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Elsherif I, Jammah AA, Ibrahim AR, Alawadi F, Sadek IS, Rahman AM, Sharify GE, AlFeky A, Aldossari K, Roushdy E, ELBarbary NS, BenRajab F, Elghweiry A, Farah SIS, Hajjaji I, AlShammary A, Abdulkareem F, AbdelRahim A, Orabi A. Clinical practice recommendations for management of Diabetes Mellitus in Arab region: An expert consensus statement from Arab Diabetes Forum (ADF). Prim Care Diabetes 2024:S1751-9918(24)00120-7. [PMID: 38955658 DOI: 10.1016/j.pcd.2024.06.003] [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: 02/24/2024] [Revised: 05/14/2024] [Accepted: 06/02/2024] [Indexed: 07/04/2024]
Abstract
Prevalence of diabetes in Arab region has significantly increased, resulting in a significant economic burden on healthcare systems. This surge can be attributed to obesity, rapid urbanization, changing dietary habits, and sedentary lifestyles. The Arab Diabetes Forum (ADF) has established localized recommendations to tackle the region's rising diabetes prevalence. The recommendations, which incorporate worldwide best practices, seek to enhance the quality of treatment for people with diabetes by raising knowledge and adherence among healthcare providers. The guidelines include comprehensive recommendations for screening, diagnosing, and treating type 1 and type 2 diabetes in children and adults for better overall health results.
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Affiliation(s)
| | - Anwar Ali Jammah
- Endocrinology and Diabetes Division, Medicine Department, King Saud University, Saudi Arabia
| | | | - Fatheya Alawadi
- Dubai Medical College - President of EDS emirates diabetes society, the United Arab Emirates
| | | | | | | | | | - Khaled Aldossari
- Department of family and community medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Saudi Arabia
| | - Eman Roushdy
- Internal medicine and Diabetes, Cairo University, Egypt
| | - Nancy Samir ELBarbary
- Department of Pediatrics, Diabetes Unit, Faculty of medicine, Ain shams University, Cairo, Egypt
| | | | - Awad Elghweiry
- National Center for Diagnosis and Treatment of Diabetes, Benghazi, Libya
| | | | - Issam Hajjaji
- Endocrine & Diabetes Hospital, University of Tripoli, Libya
| | - Afaf AlShammary
- Department of Internal Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Saudi Arabia
| | - Faris Abdulkareem
- Internal medicine, diabetes and endocrinology, Alkindy College of Medicine, Iraq
| | - Aly AbdelRahim
- Internal medicine and Diabetes Department, Alex University, Egypt
| | - Abbass Orabi
- Internal medicine and Diabetes, Zagazig University, Egypt.
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Vincenzo JL, Bergen G, Casey CM, Eckstrom E. Reframing Fall Prevention and Risk Management as a Chronic Condition Through the Lens of the Expanded Chronic Care Model: Will Integrating Clinical Care and Public Health Improve Outcomes? THE GERONTOLOGIST 2024; 64:gnae035. [PMID: 38666718 PMCID: PMC11149378 DOI: 10.1093/geront/gnae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Indexed: 06/05/2024] Open
Abstract
Falls are a leading cause of morbidity and mortality among adults aged 65 years and older (older adults) and are increasingly recognized as a chronic condition. Yet, fall-related care is infrequently provided in a chronic care context despite fall-related death rates increasing by 41% between 2012 and 2021. One of the many challenges to addressing falls is the absence of fall-focused chronic disease management programs, which improve outcomes of other chronic conditions, like diabetes. Policies, information systems, and clinical-community connections help form the backbone of chronic disease management programs, yet these elements are often missing in fall prevention. Reframing fall prevention through the Expanded Chronic Care Model (ECCM) guided by implementation science to simultaneously support the uptake of evidence-based practices could help improve the care of older adults at risk for falling. The ECCM includes seven components: (1) self-management/develop personal skills, (2) decision support, (3) delivery system design/re-orient health services, (4) information systems, (5) build healthy public policy, (6) create supportive environments, and (7) strengthen community action. Applying the ECCM to falls-related care by integrating health care delivery system changes, community resources, and public policies to support patient-centered engagement for self-management offers the potential to prevent falls more effectively among older adults.
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Affiliation(s)
- Jennifer L Vincenzo
- Department of Physical Therapy and Center for Implementation Research, Fayetteville, Arkansas, USA
| | - Gwen Bergen
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Colleen M Casey
- Department of Internal Medicine, Providence Senior Health, Portland, Oregon, USA
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Ajrouche S, Louis L, Esvan M, Chapron A, Garlantezec R, Allory E. HbA1c changes in a deprived population who followed or not a diabetes self-management programme, organised in a multi-professional primary care practice: a historical cohort study on 207 patients between 2017 and 2019. BMC Endocr Disord 2024; 24:72. [PMID: 38769550 PMCID: PMC11103828 DOI: 10.1186/s12902-024-01601-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Diabetes self-management (DSM) helps people with diabetes to become actors in their disease. Deprived populations are particularly affected by diabetes and are less likely to have access to these programmes. DSM implementation in primary care, particularly in a multi-professional primary care practice (MPCP), is a valuable strategy to promote care access for these populations. In Rennes (Western France), a DSM programme was designed by a MPCP in a socio-economically deprived area. The study objective was to compare diabetes control in people who followed or not this DSM programme. METHOD The historical cohort of patients who participated in the DSM programme at the MPCP between 2017 and 2019 (n = 69) was compared with patients who did not participate in the programme, matched on sex, age, diabetes type and place of the general practitioner's practice (n = 138). The primary outcome was glycated haemoglobin (HbA1c) change between 12 months before and 12 months after the DSM programme. Secondary outcomes included modifications in diabetes treatment, body mass index, blood pressure, dyslipidaemia, presence of microalbuminuria, and diabetes retinopathy screening participation. RESULTS HbA1c was significantly improved in the exposed group after the programme (p < 0.01). The analysis did not find any significant between-group difference in socio-demographic data, medical history, comorbidities, and treatment adaptation. CONCLUSIONS These results, consistent with the international literature, promote the development of DSM programmes in primary care settings in deprived areas. The results of this real-life study need to be confirmed on the long-term and in different contexts (rural area, healthcare organisation).
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Affiliation(s)
- Sarah Ajrouche
- Department of General Practice, Univ Rennes, 2, Avenue du Pr Léon Bernard, RENNES Cedex, 35043, France
| | - Lisa Louis
- Department of General Practice, Univ Rennes, 2, Avenue du Pr Léon Bernard, RENNES Cedex, 35043, France
| | - Maxime Esvan
- CHU Rennes, Inserm CIC 1414 (Centre d'Investigation Clinique), Rennes, 35000, France
| | - Anthony Chapron
- Department of General Practice, Univ Rennes, 2, Avenue du Pr Léon Bernard, RENNES Cedex, 35043, France
- CHU Rennes, Inserm CIC 1414 (Centre d'Investigation Clinique), Rennes, 35000, France
| | - Ronan Garlantezec
- CHU de Rennes, Univ Rennes, Inserm, EHESP (Ecole des Hautes Etudes en Santé Publique), Irset - UMR_S 1085, Rennes, 35000, France
| | - Emmanuel Allory
- Department of General Practice, Univ Rennes, 2, Avenue du Pr Léon Bernard, RENNES Cedex, 35043, France.
- CHU Rennes, Inserm CIC 1414 (Centre d'Investigation Clinique), Rennes, 35000, France.
- LEPS (Laboratoire Educations et Promotion de la Santé), University of Sorbonne Paris Nord, UR 3412, Villetaneuse, F-93430, France.
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Bolgeo T, Di Matteo R, Simonelli N, Dal Molin A, Bassola B, Lusignani M, Maconi A, Rasero L, Iovino P, Vellone E. Psychometric testing of the caregiver contribution to self-care of coronary heart disease inventory. PLoS One 2024; 19:e0302891. [PMID: 38728276 PMCID: PMC11086860 DOI: 10.1371/journal.pone.0302891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Caregivers are important contributors to the self-care of patients with coronary heart disease (CHD). AIMS The aims of this study are to describe the development and psychometric properties of the caregiver contribution to self-care of coronary heart disease inventory (CC-SC-CHDI). METHODS The CC-SC-CHDI was developed from the patient version of the scale, the Self-care of Coronary Heart Disease Inventory (SC-CHDI) and translated into Italian using forward and backward translation. Baseline data from the HEARTS-IN-DYADS study were used. Confirmatory factor analysis (CFA) was conducted to assess factorial validity; Cronbach's alpha and the model-based internal consistency index were used to test internal consistency reliability, and Pearson's correlation coefficient was used to test convergent validity, by investigating the association between the CC-SC-CHDI and the SC-CHDI scores. RESULTS We included 131 caregivers (mean age 55 years, 81.2% females, 74% married) of patients affected by CHD (mean age 66 years, 80.2% males, 74% married). The CFA confirmed two factors in the caregiver contribution to self-care maintenance scale ("consulting behaviors" and "autonomous behaviors"), one factor for the CC to self-care monitoring scale, and two factors in the CC to self-care management scale ("consulting behaviors and problem-solving behaviors"). Reliability estimates were adequate for each scale (Cronbach's alpha and model-based internal consistency indexes ranging from 0.73 to 0.90). Significant and positive correlations were observed between CC-SC-CHDI and SC-CHDI scales. CONCLUSION The CC-SC-CHDI has satisfactory validity and reliability and can be used confidently in clinical settings and research to assess caregiver contributions to CHD self-care.
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Affiliation(s)
- Tatiana Bolgeo
- Research Training Innovation Infrastructure, Department of Research and Innovation, Azienda Ospedaliero-Universitaria SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Roberta Di Matteo
- Research Training Innovation Infrastructure, Department of Research and Innovation, Azienda Ospedaliero-Universitaria SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Niccolò Simonelli
- SC Cardiology, Azienda Ospedaliero-Universitaria SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Health Professions’ Direction, Maggiore della Carità Hospital, Novara, Italy
| | - Barbara Bassola
- School of Nursing, University of Milan, Niguarda Hospital, Milan, Italy
| | - Maura Lusignani
- School of Nursing, University of Milan, Niguarda Hospital, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonio Maconi
- Director of Department of Research and Innovation, Azienda Ospedaliero-Universitaria SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Laura Rasero
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Paolo Iovino
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
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Ortíz GO, Vega García S, Islas Salinas C, Muñoz Torres AV, Velázquez López L. Usability evaluation of the educational website "understanding my diabetes" for Mexican patients with type 2 diabetes. Front Public Health 2024; 12:1394066. [PMID: 38799692 PMCID: PMC11116676 DOI: 10.3389/fpubh.2024.1394066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Background Diabetes education is an integral part of the treatment for the metabolic control of patients with diabetes. The use of the Internet as a tool for diabetes education, as well as its acceptance, is still under study. Aim To assess the usability of the educational website "I understand my diabetes" designed for patients with type 2 diabetes attending primary care clinics. Material and method A cross-sectional study was done in 110 patients with type 2 diabetes from two family medicine clinics, each of whom was assigned a user account on the educational website "Entiendo mi diabetes." The web site assigned a user name and password to each patient. They were able to access the educational website at home. After a 15-day review period, participants were asked to evaluate usability using the Computer System Usability Questionnaire. Additionally, we developed an eight-item questionnaire usability focusing on diabetes care. Sociodemographic data, blood pressure, and anthropometric measurements were recorded. Glucose levels and lipid profiles were also measured. Results The patients with diabetes had a mean age of 52.7 years and a median of 5 years since they were diagnosed with diabetes. The website received a good usability rating from 89.1% of participants, with favorable assessments in all three dimensions: 87.3% for information, 85.5% for quality, and 88.2% for interface. Regarding usability specifically for diabetes care, 98.2% rated it as having good usability. Conclusion The website for education about the disease in patients "I understand my diabetes" had an adequate usability evaluation by patients, so they also considered it very useful for diabetes care. The diabetes care instrument had adequate usability and reliability.
