Diabetes symptoms and self-management behaviors in rural older adults

Contributing factors of fatigue in patients with type 2 diabetes: A systematic review

Remarkable evidence supports the link between type 2 diabetes (T2DM) and fatigue. However, a unifying recommendation to identify and prevent fatigue or to prevent its clinical consequences in T2DM is not available at present. Therefore, this study aimed to conduct a systematic review to summarize the definition, measurement tools, and contributing factors of fatigue in T2DM. Nine articles were included for analysis, and results showed that T2DM fatigue was associated with five major factors, including sociodemographic factors, clinical disease factors, inflammatory factors, psychological factors, and behavior and lifestyle. The contributing factors of T2DM fatigue are reviewed, and clinical benefits provide a theoretical basis for further clinical intervention to prevent the occurrence of fatigue and improve the patient's treatment compliance and self-management ability and may be beneficial to their quality of life.

Fatigue and Sleep Quality Predict Eating Behavior Among People With Type 2 Diabetes

BACKGROUND

People with Type 2 diabetes frequently report increased fatigue and sleep disturbance. These symptoms might put them at a higher risk for unhealthy eating behavior-detrimental to diabetes control.

OBJECTIVES

The aim of the study was to examine the effect of fatigue and sleep on eating behavior in people with Type 2 diabetes by using a daily diary approach.

METHODS

Data from 56 patients were collected during a baseline interview and an 8-day ambulatory assessment period in the free-living setting. Each day, participants completed one diary upon awakening to assess their sleep duration and sleep quality during the previous night and morning fatigue. They also completed one diary before going to bed to assess their eating behavior during the day (e.g., uncontrolled eating, cognitive restraint, emotional eating, and snacking). Data from 7 days were analyzed using generalized estimating equations.

RESULTS

During the 7 days, controlling for age, gender, and body mass index, between-person fatigue was a significant predictor of uncontrolled eating, emotional eating, and snacking. Similarly, controlling for the covariates, between-person sleep quality was a significant predictor of uncontrolled eating and emotional eating. No associations were found between sleep duration and eating behavior.

DISCUSSIONS

At the between-person level, reporting higher fatigue or poorer sleep quality was associated with higher levels of unhealthy eating behavior. Patients with Type 2 diabetes with high fatigue or poor sleep quality may require additional attention to support their healthy eating.

Predicting Healthy Lifestyle Behaviours Among Patients With Type 2 Diabetes in Rural Bali, Indonesia

Background

Type 2 diabetes is a lifelong metabolic disease closely related to unhealthy lifestyle behaviours. This study aimed to identify factors explaining the healthy lifestyle behaviours of patients with type 2 diabetes in rural Indonesia. The extended health belief model, demographic characteristics, clinical lifestyle factors and diabetes knowledge were investigated to provide a complete description of these behaviours.

Method

A sample of 203 patients with type 2 diabetes representing a cross-section of the population were recruited from community health centres in the rural areas of Bali province. The data were collected through questionnaires. Descriptive statistics and a hierarchical regression test were employed.

Results

This study showed demographic characteristics, clinical and lifestyle factors, diabetes knowledge and the extended health belief model accounted for 71.8% of the variance in healthy lifestyle behaviours of patients with type 2 diabetes in rural Indonesia. The significant demographic factors were age, education level, employment status and traditional beliefs. The significant clinical and lifestyle factors were alcohol use, diabetic medicine and duration of symptoms. Finally, the significant extended health belief model factors were perceived severity, susceptibility, barriers, family support, bonding social capital and chance locus of control.

Conclusions

The extended health belief model forms an adequate model for predicting healthy lifestyle behaviours among patients with diabetes in rural Indonesia. The contribution of this model should be strengthened in developing the diabetes management.

The Lived Experience of Older Adults With Type 2 Diabetes Mellitus and Diabetes-Related Distress

An older, more diverse population and longer lifespans are major contributors to the anticipated tripling of diabetes prevalence by 2050. Diabetes-related distress affects up to 40% of people with diabetes and may be a higher risk for older adults due to greater prevalence of comorbidities. The objective of the current phenomenological study was to describe how diabetes-related distress might be uniquely experienced by older adults (age ≥65) with type 2 diabetes mellitus (T2DM). Interpretive phenomenology guided the research design and analysis. Everyday life experiences of living with T2DM and elevated diabetes distress were investigated with interpretive interviews. The most prevalent lived experiences were strained relationships with health care providers, guilt, fear, loneliness, and forgetfulness. These experiences created challenges in managing diabetes and increased diabetes-related distress. Improving knowledge regarding the lived experience of older adults with diabetes-related distress may allow health care providers to tailor treatment to this population, thus improving outcomes. [Journal of Gerontological Nursing, 46(3), 37-44.].

