Lin KK, Livingston M, Mata P, Parhofer KG, Raal FJ, Santos RD, Sijbrands EJ, Simpson WG, Sullivan DR, Susekov AV, Tomlinson B, Wiegman A, Yamashita S, Kastelein JJ. Integrated guidance on the care of familial hypercholesterolaemia from the International FH Foundation. Int J Cardiol 2014; 171:309-25. [DOI: 10.1016/j.ijcard.2013.11.025] [Citation(s) in RCA: 221] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/02/2013] [Indexed: 12/18/2022]
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125
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Ayala J, Howe C, Dumser S, Buzby M, Murphy K. Partnerships with providers: reflections from parents of children with type 1 diabetes. West J Nurs Res 2014; 36:1238-53. [PMID: 24457181 DOI: 10.1177/0193945913518848] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sixty-three parents with a child or an adolescent with type 1 diabetes participated in this study that focused on what helped them "live well with diabetes." Beyond medical expertise, parents described a partnering relationship with their provider as one of the factors that supported their efforts to live well with diabetes. Parents reported that a partnership was enhanced when the provider had the ability to understand the dynamic nature of the journey in living with diabetes, connect with their family and set the tone by inviting them to openly communicate about all aspects of family life impacting diabetes care, recognize when and how the provider may have to assume the role of Captain of the Ship in times of need, and empathize and respond therapeutically to intense emotions inherent in managing diabetes over time.
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Affiliation(s)
- Judith Ayala
- The Children's Hospital of Philadelphia, PA, USA
| | - Carol Howe
- The Children's Hospital of Philadelphia, PA, USA
| | - Susan Dumser
- The Children's Hospital of Philadelphia, PA, USA
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Moreno G, Mangione CM, Kimbro L, Vaisberg E. Guidelines abstracted from the American Geriatrics Society Guidelines for Improving the Care of Older Adults with Diabetes Mellitus: 2013 update. J Am Geriatr Soc 2014; 61:2020-6. [PMID: 24219204 DOI: 10.1111/jgs.12514] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fisher EB, Coufal MM, Parada H, Robinette JB, Tang PY, Urlaub DM, Castillo C, Guzman-Corrales LM, Hino S, Hunter J, Katz AW, Symes YR, Worley HP, Xu C. Peer support in health care and prevention: cultural, organizational, and dissemination issues. Annu Rev Public Health 2014; 35:363-83. [PMID: 24387085 DOI: 10.1146/annurev-publhealth-032013-182450] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As reviewed in the article by Perry and colleagues (2014) in this volume, ample evidence has documented the contributions of peer support (PS) to health, health care, and prevention. Building on that foundation, this article discusses characteristics, contexts, and dissemination of PS, including (a) fundamental aspects of the social support that is often central to it; (b) cultural influences and ways PS can be tailored to specific groups; (c) key features of PS and the importance of ongoing support and backup of peer supporters and other factors related to its success; (d) directions in which PS can be expanded beyond prevention and chronic disease management, such as in mental health or interventions to prevent rehospitalization; (e) other opportunities through the US Affordable Care Act, such as through patient-centered medical homes and chronic health homes; and (f) organizational and policy issues that will govern its dissemination. All these demonstrate the extent to which PS needs to reflect its contexts--intended audience, health problems, organizational and cultural settings--and, thus, the importance of dissemination policies that lead to flexible response to contexts rather than constraint by overly prescriptive guidelines.