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Affiliation(s)
- Gabriela Ortíz Ortíz
- Unidad de Investigación en Epidemiología Clínica, Hospital General Regional No. 1 “Dr. Carlos Mac Gregor Sánchez Navarro” Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - Sandra Vega García
- Unidad de Medicina Familiar Número 7, Coordinación de Educación e Investigación en Salud, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - Cristina Islas Salinas
- Unidad de Medicina Familiar Número 7, Coordinación de Educación e Investigación en Salud, Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - Abril Violeta Muñoz Torres
- Departamento de Salud Publica, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Lubia Velázquez López
- Unidad de Investigación en Epidemiología Clínica, Hospital General Regional No. 1 “Dr. Carlos Mac Gregor Sánchez Navarro” Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
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Zhu X, Ren B, Liu W, Lei S, Lin S, Liu Q, Yin L, Feng B. The short- and long-term effects of community-family-doctor-based type 2 diabetes self-management interventions. Public Health 2024; 230:96-104. [PMID: 38521030 DOI: 10.1016/j.puhe.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/27/2024] [Accepted: 02/16/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES The popularity of contracted family doctor services in China has been growing in recent years, but community-family-doctor-based type 2 diabetes mellitus (T2DM) intervention programs have yet to be adequately studied. This study was to evaluate the short- and long-term effects of community-family-doctor-based self-management interventions for T2DM and to explore strategies for long-term glycemic control. STUDY DESIGN This was a randomized controlled trial. METHODS A total of 144 eligible participants were randomly assigned to intervention and control groups. The control group received only routine community diabetes care, and the intervention group received community-family-doctor-based interventions involving the same standard of care. The interventions lasted for 3 months, and the follow-up was continued for 15 months. Intention-to-treat analysis and generalized estimation equations were then used to determine the short- and long-term effects of the interventions on glycated hemoglobin (HbA1c), diabetes self-management, and medication adherence. RESULTS There were statistically significantly greater improvements in all aspects of the intervention group after 3 months of intervention. Compared with baseline, changes in the attitude (β = 0.384, 95% confidence interval [CI; 0.194, 0.574], P < 0.001), practice (β = 1.751, 95% CI [0.762, 2.739], P = 0.001), and knowledge, attitudes, practice total scores (β = 2.338, 95% CI [0.682, 3.995], P = 0.006) of patients in the intervention group were statistically significant after 15 months, and the HbA1c (8.19 ± 1.73%), knowledge (16.42 ± 3.21), and medication adherence (5.53 ± 1.76) scores were slightly better than those at baseline, although not statistically significant (P > 0.05). CONCLUSIONS T2DM self-management interventions based on community family doctors improved patients' HbA1c, diabetes self-management, and medication adherence, did not do so significantly in the long term.
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Affiliation(s)
- Xiaoying Zhu
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Biqi Ren
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China; Xi'an People's Hospital (Xi'an Fourth Hospital), Xi'an, Shaanxi, China
| | - Wei Liu
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shuang Lei
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shuzhi Lin
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qian Liu
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lin Yin
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Bianling Feng
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Carvalho M, Byrne M, Kenny E, Caba M, Hadjiconstantinou M, Dunbar J, Powell S, McSharry J. Understanding how self-management education and support programmes for type 2 diabetes are expected to change behaviour: A document analysis of two programmes. Diabet Med 2024; 41:e15233. [PMID: 37777342 DOI: 10.1111/dme.15233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023]
Abstract
AIMS Attendance at diabetes self-management education and support (DSMES) programmes for type 2 diabetes is associated with positive outcomes, but the impact on some outcomes is inconsistent and tends to decline over time. Understanding the active ingredients of effective programmes is essential to optimise their effectiveness. This study aimed to (1) retrospectively identify behaviour change techniques (BCTs), mechanisms of action (MoAs) and intervention functions in two DSMES programmes, the Community-Oriented Diabetes Education and the Diabetes Education and Self-Management for Ongoing and Newly Diagnosed and (2) examine variation in content between programmes. METHODS A multiple case study approach, including a documentary analysis of the programme materials, was conducted. Materials were coded using the BCT Taxonomy v1, the Mode of Delivery Ontology v1 and the Intervention Source Ontology v1. The Behaviour Change Wheel guidance and the Theory and Techniques tool were used to identify intervention functions and MoAs. Programme stakeholders provided feedback on the findings. RESULTS Thirty-four BCTs were identified across the programmes, with 22 common to both. The identified BCTs were frequently related to 'goals and planning', 'feedback and monitoring' and 'natural consequences'. BCTs were linked with 15 MoAs, predominantly related to reflective motivation ('beliefs about capabilities' and 'beliefs about consequences') and psychological capability ('knowledge'). BCTs served six intervention functions, most frequently 'education', 'enablement' and 'persuasion'. CONCLUSIONS Although both programmes included several BCTs, some BCTs were rarely or never used. Additional BCTs could be considered to potentially enhance effectiveness by addressing a wider range of barriers.
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Affiliation(s)
- Márcia Carvalho
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Republic of Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Republic of Ireland
| | - Eanna Kenny
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Republic of Ireland
| | - Molly Caba
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | | | | | | | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Republic of Ireland
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Vickery KD, Gelberg L, Hyson AR, Strother E, Carter J, Oranday Perez O, Franco M, Kavistan S, Gust S, Adair E, Anderson-Campbell A, Brito L, Butler A, Robinson T, Connett J, Evans MD, Emmons KM, Comulada WS, Busch AM. Pilot trial results of D-HOMES: a behavioral-activation based intervention for diabetes medication adherence and psychological wellness among people who have been homeless. Front Psychiatry 2024; 15:1329138. [PMID: 38487573 PMCID: PMC10937567 DOI: 10.3389/fpsyt.2024.1329138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction People living with type 2 diabetes who experience homelessness face a myriad of barriers to engaging in diabetes self-care behaviors that lead to premature complications and death. This is exacerbated by high rates of comorbid mental illness, substance use disorder, and other physical health problems. Despite strong evidence to support lay health coach and behavioral activation, little research has effectively engaged people living with type 2 diabetes who had experienced homelessness (DH). Methods We used community engaged research and incremental behavioral treatment development to design the Diabetes HOmeless MEdication Support (D-HOMES) program, a one-on-one, 3 month, coaching intervention to improve medication adherence and psychological wellness for DH. We present results of our pilot randomized trial (with baseline, 3 mo., 6 mo. assessments) comparing D-HOMES to enhanced usual care (EUC; brief diabetes education session and routine care; NCT05258630). Participants were English-speaking adults with type 2 diabetes, current/recent (<24 mo.) homelessness, and an HbA1c‗7.5%. We focused on feasibility (recruitment, retention, engagement) and acceptability (Client Satisfaction Questionnaire, CSQ-8). Our primary clinical outcome was glycemic control (HbA1c) and primary behavioral outcome was medication adherence. Secondary outcomes included psychological wellness and diabetes self-care. Results Thirty-six eligible participants enrolled, 18 in each arm. Most participants identified as Black males, had high rates of co-morbidities, and lived in subsidized housing. We retained 100% of participants at 3-months, and 94% at 6-months. Participants reported high satisfaction (mean CSQ-8 scores=28.64 [SD 3.94] of 32). HbA1c reduced to clinically significant levels in both groups, but we found no between group differences. Mean blood pressure improved more in D-HOMES than EUC between baseline and 6 mo. with between group mean differences of systolic -19.5 mmHg (p=0.030) and diastolic blood pressure -11.1 mmHg (p=0.049). We found no significant between group differences in other secondary outcomes. Conclusion We effectively recruited and retained DH over 6 months. Data support that the D-HOMES intervention was acceptable and feasible. We observe preliminary blood pressure improvement favoring D-HOMES that were statistically and clinically significant. D-HOMES warrants testing in a fully powered trial which could inform future high quality behavioral trials to promote health equity. Clinical trial registration https://clinicaltrials.gov/study/NCT05258630?term=D-HOMES&rank=1, identifier NCT05258630.
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Affiliation(s)
- Katherine Diaz Vickery
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Lillian Gelberg
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Audrey Rose Hyson
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Ella Strother
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Jill Carter
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Oscar Oranday Perez
- The Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
| | - Moncies Franco
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Silvio Kavistan
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Susan Gust
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Edward Adair
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | | | - Lelis Brito
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Annette Butler
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Tahiti Robinson
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - John Connett
- School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Michael D. Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, United States
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - W. Scott Comulada
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- The Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
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Chowdhury HA, Harrison CL, Siddiquea BN, Tissera S, Afroz A, Ali L, Joham AE, Billah B. The effectiveness of diabetes self-management education intervention on glycaemic control and cardiometabolic risk in adults with type 2 diabetes in low- and middle-income countries: A systematic review and meta-analysis. PLoS One 2024; 19:e0297328. [PMID: 38306363 PMCID: PMC10836683 DOI: 10.1371/journal.pone.0297328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/01/2024] [Indexed: 02/04/2024] Open
Abstract
Diabetes mellitus (DM) poses a significant challenge to public health. Effective diabetes self-management education (DSME) interventions may play a pivotal role in the care of people with type 2 diabetes mellitus (T2DM) in low- and middle-income countries (LMICs). A specific up-to-date systematic review is needed to assess the effect of DSME interventions on glycaemic control, cardiometabolic risk, self-management behaviours, and psychosocial well-being among T2DM across LMICs. The MEDLINE, Embase, CINAHL, Global Health, and Cochrane databases were searched on 02 August 2022 and then updated on 10 November 2023 for published randomised controlled trials (RCTs) and quasi-experimental studies. The quality of the studies was assessed, and a random-effect model was used to estimate the pooled effect of diabetes DSME intervention. Heterogeneity (I2) was tested, and subgroup analyses were performed. Egger's regression test and funnel plots were used to examine publication bias. The risk of bias of the included studies was assessed using the Cochrane risk-of-bias tool for randomized trial (RoB 2). The overall assessment of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. A total of 5893 articles were retrieved, and 44 studies (n = 11838) from 21 LMICs met the inclusion criteria. Compared with standard care, pooled analysis showed that DSME effectively reduced the HbA1c level by 0.64% (95% CI: 0.45% to 0.83%) and 1.27% (95% CI: -0.63% to 3.17%) for RCTs and quasi-experimental design studies, respectively. Further, the findings showed an improvement in cardiometabolic risk reduction, diabetes self-management behaviours, and psychosocial well-being. This review suggests that ongoing support alongside individualised face-to-face intervention delivery is favourable for improving overall T2DM management in LMICs, with a special emphasis on countries in the lowest income group.
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Affiliation(s)
- Hasina Akhter Chowdhury
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Cheryce L. Harrison
- Monash Centre for Health Research and Implementation–MCHRI, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Bodrun Naher Siddiquea
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sanuki Tissera
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Afsana Afroz
- Department of Biochemistry and Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Liaquat Ali
- Pothikrit Institute of Health Studies (PIHS), Dhaka, Bangladesh
| | - Anju E. Joham
- Monash Centre for Health Research and Implementation–MCHRI, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Departments of Endocrinology and Diabetes, Monash Health, Melbourne, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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10
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ElSayed NA, Aleppo G, Bannuru RR, Beverly EA, Bruemmer D, Collins BS, Darville A, Ekhlaspour L, Hassanein M, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S77-S110. [PMID: 38078584 PMCID: PMC10725816 DOI: 10.2337/dc24-s005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
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, an interprofessional 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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11
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Tanhapour M, Peimani M, Rostam Niakan Kalhori S, Nasli Esfahani E, Shakibian H, Mohammadzadeh N, Qorbani M. The effect of personalized intelligent digital systems for self-care training on type II diabetes: a systematic review and meta-analysis of clinical trials. Acta Diabetol 2023; 60:1599-1631. [PMID: 37542200 DOI: 10.1007/s00592-023-02133-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 08/06/2023]
Abstract
AIMS Type 2 diabetes (T2D) is rising worldwide. Self-care prevents diabetic complications. Lack of knowledge is one reason patients fail at self-care. Intelligent digital health (IDH) solutions have a promising role in training self-care behaviors based on patients' needs. This study reviews the effects of RCTs offering individualized self-care training systems for T2D patients. METHODS PubMed, Web of Science, Scopus, Cochrane Library, and Science Direct databases were searched. The included RCTs provided data-driven, individualized self-care training advice for T2D patients. Due to the repeated studies measurements, an all-time-points meta-analysis was conducted to analyze the trends over time. The revised Cochrane risk-of-bias tool (RoB 2.0) was used for quality assessment. RESULTS In total, 22 trials met the inclusion criteria, and 19 studies with 3071 participants were included in the meta-analysis. IDH interventions led to a significant reduction of HbA1c level in the intervention group at short-term (in the third month: SMD = - 0.224 with 95% CI - 0.319 to - 0.129, p value < 0.0; in the sixth month: SMD = - 0.548 with 95% CI - 0.860 to - 0.237, p value < 0.05). The difference in HbA1c reduction between groups varied based on patients' age and technological forms of IDH services delivery. The descriptive results confirmed the impact of M-Health technologies in improving HbA1c levels. CONCLUSIONS IDH systems had significant and small effects on HbA1c reduction in T2D patients. IDH interventions' impact needs long-term RCTs. This review will help diabetic clinicians, self-care training system developers, and researchers interested in using IDH solutions to empower T2D patients.