Real-Time Associations Between Glucose Levels and Fatigue in Type 2 Diabetes: Sex and Time Effects

OBJECTIVE

Fatigue is a pervasive and serious complaint among aging adults with type 2 diabetes. Anecdotally, hyperglycemia was thought to cause fatigue, but prior cross-sectional analyses failed to find any relationship between glucose levels and fatigue. However, study methodology may have caused this relationship to be missed. Our aim was to use concurrent and continuous data across 5 days to examine real-time momentary relationships between glucose and fatigue levels by week, day, and time of day. Additionally, we explored how these relationships differed by sex.

METHOD

Participants (N = 54, 51% male, 54% non-White) wore continuous glucose monitors and wrist actigraphy into which they inputted fatigue ratings 6-8 times daily during waking hours across 5 days. Generalized estimation equation models were used to explore the relationship between glucose and fatigue when averaged by week, day, and time of day. Differences by sex were also explored.

RESULTS

HbA1c and baseline and real-time fatigue were higher in women than in men. Baseline HbA1c and self-reported general fatigue were unrelated. Fatigue levels averaged by day and time of day were higher in women than in men (p < .05). Glucose and fatigue were significantly related at all levels of data (weekly, daily, and time of day) in women but not men.

CONCLUSIONS

Our findings suggest that, when measured concurrently, glucose excursions may affect fatigue levels in women.

Symptom Experience of Older Adults With Type 2 Diabetes and Diabetes-Related Distress

BACKGROUND

An older, more diverse population and longer life spans are major contributors to the anticipated tripling of Type 2 diabetes prevalence by 2050. Diabetes-related distress affects up to 40% of people diagnosed with Type 2 diabetes and may be a greater risk for older adults due to greater prevalence of comorbidities.

OBJECTIVE

The objective of this phenomenological study was to describe how diabetes-related distress in older adults (≥65 years) with Type 2 diabetes might be uniquely experienced.

METHODS

Participants were recruited using convenience sampling and snowball sampling. Interpretive phenomenology guided the research design and analysis. With interpretive interviews, we investigated the everyday health, symptoms, and life experiences of living with Type 2 diabetes and elevated diabetes distress.

RESULTS

Among the older adults in this study, the most prevalent symptoms were fatigue, hypoglycemia, diarrhea, pain, loss of balance, and falling. These diabetes-related symptoms led to substantial loss of independence, decreased quality of life, and constrained social lives due to restricted activities.

DISCUSSION

Diabetes-related distress presents with some unique symptoms and responses in older adults. Improving knowledge regarding the symptom experience of older adults with diabetes-related distress may allow healthcare providers to tailor treatment and thus improve outcomes for older adults struggling with diabetes.

Relationship between sleep disturbance and self-care in adults with type 2 diabetes

AIMS

Type 2 diabetes (T2D) is a metabolic disorder requiring intensive self-care to maintain optimal glycemic control. Sleep disturbance is common in T2D patients and likely impairs glycemic control. Our aim was to examine the relationship between sleep disturbance and self-care in adults with T2D.

METHODS

This study used a correlational design. Sixty-four adults with T2D were recruited. Validated instruments were used to measure self-care, subjective sleep disturbance, and covariates (e.g., diabetes distress, self-efficacy, fatigue, and daytime sleepiness). Over an 8-day period, the ActiGraph-wGT3X was used to measure objective sleep outcomes (e.g., total sleep time and number of awakenings). Bivariate correlation and multiple linear regression analyses were conducted.

RESULTS

The mean age of the participants was 60.6 (SD 6.8) years (range 50-78), and 51.6% were women. Controlling for covariates, subjective sleep disturbance (β = - 0.26), diabetes distress (β = - 0.39), and daytime sleepiness (β = - 0.21) were strong predictors of diabetes self-care (R² = 0.51, p < 0.001). When objective sleep parameters were used, the number of awakenings (β = - 0.23) also predicted self-care along with diabetes distress, fatigue, and daytime sleepiness (R² = 0.57, p < 0.001).

CONCLUSIONS

Subjective sleep disturbance and frequent nocturnal awakenings are associated with worse diabetes self-care in adults with T2D. Healthcare providers are recommended to include comprehensive sleep assessment at every clinical visit. Diabetes educators may consider including sleep-related education in their diabetes self-management classes and/or counseling sessions.