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Affiliation(s)
- Edwin B Fisher
- Peers for Progress, American Academy of Family Physicians Foundation
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128
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Choi S, Song M, Chang SJ, Kim SA. Strategies for enhancing information, motivation, and skills for self-management behavior changes: a qualitative study of diabetes care for older adults in Korea. Patient Prefer Adherence 2014; 8:219-26. [PMID: 24627626 PMCID: PMC3931579 DOI: 10.2147/ppa.s58631] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To describe strategies for enhancing information, motivation, and skills related to changes in diabetes self-management behavior among community-dwelling older adults in Korea. PATIENTS AND METHODS A total of five focus group interviews (three separate focus groups) were conducted with 12 older adults with type 2 diabetes and five diabetes educators. Qualitative content analysis was used. RESULTS "One's own willingness and ability" emerged as a fundamental belief about the strategies for diabetes self-management. Six major themes under three categories were identified. Under the information category, the recurrent themes were: 1) repeatedly offering detailed knowledge regarding self-management, 2) providing information about current health status, and 3) identifying experiential knowledge of blood glucose control. The recurrent themes in the motivation category were: 1) ensuring a positive attitude regarding self-management, and 2) encouragement or feedback from significant others. Furthermore, in the skills category, we found that the following theme emerged: hands-on skills training with numerical standards. CONCLUSION This study identified six tailored strategies for enhancing information, motivation, and skills for diabetes self-management behavior changes. These strategies can be used in the development of a culturally sensitive diabetes self-management program for older adults.
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Affiliation(s)
- Suyoung Choi
- College of Nursing, Jeju National University, Jeju, Korea
| | - Misoon Song
- College of Nursing, and The Research Institute of Nursing Science, Seoul National University, Seoul, Korea
- Correspondence: Misoon Song, College of Nursing, Seoul National University, 28 Yeongun-Dong, Chongno-Gu, Seoul 110-799, Korea, Tel +82 2 740 8826, Fax +82 2 764 8457, Email
| | - Sun Ju Chang
- Department of Nursing Science, Chungbuk National University, Cheongju, Korea
| | - Se-an Kim
- College of Nursing, Seoul National University, Seoul, Korea
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129
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Shomali M. Optimizing the Care of Patients With Type 2 Diabetes Using Incretin-Based Therapy: Focus on GLP-1 Receptor Agonists. Clin Diabetes 2014; 32:32-43. [PMID: 26246677 PMCID: PMC4521427 DOI: 10.2337/diaclin.32.1.32] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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130
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Abstract
Diabetes is a chronic, progressive disease that affects millions worldwide. The paradigm of diabetes management has shifted to focus on empowering the person with diabetes to manage the disease successfully and to improve their quality of life. Diabetes self-management education is a collaborative process through which people with diabetes gain the knowledge and skills needed to modify their behavior and to self-manage successfully the disease and its related conditions. Diabetes educators are health care professionals who apply in-depth knowledge and skills in the biological and social sciences, communication, counseling, and pedagogy to enable patients to manage daily and future challenges. Diabetes educators are integral in providing individualized education and promoting behavior change, using a framework of seven self-care behaviors known as the AADE7 Self-Care Behaviors™, developed by the American Association of Diabetes Educators. The iterative process of promoting behavior change includes assessment, goal setting, planning, implementation, evaluation, and documentation. Diabetes educators work as part of the patient's health care team to engage with the patient in informed, shared decision making. The increasing prevalence of diabetes and the growing focus on its prevention require strategies for providing people with knowledge, skills, and strategies they need and can use. The diabetes educator is the logical facilitator of change. Access to diabetes education is critically important; incorporating diabetes educators into more and varied practice settings will serve to improve clinical and quality of life outcomes for persons with diabetes.
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Affiliation(s)
- Sandra D Burke
- American Association of Diabetes educators, Chicago, IL, USA
- University of Illinois at Chicago College of Nursing, Urbana, IL, USA
- Correspondence: Sandra D Burke, University of Illinois at Chicago College of Nursing, 845 South Damen Avenue, MC 802, Chicago, IL 60612, USA, Tel +1 217 333 2507, Email
| | - Dawn Sherr
- Science and Practice, American Association of Diabetes Educators, Chicago, IL, USA
| | - Ruth D Lipman
- Science and Practice, American Association of Diabetes Educators, Chicago, IL, USA
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131
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Williams JLS, Walker RJ, Smalls BL, Campbell JA, Egede LE. Effective interventions to improve medication adherence in Type 2 diabetes: a systematic review. DIABETES MANAGEMENT (LONDON, ENGLAND) 2014; 4:29-48. [PMID: 25214893 PMCID: PMC4157681 DOI: 10.2217/dmt.13.62] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM Medication adherence is associated with improved outcomes in diabetes. Interventions have been established to help improve medication adherence; however, the most effective interventions in patients with Type 2 diabetes remain unclear. The goal of this study was to distinguish whether interventions were effective and identify areas for future research. METHODS Medline was searched for articles published between January 2000 and May 2013, and a reproducible strategy was used. Study eligibility criteria included interventions measuring medication adherence in adults with Type 2 diabetes. RESULTS Twenty seven studies met the inclusion criteria and 13 showed a statistically significant change in medication adherence. CONCLUSION Heterogeneity of the study designs and measures of adherence made it difficult to identify effective interventions that improved medication adherence. Additionally, medication adherence may not be solely responsible for achieving glycemic control. Researchers must emphasize tailored interventions that optimize management and improve outcomes, and examine the need for clear indicators of medication adherence.
