Self-efficacy, self-care and glycemic control in Saudi Arabian patients with type 2 diabetes mellitus: A cross-sectional survey

Assessment of self-management care and glycated hemoglobin level among diabetes mellitus patients attend diabetic center in armed forces hospital in southern region, Kingdom Saudi Arabia

Background

Diabetes mellitus (DM) requires patients to take on a high level of responsibility for their daily care. Thus, care for people with diabetes is moving toward patients taking an active role in their own health care.

Objective

To evaluate the impact of self-management care on glycemic control in individuals with DM and determine the correlation between glycated hemoglobin (A1C) levels and self-management practices.

Material and Methods

A cross-sectional descriptive study was conducted among diabetes patients at a diabetic center in Armed Forces Military hospitals, Southern region. A questionnaire of demographic and clinical information and self-management measured with the Diabetes Self-Management Questionnaire was used. Glycemic control was assessed using HbA1c levels.

Results

The study involved 255 patients with diabetes, of which 61.2% were females and 81.6% aged ≥41 years. The average diabetic self-management score was 6.49 on a scale of 10. The mean glucose self-management subscale score was 7.83 points, while the mean dietary control (DC) subscale score was 4.89. The patients had a mean physical activity (PA) subscale score of 6.31 and 8.75 for healthcare usage. Patients with higher education were significantly less likely to have poor glycemic control. Diabetes duration was significantly and positively correlated with poorer glycemic control. Mean perceived PA and DC scores were significantly associated with glycemic control.

Conclusion

Type 2 diabetes patients had satisfactory self-care practices. Many did not achieve the target glycemic control for diabetes.

The effect of health quotient and time management skills on self-management behavior and glycemic control among individuals with type 2 diabetes mellitus

Objective

The aim of this study was to evaluate the present status of self-management behavior and glycemic control in individuals diagnosed with Type 2 Diabetes Mellitus (T2D), as well as to examine the impact of health quotient (HQ) and time management skills on both self-management behavior and glycemic control.

Methods

Between October 2022 and March 2023, a purposive sampling method had been utilized to select 215 participants with type T2D. The survey concluded a general information questionnaire, an HQ scale, a diabetes time management questionnaire and a self-management behavior questionnaire. The health quotient(HQ)encompasses the individuals' knowledge, attitude toward health, and the ability to maintain their own well-being. The diabetes time management questionnaire was reverse-scored, with higher scores indicating an enhanced competence in time management. The path among variables was analyzed using structural equation modeling(SEM).

Results

SEM showed that the direct effect of HQ on time management was -0.566 (p < 0.05), the direct effect of time management on the effect of self-management was -0.617 (p < 0.05), the direct effect of HQ on self-management was 0.156, and the indirect effect was 0.349 (p < 0.05); the relationship between health quotient and self-management was partially mediated by time management, with a mediating effect size of 68.8%. In addition, self-management had a direct effect on HbAlc, with a size of -0.394 (p < 0.05); The impacts of both HQ and time management on HbAlc were found to be mediated by self-management, with HQ demonstrating an indirect effect of -0.199 (p < 0.05) and time management showing an indirect effect of 0.244 (p < 0.05).

Conclusion

Health quotient and time management in patients with T2D serve as catalysts for self-management behavior. They affect HbAlc level indirectly through self-management practices. The suggestion is to prioritize the cultivation of rational time organization and management skills in T2D patients, as well as enhance their health quotient level. This can facilitate a more effective improvement in patients' self-management behaviors, ultimately achieving the objective of maintaining optimal glycemic control.

Relationship Between Patient Activation and Type 2 Diabetes Mellitus Self-management and Clinical Outcomes in Saudi Arabian Primary Care Setting

PURPOSE

Type 2 diabetes mellitus (T2DM) self-management is a comprehensive approach that individuals with T2DM employ to manage and control their condition. Patients' activation, "an individual's knowledge, skill, and confidence for managing their health and health care", has been used as a major driver of self-management. This study aimed to assess the relationship of patient activation with T2DM self-management and clinical outcomes.

DESIGN

A cross-sectional study.

SUBJECTS

Patients with type T2DM who age 18-years and older.

SETTING

The primary care centers in Saudi Arabia.

MEASURES

Patient activation measure (PAM) and the Summary of Diabetes Self-Care Activities (SDSCA).