The co-occurrence of depressive symptoms and cognitive impairment and its relationship with self-care behaviors among community dwelling older adults with diabetes

AIMS

The aims of the present study were to investigate the co-occurrence of depressive symptoms and cognitive impairment in community dwelling older adults with diabetes and its relationship with specific diabetes self-care behaviors.

METHODS

We analyzed data from two national samples of older adults (65years or older) with self-reported physician-diagnosed diabetes (N=1034), who participated in the 2005 or 2009 National Health Interview Survey in Taiwan. The Mini-Mental State Examination was used to assess cognitive function. The Center for Epidemiologic Studies Depression Scale was used to assess depressive symptoms. The study assessed self-care behaviors including medication adherence, exercise, healthy diet, and self-monitoring of blood glucose.

RESULTS

In this study, 8.8% of participants with diabetes had both depressive symptoms and cognitive impairment. After adjusting for other factors, participants with both cognitive impairment and depressive symptoms were less likely to exercise (Prevalence Ratios (PR)=0.66; 95% Confidence Intervals (CI)=[0.47-0.91]; P-value=0.011), and have a healthy diet (PR=0.82; 95%CI=[0.70-0.96]; P-value=0.012).

CONCLUSIONS

Our results illustrate the high prevalence of combined depressive symptoms and cognitive impairment and that this combination is associated with worse self-care behaviors in older adults with diabetes. These findings highlight the difficulty that some older adults with diabetes may have in maintaining self-care behaviors in the presence of depressed mood and cognitive impairment, particularly in the areas of diet and exercise. The results emphasize the importance of providing more support for these aspects of self-care to such older adults.

Motives for Participation in Physical Activity and Observance of Physical Activity Recommendations among Adults with Type 2 Diabetes

OBJECTIVES

Drawing on self-determination theory, this study examined how motivation to engage in physical activity (PA) influences the observance of PA recommendations by adults with type 2 diabetes.

METHODS

This study used a cross-sectional design. In total, 365 adults with type 2 diabetes (181 men and 184 women, mean age = 60.39 years; SD=6.47) completed a questionnaire assessing their motivations and behaviours regarding PA. PA behaviour was assessed by means of the weekly practice of moderate-to-vigorous PA (MVPA) during leisure time. A symptom checklist was also used to assess diabetes-related symptoms experienced over the past month.

RESULTS

Results of a hierarchic binary logistic regression revealed that participants accumulating at least 150 minutes per week of MVPA during their leisure time were more likely to display higher scores on intrinsic and identified motives, whereas participants not accumulating 150 minutes per week of MVPA during their leisure time were more likely to present higher scores on external regulation and amotivation. In addition, results of a multivariate analysis of covariance (MANCOVA) showed that participants accumulating at least 150 minutes per week of MVPA during their leisure time experienced less fatigue and fewer hyperglycemic symptoms.

CONCLUSIONS

These findings suggest that adults who observe PA recommendations for type 2 diabetes possess higher levels of autonomous motives to practise PA. Results further highlight the importance of motives for engaging in PA by adults with type 2 diabetes in terms of the positive relationship between observing PA recommendations and experiencing less fatigue and fewer hyperglycemic symptoms.

Home-based diabetes symptom self-management education for Mexican Americans with type 2 diabetes

This pilot study evaluated an innovative diabetes symptom awareness and self-management educational program for Mexican Americans, a fast growing minority population experiencing a diabetes epidemic. Patients with diabetes need assistance interpreting and managing symptoms, which are often annoying and potentially life-threatening. A repeated measures randomized controlled trial was conducted with 72 Mexican Americans aged 25-75 years with type 2 diabetes. Experimental condition participants received eight weekly, in-home, one-on-one educational and behavior modification sessions with a registered nurse focusing on symptom awareness, glucose self-testing and appropriate treatments, followed by eight biweekly support telephone sessions. Wait-listed control condition participants served as comparisons at three time points. Hierarchical linear modeling was used to evaluate the effects of the intervention between- and within groups on psychosocial, behavioral and clinical outcomes. Participants were predominantly female, middle-aged, moderately acculturated and in poor glycemic control. Experimental group participants (n = 39) significantly improved glycemic control, blood pressure, symptoms, knowledge, self-efficacy, empowerment and quality of life. Post intervention focus groups reported satisfaction with the symptom focus. Addressing symptoms led to clinical and psychosocial improvements. Symptoms seem to be an important motivator and a useful prompt to engage patients in diabetes self-management behaviors to relieve symptoms and prevent complications.