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Affiliation(s)
- Mozhgan Tanhapour
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Peimani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Science, Tehran, Iran
| | - Sharareh Rostam Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, 38106, Braunschweig, Germany
| | - Ensieh Nasli Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Science, Tehran, Iran
| | - Hadi Shakibian
- Department of Computer Engineering, Faculty of Engineering, Alzahra University, Tehran, Iran
| | - Niloofar Mohammadzadeh
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mostafa Qorbani
- Non-communicable Disease Research Center, Alborz University of Medical Sciences, Karaj, Iran
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12
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Graue M, Igland J, Haugstvedt A, Hernar I, Birkeland KI, Zoffmann V, Richards DA, Kolltveit BCH. Evaluation of an interprofessional follow-up intervention among people with type 2 diabetes in primary care-A randomized controlled trial with embedded qualitative interviews. PLoS One 2023; 18:e0291255. [PMID: 37967084 PMCID: PMC10650997 DOI: 10.1371/journal.pone.0291255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/21/2023] [Indexed: 11/17/2023] Open
Abstract
With an ageing population and improved treatments people live longer with their chronic diseases, and primary care clinics face more costly and difficult-to-treat multimorbid patients. To meet these challenges, current guidelines for the management of type 2 diabetes suggest that an interprofessional team should collaborate to enhance the delivery of worthwhile self-management support interventions. In this study, we aimed to evaluate the effects of an empowerment-based interprofessional follow-up intervention in people with type 2 diabetes in primary care on patient-reported outcomes, biomarkers and weight, and to explore the experiences of patients attending the intervention. We invited patients during regular visits to their general practitioners. The 12-month intervention included 1) empowerment-based counselling; 2) a standardized medical report. The control group received consultations with physicians only. The primary outcome was the Patient Activation Measure, a patient-reported measure assessing individual knowledge, skills, and confidence integral to managing one's health and healthcare. After the trial we conducted qualitative interviews. We observed no difference in the primary outcome scores. On secondary outcomes we found a significant between-group intervention effect in favor of the intervention group, with mean differences in glycemic control after 12 months (B [95% CI] = -8.6 [-17.1, -0.1] mmol/l; p = 0.045), and significant within-group changes of weight (B [95% CI] = -1.8 kg [-3.3, -0.3]; p = 0.02) and waist circumference (B [95% CI] = -3.9 cm [-7.3, -0.6]; p = 0.02). The qualitative data showed that the intervention opened patients' eyes for reflections and greater awareness, but they needed time to take on actions. The patients emphasized that the intervention gave rise to other insights and a greater understanding of their health challenges. We suggest testing the intervention among patients with larger disease burden and a more expressed motivation for change.
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Affiliation(s)
- Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jannicke Igland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ingvild Hernar
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Vibeke Zoffmann
- Interdisciplinary Research Unit of Women’s, Children’s and Families’ Health, Julie Marie Centre, Rigshospitalet, Copenhagen, Denmark
- Institute of Public Health Copenhagen University, Copenhagen, Denmark
| | - David A. Richards
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Beate-Christin Hope Kolltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Vossevangen Medical Center, Voss, Norway
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13
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Chepulis L, Mellsop-Kupe J, Moorhouse S, Keenan R, Norman K, Paul R. Newly diagnosed type 2 diabetes - does New Zealand General Practice adequately prepare patients to self-manage their Condition? BMC PRIMARY CARE 2023; 24:162. [PMID: 37605190 PMCID: PMC10441743 DOI: 10.1186/s12875-023-02118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2D) is predominantly managed in primary care, and patients need to be provided with appropriate knowledge and education to understand how to best self-manage their condition. For optimal T2D self-management, primary care teams should share this information from the time of diagnosis. Little is currently known about how and when these resources are being provided to patients with T2D in New Zealand. METHODS An online survey was carried out between Oct 2022 and Feb 2023. Patients diagnosed with T2D after Jan 2020 were invited to participate, with recruitment occurring via primary care and social media. Questions included information about demographics, diagnosis, provision of education resources and/or referral services as well as about current diabetes management. All responses were analysed with chi square tests. Free-text comments were summarised only. RESULTS A total of 203 participants from across New Zealand completed the survey, but 18 were excluded due to being diagnosed more than 3 years ago, or self-reporting with type 1 diabetes rather than T2D. Nearly three quarters (70.7%) of participants reported that they were given appropriate resources to understand and manage their T2D, though half of these would have like more information. Overall, family and friends, self-led research and healthcare-provided education were equally useful, though this differed by ethnic groups. Similarly, approx. 70% of patients thought that medications had been well explained. Free text comments suggested a need for more targeted information around food choice and insulin use as well as a need for empathy and appropriate language from healthcare providers. CONCLUSIONS Primary care appears to be providing most newly diagnosed patients with appropriate resources to understand and manage their T2D, but there is room for improvement with up to a third of participants not understanding how to manage foods, medication and lifestyle choices to optimise health outcomes. Further work is required to address this gap and should include the use of culturally-appropriate materials to meet the multi-ethnic population needs.
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Affiliation(s)
- Lynne Chepulis
- Waikato Medical Research Centre, Te Huataki Waiora School of Health, University of Waikato, Private Bag 3105, Hamilton, New Zealand.
| | - Jessie Mellsop-Kupe
- Waikato Medical Research Centre, Te Huataki Waiora School of Health, University of Waikato, Private Bag 3105, Hamilton, New Zealand
| | | | - Rawiri Keenan
- Waikato Medical Research Centre, Te Huataki Waiora School of Health, University of Waikato, Private Bag 3105, Hamilton, New Zealand
| | - Kimberley Norman
- Waikato Medical Research Centre, Te Huataki Waiora School of Health, University of Waikato, Private Bag 3105, Hamilton, New Zealand
| | - Ryan Paul
- Waikato Medical Research Centre, Te Huataki Waiora School of Health, University of Waikato, Private Bag 3105, Hamilton, New Zealand
- Te Whatu Ora Health New Zealand, Hamilton, New Zealand
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14
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Stojnić N, Klemenc-Ketiš Z, Mori Lukančič M, Zavrnik Č, Poplas Susič A. Perceptions of the primary health care team about the implementation of integrated care of patients with type 2 diabetes and hypertension in Slovenia: qualitative study. BMC Health Serv Res 2023; 23:362. [PMID: 37046293 PMCID: PMC10091568 DOI: 10.1186/s12913-023-09353-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/30/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Integrated care involves good coordination, networking, and communication within health care services and externally between providers and patients or informal caregivers. It affects the quality of services, is more cost-effective, and contributes to greater satisfaction among individuals and providers of integrated care. In our study, we examined the implementation and understanding of integrated care from the perspective of providers - the health care team - and gained insights into the current situation. METHODS Eight focus groups were conducted with health care teams, involving a total of 48 health care professionals, including family physicians, registered nurses, practice nurses, community nurses, and registered nurses working in a health education center. Prior to conducting the focus groups, a thematic guide was developed based on the literature and contextual knowledge with the main themes of the integrated care package. The analysis was conducted using the NVivo program. RESULTS We identified 12 main themes with 49 subthemes. Health care professionals highlighted good accessibility and the method of diagnostic screening integrated with preventive examinations as positive aspects of the current system of integrated care in Slovenia. They mentioned the good cooperation within the team, with the involvement of registered nurses and community nurses being a particular advantage. Complaints were made about the high workload and the lack of workforce. They feel that patients do not take the disease seriously enough and that patients as teachers could be useful. CONCLUSION Primary care teams described the importance of implementing integrated care for diabetes and hypertension patients at four levels: Patient, community, care providers, and state. Primary care teams also recognized the importance of including more professionals from different health care settings on their team.
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Affiliation(s)
| | - Zalika Klemenc-Ketiš
- Community Health Centre Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | | | - Črt Zavrnik
- Community Health Centre Ljubljana, Ljubljana, Slovenia
| | - Antonija Poplas Susič
- Community Health Centre Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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15
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Mongiello LL. Insulin-to-carbohydrate ratios: An overview for nurses. Nursing 2023; 53:19-27. [PMID: 36946632 DOI: 10.1097/01.nurse.0000920448.45572.df] [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: 03/23/2023]
Abstract
ABSTRACT Carbohydrate counting is an efficacious technique to safely achieve glycemic targets and improve outcomes for patients using meal-time insulin. This article provides nurses with the knowledge and skills to assist and support their patients. It also reviews how to evaluate glycemic control and provides guidelines for referral to diabetes education programs.
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Affiliation(s)
- Lorraine Laccetti Mongiello
- Lorraine Mongiello is an associate professor of clinical nutrition and interdisciplinary health sciences at the New York Institute of Technology
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16
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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: 0] [Impact Index Per Article: 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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17
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Pullyblank K, Fink A. Wrangling Diabetes: Illuminating the Latent Processes That Impact Diabetes Self-Management Behaviors. Sci Diabetes Self Manag Care 2023; 49:23-34. [PMID: 36609210 DOI: 10.1177/26350106221144961] [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: 01/09/2023]
Abstract
PURPOSE The purpose of this study is to discern the mechanisms that impact diabetes self-management from the perspective of individuals living with diabetes. METHODS Using a critical realist perspective, this qualitative descriptive study enrolled 54 individuals living with diabetes who had been exposed to diabetes self-management education and support within the previous 3 years. Focus groups were conducted between January and March 2021. Reflexive thematic analysis was used to develop themes and subthemes. RESULTS The overarching theme was wrangling diabetes: getting in control. Enablers to getting in control included professional and informal support and constant reassurance that they were on the right track. Individual-level barriers to getting in control included competing priorities, difficult emotions, and financial concerns. Health system barriers included inconsistent messaging from providers, lack of care coordination, and insurance driving treatment decisions. The latent force underlying these barriers was the limited agency individuals with diabetes had in reference to self-management behaviors. CONCLUSIONS Although the health care system ostensibly wants individuals to be in control of and responsible for managing their diabetes, system-level structures and processes do not allow for some people living with diabetes to effectively self-manage.
