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Qiu S, Liu X, Lei L, Liang H, Li X, Wang Y, Yu C, Li X, Tang Y, Wu J, Wang Y, Zha D, Liu X, Xiao M, Xiu J. Association between the stress-hyperglycemia ratio and all-cause mortality in community-dwelling populations: An analysis of the National Health and Nutrition Examination Survey (NHANES) 1999-2014. J Diabetes 2024; 16:e13567. [PMID: 38769875 PMCID: PMC11106591 DOI: 10.1111/1753-0407.13567] [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: 04/05/2023] [Revised: 02/01/2024] [Accepted: 04/01/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Reportedly, the stress-hyperglycemia ratio (SHR) is closely associated with poor prognosis in patients with severe acute disease. However, the community-dwelling may also be in a state of stress due to environmental exposure. Our study aimed to explore the association between SHR and all-cause mortality in the community-dwelling population. METHODS A total of 18 480 participants were included out of 82 091 from the NHANES 1999-2014 survey. The Kaplan-Meier survival analyses were used to assess the disparities in survival rates based on SHR, and the log-rank test was employed to investigate the distinctions between groups. The multivariate Cox regression analysis and restricted cubic spline (RCS) analysis were performed to assess the association of SHR with all-cause mortality. A subgroup analysis was also conducted. RESULTS A total of 3188 deaths occurred during a median follow-up period of 11.0 (7.7; 15.4) years. The highest risk for all-cause mortality was observed when SHR≤ 0.843 or SHR ≥0.986 (log-rank p < .001). After adjusting for the confounding factors, compared with subjects in the second SHR quartile (Q2), participants in the highest (Q4, adjusted hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.28-1.73) and lowest quartiles (Q1, adjusted HR 1.37, 95% CI 1.16-1.60) have a higher probability of all-cause death. The RCS observed a dose-response U-shaped association between SHR and all-cause mortality. The U-shaped association between SHR and all-cause mortality was similar across subgroup analysis. CONCLUSIONS The SHR was significantly associated with all-cause mortality in the community-dwelling population, and the relationship was U-shaped.
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Affiliation(s)
- Shifeng Qiu
- Department of CardiologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Shock and MicrocirculationNanfang Hospital, Southern Medical UniversityGuangzhouChina
- State Key Laboratory of Organ Failure ResearchNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Xiaocong Liu
- Department of CardiologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Shock and MicrocirculationNanfang Hospital, Southern Medical UniversityGuangzhouChina
- State Key Laboratory of Organ Failure ResearchNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Li Lei
- Department of CardiologyShenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology)ShenzhenChina
| | - Hongbin Liang
- Department of CardiologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Shock and MicrocirculationNanfang Hospital, Southern Medical UniversityGuangzhouChina
- State Key Laboratory of Organ Failure ResearchNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Xue Li
- Department of GastroenterologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Yutian Wang
- Department of CardiologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Shock and MicrocirculationNanfang Hospital, Southern Medical UniversityGuangzhouChina
- State Key Laboratory of Organ Failure ResearchNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Chen Yu
- Department of CardiologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Shock and MicrocirculationNanfang Hospital, Southern Medical UniversityGuangzhouChina
- State Key Laboratory of Organ Failure ResearchNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Xiaobo Li
- Department of CardiologyXiangdong Hospital Affiliated to Hunan Normal UniversityZhuzhouChina
| | - Yongzhen Tang
- Department of CardiologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Shock and MicrocirculationNanfang Hospital, Southern Medical UniversityGuangzhouChina
- State Key Laboratory of Organ Failure ResearchNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Juefei Wu
- Department of CardiologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Shock and MicrocirculationNanfang Hospital, Southern Medical UniversityGuangzhouChina
- State Key Laboratory of Organ Failure ResearchNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Yuegang Wang
- Department of CardiologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Shock and MicrocirculationNanfang Hospital, Southern Medical UniversityGuangzhouChina
- State Key Laboratory of Organ Failure ResearchNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Daogang Zha
- Department of CardiologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Shock and MicrocirculationNanfang Hospital, Southern Medical UniversityGuangzhouChina
- State Key Laboratory of Organ Failure ResearchNanfang Hospital, Southern Medical UniversityGuangzhouChina
- Department of General PracticeNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Xuewei Liu
- Guangdong Provincial Key Laboratory of Shock and MicrocirculationNanfang Hospital, Southern Medical UniversityGuangzhouChina
- The First School of Clinical MedicineSouthern Medical UniversityDongguanChina
| | - Min Xiao
- Department of CardiologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Shock and MicrocirculationNanfang Hospital, Southern Medical UniversityGuangzhouChina
- State Key Laboratory of Organ Failure ResearchNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Jiancheng Xiu
- Department of CardiologyNanfang Hospital, Southern Medical UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Shock and MicrocirculationNanfang Hospital, Southern Medical UniversityGuangzhouChina
- State Key Laboratory of Organ Failure ResearchNanfang Hospital, Southern Medical UniversityGuangzhouChina
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Wagner J, Barth C, Bermúdez-Millán A, Buxton OM, Kong S, Kuoch T, Lampert R, Pérez-Escamilla R, Scully M, Segura-Pérez S. Lay health worker research personnel for home-based data collection in clinical and translational research: Qualitative and quantitative findings from two trials in hard-to-reach populations. J Clin Transl Sci 2023; 7:e228. [PMID: 38028343 PMCID: PMC10643917 DOI: 10.1017/cts.2023.647] [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: 06/21/2023] [Revised: 09/16/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Aims The role of lay health workers in data collection for clinical and translational research studies is not well described. We explored lay health workers as data collectors in clinical and translational research studies. We also present several methods for examining their work, i.e., qualitative interviews, fidelity checklists, and rates of unusable/missing data. Methods We conducted 2 randomized, controlled trials that employed lay health research personnel (LHR) who were employed by community-based organizations. In one study, n = 3 Latina LHRs worked with n = 107 Latino diabetic participants. In another study, n = 6 LHR worked with n = 188 Cambodian American refugees with depression. We investigated proficiency in biological, behavioral, and psychosocial home-based data collection conducted by LHR. We also conducted in-depth interviews with lay LHR to explore their experience in this research role. Finally, we described the training, supervision, and collaboration for LHR to be successful in their research role. Results Independent observers reported a very high degree of fidelity to technical data collection protocols (>95%) and low rates of missing/unusable data (1.5%-11%). Qualitative results show that trust, training, communication, and supervision are key and that LHR report feeling empowered by their role. LHR training included various content areas over several weeks with special attention to LHR and participant safety. Training and supervision from both the academic researchers and the staff at the community-based organizations were necessary and had to be well-coordinated. Conclusions Carefully selected, trained, and supervised LHRs can collect sophisticated data for community-based clinical and translational research.
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Affiliation(s)
| | - Cheryl Barth
- Yale University School of Medicine, New Haven, CT, USA
| | | | | | - Sengly Kong
- Khmer Health Advocates, West Hartford, CT, USA
| | | | | | | | - Mary Scully
- Khmer Health Advocates, West Hartford, CT, USA
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Ornelas IJ, Rao D, Price C, Chan G, Tran A, Aisenberg G, Perez G, Maurer S, Nelson AK. Promoting mental health in Latina immigrant women: Results from the Amigas Latinas Motivando el Alma intervention trial. Soc Sci Med 2023; 321:115776. [PMID: 36809698 PMCID: PMC9998361 DOI: 10.1016/j.socscimed.2023.115776] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/25/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Latina immigrants are at increased risk of depression and anxiety and limited access to mental health care. This study evaluated the effectiveness of Amigas Latinas Motivando el Alma (ALMA), a community-based intervention to reduce stress and promote mental health among Latina immigrants. METHODS ALMA was evaluated using a delayed intervention comparison group study design. Latina immigrants (N = 226) were recruited from community organizations in King County, Washington from 2018 to 2021. Although originally developed to be delivered in-person, due to the COVID-19 pandemic the intervention was adapted mid-study to be delivered online. Participants completed surveys to assess changes in depression and anxiety post-intervention and at a two-month follow-up. We estimated generalized estimating equation models to assess differences in outcomes across groups, including stratified models for those receiving the intervention in-person or online. RESULTS In adjusted models, participants in the intervention group had lower levels of depressive symptoms than the comparison group post-intervention (β = -1.82, p = 0.01) and at two-month follow-up (β = -1.52, p = 0.01). Anxiety scores decreased for both groups, and there were no significant differences post-intervention or at follow-up. In stratified models, participants in the online intervention group had lower levels of depressive (β = -2.50, p = 0.007) and anxiety (β = -1.86, p = 0.02) symptoms than those in the comparison group, but there were no significant differences among those that received the intervention in-person. CONCLUSIONS Community-based interventions can be effective in preventing and reducing depressive symptoms among Latina immigrant women, even when delivered online. Further research should evaluate the ALMA intervention among larger more diverse Latina immigrant populations.
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Affiliation(s)
- India J Ornelas
- University of Washington, School of Public Health, Department of Health Systems and Population Health, USA.
| | - Deepa Rao
- University of Washington School of Public Health, Department of Global Health, USA.
| | | | - Gary Chan
- University of Washington, School of Public Health, Department of Health Systems and Population Health, USA; University of Washington, Department of Biostatistics, USA.
| | - Anh Tran
- Duke School of Medicine, Department of Family Medicine and Community Health, USA.
| | | | - Georgina Perez
- University of Washington, School of Public Health, Department of Health Systems and Population Health, USA.
| | - Serena Maurer
- University of Washington, School of Public Health, Department of Health Systems and Population Health, USA.
| | - Adrianne Katrina Nelson
- University of Washington, School of Public Health, Department of Health Systems and Population Health, USA.