ANALYSIS

Descriptive statistic, T-test, One-way ANOVA test, Chi-square test, and linear and logistic regressions were performed.

RESULTS

A total of 398 patients, mostly male (54.9%) with a mean age of 53.2 (±10.7) years old participated in the study. The participants' mean of Hemoglobin A1c (HbA1c) was 8.4% (±1.7%) and most of them (74.5%) had an uncontrolled HbA1c level (>7% %). The mean patient activation score was 55.9 (±13.5). 24.4% were at [PA1], 26.7% at [PA2], 37.4% at [PA3], and 11.5% at [PA4]. Patient activation level was positively associated with better glycemic control and self-management behaviors including diet, physical activity, blood glucose self-testing, foot care, and smoking (P < .05) but not with adherence to medication.

CONCLUSIONS

Our findings reveal a positive association between patient activation level and enhanced glycemic control and self-management behaviors and suggest that patient activation-informed self-management interventions are more likely to yield promising health outcomes.

Psycho-social factors associated with type two diabetes remission through lifestyle intervention: A scoping review

OBJECTIVES

There is growing evidence that type 2 diabetes (T2D) can be put into remission through lifestyle intervention. Current focus on remission in terms of physiological considerations and biomedical scales, means there is limited understanding of the role psycho-social factors play in moderating the efficacy of lifestyle interventions for T2D remission. In the current review we aimed to synthesise the emerging literature on psycho-social factors associated with T2D remission, specifically from lifestyle interventions.

METHODS

Five databases (EMBASE, MEDLINE, CINAHL ultimate, PsychINFO and PsycArticles) were searched to identify studies from 2009 onwards that reported remission outcomes from lifestyle interventions in participants ≥ 18years old, with a clinical diagnosis of T2D. Studies included were of an interventional or observational design and restricted to English language. Screening and data extraction was performed independently by two reviewers using prespecified criteria.

RESULTS

In total 6106 studies were screened, 36 studies meeting the inclusion criteria were included. Studies were globally diverse, with 30 (83%) being published ≥ 2017. Psycho-social scales were under-utilised with 22 (67%) of studies failing to include any psycho-social measures. Single arm, prospective studies were most frequently utilised, however study quality was perceived to be heterogeneous. Further disparity in the quality, content and delineation of the psycho-social interventions was also identified. Education and self-monitoring interventions were the most frequently incorporated. Self-monitoring was also identified as an important facilitator to remission, in addition to social support.

CONCLUSIONS

Our findings indicate that psycho-social factors in T2D remission are under-explored. We have identified a number of methodological issues (comparability, conflicting remission criteria and poorly defined psycho-social interventions) suggesting knowledge gaps which could inform the methodology of future research design. There is significant opportunity for future research to incorporate the social model of disease, conceptualise remission more holistically, and build a more comprehensive evidence base to guide clinical practice.

Factors affecting T2DM patients' behaviors associated with integrated treatment and prevention services in China

OBJECTIVE

To explore the relationship between type 2 diabetes mellitus (T2DM) patients' attitude, subjective norms (SN), perceived behavioral control (PBC), behavioral intention (BI) and behavior associated with integrated treatment and preventive (ITP) services.

METHODS

A convenient sampling method was employed at a community health center in Nanjing, China between January and July 2022. The collected data were processed using Epidata 3.1, SPSS 26.0, and AMOS 24.0. Descriptive statistics and a structural equation model based on the theory of planned behavior (TPB) were used to explore the correlation between the study variables.

RESULTS

430 participants were eventually included, with a response rate of 98.6%. The mean age was 72.50 ± 5.69 years. The TPB model proved to be suitable and explained 41% of the variance in the BI. Attitude (β = 0.289, P < 0.001), SN (β = 0.314, P < 0.001) and PBC (β = 0.261, P < 0.001) were the main predictors of BI, and the SN was the strongest. BI (β = 0.452, P < 0.001) and PBC (β = 0.452, P < 0.001) had similar direct effects on patients' behavior.

CONCLUSION

The TPB model explained the behavioral variations associated with ITP services and provided a framework for developing targeted interventions and improving community-based ITP services for T2DM. To encourage patients to engage in desirable behaviors, interventions should focus on modifying patients' SN towards behavior associated with ITP services by promoting peer pressure and increasing the family's emphasis on health.