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Affiliation(s)
- Kristin Pullyblank
- Bassett Research Institute Center for Rural Community Health, Bassett Healthcare Network, Cooperstown, New York
| | - Amanda Fink
- Bassett Research Institute Center for Rural Community Health, Bassett Healthcare Network, Cooperstown, New York
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18
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Strandberg RB, Nilsen RM, Pouwer F, Igland J, Forster RB, Jenum AK, Buhl ES, Iversen MM. Lower education and immigrant background are associated with lower participation in a diabetes education program - Insights from adult patients in the Outcomes & Multi-morbidity In Type 2 diabetes cohort (OMIT). PATIENT EDUCATION AND COUNSELING 2023; 107:107577. [PMID: 36462290 DOI: 10.1016/j.pec.2022.107577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/10/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Diabetes educational programmes should be offered to patients with type 2 diabetes mellitus (T2DM). We assessed the proportion of diabetes educational program participation among adults with T2DM, and its associations with place of residence in Norway, education, and immigrant background. METHODS We identified 28,128 diagnosed with T2DM (2008-2019) in the Outcomes & Multi-morbidity In Type 2 diabetes cohort. To examine associations between sociodemographic factors and participation in diabetes start courses (yes/no), we computed adjusted risk ratios (95% CI) using log-binomial regression. RESULTS Overall, 18% participated on the diabetes start course, but partaking differed by Norwegian counties (range:12-34%). Individuals with an immigrant background were 29% less likely to participate (RR 0.71, CI 0.65-0.79). Similarly, those with a lower educational level were 23% less likely to participate (RR 0.77, CI 0.72-0.83) than those with the highest education. The association between education and start course participation was not significant in the subgroup of immigrant individuals (RR 0.88 CI 0.70-1.12). CONCLUSIONS We found that diabetes start course participation was overall low, especially in individuals with low education and immigrant background. PRACTICE IMPLICATIONS More efforts are needed to promote diabetes start courses in patients with T2DM.
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Affiliation(s)
- Ragnhild B Strandberg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
| | - Roy M Nilsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark; Steno Diabetes Centre Odense, Odense University Hospital, Odense, Denmark; Department of Medical Psychology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rachel B Forster
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
| | - Anne Karen Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Esben S Buhl
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marjolein M Iversen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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19
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Simonelli N, Bolgeo T, Iovino P, Di Matteo R, Maconi A, Vellone E. Self-care in coronary heart disease patient and caregiver dyads (HEARTS-IN-DYADS)-Protocol of a multicenter longitudinal study. Res Nurs Health 2023; 46:37-47. [PMID: 36538334 DOI: 10.1002/nur.22286] [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: 02/14/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
Self-care performed by patients and the caregiver contribution to this self-care are essential for improving cardiovascular outcomes; however, so far, no studies have sufficiently investigated this field in Italy. This paper describes a research protocol of a multi-center longitudinal study designed to investigate the self-care of patients affected by coronary heart disease (CHD), the caregiver's contribution to this self-care, the predictors of patient and caregiver self-care, the mediating role of self-efficacy, and the self-care outcomes. Data collection will be performed across seven Italian inpatient settings at baseline and 3 and 6 months from enrollment. Multilevel modeling and actor partner interdependence models will be implemented on a sample of 330 patient-caregiver dyads to adjust for the interdependence of measurements. The study received approval from an ethics committee in Italy and was financed in January 2021 by a grant from the Solidal Foundation in Alessandria. This research will advance the knowledge about the self-care process in CHD. The results will guide research and clinical practice by identifying variables sensitive to educational interventions.
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Affiliation(s)
- Niccolò Simonelli
- SC Cardiology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Tatiana Bolgeo
- Research Training Innovation Infrastructure - Department of Research and Innovation - Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Paolo Iovino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,School of Nursing Midwifery and Paramedicin Australian Catholic University, Melbourne, Victoria, Australia
| | - Roberta Di Matteo
- Research Training Innovation Infrastructure - Department of Research and Innovation - Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Maconi
- Research Training Innovation Infrastructure - Department of Research and Innovation - Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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20
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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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AlHaqwi AI, Amin MM, AlTulaihi BA, Abolfotouh MA. Impact of Patient-Centered and Self-Care Education on Diabetes Control in a Family Practice Setting in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1109. [PMID: 36673862 PMCID: PMC9859274 DOI: 10.3390/ijerph20021109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Background: Diabetes mellitus is a chronic and complex medical disease that leads to significant morbidity and mortality. Patient-centered diabetes education that emphasizes active patient involvement, self, and shared care constitutes a substantial and essential component of the comprehensive diabetes management approach. Objectives: To assess the impact of patient-centered diabetes education sessions on the prescribed treatment plan in controlling diabetes and other related cardiovascular risk factors. Methods: In a pre-experimental pretest-posttest one group study design, all referred patients with type 2 diabetes (T2DM) to the diabetes educator clinic (n = 130 patients) during the period of 6 months from January to July 2021 were subjected to multiple and consecutive patient-centered diabetes education sessions, based on the framework published by the Association of Diabetes Care and Education Specialties (ADCES), in addition to their usual treatment plan. Demographic, social, and biological data were obtained at the baseline, three months, and six months after the intervention. Nonparametric Friedman and Cochran’s Q tests for related samples were applied to examine the impact of this educational intervention on glycosylated hemoglobin (HbA1c) and other associated cardiovascular risks. The results of 130 patients with T2DM showed a significant reduction of mean systolic blood pressure “SBP” (p = 0.015), glycosylated hemoglobin (HbA1c) (p < 0.001), fasting blood sugar “FBS” (p < 0.001), total cholesterol (p < 0.001), low-density lipoprotein (p < 0.001), and triglyceride (p < 0.001), and significant rise of mean high-density lipoprotein (p = 0.011). At three and six months after the intervention, 43% and 58% of patients showed improved HbA1c levels. The mean HbA1c was reduced from 10.2% at the beginning of the study to 8.7% (p < 0.001) after six months. Moreover, a significant reduction in the prevalence of obesity (p = 0.018), high FBS (p = 0.011), and high SBP (p = 0.022) was detected. Conclusions: This study showed a considerable positive impact of diabetes education and patient-centered care on optimizing glycemic and other cardiovascular risk control. The needs of certain patients with T2DM should be addressed individually to achieve the best possible outcomes. Further research is needed to explore the long-term benefits of this intervention.
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Affiliation(s)
- Ali I. AlHaqwi
- Department of Family and Community Medicine, King Abdul-Aziz Medical City, King Saud Ben Abdu Aziz University for Health Sciences (KSAU-HS), Ministry of National Guard-Health Affairs, Riyadh 22490, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), King Saud Ben Abdul Aziz University for Health Sciences (KSAU-HS), Ministry of National Guard-Health Affairs, Riyadh 11481, Saudi Arabia
| | - Marwa M. Amin
- Department of Family and Community Medicine, King Abdul-Aziz Medical City, King Saud Ben Abdu Aziz University for Health Sciences (KSAU-HS), Ministry of National Guard-Health Affairs, Riyadh 22490, Saudi Arabia
| | - Bader A. AlTulaihi
- Department of Family and Community Medicine, King Abdul-Aziz Medical City, King Saud Ben Abdu Aziz University for Health Sciences (KSAU-HS), Ministry of National Guard-Health Affairs, Riyadh 22490, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), King Saud Ben Abdul Aziz University for Health Sciences (KSAU-HS), Ministry of National Guard-Health Affairs, Riyadh 11481, Saudi Arabia
| | - Mostafa A. Abolfotouh
- King Abdullah International Medical Research Center (KAIMRC), King Saud Ben Abdul Aziz University for Health Sciences (KSAU-HS), Ministry of National Guard-Health Affairs, Riyadh 11481, Saudi Arabia
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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: 126] [Impact Index Per Article: 126.0] [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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Validation and Cross-Cultural Adaptation of the Diabetes Self-Management Questionnaire (DSMQ) and the Social Phobia Inventory (SPIN) in Romanian Patients with Diabetes Mellitus. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121823. [PMID: 36557025 PMCID: PMC9783180 DOI: 10.3390/medicina58121823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Background and Objectives: Anxiety disorders are common in individuals with diabetes mellitus (DM) and have a negative impact on diabetes-related self-management and, therefore, on patients’ evolution and prognosis. In this context, it becomes necessary to accurately and easily assess anxiety and self-management behaviours. Thus, the aim of this research was translation and cultural adaptation for Romanian patients and validation of two instruments used for assessing diabetes self-management and anxiety, namely the Diabetes Self-Management Questionnaire (DSMQ) and the Social Phobia Inventory (SPIN). Materials and Methods: The Summary of Diabetes Self-Care Activities Questionnaire (SDSCA) and the DSMQ instruments for assessing diabetes self-management, as well as the Generalised Anxiety Disorder Scale (GAD-7) and the SPIN instruments for assessing anxiety, have been administered to 117 patients from Timisoara, Romania, previously diagnosed with DM. Results: The SPIN has proven to have good internal consistency, excellent acceptability of its questions without non-responders and a median completion time of 3 min and 10 s, an excellent test−retest performance (Spearman’s rho = 0.971, p < 0.001 between two administrations of the test) and good validity in comparison with the GAD-7, a previously validated and comprehensive instrument. The DSMQ has also proven to have acceptable internal consistency, excellent acceptability of its questions without non-responders and a median completion time of 2 min and 28 s; however, it has shown a weak, positive correlation without statistical significance in comparison with the SDSCA, a previously validated questionnaire. Conclusions: The SPIN, translated in Romanian and culturally adapted, is a valid tool for the screening of social phobias in individuals with DM. The DSMQ requires additional data for its validation in DM patients from Romania.
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Romero-Castillo R, Pabón-Carrasco M, Jiménez-Picón N, Ponce-Blandón JA. Effects of a Diabetes Self-Management Education Program on Glucose Levels and Self-Care in Type 1 Diabetes: A Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16364. [PMID: 36498437 PMCID: PMC9738291 DOI: 10.3390/ijerph192316364] [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: 10/31/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Several factors have been associated with the success of health education programs, such contact time, with better results being obtained from more intensive programs and early outcome measurement. Nurses play an essential role in educating patients with diabetes both in disease-management, therapeutic education, and healthy lifestyles promotion as well as emotion management. The objective was to evaluate the effectiveness of a nurse-led educational program based on patients with type 1 diabetes; (2) Methods: An experimental, two-group comparison design, 69 patients participated in the intervention group and 62 in control group. The control group received routine health education and follow-up. The intervention group received intensive educational program led by nurses. The effects were evaluated after 1 and 3 months of intervention; (3) Results: The differences between groups in sensor usage, knowledge, and diabetes self-care three months after the educational program were significant; (4) Conclusions: The program could help type 1 diabetes patients to improve the control rates for blood glucose. The continuous glucose monitoring sensor allowed knowing which parameters improved one and three months after the intervention. The hypothesis of the influence of the emotional state on glucose levels was confirmed.