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Wagner J, Bermúdez-Millán A, Buckley T, Buxton OM, Feinn R, Kong S, Kuoch T, Nye LM, Scully M. Self-reported outcomes of a randomized trial comparing three community health worker interventions for diabetes prevention among Cambodian Americans with depression. PATIENT EDUCATION AND COUNSELING 2022; 105:3501-3508. [PMID: 36307274 DOI: 10.1016/j.pec.2022.09.011] [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: 07/01/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Cambodian Americans have complex, interrelated and persistent medical and mental health problems stemming from genocide and the social determinants of health. We examined changes in multiple domains of self-reported health outcomes from a diabetes prevention trial. METHODS Cambodian Americans with depression and high risk for diabetes (n = 188) were randomized to one of three community health worker interventions: lifestyle vs lifestyle plus medication therapy management vs social services. Assessments were at baseline, 12- and 15-months. RESULTS The typical participant was 55 years old, female, earned below $20,000 annually, and had 7 years of education. About one-third were taking antidepressant medication and over half had elevated depressive symptoms. Relative to social services, lifestyle and lifestyle plus medication therapy management were both similarly effective at increasing diabetes knowledge, nutrition habits, sleep quality and decreasing pain; 2) lifestyle alone was superior to social services for self-reported health; and, 3) all three groups showed improved anxiety and insomnia. There were no effects on physical activity or physical functioning. CONCLUSION Community health worker interventions have multiple benefits beyond delaying diabetes. PRACTICE IMPLICATIONS Health promotion programs that are designed and delivered appropriately can impact even hard to reach and hard to treat groups.
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Affiliation(s)
- Julie Wagner
- UConn Schools of Medicine and Dental Medicine, United States.
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Hessler D, Fisher L, Dickinson M, Dickinson P, Parra J, Potter MB. The impact of enhancing self-management support for diabetes in Community Health Centers through patient engagement and relationship building: a primary care pragmatic cluster-randomized trial. Transl Behav Med 2022; 12:909-918. [PMID: 36205473 PMCID: PMC9540970 DOI: 10.1093/tbm/ibac046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Type 2 diabetes (T2DM) self-management support (SMS) programs can yield improved clinical outcomes but may be limited in application or impact without considering individuals' unique social and personal challenges that may impede successful diabetes outcomes. The current study compares an evidence-based SMS program with an enhanced version that adds a patient engagement protocol, to elicit and address unique patient-level challenges to support improved SMS and diabetes outcomes. Staff from 12 Community Health Center (CHC) clinical sites were trained on and delivered: Connection to Health (CTH; 6 sites), including a health survey and collaborative action planning, or Enhanced Engagement CTH (EE-CTH; 6 sites), including additional relationship building training/support. Impact of CTH and EE-CTH on behavioral self-management, psychological outcomes, and modifiable social risks was examined using general linear mixed effects. Clinics enrolled 734 individuals with T2DM (CTH = 408; EE-CTH = 326). At 6- to 12-month postenrollment, individuals in both programs reported significant improvements in self-management behaviors (sugary beverages, missed medications), psychological outcomes (stress, health-related distress), and social risks (food security, utilities; all p < .05). Compared with CTH, individuals in EE-CTH reported greater decreases in high fat foods, salt, stress and health-related distress; and depression symptoms improved within EE-CTH (all p < .05). CTH and EE-CTH demonstrated positive behavioral, psychological, and social risk impacts for T2DM in CHCs delivered within existing clinical work flows and a range of clinical roles. Given the greater improvements in psychological outcomes and behavioral self-management in EE-CTH, increased attention to relationship building strategies within SMS programs is warranted.
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Affiliation(s)
| | - Lawrence Fisher
- Department of Family & Community Medicine, University of California—San Francisco, San Francisco, CA, USA
| | - Miriam Dickinson
- Department of Family & Community Medicine, University of Colorado—Denver, Denver, CO, USA
| | - Perry Dickinson
- Department of Family & Community Medicine, University of Colorado—Denver, Denver, CO, USA
| | - José Parra
- Department of Family & Community Medicine, University of California—San Francisco, San Francisco, CA, USA
| | - Michael B Potter
- Department of Family & Community Medicine, University of California—San Francisco, San Francisco, CA, USA
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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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Oyedeji AD, Ullah I, Weich S, Bentall R, Booth A. Effectiveness of non-specialist delivered psychological interventions on glycemic control and mental health problems in individuals with type 2 diabetes: a systematic review and meta-analysis. Int J Ment Health Syst 2022; 16:9. [PMID: 35120528 PMCID: PMC8817494 DOI: 10.1186/s13033-022-00521-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background Typically, specialist mental health professionals deliver psychological interventions for individuals with poorly controlled type 2 diabetes mellitus (T2DM) and related mental health problems. However, such interventions are not generalizable to low- and middle-income countries, due to the dearth of trained mental health professionals. Individuals with little or no experience in the field of mental health (referred to as non-specialists) may have an important role to play in bridging this treatment gap. Aim To synthesise evidence for the effectiveness of non-specialist delivered psychological interventions on glycaemic control and mental health problems in people with T2DM. Methods Eight databases and reference lists of previous reviews were systematically searched for randomized controlled trials (RCTs). Outcome measures were glycated hemoglobin (HbA1c), diabetes distress and depression. The Cochrane Collaboration Risk of Bias Tool was used for risk of bias assessment. Data from the included studies were synthesized using narrative synthesis and random effects meta-analysis. Results 16 RCTs were eligible for inclusion in the systematic review. The 11 studies that were pooled in the meta-analysis demonstrated a reduction in HbA1c in favor of non-specialist delivered psychological interventions when compared with control groups (pooled mean difference = − 0.13; 95% CI − 0.22 to − 0.04, p = 0.005) with high heterogeneity across studies (I2 = 71%, p = 0.0002). The beneficial effects of the interventions on diabetes distress and depression were not consistent across the different trials. Conclusion Non-specialist delivered psychological interventions may be effective in improving HbA1c. These interventions have some promising benefits on diabetes distress and depression, although the findings are inconclusive. More studies of non-specialist delivered psychological interventions are needed in low- and middle-income countries to provide more evidence of the potential effectiveness of these interventions for individuals living with T2DM.
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Affiliation(s)
- Ayodeji D Oyedeji
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK.
| | - Ibrahim Ullah
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - Richard Bentall
- Department of Psychology, University of Sheffield, Sheffield, S1 4DA, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
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Slater A, Cantero PJ, Alvarez G, Cervantes BS, Bracho A, Billimek J. Latino Health Access: Comparative Effectiveness of a Community-Initiated Promotor/a-Led Diabetes Self-management Education Program. FAMILY & COMMUNITY HEALTH 2022; 45:34-45. [PMID: 34783689 PMCID: PMC9831659 DOI: 10.1097/fch.0000000000000311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Community-initiated health interventions fill important gaps in access to health services. This study examines the effectiveness of a community-initiated health intervention to improve diabetes management in an underserved community of color using a retrospective observational study, comparing a study intervention, the Latino Health Access Diabetes Self-Management Program (LHA-DSMP), with usual care. The LHA-DSMP is a 12-session community health worker (promotor/a) intervention developed and implemented by a community-based organization in a medically underserved area. Usual care was delivered at a federally qualified health center in the same geographic area. Participants were 688 predominantly Spanish-speaking Latinx adults with type 2 diabetes. The main outcome was change in glycemic control (glycosylated hemoglobin [HbA1c]) from baseline to follow-up. At 14-week follow-up, mean (95% CI) HbA1c decrease was -1.1 (-1.3 to -0.9; P < .001) in the LHA-DSMP cohort compared with -0.3 (-0.4 to -0.2; P < .001) in the comparison cohort. Controlling for baseline differences between cohorts, the adjusted difference-in-differences value in HbA1c was -0.6 (-0.8 to -0.3; P < .001) favoring the LHA-DSMP. A community-initiated promotor/a-led educational program for diabetes self-management is associated with clinically significant improvement in blood sugar control, superior to what was observed with usual medical care.
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Affiliation(s)
- Allison Slater
- Program in Medical Education for the Latino Community (PRIME-LC), School of Medicine (Dr Slater and Dr Billimek), Health Policy Research Institute (Mr Cervantes and Dr Billimek), and Department of Family Medicine (Dr Billimek), University of California, Irvine; and Latino Health Access, Santa Ana, California (Drs Cantero and Bracho and Mr Alvarez)
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Tasya Z, Amiruddin R, Syam A, Thamrin Y. Psychotherapy intervention diabetes distress in diabetes patients: A systematic review. ENFERMERIA CLINICA 2021. [DOI: 10.1016/j.enfcli.2021.09.007] [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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Mirahmadizadeh A, Mahizadeh H, Seif M, Sharifi MH. Factors related to psychological well-being amongst patients with type 2 diabetes. Diabetes Res Clin Pract 2021; 178:108982. [PMID: 34311021 DOI: 10.1016/j.diabres.2021.108982] [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: 01/05/2021] [Revised: 06/26/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The effect of diabetes on psychological well-being (PWB) is a concern for the development of medical care in diabetes management. There are few studies have simultaneously evaluated the impacts of related factors in PWB among patients with type 2 diabetes. METHOD This cross-sectional study was conducted on 183 male and 317 female patients with diabetes who had been registered in healthcare centers in Behbahan from November 2018 until April 2019. The patients' well-being status, medications, diet, and physical activity (PA) adherances were measured using validated questionnaires. RESULT The mean age of the participants was 52.18 ± 10.29 years. The total mean (SD) score of PWB was 87.40 ± 9.945. In addition, the results of univariate and multivariate analyses showed that the level of adherence to medication had a significant or close-to-significant relationship with PWB score (p < 0.001 and p = 0.082, respectively). The results of univariate and multivariate analyses also indicated that adherence to diet was significantly associated with PWB score (p < 0.001 and p < 0.001, respectively). However, there were no significant differences among PA levels regarding the PWB score (p = 0.087). The results showed that glycemic control was significantly correlated to PWB score (p < 0.001). CONCLUSION Despite the wide variety of relating factors to PWB, adherence to the diet and medication could be added to diabetic guidelines to improve glycemic management and well-being.