The psychometric properties of the Diabetes Self-Efficacy Scale in Saudis with type 2 diabetes

AIM

To assess the psychometric properties of the Arabic version of the Diabetes Self-Efficacy Scale (A-DSES).

DESIGN

This study used a cross-sectional design.

METHODS

This study recruited 154 Saudi adults with type 2 diabetes at two primary healthcare centres in Riyadh, Saudi Arabia. Its instruments were the Diabetes Self-Efficacy Scale and the Diabetes Self-Management Questionnaire. The psychometric properties of the A-DSES were assessed for reliability, including internal consistency and validity using exploratory factor analysis, confirmatory factor analysis and criterion validity.

RESULTS

The item-total correlation coefficients were >0.30 for all items, ranging from 0.46 to 0.70. The Cronbach's alpha for internal consistency was 0.86. One factor was extracted from the exploratory factor analysis (self-efficacy for diabetes self-management), and the one-factor model showed an acceptable fit to the data in the confirmatory factor analysis. Diabetes self-efficacy levels were positively correlated with diabetes self-management skills (r = 0.40, p < 0.001), indicating criterion validity.

CONCLUSIONS

The results indicate that the A-DSES is a reliable and valid instrument for assessing self-efficacy related to diabetes self-management.

RELEVANCE TO CLINICAL PRACTICE

The A-DSES could be used in clinical practice and research to provide a reference for assessing self-efficacy levels in areas of diabetes self-management.

NO PATIENT OR PUBLIC CONTRIBUTION

Participants were not involved in the design, conduct, reporting or dissemination plans of this research.

Assessment of type 2 diabetes mellitus patients' behavioral characteristics associated with integrated treatment and prevention services in community health centers in China

Objective

The purpose of this study was to describe behavioral characteristics of type 2 diabetes mellitus (T2DM) patients, identify homogeneous clusters, and explore factors affecting behaviors associated with integrated treatment and prevention (ITP) services for T2DM in community health centers in China.

Methods

A convenient sampling method was employed at a community health center between January and July 2022 in Nanjing. A total of 354 patients completed the self-reported questionnaires. After performing a Cluster Analysis to create a profile of participants' behaviors, a multiple linear regression analysis was conducted to explore the correlations between T2DM patients' characteristics and their behaviors associated with ITP services.

Results

316 T2DM patients with a mean age of 72.09 years (SD = 5.96) were included. The behavior profiles of patients associated with ITP services were clustered into "Lower" (n = 198) and "Higher" (n = 118) groups, with average scores of 54.41 and 71.46, respectively. Of all the behaviors, complication examination and public health utilization scored the lowest. Health insurance, duration of disease, and treatment modality were independent predictors on the patients' behaviors associated with ITP services for T2DM.

Conclusion

Patients' behaviors associated with ITP services for T2DM were moderately good (the score rate was 63.98%). Of all the behaviors, complication examination and public health service utilization scored the lowest and, as such, may warrant further research. The clustering of patients' behaviors tends to be polarization, distributed at the upper and lower ends of the behavior spectrum. It is necessary to develop and implement targeted interventions for different groups to improve T2DM patients' behaviors associated with ITP services.

Factors Associated With Self-Efficacy of Foot Self-Care Among Patients With Diabetes Attending a Tertiary Care Center in Saudi Arabia

Several reports have shown self-efficacy to be a reliable way of predicting foot self-care behavior in patients with diabetes. However, at a global level in general, and in Saudi Arabia in particular, investigation of the factors related to self-efficacy in executing foot self-care continues to remain inadequate. This study endeavors to identify the factors associated with the self-efficacy of foot self-care among patients with diabetes in Saudi Arabia. From a tertiary diabetes care center in Saudi Arabia, 175 patients with diabetes were selected to participate in this cross-sectional study. Employing the Arabic version of the Foot Care Confidence Scale (FCCS), the principal end results and the sociodemographic, clinical, and psychosocial independent variables were collected and assessed. From the total reported FCCS score, the mean was found to be 28.1 ± 8.2. Multiple linear regression analysis indicated 2 independent factors were positively associated with a higher reported FCCS score; being middle-aged (< 60 years old) (β=0.31, P< .01) and having a higher score on the Foot Care Outcome Expectations Scale (FCOES) (β=0.36, P< .01). In conclusion, patients with diabetes in Saudi Arabia have a mild level of self-efficacy to perform the needed foot self-care. Therefore, this has turned the spotlight on the young or middle-aged < 60-year-old Saudi population with diabetes as the target group, making them the priority for future self-efficacy promotion programs to upgrade the level of foot self-care.