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Affiliation(s)
- Rocío Romero-Castillo
- Centro Universitario de Enfermería de Cruz Roja, Universidad de Sevilla, Avenida de la Cruz Roja, No. 1, 41009 Seville, Spain
- Departamento de Enfermería de la Universidad de Sevilla, Calle Avenzoar, No. 6, 41009 Seville, Spain
| | - Manuel Pabón-Carrasco
- Centro Universitario de Enfermería de Cruz Roja, Universidad de Sevilla, Avenida de la Cruz Roja, No. 1, 41009 Seville, Spain
- Departamento de Enfermería de la Universidad de Sevilla, Calle Avenzoar, No. 6, 41009 Seville, Spain
| | - Nerea Jiménez-Picón
- Centro Universitario de Enfermería de Cruz Roja, Universidad de Sevilla, Avenida de la Cruz Roja, No. 1, 41009 Seville, Spain
| | - José Antonio Ponce-Blandón
- Centro Universitario de Enfermería de Cruz Roja, Universidad de Sevilla, Avenida de la Cruz Roja, No. 1, 41009 Seville, Spain
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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: 280] [Impact Index Per Article: 140.0] [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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Reininger BM, Lopez J, Zolezzi M, Lee M, Mitchell-Bennett LA, Xu T, Park SK, Saldana MV, Perez L, Payne LY, Collier C, McCormick JB. Participant engagement in a community health worker-delivered intervention and type 2 diabetes clinical outcomes: a quasiexperimental study in MexicanAmericans. BMJ Open 2022; 12:e063521. [PMID: 36446462 PMCID: PMC9710373 DOI: 10.1136/bmjopen-2022-063521] [Citation(s) in RCA: 2] [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] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This study helps to fill the existing research gap related to participant engagement in behavioural interventions and diabetes management. We examined type 2 diabetes control over time among Mexican Americans by level of engagement in a chronic care management (CCM) program that included community health worker (CHW)-delivered multilevel interventions. The programme complemented clinical care and promoted behaviour changes to improve diabetes self-management. DESIGN Quasiexperimental study. SETTING The study was implemented in the Rio Grande Valley region in the USA. Recruitment was conducted in clinics and community events. All other visits were provided in participant homes and community locations. PARTICIPANTS 5649 adults (aged ≥18 years) with poorly controlled type 2 diabetes who enrolled in a community-delivered CCM programme between September 2013 and 2018. INTERVENTIONS The intervention comprised two components: CHW home visits conducted every 3 months and diabetes self-management education (DSME) classes provided in community locations. PRIMARY OUTCOME MEASURES The primary outcome was haemoglobin A1c (HbA1c) measured at baseline every 3 months for up to 24 months. We first examined changes in HbA1c levels over time. The number of completed CHW and DSME encounters was used to classify participants into engagement groups-high engagement defined as ≥10 encounters (n=2952); low engagement defined as 1-9 encounters (n=2697). We used univariable and multivariable longitudinal linear regression models with a generalised estimating equation method. We tested interactions between engagement groups and time. RESULTS Participants' mean HbA1c decreased from 10.20% at baseline to 8.93% (p<0.0001) at 3 months, remaining stable thereafter. Changes in HbA1c were statistically different between the engagement groups. High engagement participants had lower HbA1c levels over the first 15 months of the follow-up period compared with low engagement participants, as compared at 3 months (-0.44%, 95% CI -0.57% to -0.31%; p<0.0001), 6 months (-0.31%, 95% CI -0.43% to -0.14%; p<0.0001), 9 months (-0.27%, 95% CI -0.42% to -0.13%; p=0.0001), 12 months (-0.23%, 95% CI -0.37% to -0.08%; p=0.0025) and 15 months (-0.32%, 95% CI -0.54% to -0.10%; p=0.0040). At months 18, 21 and 24, the HbA1c differences were not statistically significant (18 months: -0.34%, 95% CI -0.77% to 0.08%; p=0.1086; 21 months: -0.22%, 95% CI -1.00% to 0.56%; p=0.5721; 24 months: -0.42%, 95% CI -1.38% to 0.55%; p=0.3966). CONCLUSIONS Higher engagement in the CCM programme delivered by CHWs and coordinated with clinical care was associated with beneficial improvements in type 2 diabetes control, but both engagement groups showed strong improvements.
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Affiliation(s)
- Belinda M Reininger
- School of Public Health, Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, Texas, USA
| | - Juliana Lopez
- School of Public Health, Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, Texas, USA
| | - Maria Zolezzi
- School of Public Health, Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, Texas, USA
| | - MinJae Lee
- Division of Biostatistics, Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lisa A Mitchell-Bennett
- School of Public Health, Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, Texas, USA
| | - Tianlin Xu
- Biostatistics, University of Texas School of Public Health, Houston, Texas, USA
| | - Soo Kyung Park
- Department of Biostatistics and Data Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Mayra V Saldana
- School of Public Health, Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, Texas, USA
| | - LuBeth Perez
- School of Public Health, Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, Texas, USA
| | - Lisa Y Payne
- School of Public Health, The University of Texas Health Science Center at Houston, Brownsville, Texas, USA
| | - Cindy Collier
- Public Health College of Nursing and Health Sciences, Texas A&M International University, Laredo, Texas, USA
| | - Joseph B McCormick
- School of Public Health, Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, Texas, USA
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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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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: 440] [Impact Index Per Article: 220.0] [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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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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30
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Mongiello LL. Medical Nutrition Therapy for Glycemic Control. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Deng Q, Wei Y, Chen Y. Inequalities in access to community-based diabetes examination and its impact on healthcare utilization among middle-aged and older adults with diabetes in China. Front Public Health 2022; 10:956883. [PMID: 36187706 PMCID: PMC9523590 DOI: 10.3389/fpubh.2022.956883] [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: 07/08/2022] [Accepted: 08/22/2022] [Indexed: 01/24/2023] Open
Abstract
Globally, diabetes and its complications are becoming one of the leading challenges in health governance. As health inequalities and primary care services related to diabetes are gaining traction, the status of community-based diabetes examination largely remains unclear in the literature. This study aims to investigate inequalities in access to community-based diabetes examination among people with diabetes and to analyze its impact on healthcare utilization. Data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were applied, and a total of 767 patients with diabetes were included. Inequalities in community-based diabetes examination were illustrated by the concentration curve and normalized concentration index. Propensity score matching (PSM) were used to identify the impact of community-based diabetes examination on outpatient and inpatient care utilization. We found that community-based diabetes examination was accessible to 23.08% of the respondents, of which 76.84% were free, and the highest frequency was 2-6 times per year, accounting for 47.46%. Community-based diabetes examinations were more concentrated among people with poorer-economic condition (95% confidence interval, 95%CI = -0.104, p = 0.0035), lower-education level (95%CI = -0.092, p = 0.0129), and less-developed areas (95%CI = -0.103, p = 0.0007). PSM analyses showed that community-based diabetes examination increased the utilization of outpatient care (odds ratio, OR = 1.989, 95%CI = 1.156-3.974) and decreased the use of inpatient care (OR = 0.544, 95%CI = 0.325-0.909), and the sensitivity analyses confirmed the robustness of the results. This study is the first to examine the status and inequalities of community-based regular diabetes examination and its effect on the likelihood of healthcare utilization among patients with diabetes. The findings suggest that the overall level of community-based diabetes examination is low, and there are pro-socioeconomically disadvantaged inequalities. The value of community-based diabetes examination should be recognized to help person with diabetes face up to their health needs for better disease control and health promotion.
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Bakaruddin S, Mohd Noordin Z, Karuppannan M. Affecting children’s knowledge about rational use of medicines using read-along videos of pictorial storybooks. Front Pharmacol 2022; 13:933546. [PMID: 36120329 PMCID: PMC9478889 DOI: 10.3389/fphar.2022.933546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Although efforts have been taken to educate the public about medication from a very young age, there are very limited availability and accessibility of education material for children. The aim of this study is to assess the impact of read-along videos of pictorial storybooks on children’s knowledge about rational use of medicines. This study compared pre and post knowledge scores in a nonrandomized, one-group pre-test-post-test experimental design. Pre-recorded read-along storytelling videos were used as intervention covering two topics on rational use of medicine -medicine storage and antibiotic resistance. The questionnaire and intervention videos were distributed using Google Forms to children aged six and seven in Malaysia via online social media platforms. 521 children completed the study. The mean baseline knowledge score for medication storage was 4.89 (SD = 1.12) pre-test and 5.44 (SD = 0.78) post-test while for antibiotic resistance the mean was 3.616 (SD = 1.340) pre-test and 4.820 (SD = 1.134) post-test. A Wilcoxon signed-rank test showed statistically significant changes on medication storage (Z = −10.21, p < 0.001) and antibiotic resistance (Z = −14.869, p < 0.001) related knowledge among children. Pictorial storybook read-along video interventions were shown to be effective in improving children’s knowledge on rational use of medicine. Education and awareness on the use of antibiotics should be prioritized.
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Affiliation(s)
| | - Zakiah Mohd Noordin
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, Puncak Alam Campus, Bandar Puncak Alam, Malaysia
| | - Mahmathi Karuppannan
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, Puncak Alam Campus, Bandar Puncak Alam, Malaysia
- *Correspondence: Mahmathi Karuppannan,
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Nickelson J, McFadden N, Johnson P, Boucher A. Effectiveness of Student-Led Interventions on Improving Diabetes Outcomes: A Systematic Review. AMERICAN JOURNAL OF HEALTH EDUCATION 2022. [DOI: 10.1080/19325037.2022.2100020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Chang SJ, Kim HJ, Lee KE, Yang E. Factors Associated With Diabetes Self-Care Behaviors of People With Visual Impairment: A Cross-Sectional Study. Sci Diabetes Self Manag Care 2022; 48:324-335. [PMID: 35915583 DOI: 10.1177/26350106221116023] [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: 11/17/2022]
Abstract
PURPOSE The purpose of the study was to examine the factors associated with diabetes self-care behaviors (DSCB) in people with visual impairment (PVI), including demographics, disease-related characteristics, and psychosocial factors (self-efficacy, depression, and family support). METHODS A descriptive cross-sectional study was conducted. Adults with visual impairment and diabetes were recruited online and through posting notices, and a total of 141 participants were included. Measurements were completed using email and telephone surveys. Multiple linear regression analysis was performed to examine the factors associated with DSCB. RESULTS Higher self-efficacy and positive family support were significant predictors of better DSCB, whereas higher negative family support was a significant predictor of worse DSCB. Diabetes medication regimen was another major influencing factor on DSCB. However, depression was not associated with DSCB. CONCLUSION Diabetes interventions for the visually impaired should have strategies to improve vulnerable areas of diabetes self-care, such as blood glucose monitoring. Health care providers are needed to consider diabetes education programs focused on improving self-efficacy or include family members in interventions to promote DSCB in PVI. Further studies are required to understand the problems and solutions for diabetes self-care in this population.
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Affiliation(s)
- Sun Ju Chang
- College of Nursing & the Research Institute of Nursing Science, Seoul National University, Seoul, South Korea
| | - Hee Jung Kim
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Kyoung-Eun Lee
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Eunjin Yang
- College of Nursing, Seoul National University, Seoul, South Korea
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Diabetes Management after a Therapeutic Education Program: A Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10081375. [PMID: 35893197 PMCID: PMC9394246 DOI: 10.3390/healthcare10081375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Structured education has been used in patients treated with insulin, promoting their ability to adhere to and self-manage their treatment. We aimed to know the perception and adherence to the recommendations on the management of diabetes in type 1 diabetes patients after participating in a therapeutic education program. (2) Methods: A descriptive qualitative study followed the Standards for Reporting Qualitative Research guidelines. Patients with type 1 diabetes participating in a therapeutic education program were recruited from February to April 2022. Semi-structured, in-depth interviews were used, and transcriptions were analyzed using the inductive qualitative content analysis method. The final sample consisted of 18 type 1 diabetes mellitus patients. (3) Results: A number of patients with type 1 diabetes said that they had improved their glycemic control after participating in the therapeutic education program. Some patients recognized that the chronic disease and the complications complexity generated stress and anxiety. This influenced their usual life, at work, and their interpersonal relationships. (4) Conclusions: In terms of satisfaction, the majority of patients reported a good perception of the quality of the organization, the professionals involved, and the contents of the program. The physical and psychosocial benefits of self-care training have been demonstrated.
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Gao R, Guo H, Liu Y, Pang Y, Zhang X, Lian X, Yu T, Zhu L, Li F. Effects of message framing on self-management behaviour among patients with type 2 diabetes: a randomised controlled trial protocol. BMJ Open 2022; 12:e056450. [PMID: 35768085 PMCID: PMC9240941 DOI: 10.1136/bmjopen-2021-056450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Accumulating evidence has indicated successful diabetes health education can potentially help to improve blood sugar levels in people with diabetes. However, with a rapid rise in the number of people with diabetes cases and the increasing burden on healthcare, it is often difficult for healthcare providers to find suitable time to provide health education to meet their needs. Thus, more novel and effective ways are needed to conduct education. The message frame provides a new perspective for implementation of a more effective health education in the form of changing information presentation, and the same objective content is described in either positive or negative language or outcomes. Gain framing emphasises the positive consequences of adhering to useful recommendations, while loss framing highlights the negative consequences of the non-adherence. The purpose of our research is to potentially explore the effectiveness of diabetes education based on message framing on the self-management behaviour. METHODS AND ANALYSIS A single-blind, three-arm randomised controlled trial involving 84 participants will be conducted. The participants will be assigned into three groups randomly in a 1:1:1 ratio and will receive 12-week intervention. Patients in group 1 will be provided gain framing education videos about the self-management skills for type 2 diabetes, patients in group 2 will be given education videos based on loss framing and patients in group 3 will receive education with no specific message framing. The primary outcome is self-management behaviour. The secondary outcomes will be self-efficacy, patient activation, diabetes-related knowledge and attitude, quality of life and blood glucose level. All outcomes will be measured at baseline and 12 weeks. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of School of Nursing, Jilin University (No. 2020101501). The research results will be published in peer-reviewed publications and presented in international conferences. TRIAL REGISTRATION NUMBER ChiCTR 2100045772; Pre-results.