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Affiliation(s)
- Alireza Mirahmadizadeh
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Mozhgan Seif
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Sharifi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Upsher R, Onabajo D, Stahl D, Ismail K, Winkley K. The Effectiveness of Behavior Change Techniques Underpinning Psychological Interventions to Improve Glycemic Levels for Adults With Type 2 Diabetes: A Meta-Analysis. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:699038. [PMID: 36994330 PMCID: PMC10012110 DOI: 10.3389/fcdhc.2021.699038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022]
Abstract
An existing systematic review and meta-analysis found a significant reduction in glycemic levels for adults with type 2 diabetes who received a psychological intervention over control conditions. To help develop effective interventions in the future, there is a need to understand the active ingredients which underpin these psychological interventions. We conducted a secondary meta-analysis including 67 randomized controlled trials (RCTs) reported in English. We reviewed the psychological intervention descriptions of the included studies of the existing review and extracted the behavior change techniques (BCTs) according to the BCT taxonomy (BCTTv1). We also extracted information on primary behavioral target versus primary outcome, and presence of fidelity assessment. The most frequent BCTs across RCTs were ‘social support (unspecified)’ (n=50), ‘problem solving’ (n=38) and ‘goal setting (behavior’) (n=30). These BCTs were independently associated with a significant reduction in glycemic levels (HbA1c) compared to control conditions, but not significantly different from studies that did not include these BCTs. Meta-regressions revealed no significant associations between HbA1c, and psychological intervention category (counselling versus cognitive behavioral therapy interventions) (p=0.84), frequency of BCTs per psychological intervention (p=0.29), primary behavioral target versus primary outcome (p=0.48), or presence of fidelity assessment (p=0.15). Social support (unspecified), problem solving, and goal setting (behavior) could be useful BCTs to develop psychological interventions for people with type 2 diabetes to improve glycemic levels. However, more research is required to understand which combination of individual BCTs are most effective for this population.Systematic Review RegistrationRegistered with the international prospective register of systematic reviews registration (PROSPERO) CRD42016033619.
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Affiliation(s)
- Rebecca Upsher
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- *Correspondence: Rebecca Upsher,
| | - Deborah Onabajo
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, James Clerk Maxwell Building, London, United Kingdom
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Andreae SJ, Andreae LJ, Richman JS, Cherrington AL, Safford MM. Peer-delivered Cognitive Behavioral Therapy-based Intervention Reduced Depression and Stress in Community Dwelling Adults With Diabetes and Chronic Pain: A Cluster Randomized Trial. Ann Behav Med 2021; 55:970-980. [PMID: 33969866 DOI: 10.1093/abm/kaab034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Finding effective, accessible treatment options such as professional-delivered cognitive behavioral therapy (CBT) for medically complex individuals is challenging in rural communities. PURPOSE We examined whether a CBT-based program intended to increase physical activity despite chronic pain in patients with diabetes delivered by community members trained as peer coaches also improved depressive symptoms and perceived stress. METHODS Participants in a cluster-randomized controlled trial received a 3-month telephonic lifestyle modification program with integrated CBT elements. Peer coaches assisted participants in developing skills related to adaptive coping, diabetes self-management goal-setting, stress reduction, and cognitive restructuring. Attention controls received general health advice with an equal number of contacts but no CBT elements. Depressive symptoms and stress were assessed using the Centers for Epidemiologic Studies Depression and Perceived Stress scales. Assessments occurred at baseline, 3 months, and 1 year. RESULTS Of 177 participants with follow-up data, 96% were African Americans, 79% women, and 74% reported annual income <$20,000. There was a significant reduction in perceived stress in intervention compared to control participants at 3-months (β = -2.79, p = .002 [95% CI -4.52, -1.07]) and 1 year (β = -2.59, p < .0001 [95% CI -3.30, -1.87]). Similarly, intervention participants reported significant decreases in depressive symptoms at 3-months (β = -2.48, p < .0001 [95% CI -2.48, -2.02]) and at 1 year (β = -1.62, p < .0001 [95% CI -2.37, -0.86]). CONCLUSIONS This peer-delivered CBT-based program improved depressive symptoms and stress in individuals with diabetes and chronic pain. Training community members may be a feasible strategy for offering CBT-based interventions in rural and under-resourced communities. CLINICAL TRIAL REGISTRATION NCT02538055.
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Affiliation(s)
- Susan J Andreae
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Lynn J Andreae
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joshua S Richman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrea L Cherrington
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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Megan Berthold S, Bermudez-Millan A, Buckley T, Buxton OM, Feinn R, Kong S, Kuoch T, Scully M, Seng K, Wagner J. Social disconnection and metabolic syndrome score among Cambodian Americans with depression. Diabetes Res Clin Pract 2021; 175:108792. [PMID: 33872632 PMCID: PMC8254938 DOI: 10.1016/j.diabres.2021.108792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/15/2020] [Accepted: 03/30/2021] [Indexed: 11/15/2022]
Abstract
AIMS Migrants experience social disconnection and also have high risk for metabolic syndrome (MetS). This study explored associations of social alienation, social isolation, and social support with MetS among Cambodian Americans. METHODS We conducted secondary data analysis on baseline assessments from a diabetes prevention trial for Cambodian Americans with depression and high risk for diabetes. Participants were aged 35-75, Cambodian or Cambodian-American, Khmer speaking, lived in Cambodia during the Pol Pot regime, lived in the northeastern U.S. at the time of study, endorsed elevated risk factors for diabetes and met criteria for depression by medication for depression and/or elevated depressive symptoms. They completed surveys and provided anthropometric and blood pressure measurements and fasting blood samples. RESULTS In multiple linear regressions, greater social alienation was associated with increased risk for MetS. The social alienation-MetS association was stronger in men than women. Associations were not better accounted for by crude indicators of social isolation such as marital status, living alone, and number of people in the household. Social support was not associated with MetS and did not buffer the deleterious association between social alienation and MetS. CONCLUSIONS Decreasing social alienation may mitigate risk for MetS among migrant populations.
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Affiliation(s)
- S Megan Berthold
- University of Connecticut School of Social Work, University of Connecticut, Storrs, CT, USA
| | | | - Thomas Buckley
- University of Connecticut School of Pharmacy, University of Connecticut, Storrs, CT, USA
| | | | | | - Sengly Kong
- Khmer Health Advocates, West Hartford, CT, USA
| | | | - Mary Scully
- Khmer Health Advocates, West Hartford, CT, USA
| | - Kagnica Seng
- Central Connecticut State University, New Britain, CT, USA
| | - Julie Wagner
- Behavioral Sciences and Community Health, UConn Health, Farmington, CT, USA.
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14
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Balcha Hailu F, Hjortdahl P, Moen A. Effect of locally-contextualized nurse-led diabetes self-management education on psychosocial health and quality of life: A controlled before-after study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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15
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Walker RJ, Garacci E, Campbell JA, Egede LE. The influence of daily stress on glycemic control and mortality in adults with diabetes. J Behav Med 2020; 43:723-731. [PMID: 31617047 PMCID: PMC7156304 DOI: 10.1007/s10865-019-00109-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 10/04/2019] [Indexed: 01/01/2023]
Abstract
There is mixed evidence regarding the relationship between different types of stress and outcomes in adults with diabetes. The aim of this study was to understand the relationship between daily stress and glycemic control (HbA1c), and to examine whether multiple daily stressors is associated with early mortality among individuals with diabetes. This was a cross-sectional analysis of national Midlife Development in the United States (MIDUS) study data. A total of 141 adults with diabetes completed the National Study of Daily Experiences (NSDE) project during the initial phase of the study, which was summarized through a series of measures about daily stress frequency, type and impact. General linear models investigated the relationship between daily stress and HbA1c. Kaplan-Meier curves based on national death index information linked to MIDUS were investigated for individuals reporting no/one stressor per week versus multiple stressors per week. On average, this population of adults with diabetes reported 3.1 days with a stressor and 2.45 stressor types per week. No significant relationships existed between glycemic control and frequency of daily stress. Higher stress from work was associated with higher HbA1c (β = 0.65, 95% CI 0.08, 1.22) and higher perceived risk of stress influencing physical health was associated with higher HbA1c (β = 0.60, 95% CI 0.01, 1.20). In conclusion, while many ways of measuring daily stress were shown not to have a significant influence on glycemic control, daily stress related to work and the perceived risk of stress influencing one's physical health may influence outcomes for adults with diabetes. Interventions incorporating stress management, and in particular coping with the risk that stress has on health may help adults with diabetes better manage glycemic control over time.
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Affiliation(s)
- Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226-3596, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Emma Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226-3596, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226-3596, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
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16
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A daily study of stressors, continuously measured glucose, and diabetes symptoms in latinos with type 2 diabetes. J Behav Med 2020; 44:94-103. [PMID: 32494976 DOI: 10.1007/s10865-020-00162-1] [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: 11/20/2019] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
This study examined whether daily stressors and continuously monitored glucose levels and glucose variability predict daily diabetes symptoms. Fifty Latinos with type 2 diabetes were randomized to either diabetes education (DE-only; N = 23) or DE plus stress management and relaxation training (DE + SMR; N = 32). After treatment, for 7 days they wore 'blinded' continuous glucose monitors and reported common stressors and diabetes symptoms twice daily. Between individuals, participants with more numerous overall stressors and more time in hyperglycemia reported higher symptoms. Within individuals, symptoms were higher during intervals of greater than usual stressors. Yet, diabetes symptoms did not covary with changes in glucose levels or glucose variability. The within-person stressor-symptom association was stronger among older individuals and non-significant for participants in DE + SMR condition. Diabetes symptoms were associated with recent stressor exposure, but not recent glucose level or changes in glucose. CLINICAL TRIAL NUMBER: ClinicalTrials.gov Identifier (No. NCT01578096).