Mediating Role of Depression Between Diabetes Management Self-Efficacy and Diabetes Self-Care Behavior Among Elderly Type 2 Diabetes Mellitus Patients in China

Objective

To investigate the current status of diabetes self-care behavior and the association between depression, self-efficacy and self-care in a sample of Chinese elderly type 2 diabetes mellitus (T2DM) patients.

Methods

A cross-sectional study with a convenient sample including 240 elderly T2DM patients collected the data of demographic characteristics, diabetes self-care behavior, self-efficacy and depression status. The difference of self-care behavior in different sample characteristics was compared by independent t-test. The Personal correlation analysis was employed to examine the correlation of study variables. The method of bootstrap was used to analyze mediating role of depression.

Results

Only 22.5% of patients reported better diabetes self-care behavior and depression partly mediated the association between self-efficacy and self-care behavior. The significant coefficient of path a (B = -0.052, p < 0.001) and path b (B = -0.423, p < 0.05) indicated negative associations of self-efficacy on depression, and depression on self-care behavior. The indirect effect (Path a × b) between self-efficacy and self-care behavior through depression was significant (B = 0.022, p < 0.05), the 95% bias-corrected bootstrap confidence interval was 0.004 to 0.006. Meanwhile, the mediating role of depression was not found significant among the participants reported 60-74 years old (B = 0.104, p < 0.001). But depression completely mediated this association among the participants reported 75-89 years old (B = 0.034, p > 0.05).

Conclusion

The level of diabetes self-care behavior among the elderly T2DM patients in Dahu community of Anqing city was hardly optimistic. The self-efficacy focused intervention could be encouraged for community and clinicians to improve diabetes self-care behavior. Moreover, the prevalence of depression and T2DM is increasing in younger population. More work is needed to confirm these findings, especially conducting cohort studies on different populations.

A novel multistage ensemble approach for prediction and classification of diabetes

Diabetes mellitus is a metabolic syndrome affecting millions of people worldwide. Every year, the rate of occurrence rises drastically. Diabetes-related problems across several vital organs of the body can be fatal if left untreated. Diabetes must be detected early to receive proper treatment, preventing the condition from escalating to severe problems. Tremendous health sciences and biotechnology advancements have resulted in massive data that generated massive Electronic Health Records and clinical information. The exponential increase of electronically gathered information has resulted in more complicated, accurate prediction models that can be updated continuously using machine learning techniques. This research mainly emphasizes discovering the best ensemble model for predicting diabetes. A new multistage ensemble model is proposed for diabetes prediction. In this model, accuracy is predicated on the Pima Indian Diabetes dataset. The accuracy of the proposed ensemble model is compared with the existing machine learning model, and the experimental results demonstrate the performance of the proposed model in terms of higher Precision, f-measure, Recall, and area under the curve.

Diabetes self-care activities and perception and glycemic control in adult Puerto Rican residents with Type 2 Diabetes: The LLIPDS Study

Background

Individuals with diabetes frequently have comorbid health conditions and suffer longer term complications. The control of blood glucose relies on diabetes management/self-care behaviors. Poor glycemic control, commonly encountered in underserved populations with type 2 diabetes (T2D) often results from inadequate diabetes self-care activities and/or perception. We aimed to assess the association between diabetes self-care activities/perception and glycemic control in adult Puerto Rican residents with T2D.

Design and methods

We used a cross-sectional study design; our sample population was 260 individuals aged 40-65 years with T2D. We asked participants about their diabetes self-care over 8 weeks. High fasting blood glucose (≥130 mg/dL) and glycated hemoglobin (HbA1c; ≥7%) measures were defined. We estimated the strength of the following associations using logistic regression: each of three self-care activities and fasting glucose or HbA1c, adjusting for confounders.

Results

Nearly 27% of the participants reported not checking their glucose levels, 7% did not take their medications as prescribed and 31% perceived their diabetes self-care as poor. Participants with less education perceived their diabetes self-care as poor more often than their counterparts (44% vs 25%; p = 0.003). Most participants had high glycemic levels (60%) or hbA1c levels (65%). Participants who perceived their diabetes self-care as poor had higher HbA1c levels than their counterparts (adj. odds ratio: 2.14, 95% CI (1.13, 4.08)).