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Affiliation(s)
- Joni L Strom Williams
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Rebekah J Walker
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA
- Center for Disease Prevention & Health Interventions for Diverse Populations, Charleston VA, REAP, Ralph H Johnson VAMC, Charleston, SC, USA
| | - Brittany L Smalls
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer A Campbell
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Leonard E Egede
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
- Center for Disease Prevention & Health Interventions for Diverse Populations, Charleston VA, REAP, Ralph H Johnson VAMC, Charleston, SC, USA
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Hu J, Wallace DC, McCoy TP, Amirehsani KA. A family-based diabetes intervention for Hispanic adults and their family members. DIABETES EDUCATOR 2013; 40:48-59. [PMID: 24248832 DOI: 10.1177/0145721713512682] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS The purpose of this quasi-experimental, 1-group longitudinal study is to examine the effects of a family-based intervention program on diabetes self-management behaviors, A1C, other biomarkers, psychosocial factors, and health-related quality of life in Hispanics with diabetes. METHODS Adult patients with diabetes (n = 36) and family members (n = 37) were recruited from a community clinic in rural central North Carolina. Patients and family members attended an 8-week culturally tailored diabetes educational program taught in Spanish. Data were collected pre- and post-intervention for both patients and family members, with an additional data collection for patients 1 month post-intervention. RESULTS Most patients and family members were female, and almost all were immigrants. A1C decreased by 4.9% on average among patients from pre-intervention to 1 month post-intervention. Patients showed significant improvements in systolic blood pressure, diabetes self-efficacy, diabetes knowledge, and physical and mental components of health-related quality of life. Higher levels of intake of healthy foods and performance of blood glucose tests and foot inspections were reported. Family members significantly lowered body mass index and improved diabetes knowledge from pre-intervention to immediately post-intervention. No significant changes in levels of physical activity were found among patients with diabetes or family members. CONCLUSIONS Findings suggest that including family members in educational interventions may provide emotional and psychological support to patients with diabetes, help to develop healthy family behaviors, and promote diabetes self-management.
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Affiliation(s)
- Jie Hu
- the University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Debra C Wallace
- the University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Thomas P McCoy
- the University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Karen A Amirehsani
- the University of North Carolina at Greensboro, Greensboro, North Carolina
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133
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Quandt SA, Ip EH, Kirk JK, Saldana S, Chen SH, Nguyen H, Bell RA, Arcury TA. Assessment of a short diabetes knowledge instrument for older and minority adults. DIABETES EDUCATOR 2013; 40:68-76. [PMID: 24163359 DOI: 10.1177/0145721713508824] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of the study was to assess the performance of a Short Diabetes Knowledge Instrument (SDKI) in a large multi-ethnic sample of older adults with diabetes and to identify possible modifications to improve its ability to document diabetes knowledge. RESEARCH DESIGN AND METHODS A sample of 593 African American, American Indian, and white female and male adults 60 years and older, with diabetes diagnosed at least 2 years prior, was recruited from 8 North Carolina counties. All completed an interview that included a 16-item questionnaire to assess diabetes knowledge. A subsample of 46 completed the questionnaire a second time at a subsequent interview. Item-response analysis was used to refine the instrument to well-performing items. The instrument consisting of the remaining items was subjected to analyses to assess validity and test-retest reliability. RESULTS Three items were removed after item-response analysis. Scores for the resulting instrument were lower among minority and older participants, as well as those with lower educational attainment and income. Scores for test-retest were highly correlated. CONCLUSIONS The SDKI (13-item questionnaire) appears to be a valid and reliable instrument to evaluate knowledge about diabetes. Assessment in a multi-ethnic sample of older adults suggests that this instrument can be used to measure diabetes knowledge in diverse populations. Further evaluation is needed to determine whether or not this instrument can detect changes in knowledge resulting from diabetes education or other interventions.