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17
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Turner BJ, Liang Y, Ramachandran A, Poursani R. Telephone or Visit-Based Community Health Worker Care Management for Uncontrolled Diabetes Mellitus: A Longitudinal Study. J Community Health 2020; 45:1123-1131. [PMID: 32472457 PMCID: PMC7256181 DOI: 10.1007/s10900-020-00849-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Community health workers (CHWs) can reduce health disparities for low income patients but type of contact and outcomes has had limited study. Low-income Hispanic primary care patients with hemoglobin A1c [HbA1c] ≥ 9% received care managment (CM) over 6 months classified as: (CM1) telephone only; (CM2) clinic visit but no calls; (CM3) clinic visit with calls; and (CM4) ≥ 2 visits ± calls. Type of CM delivery and time to DM control (HbA1c < 9%) examined in Cox proportional hazards model and more rapid control within 6 months using logistic regression. Models adjusted for demographics, clinical, and health care variables. At baseline, 523 patients had mean HbA1c 10.9% (SD = 1.7%), mean age 57.9 years (SD = 10), 58.5% women, 87.6% Hispanic, and 55.5% uninsured. CM types for patients: 51 (9.8%) CM1; 192 (36.7%) CM2; 44 (8.4%) CM3; and 236 (45.4%) CM4. Median time to HbA1c control was 197 days (95% CI [71, 548]) and 41.5% achieved control within 6 months. Compared with CM1, control was more rapid for CM2 (Hazard ratio [HR] 1.45, 95% CI [1.01, 2.09], p = 0.043) and CM4 but not significant (HR [95% CI] 1.29 [0.91, 1.83], p = 0.15). Adjusted odds of more rapid control within 6 months were twofold higher for CM2 (p = 0.04) and CM4 (p = 0.055), respectively, versus CM1. CM2 did not differ from CM1. DM control was less likely for CM by telephone only than face-to-face in clinic. To benefit vulnerable patients with uncontrolled DM, in-person engagement may be required.
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Affiliation(s)
- Barbara J Turner
- Department of Medicine, Keck Medical Center of University of Southern California, 2020 Zonal Avenue, Los Angeles, CA, 90033, USA.
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine of USC, 2020 Zonal Avenue, IRD 322, Los Angeles, CA, 90033, USA.
| | - Yuanyuan Liang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 W. Redwood Street, Baltimore, MD, 21201, USA
| | - Ambili Ramachandran
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio (UT Health San Antonio), 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Ramin Poursani
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio (UT Health San Antonio), 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
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Whittemore R, Vilar-Compte M, De La Cerda S, Delvy R, Jeon S, Burrola-Méndez S, Pardo-Carrillo M, Lozano-Marrufo A, Pérez-Escamilla R. ¡Sí, Yo Puedo Vivir Sano con Diabetes! A Self-Management Randomized Controlled Pilot Trial for Low-Income Adults with Type 2 Diabetes in Mexico City. Curr Dev Nutr 2020; 4:nzaa074. [PMID: 32368713 PMCID: PMC7186776 DOI: 10.1093/cdn/nzaa074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/28/2020] [Accepted: 04/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is a worldwide epidemic and a leading cause of death in Mexico, with a prevalence of 15.9%, and >70% of diagnosed adults have poor glycemic control [glycated hemoglobin (HbA1c) >7.5%]. We developed a diabetes self-management education program contextualized to the study population, including dietary preferences, health literacy, and health system. OBJECTIVES We aimed to evaluate the efficacy of a self-management + text message program (¡Sí, Yo Puedo Vivir Sano con Diabetes!) on primary (HbA1c), and secondary behavioral (self-management), clinical, and psychosocial outcomes in adults with T2D in Mexico City. METHODS Participants were recruited at public primary healthcare centers (Seguro Popular), and randomly allocated to treatment (n = 26) or wait-list control groups (n = 21) with data collected at 3 and 6 mo. The program included 7 weekly sessions and 6 mo of daily text/picture messages. Descriptive statistics and a generalized linear mixed model with intent-to-treat analysis were calculated. RESULTS Participants were 55.5 ± 8.8 y of age (mean ± SD), 68% female, 88.6% overweight/obese, and 57% lived in food-insecure households. Mean ± SD T2D duration was 11.9 ± 7.8 y and HbA1c was 9.2% ± 1.5%. There was 89% attendance at sessions and 6.4% attrition across both groups at 6 mo. Group-by-time effects were seen in self-monitoring of blood glucose (P < 0.01) and diabetes self-efficacy (P < 0.04); and a trend for lower HbA1c was seen in the intervention group at 6 mo (P = 0.11). Significant improvements in dietary behavior (P < 0.01) were demonstrated in the intervention group over time, but this did not reach statistical significance compared with the control group. CONCLUSIONS The program was associated with clinically significant improvements in T2D self-management, self-efficacy, and HbA1c over time. Thus, T2D self-management skills, including diet, were improved in a vulnerable metropolitan population.This trial was registered at clinicaltrials.gov as NCT03159299.
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Affiliation(s)
| | - Mireya Vilar-Compte
- Research Institute for Equitable Development (EQUIDE), Universidad Iberoamericana , Mexico City, Mexico
| | - Selene De La Cerda
- Research Institute for Equitable Development (EQUIDE), Universidad Iberoamericana , Mexico City, Mexico
| | | | | | - Soraya Burrola-Méndez
- Research Institute for Equitable Development (EQUIDE), Universidad Iberoamericana , Mexico City, Mexico
| | - Mariana Pardo-Carrillo
- Research Institute for Equitable Development (EQUIDE), Universidad Iberoamericana , Mexico City, Mexico
| | - Annel Lozano-Marrufo
- Research Institute for Equitable Development (EQUIDE), Universidad Iberoamericana , Mexico City, Mexico
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Polhuis CMM, Bouwman LI, Vaandrager L, Soedamah-Muthu SS, Koelen MA. Systematic review of salutogenic-oriented lifestyle randomised controlled trials for adults with type 2 diabetes mellitus. PATIENT EDUCATION AND COUNSELING 2020; 103:764-776. [PMID: 31711677 DOI: 10.1016/j.pec.2019.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Describe the characteristics (development, intensity, deliverers, setting, strategies) and assess the effect of salutogenic-oriented lifestyle interventions on physical and psychosocial health outcomes in adults with type 2 diabetes mellitus (T2DM). METHOD PubMed, Scopus and PsycINFO were systematically searched for randomised controlled trials (RCTs) published up to August 2019 that complied with predefined salutogenic criteria: the participant as a whole, the participant's active involvement and the participant's individual learning process. Characteristics of the salutogenic-oriented interventions with and without significant results were compared and qualitatively summarised. RESULTS Twenty-eight RCTs were identified. Salutogenic oriented interventions that significantly improved both physical and psychosocial health were characterized by being based on formative research, culturally targeted, and delivered in 10-20 sessions in group settings, whereas salutogenic oriented interventions that neither improved physical or psychosocial health significantly were characterized by being individually tailored and delivered in less than 10 group sessions in individual settings. CONCLUSIONS This systematic review suggests that salutogenic-oriented lifestyle interventions are effective for physical and psychosocial health in the short term. More research is needed to determine how intervention characteristics moderate (long-term) effectiveness. PRACTICE IMPLICATIONS The results provide a basis for purposefully developing effective salutogenic interventions for adults with T2DM.
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Affiliation(s)
- C M M Polhuis
- Health and Society, Wageningen University, Wageningen, The Netherlands.
| | - L I Bouwman
- Health and Society, Wageningen University, Wageningen, The Netherlands
| | - L Vaandrager
- Health and Society, Wageningen University, Wageningen, The Netherlands
| | - S S Soedamah-Muthu
- Center of Research on Psychological and Somatic disorders (CORPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Institute for Food, Nutrition and Health, University of Reading, Reading, United Kingdom
| | - M A Koelen
- Health and Society, Wageningen University, Wageningen, The Netherlands
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Whittemore R, Vilar-Compte M, Burrola-Méndez S, Lozano-Marrufo A, Delvy R, Pardo-Carrillo M, De La Cerda S, Pena-Purcell N, Pérez-Escamilla R. Development of a diabetes self-management + mHealth program: tailoring the intervention for a pilot study in a low-income setting in Mexico. Pilot Feasibility Stud 2020; 6:25. [PMID: 32082611 PMCID: PMC7023698 DOI: 10.1186/s40814-020-0558-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 01/27/2020] [Indexed: 11/12/2022] Open
Abstract
Background Type 2 diabetes (T2D) is a public health pandemic disproportionately affecting low- and middle-income countries. The purpose of this formative research was to adapt evidence-based diabetes self-management education programs to the context of Seguro Popular clinics in Mexico. A theory-based mHealth (pictorial text messaging) component was developed. Method Our formative research and development of the program protocol consisted of six phases: (1) interviews and focus groups with stakeholders on the challenges to T2D management, curriculum content needs, and the use of mHealth as a supplement to a DSME program; (2) review of the theoretical underpinning, curriculum, and interactive strategies of four evidence-based DSME programs and modification to meet the needs of adults with T2D and systems of care in Mexico City; (3) development of theory-based illustrated text messages; (4) evaluation of text messaging acceptability and access in adults with T2D via focus groups; (5) development of program manual; and (6) development of a training program for health care providers. Results The ¡Sí, Yo Puedo Vivir Sano Con Diabetes! included 7 group-based weekly lessons; simple, interactive content; weekly empowerment messages; video novellas; group activities; and goal setting. Adaptations to the cultural context of Mexico included content/activities on diabetes etiology (addressing cultural misconceptions), nutrition (indigenous foods and plate method), self-blood glucose monitoring, and diabetes-related stress/coping. We used the Health Action Process Approach to guide the text message development, which posits that adoption, initiation, and maintenance of health behaviors require the development of intentions, plans, coping, and self-efficacy. Our final text message bank consisted of 181 messages. There were approximately 20–30 messages for each process of behavior change (e.g., action planning, maintenance self-efficacy) and 30 messages for each content topic (e.g., eating healthy, physical activity). There were 96 messages that were illustrated. Training materials were also developed. Discussion We used a systematic approach, collaboration with stakeholders, and a well-established behavior change theory to develop an evidence-based intervention to an international context and system of care. Collectively, this process has the potential to enhance the feasibility, acceptability, and efficacy of the program.