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Affiliation(s)
- Ruitong Gao
- School of Nursing, Jilin University, Changchun, Jilin, China
- School of Health and Exercise Sciences, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Hui Guo
- Department of Endocrinology and Metabolism, Eastern Division of the First Bethune Hospital of Jilin University, Changchun, China
| | - Yandi Liu
- Department of Endocrinology and Metabolism, First Bethune Hospital of Jilin University, Changchun, China
| | - Yue Pang
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Xin Zhang
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Xiaoqian Lian
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Tianyue Yu
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Lanyu Zhu
- School of Nursing, Jilin University, Changchun, Jilin, China
- School of Nursing, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Feng Li
- School of Nursing, Jilin University, Changchun, Jilin, China
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Chen F, Jasik CB, Dall TM, Siego CV. Impact of a Digitally Enhanced Diabetes Self-Management Program on Glycemia and Medical Costs. Sci Diabetes Self Manag Care 2022; 48:258-269. [PMID: 35658628 DOI: 10.1177/26350106221100779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyze economic savings and health impacts associated with a virtual digitally enhanced diabetes self-management education and support (DSMES) program. RESEARCH DESIGN AND METHODS Participants (n = 1,494) were nonpregnant adults with diagnosed type 2 diabetes and baseline body mass index (BMI) of 25 kg/m2 (23 kg/m2 if of Asian descent) or higher who enrolled in virtual DSMES between February 2019 and April 2020 for at least 4 months. Participants' changes in glycated hemoglobin (A1C) and body weight were calculated as the difference between program start and last recorded values between months 4 and 6. Outcomes for all participants were analyzed; subanalyses were done on 628 participants with starting A1C >7% (53 mmol/mol), who could benefit most from DSMES. Markov-based microsimulation approach was used to model the potential reductions in diabetes sequalae and medical expenditures if observed improvements in A1C and BMI were maintained. RESULTS DSMES participants with starting A1C >7% experienced average reductions of 0.9% A1C and 2.1 kg of body weight (-1.7% of BMI) within 6 months. If these improvements were maintained, simulated outcomes include reduced 5-year onset of ischemic heart disease by 9.2%, myocardial infarction by 10.6%, stroke by 12.1%, chronic kidney disease by 16.5%, and reduced onset of other sequelae. Simulated cumulative reduction in medical expenditures is $1160 after 1 year, $4150 after 3 years, $7790 after 5 years, and $18 020 after 10 years. CONCLUSIONS Participation in virtual DSMES improves A1C and body weight, with the potential to slow onset of diabetes sequelae and reduce medical expenditures.
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Narindrarangkura P, Boren SA, Khan U, Day M, Simoes EJ, Kim MS. SEE-Diabetes, a patient-centered diabetes self-management education and support for older adults: Findings and information needs from patients' perspectives. Prim Care Diabetes 2022; 16:395-403. [PMID: 35227635 PMCID: PMC9133060 DOI: 10.1016/j.pcd.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/26/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022]
Abstract
AIMS This study identified the information needs of people with diabetes aged 65 and older through surveys and focus groups to inform the development of a patient-centered educational decision aid for diabetes care, SEE-Diabetes (Support-Engage-Empower-Diabetes). METHODS We conducted survey (N = 37) and three focus groups (N = 9). The survey collected demographics, diabetes duration, insulin usage, and clinic notes accessibility through a patient portal. In focus groups, participants evaluated the Assessment and Plan section of three selected deidentified clinic notes to assess readability and helpfulness for diabetes care. RESULTS The mean age of participants was 66 (24-82, SD = 12), and 22 were female (60%). The mean diabetes duration was 20.9 years (1-63, SD=15). Most participants (80%) read their clinical notes via patient portal. In the focus groups, the readability of clinic notes was noted as a primary concern because of medical abbreviations and poor formatting. Participants found the helpfulness of clinic notes was negatively impacted by vague or insufficient self-care information. CONCLUSIONS We found the high use of patient portal for reading clinic notes, which offers a use case opportunity for the proposed SEE-Diabetes educational aid. Feedback about the readability and helpfulness of clinic notes will be considered during the design process.
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Affiliation(s)
- Ploypun Narindrarangkura
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Suzanne A Boren
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States; Department of Health Management and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Uzma Khan
- Cosmopolitan International Diabetes and Endocrinology Center, University of Missouri, Columbia, 3315 Berrywood Dr, Suite 201, Columbia, MO 65201, United States; Department of Medicine, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Margaret Day
- Department of Family and Community Medicine, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Eduardo J Simoes
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States; Department of Health Management and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
| | - Min Soon Kim
- University of Missouri Institute for Data Science and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States; Department of Health Management and Informatics, University of Missouri, Columbia, 5 Hospital Drive, Columbia, MO 65212, United States.
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Dallosso H, Mandalia P, Gray LJ, Chudasama YV, Choudhury S, Taheri S, Patel N, Khunti K, Davies MJ. The effectiveness of a structured group education programme for people with established type 2 diabetes in a multi-ethnic population in primary care: A cluster randomised trial. Nutr Metab Cardiovasc Dis 2022; 32:1549-1559. [PMID: 35459607 DOI: 10.1016/j.numecd.2022.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/17/2022] [Accepted: 03/15/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Structured self-management education has been shown to be effective in type 2 diabetes (T2DM) but more research is needed to look at culturally appropriate programmes in ethnic minority groups, where prevalence of T2DM is higher and diagnosis earlier. The study tested the effectiveness of a group education programme for people with established T2DM in a multi-ethnic primary care population. METHODS AND RESULTS Cluster randomised trial conducted in two multi-ethnic UK sites. Practices were randomised (1:1) to a structured T2DM group education programme or to continue with routine care. A culturally-adapted version was offered to South Asians, who formed the majority of ethnic minority participants. Other ethnic minority groups were invited to attend the standard programme. Primary outcome was change in HbA1c at 12 months. All analyses accounted for clustering and baseline value.367 participants (64(SD 10.8) years, 36% women, 34% from minority ethnic groups) were recruited from 31 clusters. At 12 months, there was no difference in mean change in HbA1c between the two groups (-0.10%; (95% CI: -0.37, 0.17). Subgroup analyses suggested the intervention was effective at lowering HbA1c in White European compared with ethnic minority groups. The intervention group lost more body weight than the control group (-0.82 kg at 6 months and -1.06 kg at 12 months; both p = 0.03). CONCLUSION Overall, the programme did not result in HbA1c improvement but in subgroup analysis, a beneficial effect occurred in White Europeans. Findings emphasise a need to develop and evaluate culturally-relevant programmes for ethnic minority groups.
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Affiliation(s)
- Helen Dallosso
- NIHR Applied Research Collaboration East Midlands, UK; Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Panna Mandalia
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, UK
| | | | - Sopna Choudhury
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Birmingham and Black Country, University of Birmingham, UK; School of Health and Population Sciences, University of Birmingham, UK
| | - Shahrad Taheri
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Birmingham and Black Country, University of Birmingham, UK; School of Health and Population Sciences, University of Birmingham, UK
| | - Naina Patel
- Diabetes Research Centre, University of Leicester, UK
| | - Kamlesh Khunti
- NIHR Applied Research Collaboration East Midlands, UK; Diabetes Research Centre, University of Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, UK; NIHR Leicester Biomedical Research Centre, Leicester, UK
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Moreira AM, Marobin R, Escott GM, Rados DV, Silveiro SP. Telephone calls and glycemic control in type 2 diabetes: A PRISMA-compliant systematic review and meta-analysis of randomized clinical trials. J Telemed Telecare 2022:1357633X221102257. [PMID: 35611521 DOI: 10.1177/1357633x221102257] [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: 11/16/2022]
Abstract
AIMS In-depth and updated systematic reviews evaluating telephone calls in type 2 diabetes (T2DM) management are missing. This study aimed to assess the effect of this intervention on glycemic control in T2DM patients when compared with usual care. METHODS We systematically searched for randomized controlled trials (RCT) on T2DM using Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and LILACS, up to March 2021. The Risk of Bias 2.0 (Rob 2.0) tool and GRADE were used for the quality evaluation. The intervention effect was estimated by the change in glycated hemoglobin (HbA1c). PROSPERO registry CRD42020204519. RESULTS 3545 references were reviewed and 32 were included (8598 patients). Telephone calls, all approaching education, improved HbA1c by 0.33% [95% CI, -0.48% to -0.18%; I2 = 78%; p < 0.0001] compared to usual care. A greater improvement was found when the intervention included pharmacologic modification (-0.82%, 95% CI, -1.42% to -0.22%; I2 = 92%) and when it was applied by nurses (-0.53%, 95% CI, -0.86% to -0.2%; I2 = 87%). Meta-regression showed no relationship between DM duration and HbA1c changes. CONCLUSION The telephone call intervention provided a benefit regarding T2DM glycemic control, especially if provided by nurses, or if associated with patient education and pharmacological treatment modification.
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Affiliation(s)
- Ana Marina Moreira
- Post-Graduate Program in Medical Sciences: Endocrinology, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, 37895Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Roberta Marobin
- Post-Graduate Program in Medical Sciences: Endocrinology, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, 37895Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gustavo Monteiro Escott
- Post-Graduate Program in Medical Sciences: Endocrinology, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, 37895Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Dimitris Varvaki Rados
- Post-Graduate Program in Medical Sciences: Endocrinology, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, 37895Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- TelessaúdeRS, RS, Brazil
| | - Sandra Pinho Silveiro
- Post-Graduate Program in Medical Sciences: Endocrinology, 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Diabetes and Metabolism Group, Centro de Pesquisa Clínica, 37895Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Division of Endocrinology, 37895Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Guariguata L, Garcia L, Sobers N, Ferguson TS, Woodcock J, Samuels TA, Guell C, Unwin N. Exploring ways to respond to rising obesity and diabetes in the Caribbean using a system dynamics model. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000436. [PMID: 36962372 PMCID: PMC10021196 DOI: 10.1371/journal.pgph.0000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/05/2022] [Indexed: 11/19/2022]
Abstract
Diabetes and obesity present a high and increasing burden of disease in the Caribbean that have failed to respond to prevention policies and interventions. These conditions are the result of a complex system of drivers and determinants that can make it difficult to predict the impact of interventions. In partnership with stakeholders, we developed a system dynamics simulation model to map the system driving diabetes and obesity prevalence in the Caribbean using Jamaica as a test case. The study aims to use the model to assess the magnitude changes necessary in physical activity and dietary intake to achieve global targets set by the WHO Global Action plan and to test scenarios for interventions to reduce the burden of diabetes and obesity. Continuing current trends in diet, physical activity, and demographics, the model predicts diabetes in Jamaican adults (20+ years) to rise from 12% in 2018 to 15.4% in 2030 and 20.9% by 2050. For obesity, it predicts prevalence to rise from 28.6% in 2018 to 32.1% by 2030 and 39.2% by 2050. The magnitude change necessary to achieve the global targets set by the World Health Organization is so great as to be unachievable. However, a combination of measures both upstream (including reducing the consumption of sugar sweetened beverages and ultra processed foods, increasing fruit and vegetable intake, and increasing moderate-to-vigorous activity) at the population level, and downstream (targeting people at high risk and with diabetes) can significantly reduce the future burden of diabetes and obesity in the region. No single intervention reduces the prevalence of these conditions as much as a combination of interventions. Thus, the findings of this model strongly support adopting a sustained and coordinated approach across various sectors to synergistically maximise the benefits of interventions.