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Affiliation(s)
- Sara A Quandt
- Wake Forest University School of Medicine, Winston-Salem, North Carolina (Dr Quandt, Dr Bell, Dr Ip, Mr Saldana, Dr Chen, Dr Kirk, Dr Nguyen, Dr Arcury)
| | - Edward H Ip
- Wake Forest University School of Medicine, Winston-Salem, North Carolina (Dr Quandt, Dr Bell, Dr Ip, Mr Saldana, Dr Chen, Dr Kirk, Dr Nguyen, Dr Arcury)
| | - Julienne K Kirk
- Wake Forest University School of Medicine, Winston-Salem, North Carolina (Dr Quandt, Dr Bell, Dr Ip, Mr Saldana, Dr Chen, Dr Kirk, Dr Nguyen, Dr Arcury)
| | - Santiago Saldana
- Wake Forest University School of Medicine, Winston-Salem, North Carolina (Dr Quandt, Dr Bell, Dr Ip, Mr Saldana, Dr Chen, Dr Kirk, Dr Nguyen, Dr Arcury)
| | - Shyh-Huei Chen
- Wake Forest University School of Medicine, Winston-Salem, North Carolina (Dr Quandt, Dr Bell, Dr Ip, Mr Saldana, Dr Chen, Dr Kirk, Dr Nguyen, Dr Arcury)
| | - Ha Nguyen
- Wake Forest University School of Medicine, Winston-Salem, North Carolina (Dr Quandt, Dr Bell, Dr Ip, Mr Saldana, Dr Chen, Dr Kirk, Dr Nguyen, Dr Arcury)
| | - Ronny A Bell
- Wake Forest University School of Medicine, Winston-Salem, North Carolina (Dr Quandt, Dr Bell, Dr Ip, Mr Saldana, Dr Chen, Dr Kirk, Dr Nguyen, Dr Arcury)
| | - Thomas A Arcury
- Wake Forest University School of Medicine, Winston-Salem, North Carolina (Dr Quandt, Dr Bell, Dr Ip, Mr Saldana, Dr Chen, Dr Kirk, Dr Nguyen, Dr Arcury)
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Ribu L, Holmen H, Torbjørnsen A, Wahl AK, Grøttland A, Småstuen MC, Elind E, Bergmo TS, Breivik E, Arsand E. Low-intensity self-management intervention for persons with type 2 diabetes using a mobile phone-based diabetes diary, with and without health counseling and motivational interviewing: protocol for a randomized controlled trial. JMIR Res Protoc 2013; 2:e34. [PMID: 23978690 PMCID: PMC3758066 DOI: 10.2196/resprot.2768] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/05/2013] [Accepted: 08/05/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The present study protocol is designed to cover the Norwegian part of the European Union Collaborative Project-REgioNs of Europe WorkINg together for HEALTH (RENEWING HEALTH). Self-management support is an important element of care for persons with type 2 diabetes (T2D) for achieving metabolic control and positive lifestyle changes. Telemedicine (TM) with or without health counseling may become an important technological aid for self-management and may provide a user-centered model of care. In spite of many earlier studies on TM, there remains a lack of consensus in research findings about the effect of TM interventions. OBJECTIVE The aim of RENEWING HEALTH is to validate and evaluate innovative TM tools on a large scale through a common evaluation, making it easier for decision makers to choose the most efficient and cost-effective technological interventions. The Norwegian pilot study evaluates whether the introduction of a mobile phone with a diabetes diary application together with health counseling intervention produces benefits in terms of the desired outcomes, as reflected in the hemoglobin A1c level, health-related quality of life, behavior change, and cost-effectiveness. METHODS The present study has a mixed-method design comprising a three-armed prospective randomized controlled trial and qualitative interviews with study data collected at three time points: baseline, after 4 months, and after 1 year. The patients' registrations on the application are recorded continuously and are sent securely to a server. RESULTS The inclusion of patients started in March 2011, and 100% of the planned sample size is included (N=151). Of all the participants, 26/151 patients (17.2%) are lost to follow-up by now, and 11/151 patients (7.3%) are still in the trial. Results of the study protocol will be presented in 2014. CONCLUSIONS The key goals of this trial are to investigate the effect of an electronic diabetes diary app with and without health counseling, and to determine whether health counseling is important to the continued use of the application and the patients' health competence and acceptability. Research within this area is needed because few studies have investigated the effectiveness of apps used in long-term interventions with this degree of self-management. TRIAL REGISTRATION Clinicaltrials.gov NCT01315756; http://clinicaltrials.gov/ct2/show/NCT01315756 (Archived by WebCite at http://www.webcitation/6BTyuRMpH).