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Affiliation(s)
- Robin Whittemore
- 1Yale School of Nursing, 400 West Campus Drive, West Haven, CT 06516 USA
| | - Mireya Vilar-Compte
- 2Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219 Mexico City, Mexico
| | - Soraya Burrola-Méndez
- 2Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219 Mexico City, Mexico
| | - Annel Lozano-Marrufo
- 2Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219 Mexico City, Mexico
| | - Roberta Delvy
- 1Yale School of Nursing, 400 West Campus Drive, West Haven, CT 06516 USA
| | - Mariana Pardo-Carrillo
- 2Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219 Mexico City, Mexico
| | - Selene De La Cerda
- 2Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219 Mexico City, Mexico
| | - Ninfa Pena-Purcell
- 3Texas A & M University, 2251 TAMU Mailstop, College Station, Texas 77845 USA
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Wagner JA, Feinn R, Lampert R, Bermúdez-Millán A, Pérez-Escamilla R. Changes in negative affect and changes in heart rate variability among low-income latinos with type 2 diabetes in a randomized, controlled stress management trial. J Psychosom Res 2019; 124:109774. [PMID: 31443815 DOI: 10.1016/j.jpsychores.2019.109774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Structural equation modeling examined the relationship between change in negative affect (NA) and change in heart rate variability (HRV) among 121 Latinos with type 2 diabetes. METHODS This study leveraged data from the Community Health Workers Assisting Latinos Manage Stress and Diabetes (CALMSD) study which compared diabetes education vs diabetes education plus stress management. Participants completed surveys of NA at baseline and again 8-10 weeks later. They also wore 7‑lead, 3-channel ambulatory ECG monitors for 24 h at both time points. The latent variable NA was modeled by observed scores on symptoms of depression, anxiety, diabetes distress, and wellbeing (reversed). The latent variable HRV was modeled by observed scores in the time domain (the standard deviation of the R-R interval [SDNN] and the root mean square of the successive differences [RMSSD]) and in the frequency domain, i.e., log-transformed ultra-low frequency, very-low frequency, low frequency, and high frequency. RESULTS At baseline, there were strong, negative cross-sectional associations between NA and HRV. Baseline NA predicted change in HRV, whereas baseline HRV did not predict change in NA. Controlling for fasting glucose and treatment assignment did not meaningfully alter the findings. Stress management improved NA but not HRV. At followup, a greater reduction (improvement) in NA was associated with a larger increase (improvement) in HRV, with a small-to-medium negative association that approached statistical significance. CONCLUSIONS Findings indicate a longitudinal relationship between NA and HRV, and suggest that improvement in one may be associated with improvement in the other.
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Affiliation(s)
- Julie A Wagner
- University of Connecticut Schools of Medicine and Dental Medicine, United States of America.
| | - Richard Feinn
- Quinnipiac University School of Medicine, United States of America
| | - Rachel Lampert
- Yale University School of Medicine, United States of America
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Bermúdez-Millán A, Wagner JA, Feinn RS, Segura-Pérez S, Damio G, Chhabra J, Pérez-Escamilla R. Inflammation and Stress Biomarkers Mediate the Association between Household Food Insecurity and Insulin Resistance among Latinos with Type 2 Diabetes. J Nutr 2019. [PMID: 31006809 DOI: 10.1093/jn/nxz021+[doi]] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Household food insecurity (HFI) is a stressor that is associated with type 2 diabetes (T2D). However, little is known about HFI and the insulin resistance (IR) underlying T2D, and the mechanisms involved. OBJECTIVE We examined the cross-sectional association between HFI and IR among low-income Latinos with T2D and tested whether inflammation and stress hormones mediated this association. METHODS HFI was measured with the 6-item US Household Food Security Survey module. IR was calculated from fasting plasma blood glucose and serum insulin. Inflammation was indicated by high-sensitivity C-reactive protein (hsCRP), and stress hormones included urinary cortisol, metanephrine, and normetanephrine. To test for an indirect effect of HFI on homeostasis model assessment of IR, a parallel multiple mediation model was run with biological markers that significantly differed between food security status-entered as mediators in the model. We used 95% bias-corrected bootstrap CIs, with 10,000 bootstrap samples, to assess the significance of the indirect effects. RESULTS The 121 participants with T2D were primarily Puerto Rican (85.8%), aged mean = 60.7 y, and 74% were female. Eighty-two (68%) were classified as food insecure. Compared with food-secure individuals, food-insecure individuals had a significantly higher IR [mean difference (Δ) = 7.21, P = 0.001], insulin (Δ = 9.7, P = 0.019), glucose (Δ = 41, P < 0.001), hsCRP (Δ = 0.8, P = 0.008), cortisol (Δ = 21, P = 0.045), and total cholesterol (Δ = 29, P = 0.004). Groups did not differ on other lipids, metanephrine, normetanephrine, or A1c. The mediation model showed a significant direct effect of HFI on hsCRP (P = 0.020) and on cortisol (P = 0.011). There was a direct effect of cortisol (P = 0.013), hsCRP (P = 0.044), and HFI on IR (P = 0.015). The total combined indirect effect of HFI through cortisol and hsCRP indicated partial mediation. CONCLUSIONS Among Latinos with T2D, HFI is associated with IR partially through inflammation and stress hormones. Interventions to ameliorate HFI and mitigate its effects on inflammation, stress, and IR are warranted. This trial was registered at clinicaltrials.gov as NCT01578096.
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Affiliation(s)
| | - Julie A Wagner
- Psychiatry, University of Connecticut School of Medicine.,Division of Behavioral Sciences and Community Health, University of Connecticut School of Dental Medicine, UConn Health, Farmington, CT
| | - Richard S Feinn
- School of Medicine, Medical Sciences, Quinnipiac University, Hamden, CT
| | | | | | - Jyoti Chhabra
- Research Administration, Hartford Hospital, Hartford, CT
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
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Bermúdez-Millán A, Wagner JA, Feinn RS, Segura-Pérez S, Damio G, Chhabra J, Pérez-Escamilla R. Inflammation and Stress Biomarkers Mediate the Association between Household Food Insecurity and Insulin Resistance among Latinos with Type 2 Diabetes. J Nutr 2019; 149:982-988. [PMID: 31006809 PMCID: PMC6543200 DOI: 10.1093/jn/nxz021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 11/27/2018] [Accepted: 01/28/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Household food insecurity (HFI) is a stressor that is associated with type 2 diabetes (T2D). However, little is known about HFI and the insulin resistance (IR) underlying T2D, and the mechanisms involved. OBJECTIVE We examined the cross-sectional association between HFI and IR among low-income Latinos with T2D and tested whether inflammation and stress hormones mediated this association. METHODS HFI was measured with the 6-item US Household Food Security Survey module. IR was calculated from fasting plasma blood glucose and serum insulin. Inflammation was indicated by high-sensitivity C-reactive protein (hsCRP), and stress hormones included urinary cortisol, metanephrine, and normetanephrine. To test for an indirect effect of HFI on homeostasis model assessment of IR, a parallel multiple mediation model was run with biological markers that significantly differed between food security status-entered as mediators in the model. We used 95% bias-corrected bootstrap CIs, with 10,000 bootstrap samples, to assess the significance of the indirect effects. RESULTS The 121 participants with T2D were primarily Puerto Rican (85.8%), aged mean = 60.7 y, and 74% were female. Eighty-two (68%) were classified as food insecure. Compared with food-secure individuals, food-insecure individuals had a significantly higher IR [mean difference (Δ) = 7.21, P = 0.001], insulin (Δ = 9.7, P = 0.019), glucose (Δ = 41, P < 0.001), hsCRP (Δ = 0.8, P = 0.008), cortisol (Δ = 21, P = 0.045), and total cholesterol (Δ = 29, P = 0.004). Groups did not differ on other lipids, metanephrine, normetanephrine, or A1c. The mediation model showed a significant direct effect of HFI on hsCRP (P = 0.020) and on cortisol (P = 0.011). There was a direct effect of cortisol (P = 0.013), hsCRP (P = 0.044), and HFI on IR (P = 0.015). The total combined indirect effect of HFI through cortisol and hsCRP indicated partial mediation. CONCLUSIONS Among Latinos with T2D, HFI is associated with IR partially through inflammation and stress hormones. Interventions to ameliorate HFI and mitigate its effects on inflammation, stress, and IR are warranted. This trial was registered at clinicaltrials.gov as NCT01578096.
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Affiliation(s)
| | - Julie A Wagner
- Psychiatry, University of Connecticut School of Medicine
- Division of Behavioral Sciences and Community Health, University of Connecticut School of Dental Medicine, UConn Health, Farmington, CT
| | - Richard S Feinn
- School of Medicine, Medical Sciences, Quinnipiac University, Hamden, CT
| | | | | | - Jyoti Chhabra
- Research Administration, Hartford Hospital, Hartford, CT
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
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Bermúdez-Millán A, Wagner JA, Feinn RS, Segura-Pérez S, Damio G, Chhabra J, Pérez-Escamilla R. Inflammation and Stress Biomarkers Mediate the Association between Household Food Insecurity and Insulin Resistance among Latinos with Type 2 Diabetes. J Nutr 2019. [DOI: 10.1093/jn/nxz021 [doi]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
Background
Household food insecurity (HFI) is a stressor that is associated with type 2 diabetes (T2D). However, little is known about HFI and the insulin resistance (IR) underlying T2D, and the mechanisms involved.
Objective
We examined the cross-sectional association between HFI and IR among low-income Latinos with T2D and tested whether inflammation and stress hormones mediated this association.
Methods
HFI was measured with the 6-item US Household Food Security Survey module. IR was calculated from fasting plasma blood glucose and serum insulin. Inflammation was indicated by high-sensitivity C-reactive protein (hsCRP), and stress hormones included urinary cortisol, metanephrine, and normetanephrine. To test for an indirect effect of HFI on homeostasis model assessment of IR, a parallel multiple mediation model was run with biological markers that significantly differed between food security status—entered as mediators in the model. We used 95% bias-corrected bootstrap CIs, with 10,000 bootstrap samples, to assess the significance of the indirect effects.