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Affiliation(s)
- Leonor Guariguata
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill, Barbados
| | - Leandro Garcia
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, United Kingdom
| | - Natasha Sobers
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill, Barbados
| | - Trevor S. Ferguson
- Epidemiology Research Unit, Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - James Woodcock
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - T. Alafia Samuels
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - Cornelia Guell
- European Centre for Environment and Human Health, University of Exeter Medical School, Cornwall, United Kingdom
| | - Nigel Unwin
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill, Barbados
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- European Centre for Environment and Human Health, University of Exeter Medical School, Cornwall, United Kingdom
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Yaagoob E, Hunter S, Chan S. The effectiveness of social media intervention in people with diabetes: An integrative review. J Clin Nurs 2022; 32:2419-2432. [PMID: 35545822 DOI: 10.1111/jocn.16354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/21/2022] [Accepted: 04/25/2022] [Indexed: 12/29/2022]
Abstract
AIM This integrative review aimed to synthesise the available quantitative and qualitative studies on the effectiveness of diabetes self-management education (DSME) delivered through social media on glycaemic control (HbA1c), knowledge, health-related quality-of-life (HRQoL), anxiety, depression and self-efficacy in people with diabetes mellitus. BACKGROUND DSME is the main component of diabetes management which contributes to behavioural changes and the improvement of metabolic control and self-monitoring skills. Due to limited face-to-face access to healthcare services, social media has increasingly been used to deliver DSME for people with diabetes. However, there is a paucity of reviews addressing the effectiveness of using social media in delivering DSME. DESIGN An integrative review was conducted based on Whittemore and Knafl's (2005) methodology. METHODS The following databases were searched for relevant studies published between 2000 and 2020: Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Cochrane Library, PsycINFO, EMBASE, EMCare and Google Scholar. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. The PRISMA checklist for systematic reviews was used. RESULTS A total of 13 studies met the inclusion criteria and were included in this review. Facebook and WhatsApp were the most common social media platforms used to deliver DSME intervention. Nurses were the most frequent DSME providers. The duration and content of DSME in the reviewed studies varied. Consistent positive outcomes were found on glycaemic control, diabetic knowledge and self-efficacy. No studies considered the effect of DSME on HRQoL, anxiety and depression. CONCLUSIONS Social media DSME can be effective in reducing HbA1c levels, increasing diabetic knowledge and self-efficacy. Further studies are needed to examine the effectiveness of using social media to deliver DSME intervention on HRQoL, anxiety and depression. RELEVANCE TO CLINICAL PRACTICE This review provides nurses and healthcare professionals with evidence to support the use of social media to deliver DSME for people with diabetes. DSME delivered via social media supported by nurses would overcome limitations of face-to-face delivery such as geographical distance, travelling time, or other limited resources by patients with diabetes.
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Affiliation(s)
- Esmaeel Yaagoob
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Sharyn Hunter
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia
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Greenfield M, Stuber D, Stegman-Barber D, Kemmis K, Matthews B, Feuerstein-Simon CB, Saha P, Wells B, McArthur T, Morley CP, Weinstock RS. Diabetes Education and Support Tele-Visit Needs Differ in Duration, Content, and Satisfaction in Older Versus Younger Adults. TELEMEDICINE REPORTS 2022; 3:107-116. [PMID: 35720451 PMCID: PMC9153986 DOI: 10.1089/tmr.2022.0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Diabetes education and support are critical components of diabetes care. During the COVID-19 pandemic, when telemedicine took the place of in-person visits, remote Certified Diabetes Care and Education Specialist (CDCES) services were offered to address diabetes education and support. Specific needs for older adults, including the time required to provide education and support remotely, have not been previously reported. METHODS Adults with diabetes (primarily insulin-requiring) were referred to remote CDCESs. Utilization was individualized based on patient needs and preferences. Topics discussed, patient satisfaction, and time spent in each tele-visit were evaluated by diabetes type, age, sex, insurance type, glycosylated hemoglobin (HbA1c), pump, and continuous glucose monitor (CGM) usage. t-Tests, one-way analysis of variance, and Pearson correlations were employed as appropriate. RESULTS Adults (n = 982; mean age 48.4 years, 41.0% age ≥55 years) with type 1 diabetes (n = 846) and type 2 diabetes mellitus (n = 136, 86.0% insulin-treated), 50.8% female; 19.0% Medicaid, 29.1% Medicare, 48.9% private insurance; mean HbA1c 8.4% (standard deviation 1.9); and 46.6% pump and 64.5% CGM users had 2203 tele-visits with remote CDCESs over 5 months. Of those referred, 272 (21.7%) could not be reached or did not receive education/support. Older age (≥55 years), compared with 36-54 year olds and 18-35 year olds, respectively, was associated with more tele-visits (mean 2.6 vs. 2.2 and 1.8) and more time/tele-visits (mean 20.4 min vs. 16.5 min and 14.8 min; p < 0.001) as was coverage with Medicare (mean 2.8 visits) versus private insurance (mean 2.0 visits; p < 0.001) and lower participant satisfaction. The total mean time spent with remote CDCESs was 53.1, 37.4, and 26.2 min for participants aged ≥55, 36-54, and 18-35 years, respectively. During remote tele-visits, the most frequently discussed topics per participant were CGM and insulin pump use (73.4% and 49.7%). After adjustment for sex and diabetes type, older age was associated with lack of access to a computer, tablet, smartphone, or internet (p < 0.001), and need for more education related to CGM (p < 0.001), medications (p = 0.015), hypoglycemia (p = 0.044), and hyperglycemia (p = 0.048). DISCUSSION Most remote CDCES tele-visits were successfully completed. Older adults/those with Medicare required more time to fulfill educational needs. Although 85.7% of individual sessions lasted <30 min, which does not meet current Medicare requirements for reimbursement, multiple visits were common with a total time of >50 min for most older participants. This suggests that new reimbursement models are needed. Education/support needs of insulin-treated older adults should be a focus of future studies.
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Affiliation(s)
- Margaret Greenfield
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Diana Stuber
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | | | - Karen Kemmis
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | | | | | - Prasenjit Saha
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Beth Wells
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | | | - Christopher P. Morley
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Ruth S. Weinstock
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
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Ngetich E, Pateekhum C, Hashmi A, Nadal IP, Pinyopornpanish K, English M, Quansri O, Wichit N, Kinra S, Angkurawaranon C. Illness perceptions, self-care practices, and glycemic control among type 2 diabetes patients in Chiang Mai, Thailand. Arch Public Health 2022; 80:134. [PMID: 35524335 PMCID: PMC9078014 DOI: 10.1186/s13690-022-00888-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 05/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes Self-Management Education (DSME) is a fundamental aspect of diabetes care, but no standard program exists in Thailand. Understanding current patterns of illness perceptions (concerns) and self-management practices among patients with diabetes in Thailand is vital to develop culturally tailored DSME programs. This study sought to explore the association between reported self-management practices and diabetes perceptions on glycemic control among patients with type 2 diabetes in Chiang Mai Province, Thailand. Specifically, the study examined whether the association between illness perceptions and diabetes control was mediated by self-management. METHODS This was a cross-sectional study conducted among type 2 diabetes patients on outpatient care and follow-up in four districts hospitals in Chiang Mai, Thailand. Illness perceptions was measured by the Brief Illness Perceptions Questionnaire (BIPQ). Self-management practices were measured by Summary Diabetes Self-Care activities (SDSCA). For illness perceptions and self-management practices, patients were classified into two groups, high level and low level based on the median values. Univariate and multivariable analyses were done to determine the association between the determinant factors: self-care practices and illness perceptions and the outcome of interest- good glycemic control (HbA1c < 7%). RESULTS Of the 200 participants recruited into the study, 180 completed the questionnaire. Only 35% of participants had good glycemic control (HBA1c < 7.0). Both illness perceptions and self-management practices were independently linked to glycemic control. Among illness perceptions, a sense of personal control was strongly associated with good glycemic control (p = 0.01). For self-management, appropriate diet (p = 0.03) and medication adherence (p = 0.05) were associated with good glycemic control. After adjustments for key baseline characteristics, patients with high levels of illness perceptions were less likely to achieve glycemic control (OR 0.55, 95% CI 0.29 to 1.14, p = 0.11) and those with high level of self-management were more likely to achieve glycemic control (OR 2.11, 95% CI 1.04 to 4.30, p = 0.04). The effect size for illness perception attenuated when further adjusted for levels of self-management (OR 0.88, 95% CI 0.39 to 1.96, p = 0.75) while the effect size for self-management and glycemic control did not materially change (OR 2.30, 95% CI 1.06 to 5.02, p = 0.04). CONCLUSION Illness perceptions and self-management practices are associated with glycemic control. Future culturally tailored interventions in Thailand aimed at improving glycemic should focus on personal control, improving diet and treatment adherence as these are more likely to help improve diabetes control as demonstrated in this study.
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Affiliation(s)
- Elisha Ngetich
- Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Chanapat Pateekhum
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ahmar Hashmi
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Iliatha Papachristou Nadal
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Mike English
- Nuffield Department of Medicine, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Orawan Quansri
- ASEAN Institute for Health Development, Mahidol University, Salaya, Nakorn Pathom, Thailand
| | | | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Ghisi GLDM, Vanzella LM, Pakosh M, Trani MR, Bilocura I, Bersabal S, Panilagao RK, Aultman C, Oh P. Patient education for people living with diabetes in the Philippines: A scoping review of information needs, diabetes knowledge and effectiveness of educational interventions. Diabetes Metab Syndr 2022; 16:102494. [PMID: 35525194 DOI: 10.1016/j.dsx.2022.102494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Despite the growing burden of diabetes in the Philippines, available evidence indicates that its care and control are far from optimal, including patient education. The aim of this scoping review was to synthesize information in the available literature to describe the state of science of patient education for people living with diabetes in the Philippines, specific to educational needs, diabetes knowledge, and effectiveness of educational interventions. METHODS Medline, Embase, Emcare, CINAHL, Pubmed and American Psychological Association PsycInfo were searched from data inception through July 2021. Studies of any methodology (qualitative/quantitative/mixed methods), sample size, and language were eligible for inclusion. RESULTS Of 2021 initial citations, 7 studies were included, with all being quantitative in design and with a median Critical Appraisal Skills Program score of 8/12. Information needs were described by one study and related to self-care abilities. Diabetes knowledge was measured in 6 studies and improved significantly after educational interventions. Overall, studies showed that educational interventions significantly impacted self-efficacy, anthropometric measures, hemoglobin A1c levels, utilization of care and routine programme and attitudes regarding their health. CONCLUSIONS The findings highlight the importance of a comprehensive and culturally appropriate educational intervention for this population. Further research is needed to develop such intervention and assess its effectiveness to change behaviour, such as increasing physical activity.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Lais Manata Vanzella
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto Rehabilitation Institute, Toronto, Canada
| | - Maria Rosan Trani
- Cardiac Rehabilitation Unit, Chong Hua Hospital, Cebu City, Philippines
| | - Imelda Bilocura
- Section of Endocrinology, Chong Hua Hospital, Cebu City, Philippines
| | - Shazna Bersabal
- Cardiac Rehabilitation Unit, Chong Hua Hospital, Cebu City, Philippines
| | | | - Crystal Aultman
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Paul Oh
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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Olson J, Hadjiconstantinou M, Luff C, Watts K, Watson N, Miller V, Schofield D, Khunti K, Davies MJ, Calginari S. From the United Kingdom to Australia-Adapting a Web-Based Self-management Education Program to Support the Management of Type 2 Diabetes: Tutorial. J Med Internet Res 2022; 24:e26339. [PMID: 35442198 PMCID: PMC9069279 DOI: 10.2196/26339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/24/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Diabetes self-management education and support can improve outcomes in people with diabetes. Providing health interventions via digital modes of delivery can extend the reach of programs delivered through traditional means. The web-based version of the Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (MyDESMOND) is a digital diabetes education and support program for people with type 2 diabetes. The program was originally developed in the United Kingdom and is evidence-based, grounded in behavioral theory, and designed through a rigorous process of intervention mapping. As such, MyDESMOND was considered an ideal candidate for adaptation to the Australian setting. Program content and the digital platform were modified to suit the local context to increase the likelihood that the revised version of MyDESMOND will deliver similar outcomes to the original program. The aim of this paper is to describe the systematic processes undertaken to adapt the digital MyDESMOND diabetes education and support program for people with type 2 diabetes to the Australian setting. The adaptation involved a multidisciplinary group with a diverse range of skills and expertise-a governance structure was established, a skilled project team was appointed, and stakeholder engagement was strategically planned. The adaptation of the program content included modifications to the clinical recommendations, the inclusion of local resources, practical changes, and revisions to optimize readability. A 2-stage independent review of the modified content was enacted. Digital adaptations were informed by relevant standards, local legislative requirements, and considerations of data sovereignty. The digital platform was extensively tested before deployment to the production setting. MyDESMOND is the first evidence-based digital diabetes education and support program for Australians with type 2 diabetes. This paper provides a road map for the adaptation of digital health interventions to new contexts.