Conclusion

Poor diabetes self-care perception, possibly related to less education, likely explains poor glycemic control among adult Puerto Rican residents with T2D.

Effectiveness of a mobile-based educational intervention on self-care activities and glycemic control among the elderly with type 2 diabetes in southwest of Iran in 2020

Background

The elderly constitute a large fraction of patients with type 2 diabetes worldwide. It has been well documented that the elderly’s adherence to disease control is not adequate. The present study aimed to evaluate the impact of a mobile-based educational intervention on self-care behaviors and glycemic control among elderly with type 2 diabetes.

Methods

The present study was conducted on 118 older people (59 in the intervention group and 59 in the control group) with type 2 diabetes who referred to Golestan Hospital in Ahvaz, southwest of Iran in 2020. Participants were randomly divided into experimental and control groups. Data were collected at baseline and after a 3-month follow-up. At baseline, the participants completed a valid and reliable multi-section questionnaire including items on attitude, the multidimensional scale of perceived social support (MSPSS), the Coping Self-Efficacy Scale (CSES), self-care constructs, and HBA1C. After analyzing the pre-test data, we designed a training program which was offered to the intervention group online via mobile phone in three online sessions. The control group, however, received no intervention except diabetes routine care. Data were analyzed using SPSS-15 at a significance level of 0.05.

Results

Before the intervention, the mean scores of CSES, attitudes towards self-care, MSPSS, and self-care were not statistically significant between study groups (P > 0.05), but after intervention, the study found significant differences between the groups in terms of CSES, attitude, MSPSS, and self-care (P = 0.001). Furthermore, after implementation of the intervention, the mean value of HbA1C in the intervention group was significantly less than that of the control group (7.00 vs. 7.32%) (P = 0.001).

Conclusion

The present results indicated that implementing an educational intervention via mobile phone can improve self-care practice and reduce HbA1C in the elderly with type 2 diabetes. The study also showed a moderate to large effect on the outcome variables. However, further studies with longer follow-up periods are recommended to confirm the results.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00957-5.

- The study provided a framework for developing a targeted mobile phone health education intervention.

- Mobile phone education can improve both behavioral and clinical indexes. This intervention increased the scores of perceived social support (MSPSS) and Coping Self-Efficacy Scale (CSES), and self-care practice and reduced HbA1C in the elderly with type 2 diabetes.

- Further studies with longer follow-up periods are warranted.

Glycaemic control and its associated factors in patients with type 2 diabetes in the Middle East and North Africa: An updated systematic review and meta-analysis

Aims

To examine the patient‐related factors that have been linked to glycaemic control in people living with type 2 diabetes mellitus in Middle Eastern countries.

Design

A systematic review and meta‐analysis.

Data Sources

A computerized search was conducted using the databases MEDLINE (via PubMed and Ovid), EMBASE, Scopus and CINAHL to identify peer‐reviewed articles published in English between 1 January 2010 and 21 May 2020. On 28 June 2021, the search was updated with the same keywords and databases; however, no further relevant studies were identified.

Review Methods

Extracted data were analysed using Review Manager 5.4.

Results

The final sample consisted of 54 articles with a total of 41,079 participants. Pooled data showed an increased risk of inadequate glycaemic control in smokers [OR = 1.26, 95% confidence interval (CI): 1.05, 1.52; p = .010], obese patients (OR = 1.30, 95% CI: 1.10, 1.54; p = .002), patients with elevated waist to hip ratio (OR = 1.62, 95% CI: 1.16, 2.26; p = .004) and longer disease duration (OR = 2.01, 95% CI: 1.64, 2.48; p < .001). A lower risk of inadequate control was associated with physical activity (OR = 0.40, 95% CI: 0.24, 0.67; p < .001) and self‐management (OR = 0.49, 95% CI: 0.29, 0.82; p = .006).

Conclusion

These findings highlight the opportunity to address factors to improve glycaemic control. Further longitudinal studies are required to better understand these variations, to assess all predictors of glycaemic control in participants with type 2 diabetes, and to provide a strong basis for future measures to optimize glycaemic control.