Results
The 121 participants with T2D were primarily Puerto Rican (85.8%), aged mean = 60.7 y, and 74% were female. Eighty-two (68%) were classified as food insecure. Compared with food-secure individuals, food-insecure individuals had a significantly higher IR [mean difference (Δ) = 7.21, P = 0.001], insulin (Δ = 9.7, P = 0.019), glucose (Δ = 41, P < 0.001), hsCRP (Δ = 0.8, P = 0.008), cortisol (Δ = 21, P = 0.045), and total cholesterol (Δ = 29, P = 0.004). Groups did not differ on other lipids, metanephrine, normetanephrine, or A1c. The mediation model showed a significant direct effect of HFI on hsCRP (P = 0.020) and on cortisol (P = 0.011). There was a direct effect of cortisol (P = 0.013), hsCRP (P = 0.044), and HFI on IR (P = 0.015). The total combined indirect effect of HFI through cortisol and hsCRP indicated partial mediation.
Conclusions
Among Latinos with T2D, HFI is associated with IR partially through inflammation and stress hormones. Interventions to ameliorate HFI and mitigate its effects on inflammation, stress, and IR are warranted. This trial was registered at clinicaltrials.gov as NCT01578096.
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Affiliation(s)
| | - Julie A Wagner
- Psychiatry, University of Connecticut School of Medicine
- Division of Behavioral Sciences and Community Health, University of Connecticut School of Dental Medicine, UConn Health, Farmington, CT
| | - Richard S Feinn
- School of Medicine, Medical Sciences, Quinnipiac University, Hamden, CT
| | | | | | - Jyoti Chhabra
- Research Administration, Hartford Hospital, Hartford, CT
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
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Guérin E, Jaafar H, Amrani L, Prud'homme D, Aguer C. Intervention Strategies for Prevention of Comorbid Depression Among Individuals With Type 2 Diabetes: A Scoping Review. Front Public Health 2019; 7:35. [PMID: 30891439 PMCID: PMC6411710 DOI: 10.3389/fpubh.2019.00035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/12/2019] [Indexed: 01/04/2023] Open
Abstract
Background: Type 2 diabetes (T2D)-related depression has a significant impact on quality of life and leads to greater morbidity and mortality. Current educational and treatment programs for T2D rarely include a specific depression-prevention component, focusing largely on remediating depressive symptoms that have reached clinical levels. Objective: Given the vast field of research on the association between T2D and depression, and the unknown status of prevention efforts for the latter, the goal of this scoping review was to conduct a synopsis of intervention strategies specifically targeting the prevention of depression among adults with T2D. Eligibility Criteria: (1) participants aged 18 and over with T2D; (2) experimental and quasi-experimental designs (3) intervention strategies seeking to prevent the onset or worsening of (non-clinical) depressive symptoms; (4) a valid measure of depressive symptoms; (5) full-text articles available in English or French. Sources of Evidence: Databases including Medline, PubMed, and SCOPUS were searched between 2000 and 2018 resulting in 4,219 potential articles. Charting Methods: This review was conducted in-line with the current methodological framework for scoping reviews. Titles, abstract and full text articles were screened independently and in duplicate. A narrative analysis was conducted to synthesize study characteristics and the nature of intervention strategies and components. Results: Twelve studies were identified with the primary aim of preventing the incidence of depressive symptoms or improving non-clinical depression levels. Individual and group-based approaches included educational interventions incorporating diabetes self-management, problem-solving, and resilience-focused approaches, emotion-targeted techniques as well as alternative interventions. Self-monitoring, home practices, and motivational interviewing were common elements. Conclusions: This review lays the groundwork for future studies seeking to develop, validate, and improve prevention strategies targeting the diabetes-depression comorbidity. More studies over longer periods and with larger samples are needed to capture the effects of prevention efforts.
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Affiliation(s)
- Eva Guérin
- Institut du Savoir Montfort-Recherche, Ottawa, ON, Canada
| | - Hamdi Jaafar
- Institut du Savoir Montfort-Recherche, Ottawa, ON, Canada
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lisa Amrani
- Institut du Savoir Montfort-Recherche, Ottawa, ON, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort-Recherche, Ottawa, ON, Canada
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Céline Aguer
- Institut du Savoir Montfort-Recherche, Ottawa, ON, Canada
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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26
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Massey CN, Feig EH, Duque-Serrano L, Wexler D, Moskowitz JT, Huffman JC. Well-being interventions for individuals with diabetes: A systematic review. Diabetes Res Clin Pract 2019; 147:118-133. [PMID: 30500545 PMCID: PMC6370485 DOI: 10.1016/j.diabres.2018.11.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/19/2018] [Accepted: 11/21/2018] [Indexed: 12/25/2022]
Abstract
In patients with diabetes, psychological well-being constructs (e.g., optimism, positive affect) have been associated with superior medical outcomes, including better glucose control and lower mortality rates. Well-being interventions may be well-suited to individuals with diabetes, as they are simple to deliver, broadly applicable across a range of psychological distress, and may help increase self-efficacy and motivation for diabetes self-care. This systematic review, completed using PRISMA guidelines, examined peer-reviewed studies indexed in PubMed, PsycINFO, and/or Scopus between database inception and October 2017 that investigated the effects of well-being interventions (e.g., positive psychology interventions, mindfulness-based interventions, resilience-based interventions) on psychological and physical health outcomes in individuals with Type 1 or Type 2 diabetes. The search yielded 34 articles (N = 1635 participants), with substantial variability in intervention type, measures used, and outcomes studied; the majority found the intervention to provide benefit. Overall, results indicate that a range of well-being interventions appear to have promise in improving health outcomes in this population, but the literature does not yet provide definitive data about which specific interventions are most effective. The variability in interventions and outcomes points to a need for further rigorous, controlled, and well-powered studies of specific interventions, with well-accepted, clinically relevant outcome measures.
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Affiliation(s)
- Christina N Massey
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Emily H Feig
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Laura Duque-Serrano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Deborah Wexler
- Harvard Medical School, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Judith Tedlie Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Mathiesen AS, Egerod I, Jensen T, Kaldan G, Langberg H, Thomsen T. Psychosocial interventions for reducing diabetes distress in vulnerable people with type 2 diabetes mellitus: a systematic review and meta-analysis. Diabetes Metab Syndr Obes 2019; 12:19-33. [PMID: 30588053 PMCID: PMC6301434 DOI: 10.2147/dmso.s179301] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Diabetes distress (DD) disproportionately affects vulnerable people with type 2 diabetes mellitus and interventions targeting this population are therefore relevant. A systematic review and meta-analysis was performed to assess the evidence for an effect of psychosocial interventions for reducing DD, and, secondly HbA1c, depression, and health-related quality of life in vulnerable people with type 2 diabetes mellitus. Vulnerability encompasses poor glycemic control (HbA1c >7.5%) and at least one additional risk factor for poor diabetes outcomes such as low educational level, comorbidity, and risky lifestyle behavior. The interventions should be theoretically founded and include cognition- or emotion-focused elements. We systematically searched four databases for articles published between January 1995 and March 2018. Eighteen studies testing a variety of psychosocial interventions in 4,066 patients were included. We adhered to the Cochrane methodology and PRISMA guidelines. Review Manager 5.3 was used for data extraction and risk of bias assessment, and Grades of Recommendation, Assessment, Development and Evaluation for assessing the quality of the evidence. Data were pooled using the fixed or random effects method as appropriate. We investigated effects of individual vs group, intensive vs brief interventions, and interventions with and without motivational interviewing in subgroup analyses. To assess the robustness of effect estimates, sensitivity analyses excluding studies with high risk of bias and attrition >20% were conducted. We found low to moderate quality evidence for a significant small effect of psychosocial interventions on DD, and very low to moderate quality evidence for no effect on HbA1c, both outcomes assessed at 3, 6, 12, and 24 months follow-up. The effect on depression was small, while there was no effect on health-related quality of life. Exploratory subgroup analyses suggested that interventions using motivational interviewing and individual interventions were associated with incremental effects on DD. Likewise, intensive interventions were associated with significant reductions in both DD and HbA1c.
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Affiliation(s)
- Anne Sophie Mathiesen
- Department of Endocrinology, Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark,
| | - Ingrid Egerod
- Intensive Care Unit 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Tonny Jensen
- Department of Endocrinology, Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark,
| | - Gudrun Kaldan
- Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Henning Langberg
- CopenRehab, Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thordis Thomsen
- Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Gutierrez AP, Fortmann AL, Savin K, Clark TL, Gallo LC. Effectiveness of Diabetes Self-Management Education Programs for US Latinos at Improving Emotional Distress: A Systematic Review. DIABETES EDUCATOR 2018; 45:13-33. [PMID: 30569831 DOI: 10.1177/0145721718819451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE This systematic review examined whether diabetes self-management education (DSME) interventions for US Latino adults improve general emotional distress (eg, depression symptoms) and/or health-specific emotional distress (eg, diabetes distress). The topic is important given the high prevalence of type 2 diabetes (T2DM), concomitant distress, and worse health outcomes among Latinos and considering the barriers that distress poses for effective diabetes self-management. METHODS Following PRISMA guidelines, a search of the online databases PsycINFO, CINAHL, PubMed, and CENTRAL was conducted from database inception through April 2018. A comprehensive search strategy identified trials testing DSME interventions for US Latinos with T2DM that reported on changes in general or health-specific emotional distress. Risk of bias was assessed using the EPHPP Quality Assessment Tool. Raw mean differences ( D) and effect sizes ( d) were computed where possible. RESULTS Fifteen studies were included in the review. Six of 8 studies that examined depression symptoms reported significant symptom reduction. Of 10 studies that examined health-specific emotional distress, 6 reported significant symptom reduction. Effect sizes ranged from -0.20 to -3.85. Null findings were more readily found among studies with very small sample sizes (n < 30) and studies testing interventions without specific psychosocial content, with little cultural tailoring, with less frequent intervention sessions, and with support sessions lacking concurrent diabetes education. Most studies (11) received a weak rating of evidence quality. CONCLUSIONS There is an absence of strong evidence to support that DSME programs tailored for Latino adults with T2DM are beneficial for improving emotional distress. Methodologically robust studies are needed.