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Affiliation(s)
- Lis Ribu
- Department of Nursing, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
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136
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Siminerio L, Ruppert KM, Gabbay RA. Who Can Provide Diabetes Self-Management Support in Primary Care? DIABETES EDUCATOR 2013; 39:705-13. [DOI: 10.1177/0145721713492570] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this comparative effectiveness study is to compare diabetes self-management support (DSMS) approaches and determine who can be most effective in helping patients maintain/improve clinical outcomes, self-care behaviors, distress, and satisfaction following diabetes self-management education (DSME) delivered in primary care. Methods After receiving DSME, 141 participants were randomized to receive DSMS delivered by a trained supporter: educator, peer, practice staff, or usual education during a 6-month follow-up period. DSMS groups were compared to determine which supporter helped participants to maintain/improve A1C, blood pressure, lipids, weight, self-care, and distress. DSMS satisfaction was also examined. Results There was a significant improvement in A1C, empowerment, aspects of self-care, and distress following DSME at 6 weeks. Those in the educator DSMS group best sustained improved A1C while those in the other DSMS groups maintained glycemic improvements but began to show trends toward worsening. No significant differences or clear trends were seen in other clinical, behavioral, or psychosocial outcomes. The Program Reinforcement Impacts Self-Management (PRISM) study demonstrates that following DSME, participants maintained improved glycemia, lipid, weight, and self-care behaviors and reductions in distress throughout the delivery of DSMS interventions regardless of DSMS supporter. All of the participants reported satisfaction with DSMS. Conclusions These findings reaffirm the critical role of educators but suggest that others may serve as DSMS supporters. Results suggest that DSME delivered in primary care is effective and multiple DSMS agents are reasonable. As patient-centered self-management approaches are being explored in primary care, delivery of DSME and DSMS becomes paramount.
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Affiliation(s)
- Linda Siminerio
- University of Pittsburgh Department of Medicine, Pittsburgh, PA, USA (Dr. Siminerio)
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA (Dr Ruppert)
- Penn State College of Medicine, Hershey, PA, USA (Dr Gabbay)
| | - Kristine M. Ruppert
- University of Pittsburgh Department of Medicine, Pittsburgh, PA, USA (Dr. Siminerio)
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA (Dr Ruppert)
- Penn State College of Medicine, Hershey, PA, USA (Dr Gabbay)
| | - Robert A. Gabbay
- University of Pittsburgh Department of Medicine, Pittsburgh, PA, USA (Dr. Siminerio)
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA (Dr Ruppert)
- Penn State College of Medicine, Hershey, PA, USA (Dr Gabbay)
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Lorber DL, Chavez RS, Dorman J, Fisher LK, Guerken S, Haas LB, Hill JV, Kendall D, Puisis M, Salomone K, Shansky RM, Wakeen B. Diabetes management in correctional institutions. Diabetes Care 2013; 36 Suppl 1:S86-92. [PMID: 23264428 PMCID: PMC3537278 DOI: 10.2337/dc13-s086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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