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Affiliation(s)
- Jenny Olson
- Diabetes WA, Subiaco, Australia.,Department of Kinesiology, The Pennsylvania State University, University Park, PA, United States.,College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | | | | | | | | | - Venus Miller
- Catalysis Research and Evaluation Consultancy, Perth, Australia
| | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
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Höld E, Grüblbauer J, Wiesholzer M, Wewerka-Kreimel D, Stieger S, Kuschei W, Kisser P, Gützer E, Hemetek U, Ebner-Zarl A, Pripfl J. Improving glycemic control in patients with type 2 diabetes mellitus through a peer support instant messaging service intervention (DiabPeerS): study protocol for a randomized controlled trial. Trials 2022; 23:308. [PMID: 35422003 PMCID: PMC9009500 DOI: 10.1186/s13063-022-06202-2] [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: 09/27/2021] [Accepted: 03/26/2022] [Indexed: 12/15/2022] Open
Abstract
Background Diabetes mellitus is one of the four priority non-communicable diseases worldwide. It can lead to serious long-term complications and produces significant costs. Due to the chronicle character of the disease, it requires continuous medical treatment and good therapy adherence of those suffering. Therefore, diabetes self-management education (DSME) (and support DSMES) plays a significant role to increase patient’s self-management capacity and improve diabetes therapy. Research indicates that these outcomes might be difficult to maintain. Consequently, effective strategies to preserve the positive effects of DSMES are needed. Preliminary results show that peer support, which means support from a person who has experiential knowledge of a specific behavior or stressor and similar characteristics as the target population, is associated with better outcomes in terms of HbA1c, cardiovascular disease risk factors or self-efficacy at a lower cost compared to standard therapy. Peer-supported instant messaging services (IMS) approaches have significant potential for diabetes management because support can be provided easily and prompt, is inexpensive, and needs less effort to attend compared to standard therapy. The major objective of the study is to analyze the impact of a peer-supported IMS intervention in addition to a standard diabetes therapy on the glycemic control of type 2 diabetic patients. Methods A total of 205 participants with type 2 diabetes mellitus will be included and randomly assigned to an intervention or control group. Both groups will receive standard therapy, but the intervention group will participate in the peer-supported IMS intervention, additionally. The duration of the intervention will last for 7 months, followed by a follow-up of 7 months. Biochemical, behavioral, and psychosocial parameters will be measured before, in the middle, and after the intervention as well as after the follow-up. Discussion Type 2 diabetes mellitus and other non-communicable diseases put healthcare systems worldwide to the test. Peer-supported IMS interventions in addition to standard therapy might be part of new and cost-effective approaches to support patients independent from time and place. Trial registration ClinicalTrials.govNCT04797429. Registered on 15 March 2021.
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Affiliation(s)
- Elisabeth Höld
- Institute of Health Sciences, St. Pölten University of Applied Sciences, St. Pölten, Austria.
| | - Johanna Grüblbauer
- Institute of Creative\Media/Technologies, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Martin Wiesholzer
- Department of Internal Medicine I, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Daniela Wewerka-Kreimel
- Bachelor Degree Program Dietetics, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Stefan Stieger
- Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Werner Kuschei
- Department of Internal Medicine I, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Philip Kisser
- Fachbereich Versorgungsmanagement 3, Austrian Health Insurance Fund, St. Pölten, Austria
| | - Elisabeth Gützer
- Fachbereich Versorgungsmanagement 3, Austrian Health Insurance Fund, St. Pölten, Austria
| | - Ursula Hemetek
- Bachelor Degree Program Dietetics, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Astrid Ebner-Zarl
- Institute of Creative\Media/Technologies, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Jürgen Pripfl
- Institute of Health Sciences, St. Pölten University of Applied Sciences, St. Pölten, Austria.,Christian Doppler Forschungsgesellschaft, Vienna, Austria
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Iovino P, Nolan A, De Maria M, Ausili D, Matarese M, Vellone E, Riegel B. The influence of social support on self-care is mediated by self-efficacy and depression in chronic illness: key findings from the 'SODALITY' observational study. Aging Ment Health 2022; 27:820-828. [PMID: 35416091 DOI: 10.1080/13607863.2022.2056877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objectives: Family is a major source of support for older chronically-ill patients and known to be associated with better self-care. Depression and self-care self-efficacy are associated with healthy behaviors and thus may serve as mechanisms by which family support influences self-care.We explored depression and self-care self-efficacy as mediators of the relationship between perceived family support and self-care.Methods: Five hundred forty-one older adults with multiple chronic illnesses were recruited from outpatients and community settings. Three structural equation models (SEM) were fit on cross-sectional data. We measured perceived family support (subscale of the Multidimensional Scale of Perceived Social Support, scores range 1-7), depression (Patient Health Questionnaire, scores range 0-27), selfcare self-efficacy (Self-Care Self Efficacy Scale, standardized scores range 0-100), and self-care maintenance, monitoring, and management (Self-care of Chronic Illness Inventory, standardized scores range 0-100).Results: Participants (mean age = 76.6±7.3 yrs) were predominantly females (55.6%). In the full sample, depression and self-care self-efficacy mediated the relationship between perceived family support and self-care; in the gender-stratified SEM, men's depression was no longer a significant mediator. Depression and self-care self-efficacy were significant mediators of the relation between perceived family support and self-care.Conclusion: In older chronically-ill patients, interventions addressing perceived family support may facilitate a rapid improvement in self-care self-efficacy and a decrease in depressive symptoms, particularly among women.
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Affiliation(s)
- Paolo Iovino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,School of Nursing, Midwifery and Paramedicine Faculty of Health Science, Australian Catholic University, Melbourne, Australia
| | - Amy Nolan
- University of Pennsylvania, Philadelphia, PA, USA
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Li J, Yin J, Luo Y, Ma T, He L, Xie H, Li J, Zhang G, Cheng X, Bai Y. Association of healthy sleep pattern with the risk of cardiovascular disease and all-cause mortality among people with diabetes: A prospective cohort study. Diabetes Res Clin Pract 2022; 186:109822. [PMID: 35271877 DOI: 10.1016/j.diabres.2022.109822] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 01/08/2023]
Abstract
AIMS This study aimed to assess the association of healthy sleep pattern with the risk of cardiovascular disease and all-cause mortality among people with diabetes. METHODS Our study included 12,770 individuals from the UK Biobank at baseline. Sleep patterns were defined by a combination of five sleep behaviors (chronotype, sleep duration, snoring, insomnia, and excessive daytime sleepiness). The competing risk models were used to estimate the relationship between sleep patterns and CVD (including coronary heart disease [CHD] and stroke) in individuals with diabetes. To examine the association between sleep patterns and all-cause mortality risk, we utilized the flexible parametric Royston-Parmar proportion-hazard models. RESULTS We recorded 2627 CVD events, which includes 1999 CHD and 903 S events, and 1576 all-cause mortality events. Compared to those with poor sleep pattern, individuals having healthy sleep pattern have a 24% lower CVD risk (p < 0.001), a 26% lower CHD risk (p = 0.001), a 25% lower stroke risk (p = 0.036), and a 21% lower all-cause mortality risk (p = 0.020). CONCLUSIONS Adherence to healthy sleep pattern has been significantly related to cardiovascular disease and all-cause mortality risk reduction among people with diabetes.
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Affiliation(s)
- Jing Li
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jinghua Yin
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yi Luo
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Tianqi Ma
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Lingfang He
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Hejian Xie
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jinchen Li
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China; Department of Geriatric Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Guogang Zhang
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha 410008, China; Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Xunjie Cheng
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China.
| | - Yongping Bai
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China.
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50
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Leong CM, Lee TI, Chien YM, Kuo LN, Kuo YF, Chen HY. Social Media-Delivered Patient Education to Enhance Self-management and Attitudes of Patients with Type 2 Diabetes During the COVID-19 Pandemic: Randomized Controlled Trial. J Med Internet Res 2022; 24:e31449. [PMID: 35319478 PMCID: PMC8987969 DOI: 10.2196/31449] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/03/2021] [Accepted: 02/04/2022] [Indexed: 12/17/2022] Open
Abstract
Background The use of mobile health technologies has been necessary to deliver patient education to patients with diabetes during the COVID-19 pandemic. Objective This open-label randomized controlled trial evaluated the effects of a diabetes educational platform—Taipei Medical University–LINE Oriented Video Education—delivered through a social media app. Methods Patients with type 2 diabetes were recruited from a clinic through physician referral. The social media–based program included 51 videos: 10 about understanding diabetes, 10 about daily care, 6 about nutrition care, 21 about diabetes drugs, and 4 containing quizzes. The intervention group received two or three videos every week and care messages every 2 weeks through the social media platform for 3 months, in addition to usual care. The control group only received usual care. Outcomes were measured at clinical visits through self-reported face-to-face questionnaires at baseline and at 3 months after the intervention, including the Simplified Diabetes Knowledge Scale (true/false version), the Diabetes Care Profile–Attitudes Toward Diabetes Scales, the Summary of Diabetes Self-Care Activities, and glycated hemoglobin (HbA1c) levels. Health literacy was measured at baseline using the Newest Vital Sign tool. Differences in HbA1c levels and questionnaire scores before and after the intervention were compared between groups. The associations of knowledge, attitudes, and self-care activities with health literacy were assessed. Results Patients with type 2 diabetes completed the 3-month study, with 91 out of 181 (50.3%) patients in the intervention group and 90 (49.7%) in the control group. The change in HbA1c did not significantly differ between groups (intervention group: mean 6.9%, SD 0.8% to mean 7.0%, SD 0.9%, P=.34; control group: mean 6.7%, SD 0.6% to mean 6.7%, SD 0.7%, P=.91). Both groups showed increased mean knowledge scores at 12 weeks, increasing from 68.3% (SD 16.4%) to 76.7% (SD 11.7%; P<.001) in the intervention group and from 64.8% (SD 18.2%) to 73.2% (SD 12.6%; P<.001) in the control group. Positive improvements in attitudes and self-care activities were only observed in the intervention group (attitudes: mean difference 0.2, SD 0.5, P=.001; self-care activities: mean difference 0.3, SD 1.2, P=.03). A 100% utility rate was achieved for 8 out of 21 (38%) medication-related videos. Low health literacy was a significant risk factor for baseline knowledge scores in the intervention group, with an odds ratio of 2.80 (95% CI 1.28-6.12; P=.01); this became insignificant after 3 months. Conclusions The social media–based program was effective at enhancing the knowledge, attitudes, and self-care activities of patients with diabetes. This intervention was also helpful for patients with low health literacy in diabetes knowledge. The program represents a potentially useful tool for delivering diabetes education to patients through social media, especially during the COVID-19 pandemic. Trial Registration ClinicalTrials.gov NCT04876274; https://clinicaltrials.gov/ct2/show/results/NCT04876274
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Affiliation(s)
- Cheng Man Leong
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Ting-I Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Mei Chien
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Li-Na Kuo
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Feng Kuo
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Hsiang-Yin Chen
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan.,Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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