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Affiliation(s)
- Angela P Gutierrez
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA
| | - Kimberly Savin
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Taylor L Clark
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA
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29
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Dutcher JM, Creswell JD. The role of brain reward pathways in stress resilience and health. Neurosci Biobehav Rev 2018; 95:559-567. [DOI: 10.1016/j.neubiorev.2018.10.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/10/2018] [Accepted: 10/22/2018] [Indexed: 01/26/2023]
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Srulovici E, Feldman B, Reges O, Hoshen M, Balicer RD, Rotem M, Shadmi E, Key C, Curtis B, He X, Rubin G, Strizek A, Leventer-Roberts M. Which patients with Type 2 diabetes will have greater compliance to participation in the Diabetes Conversation Map™ program? A retrospective cohort study. Diabetes Res Clin Pract 2018; 143:337-347. [PMID: 30081107 DOI: 10.1016/j.diabres.2018.07.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/08/2018] [Accepted: 07/30/2018] [Indexed: 11/19/2022]
Abstract
AIM To investigate the characteristics of participants in the Diabetes Conversation Map™ (Map™) program who had higher vs. lower compliance to the program, to determine if program tailoring and monitoring is needed among these groups. METHODS This was a retrospective cohort study of 8990 patients enrolled in the Map™ program (low compliance [attending 0-1 sessions, n = 2759] and high compliance [attending ≥2 sessions, n = 6231]). Socio-demographic, clinical, health behaviors, and healthcare utilization characteristics were extracted. Multivariable stepwise logistic regression was used as the analysis strategy. RESULTS Those who were of higher socio-economic status (OR = 1.567, 95%CI:1.317-1.865), who lived in urban area (OR = 1.501, 95%CI:1.254-1.798), with greater frequency of primary care visits (OR = 1.012, 95%CI:1.002-1.021), with medium (OR = 1.176, 95%CI:1.013-1.365) or high oral medication adherence (OR = 1.198, 95%CI:1.059-1.356), and with a greater frequency of blood glucose tests (OR = 1.102, 95%CI:1.033-1.175) had greater odds of being in the high compliance group. Conversely, those aged 35-44 (OR = 0.538, 95%CI:0.402-0.721) and 45-54 years (OR = 0.763, 95%CI:0.622-0.937), with longer Type 2 diabetes duration (OR = 0.980, 95%CI:0.967-0.993), with higher blood glucose levels (OR = 0.999, 95%CI:0.998-1.000), and current (OR = 0.659, 95%CI:0.569-0.762) or former smokers (OR = 0.831, 95%CI:0.737-0.938) had reduced odds for being in the higher compliance group. CONCLUSIONS Instructors in advance can target sub-groups to increase their attendance rates, and consequently improve their outcomes.
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Affiliation(s)
- Einav Srulovici
- Department of Nursing, University of Haifa, Haifa, Israel; Clalit Research Institute, Clalit Healthcare Services, Tel Aviv, Israel.
| | - Becca Feldman
- Clalit Research Institute, Clalit Healthcare Services, Tel Aviv, Israel
| | - Orna Reges
- Clalit Research Institute, Clalit Healthcare Services, Tel Aviv, Israel
| | - Moshe Hoshen
- Clalit Research Institute, Clalit Healthcare Services, Tel Aviv, Israel
| | - Ran D Balicer
- Clalit Research Institute, Clalit Healthcare Services, Tel Aviv, Israel
| | - Mina Rotem
- Community Nursing Division, Clalit Healthcare Services, Tel Aviv, Israel
| | - Efrat Shadmi
- Department of Nursing, University of Haifa, Haifa, Israel
| | - Calanit Key
- Community Nursing Division, Clalit Healthcare Services, Tel Aviv, Israel
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31
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Merius HN, Rohan AJ. An Integrative Review of Factors Associated with Patient Attrition from Community Health Worker Programs that Support Diabetes Self-Care. J Community Health Nurs 2018; 34:214-228. [PMID: 29023161 DOI: 10.1080/07370016.2017.1369811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
An integrative review was conducted using PubMed and CINAHL databases to answer: What is known about adult attrition from community health worker (CHW) programs on diabetes self-care? The 14 articles described patients of multiple races who were mainly of lower socioeconomic status. CHW interventions were given in individual meetings and/or group sessions. Incentives to reduce attrition came in different forms. Barriers involved transportation, family obligations, and scheduling conflicts. Attrition from these programs is a multifactorial problem. Alleviating transportation barrier appears to be protective. Program planners should consider these barriers when planning CHW programs.
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Affiliation(s)
- Heidy N Merius
- a School of Nursing, Stony Brook University , Stony Brook , New York
| | - Annie J Rohan
- a School of Nursing, Stony Brook University , Stony Brook , New York
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Schmidt CB, van Loon BJP, Vergouwen ACM, Snoek FJ, Honig A. Systematic review and meta-analysis of psychological interventions in people with diabetes and elevated diabetes-distress. Diabet Med 2018; 35:1157-1172. [PMID: 29896760 DOI: 10.1111/dme.13709] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2018] [Indexed: 12/13/2022]
Abstract
AIMS The clinical relevance of diabetes-distress is increasingly recognized, but little is known about the efficacy of interventions specifically targeted to treat elevated diabetes-distress. Therefore, this systematic review sought to determine the efficacy of psychological interventions aimed at treating elevated diabetes-distress in people with Type 1 or Type 2 diabetes. METHODS We systematically searched literature from five databases. Randomized controlled trials (RCTs) with an English abstract, describing the results of a psychological intervention in adults with diabetes were included. Articles were eligible for inclusion if the primary outcome was diabetes-distress measured by the Problem Areas in Diabetes Scale (PAID-5/PAID-20) or the Diabetes Distress Scale (DDS-17). Only mean group diabetes-distress values above cut-off at baseline or the results of a subgroup above cut-off (PAID-5 ≥ 8, PAID-20 ≥ 40 or DDS-17 ≥ 3) were included. RESULTS The search yielded 8907 articles. After removing 2800 duplicates, 6107 articles remained. Titles and abstracts were screened, leaving 394 potential articles of interest, nine of which were RCTs. In a random-effects meta-analysis, the pooled effect size for diabetes-distress was 0.48 (Cohen's d), Z = 3.91, P < 0.0001. Statistical heterogeneity was I² = 46.67% (confidence intervals 45.06% to 48.28%). Diabetes-tailored psychological interventions reduced HbA1c (Cohen's d = 0.57), whereas mindfulness-based interventions did not (Cohen's d = 0.11). CONCLUSIONS This systematic review shows that specifically diabetes-tailored psychological interventions are effective in reducing elevated diabetes-distress and HbA1c . More rigorous studies are warranted to establish the full potential of these interventions. PROSPERO database registration ID: CRD42017075290.
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Affiliation(s)
- C B Schmidt
- Departments of Psychiatry, Amsterdam, The Netherlands
- Departments of Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | | | - F J Snoek
- Departments of Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Medical Psychology, Academic Medical Centre (AMC), Amsterdam, The Netherlands
- Departments of Medical Psychology, Amsterdam, The Netherlands
| | - A Honig
- Departments of Psychiatry, Amsterdam, The Netherlands
- Departments of Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Departments of Psychiatry, VU Medical Centre, Amsterdam, The Netherlands
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Wagner J, Armeli S, Tennen H, Bermudez-Millan A, Pérez-Escamilla R. Effects of stress management and relaxation training on the relationship between diabetes symptoms and affect among Latinos. Psychol Health 2018; 33:1172-1190. [PMID: 29857776 DOI: 10.1080/08870446.2018.1478975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Stress management and relaxation (SMR) interventions can reduce symptoms of chronic disease and associated distress. However, there is little evidence that such interventions disrupt associations between symptoms and affect. This study examined whether SMR dampened the link between symptoms of hyperglycemia and proximal levels of affect. We predicted that during periods of increased hyperglycemia, individuals receiving SMR training, relative to controls, would demonstrate smaller increases in negative affect. DESIGN Fifty-five adult Latinos with type 2 diabetes were randomised to either one group session of diabetes education (DE-only; N = 23) or diabetes education plus eight group sessions of SMR (DE + SMR; N = 32). After treatment, participants reported five diabetes symptoms and four affective states twice daily for seven days using a bilingual telephonic system. RESULTS Mean age = 57.8 years, mean A1c = 8.4%, and ¾ was female with less than a high school education. Individuals receiving DE + SMR, compared to DE-only, showed a weaker positive within-person association between daily diabetes symptoms and nervous affect. Groups also differed on the association between symptoms and enthusiasm. Age moderated these associations in most models with older individuals showing less affect reactivity to symptoms. CONCLUSIONS Findings provide partial support for theorised mechanisms of SMR.
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Affiliation(s)
- Julie Wagner
- a Division of Behavioral Sciences and Community Health and Department of Psychiatry , UConn Schools of Dental Medicine and Medicine , Farmington , CT , USA
| | - Stephen Armeli
- b Department of Psychology , Farleigh Dickinson University , Taeneck , NJ , USA
| | - Howard Tennen
- c Department of Community Medicine , UConn School of Medicine , Farmington , CT , USA
| | | | - Rafael Pérez-Escamilla
- d Department of Social and Behavioral Sciences , Yale School of Public Health , New Haven , CT , USA
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Lian Y, Sun Q, Guan S, Ge H, Tao N, Jiang Y, Zhang Y, Ning L, Xiao J, Liu J. Effect of Changing Work Stressors and Coping Resources on the Risk of Type 2 Diabetes: The OHSPIW Cohort Study. Diabetes Care 2018; 41:453-460. [PMID: 29255061 DOI: 10.2337/dc17-0749] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 11/20/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Little is known about the relationship between changing psychosocial work conditions and type 2 diabetes. We determined whether changing work stressors and coping resources affect the risk of type 2 diabetes. RESEARCH DESIGN AND METHODS In this prospective cohort (2003-2014) of 3,740 workers without diabetes (OHSPIW [Occupational Health Study of Petroleum Industry Workers]), participants completed an evaluation of work-related stress and coping resources and type 2 diabetes diagnosis at baseline and 12 years follow-up (two waves). The changes in work stressors and coping resources were measured with the Occupation Stress Inventory-Revised and the Instrument for Stress-Related Job Analysis (Version 6.0). Type 2 diabetes was diagnosed on the basis of an oral glucose tolerance test supplemented by physician report. RESULTS Increased task stressors (relative risk [RR] 1.57 [95% CI 1.03-2.63]) and decreased coping resources (RR 1.68 [95% CI 1.02-2.83]) were associated with risk of type 2 diabetes. The main risk factors were increased role overload, increased role insufficiency, increased physical environment stressors, decreased self-care, and decreased rational coping. Increased coping resources also had a buffering effect on increased task stressors and type 2 diabetes. CONCLUSIONS Changes in work stressors and coping resources have an influence on the risk for type 2 diabetes, highlighting the importance of preventive measures against adverse psychosocial work conditions and reduced coping resources for diabetes prevention in the workplace.