Psychological Health and Diabetes Self-Management among Patients with Type 2 Diabetes during COVID-19 in the Southwest of Saudi Arabia

Background and objectives: The prevalence of type 2 diabetes in Saudi Arabia is high and rising steeply. However, the management of type 2 diabetic patients has largely employed a medical approach and ignored the self-care management approach. This observation has even been obscured further by the COVID-19 pandemic, which has affected the psychological health of these patients. This study aimed to understand the effects of psychological health and DSM on type 2 diabetic patients in the Jazan region during COVID-19. Materials and methods: An analytical cross-sectional study was employed in this study. Participants were type 2 diabetic patients from the diabetic center at Jazan, Saudi Arabia. The Arabic-translated version of the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7) were used to collect data. Data were analyzed using SPSS software. Results: Depression and anxiety were higher in females compared to males and were more reported by participants from urban compared to rural settings. Smoking and Khat chewing were inappropriate diabetic self-care management practices while exercising was appropriate. A negative correlation was observed between depression vs. health care utilization, and depression vs. diabetic self-care management. Anxiety results also showed similar findings to that of depression. Additionally, depression and anxiety were easily predicted by urban residence, and diabetic self-care management was predicted by exercise. Conclusions: Adequate self-care behavior in patients with type 2 diabetes is needed. Medical professionals should ensure improved efforts to accurately ascertain how an individual can implement the recommended lifestyle changes and facilitate self-care education.

Dietary patterns among Saudis with type 2 diabetes mellitus in Riyadh: A cross-sectional study

We investigated dietary patterns and their associations with sociodemographic and lifestyle factors in Saudi adults with type 2 diabetes mellitus (T2DM). A total of 297 participants (154 men and 143 women) with a mean age (standard deviation) of 54.0 (7.0) years were enrolled in the current study. Self-reported information on sociodemographic and lifestyle characteristics, eating behavior, and frequency of consumption was collected from all participants. Principal component analysis was used to determine dietary patterns. Multiple linear regressions were used to examine the associations between dietary patterns and sociodemographic and lifestyle factors. We identified five dietary patterns: "Vegetables and olive oil," "Refined grains and sweets," "Dairy products and legumes," "Dates and beverages," and "Fruit." Age was inversely associated with the pattern "Refined grains and sweets" (β = -0.036, p <0.001). Females were more likely to have higher scores with the "Fruit" pattern (β = 0.410, p = 0.011). Smoking was associated with "Vegetables and olive oil" (β = 0.919, p = 0.001) and "Dates and beverages" (β = -0.947, p = 0.001) patterns. The level of physical activity was associated with "Dates and beverages" (β = 0.104, p = 0.048) and "Vegetables and olive oil" (β = -0.102, p = 0.048) patterns. The number of snacks consumed was associated with "Dates and beverages" pattern (β = -0.241, p = 0.005), and the frequency of meals eaten in fast food locations and restaurants per month was associated with "Vegetables and olive oil" pattern (β = -0.043, p = 0.034). Each dietary pattern was associated with different sociodemographic and lifestyle factors and eating behaviors. This study provides insights into the underlying nutritional habits of Saudi Arabian patients with T2DM. Future studies are necessary to assess these associations in representative samples.

Discriminating Low to High Adherent Type 2 Patients with Diabetes by Glycosylated Hemoglobin A1c, Eating Self-Efficacy and Other Psychosocial Determinants: Difference Between Patient and Physician Adherence Models

OBJECTIVE

Develop individual discriminant models using clinical and psychosocial variables for physicians and patients with diabetes based on their perceptions of patient adherence.

METHODS

This was a cross-sectional research design utilizing a discriminant analysis approach. Type 2 patients on treatment for diabetes for at least 2 years prior to research were selected. Clinical data were obtained from patient records, and psychosocial variables were collected by survey instruments filled out by patients. A final sample of 200 patients was recruited.

RESULTS

We found a positive correlation between patient and physician assessment of patient adherence behaviors. Greater adherence efforts were associated with lower HbA1c. Better quality of the patient-physician relationship was linked to better patient adherence. Increased HbA1c, longer therapy duration and higher BMI described low patient adherence for physicians. Lower HbA1c, female gender and fewer difficulties in marital adjustment characterized high adherence for patients. Dietary self-efficacy as well as emotional and social isolation discriminated mid-level adherers in both models.