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Affiliation(s)
- Yulong Lian
- Division of Occupational and Environmental Health, College of Public Health, Nantong University, Nantong, Jiangsu, China .,Division of Occupational and Environmental Health, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Qing Sun
- Division of Occupational and Environmental Health, College of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Suzhen Guan
- Division of Occupational and Environmental Health, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hua Ge
- Division of Occupational and Environmental Health, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Ning Tao
- Division of Occupational and Environmental Health, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yu Jiang
- Division of Occupational and Environmental Health, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - YanXia Zhang
- Division of Occupational and Environmental Health, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Li Ning
- Division of Occupational and Environmental Health, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jing Xiao
- Division of Occupational and Environmental Health, College of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Jiwen Liu
- Division of Occupational and Environmental Health, College of Public Health, Xinjiang Medical University, Urumqi, Xinjiang, China
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Mean Levels and Variability in Affect, Diabetes Self-Care Behaviors, and Continuously Monitored Glucose: A Daily Study of Latinos With Type 2 Diabetes. Psychosom Med 2017; 79:798-805. [PMID: 28437381 PMCID: PMC5573602 DOI: 10.1097/psy.0000000000000477] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study investigated between- and within-person associations among mean levels and variability in affect, diabetes self-care behaviors, and continuously monitored glucose in Latinos with type 2 diabetes. METHODS Fifty participants (M [SD] age = 57.8 [11.7] years, 74% women, mean [SD] glycosylated hemoglobin A1c = 8.3% [1.5%]) wore a "blinded" continuous glucose monitor for 7 days, and they responded to twice daily automated phone surveys regarding positive affect, negative affect, and self-care behaviors. RESULTS Higher mean levels of NA were associated with higher mean glucose (r = .30), greater percent hyperglycemia (r = .34) and greater percentage of out-of-range glucose (r = .34). Higher NA variability was also related to higher mean glucose (r = .34), greater percent of hyperglycemia (r = .44) and greater percentage of out-of-range glucose (r = .43). Higher positive affect variability was related to lower percentage of hypoglycemia (r = -.33). Higher mean levels of self-care behaviors were related to lower glucose variability (r = -.35). Finally, higher self-care behavior variability was related to greater percentage of hyperglycemia (r = .31) and greater percentage of out-of-range glucose (r = -.28). In multilevel regression models, within-person increases from mean levels of self-care were associated with lower mean levels of glucose (b = -7.4, 95% confidence interval [CI] = -12.8 to -1.9), lower percentage of hyperglycemia (b = -0.04, 95% CI = -0.07 to -0.01), and higher percentage of hypoglycemia (b = 0.02, 95% CI = 0.01 to 0.03) in the subsequent 10-hour period. CONCLUSIONS Near-to-real time sampling documented associations of glucose with affect and diabetes self-care that are not detectable with traditional measures.
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Abstract
Psychological stress is common in many physical illnesses and is increasingly recognized as a risk factor for disease onset and progression. An emerging body of literature suggests that stress has a role in the aetiology of type 2 diabetes mellitus (T2DM) both as a predictor of new onset T2DM and as a prognostic factor in people with existing T2DM. Here, we review the evidence linking T2DM and psychological stress. We highlight the physiological responses to stress that are probably related to T2DM, drawing on evidence from animal work, large epidemiological studies and human laboratory trials. We discuss population and clinical studies linking psychological and social stress factors with T2DM, and give an overview of intervention studies that have attempted to modify psychological or social factors to improve outcomes in people with T2DM.
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Affiliation(s)
- Ruth A Hackett
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
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Achieving Health Equity: Federal Perspectives for 21st Century Health System Research Priorities. Med Care 2017; 55 Suppl 9 Suppl 2:S6-S8. [PMID: 28806360 DOI: 10.1097/mlr.0000000000000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Munster-Segev M, Fuerst O, Kaplan SA, Cahn A. Incorporation of a Stress Reducing Mobile App in the Care of Patients With Type 2 Diabetes: A Prospective Study. JMIR Mhealth Uhealth 2017; 5:e75. [PMID: 28554881 PMCID: PMC5468539 DOI: 10.2196/mhealth.7408] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/23/2017] [Accepted: 04/09/2017] [Indexed: 11/13/2022] Open
Abstract
Background Severe and sustained emotional stress creates a physiological burden through increased sympathetic activity and higher energy demand. This may lead to increased oxidative stress and development of the metabolic syndrome. Emotional stress has been shown to contribute to the onset, progression, and control of type 2 diabetes (T2D). Stress management and biofeedback assisted relaxation have been shown to improve glycemic control. Use of a mobile app for stress management may enhance the scalability of such an approach. Objective The aim of this study was to assess the effect of using a mobile app of biofeedback-assisted relaxation on weight, blood pressure (BP), and glycemic measures of patients with T2D. Methods Adult patients with T2D and inadequate glycemic control (hemoglobin A1c [HbA1c]>7.5%) were recruited from the outpatient diabetes clinic. Baseline weight, BP, HbA1c, fasting plasma glucose (FPG), triglycerides (TG), and 7-point self-monitoring of blood glucose were measured. Patients were provided with a stress reducing biofeedback mobile app and instructed to use it 3 times a day. The mobile app—Serenita—is an interactive relaxation app based on acquiring a photoplethysmography signal from the mobile phone’s camera lens, where the user places his finger. The app collects information regarding the user’s blood flow, heart rate, and heart rate variability and provides real-time feedback and individualized breathing instructions in order to modulate the stress level. All clinical and biochemical measures were repeated at 8 and 16 weeks of the study. The primary outcome was changes in measures at 8 weeks. Results Seven patients completed 8 weeks of the study and 4 completed 16 weeks. At week 8, weight dropped by an average of 4.0 Kg (SD 4.3), systolic BP by 8.6 mmHg (SD 18.6), HbA1c by 1.3% (SD 1.6), FPG by 4.3 mmol/l (4.2), and serum TG were unchanged. Conclusions Stress reduction using a mobile app based on biofeedback may improve glycemic control, weight, and BP.
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Affiliation(s)
- Maya Munster-Segev
- Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | | | - Steven A Kaplan
- Icahn School of Medicine and Director of the Men's Wellness Program Mount Sinai, New York, NY, United States
| | - Avivit Cahn
- Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel.,Endocrinology and Metabolism Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
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Bermúdez-Millán A, Pérez-Escamilla R, Lampert R, Segura-Pérez S, Damio G, Chhabra J, Wagner JA. Diabetes-Specific Food Insecurity Is Associated with Impaired Heart Rate Variability Independent of Glycemic Control: Exploratory Findings among Latinos with Type 2 Diabetes. Curr Dev Nutr 2017; 1:e000521. [PMID: 29955701 PMCID: PMC5998346 DOI: 10.3945/cdn.117.000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/07/2017] [Accepted: 04/16/2007] [Indexed: 11/29/2022] Open
Abstract
Background: Food insecurity (FI), diabetes prevalence, and poor diabetes outcomes all disproportionately affect Latinos in the United States. Heart rate variability (HRV) reflects autonomic tone, is associated with glycemic control, and predicts mortality in type 2 diabetes. It is unknown whether FI is related to HRV and, if so, whether glycemic control accounts for this association. Objective: This exploratory cross-sectional study examined FI and HRV among US Latinos with type 2 diabetes. Methods: Participants reported demographic characteristics, socioeconomic status, and FI, including the 6-item USDA food security module and a 1-item measure of diabetes-specific food security. Participants wore an ambulatory electrocardiogram monitor for 24 h. In the time domain, HRV was assessed with the SD of the R-R interval (SDNN). In the frequency domain, the power spectrum was integrated over 3 frequency bands-very low frequency (VLF), low frequency (LF), and high frequency (HF)-and then natural log transformed. Unadjusted ANOVA and ANCOVA adjusted for age, sex, glycated hemoglobin (HbA1c), and indicators of socioeconomic status compared food security groups on HRV. Results: Participants' mean ± SD age was 59.7 ± 10.9 y, and 73% were women. Of the 94 participants, 63 reported FI according to the USDA food security module and 46 reported FI according to the diabetes-specific measure. Mean ± SD HbA1c was 8.6% ± 1.7% and was marginally higher among those reporting diabetes-specific FI than those reporting diabetes-specific food security. Participants who reported diabetes-specific FI had lower SDNN, VLF, LF, and HF HRV with effect sizes in the small-to-medium range. Differences remained significant even after controlling for age, sex, socioeconomic hardship, and HbA1c. The 6-item USDA food security module was not associated with HRV. Conclusions: Diabetes-specific FI may be a unique risk factor for poor health outcomes among US Latinos. Efforts to address FI could benefit diabetes outcomes.
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Affiliation(s)
- Angela Bermúdez-Millán
- Division of Behavioral Sciences and Community Health, School of Dental Medicine, UConn Health, Farmington, CT
| | - Rafael Pérez-Escamilla
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT
| | | | | | | | - Jyoti Chhabra
- Research Program, Hartford Hospital, Research Administration, Hartford, CT
| | - Julie A Wagner
- Division of Behavioral Sciences and Community Health, School of Dental Medicine, UConn Health, Farmington, CT
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