CONCLUSION

This research confirmed that patients and physicians perceived and judged patients' adherence behaviors differently. Physicians and patients associated different clinical and psychological factors with low and high adherence. Further research is recommended to clarify how the quality of the physician-patient as well as the patient-spouse relationship affect dietary efficacy and patient adherence. A randomized, controlled clinical trial approach is recommended to establish the effectiveness of interventions aiming to improve dietary self-efficacy on adherence outcomes.

Medication adherence in type 2 diabetes mellitus patients during Covid-19 pandemic: a cross-sectional study from the United Arab Emirates

Background: Patients with chronic diseases often experience difficulty adhering to recommended treatments as instructed by their healthcare professionals. Recently, diabetes has been associated with the severity of the novel coronavirus disease (Covid-19), which raises the importance of improving medication adherence for diabetic patients to enhance the right use of antidiabetics amid the Covid-19 pandemic.

Methods: This work assesses medication adherence among type 2 diabetes mellitus patients in the United Arab Emirates (UAE) and identifies the set of key demographic and health factors significantly associated with medication adherence. A descriptive cross-sectional study was conducted on an appropriate sample of type 2 diabetic patients in the UAE, with 180 patients of both genders and various social levels. A validated version of the eight-item Morisky Medication Adherence Scale (MMAS) was used for data collection.

Results:  The average MMAS score was 4.88, with 95% confidence intervals (CI) 4.6 and 5.2. 61.67% (n=111), 28.89% (n=52), and 9.44% (n=17) of patients were categorized into low, medium, and high adherent groups, respectively. These findings indicate that a high level of non-compliance to antidiabetic regimens among the population in the UAE.

Conclusions: Patients demonstrated low level of compliance to antidiabetic regimens. Therefore, they must receive up-to-date knowledge about the disease and the treatment and enable easy access to their health care providers to enhance medication adherence.

Medication adherence in type 2 diabetes mellitus patients during Covid-19 pandemic: a cross-sectional study from the United Arab Emirates

Background: Patients with chronic diseases often experience difficulty adhering to recommended treatments as instructed by their healthcare professionals. Recently, diabetes has been associated with the severity of the novel coronavirus disease (Covid-19), which raises the importance of improving medication adherence for diabetic patients to enhance the right use of antidiabetics amid the Covid-19 pandemic. Methods: This work assesses medication adherence among type 2 diabetes mellitus patients in the United Arab Emirates (UAE) and identifies the set of key demographic and health factors significantly associated with medication adherence. A descriptive cross-sectional study was conducted on an appropriate sample of type 2 diabetic patients in the UAE, with 180 patients of both genders and various social levels. A validated version of the eight-item Morisky Medication Adherence Scale (MMAS) was used for data collection. Results:  The average MMAS score was 4.88, with 95% confidence intervals (CI) 4.6 and 5.2. 61.67% (n=111), 28.89% (n=52), and 9.44% (n=17) of patients were categorized into low, medium, and high adherent groups, respectively. These findings indicate that a high level of non-compliance to antidiabetic regimens among the population in the UAE. Conclusions : Patients demonstrated low level of compliance to antidiabetic regimens. Therefore, they must receive up-to-date knowledge about the disease and the treatment and enable easy access to their health care providers to enhance medication adherence.

Factors related to hospital-to-home transitional self-monitoring blood glucose behaviour among patients with diabetes-related foot ulcer

AIMS

To explore the factors related to hospital-to-home transitional self-monitoring blood glucose behaviour among patients with diabetes-related foot ulcer.

BACKGROUND

The 30-day readmission rate of patients with diabetes-related foot ulcer can be reduced when good glycaemic control is achieved. The practice of self-monitoring blood glucose promotes optimal glycaemic control.

DESIGN

A comparative descriptive study.

METHODS

In this study, 200 participants, who had been hospitalized due to diabetes-related foot ulcer, were recruited from August 2017 to July 2018. Before participants were discharged from the hospital, psychosocial factors (family support, threat belief, self-efficacy and knowledge) and pre-hospitalization self-monitoring blood glucose behaviour were collected using a structured questionnaire. Then, after discharge, self-monitoring blood glucose behaviour delivery was collected again.

RESULTS

Five variables explained 47% of the variance in the delivery of self-monitoring of blood glucose at home. The delivery of hospital-to-home transitional self-monitoring blood glucose behaviour was more likely for individuals with higher pre-discharge self-efficacy, higher post-discharge self-efficacy, more attention to pre-hospitalization glycaemic status and post-discharge insulin usage and those without an insensitive foot.

CONCLUSION

Self-monitoring blood-glucose behaviour should be promoted among post-discharge patients with diabetes-related foot ulcer. The modifiable factors identified in this study can be integrated into the discharge plan.

Patterns and associated factors of diabetes self-management: Results of a latent class analysis in a German population-based study

OBJECTIVE

Few studies on diabetes self-management considered the patterns and relationships of different self-management behaviours (SMB). The aims of the present study are 1) to identify patterns of SMB among persons with diabetes, 2) to identify sociodemographic and disease-related predictors of SMB among persons with diabetes.

RESEARCH DESIGN AND METHODS

The present analysis includes data of 1,466 persons (age 18 to 99 years; 44.0% female; 56.0% male) with diabetes (type I and II) from the population-based study German Health Update 2014/2015 (GEDA 2014/2015-EHIS). We used latent class analysis in order to distinguish different patterns of self-management behaviours among persons with diabetes. The assessment of SMB was based on seven self-reported activities by respondents (dietary plan, diabetes-diary, diabetes health pass, self-assessment of blood glucose, self-examination of feet, retinopathy-screenings and assessment of HbA1c). Subsequent multinomial latent variable regressions identified factors that were associated with self-management behaviour.

RESULTS

Latent class analysis suggested a distinction between three patterns of SMB. Based on modal posterior probabilities 42.8% of respondents showed an adherent pattern of diabetes self-management with above-average frequency in all seven indicators of SMB. 32.1% showed a nonadherent pattern with a below-average commitment in all seven forms of SMB. Another 25.1% were assigned to an ambivalent type, which showed to be adherent with regard to retinopathy screenings, foot examinations, and the assessment of HbA1c, yet nonadherent with regard to all other forms of SMB. In multivariable regression analyses, participation in Diabetes Self-Management Education programs (DSME) was the most important predictor of good self-management behaviour (marginal effect = 51.7 percentage points), followed by attentiveness towards one's personal health (31.0 percentage points). Respondents with a duration of illness of less than 10 years (19.5 percentage points), employed respondents (7.5 percentage points), as well as respondents with a high socioeconomic status (24.7 percentage points) were more likely to show suboptimal forms of diabetes self-management.

DISCUSSION

In the present nationwide population-based study, a large proportion of persons with diabetes showed suboptimal self-management behaviour. Participation in a DSME program was the strongest predictor of good self-management. Results underline the need for continual and consistent health education for patients with diabetes.

A systematic review of factors associated with uncontrolled diabetes and meta-analysis of its prevalence in Saudi Arabia since 2006

The study aims to systematically review the literature for risk factors associated with poor glycaemic control among type 2 diabetes mellitus (T2DM) patients in Saudi Arabia (SA) and conducts a meta-analysis of its prevalence. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, we searched the Scopus, PubMed, PsycINFO, Web of Science, and CINAHL Plus databases from May to November 2018. The search terms were T2DM, glycaemic control, and SA. The inclusion criteria include the following: observational studies which were conducted in T2DM patients in SA reporting prevalence or/and personal, psychological or behavioural predictors in papers published after 2006. Articles were assessed using a modified Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) tool. Studies included in the meta-analysis defined uncontrolled T2DM as glycated haemoglobin ≥7% (53 mmol/mol), and reported results were based on a random-effects model. Eighteen of the following articles (3 retrospective cohort studies, 1 case-control study, and 14 cross-sectional studies) were included. The quality of the studies (high: 2; moderate: 7, and low: 9) varied. The pooled prevalence of uncontrolled T2DM in SA was 77.7% (95% CI, 71.2-84.2). In the included studies, the most consistent predictors of poor glycaemic control were longer diabetes duration, lack of self-efficacy, and low knowledge of diabetes. However, significant variations in research designs were observed across the studies. A national diabetes prevention and treatment program is needed to lessen the burden of diabetes in SA. Future studies should address the personal, psychological, and behavioural factors of poor glycaemic control in SA at national level.

Association between self-care management practices and glycemic control of patients with type 2 diabetes mellitus in Saud Arabia: A cross -sectional study

Objective

In this cross-sectional study, we aimed to determine the association of self-care management practices and glycemic control of type 2 diabetes mellitus in Saudi Arabia.

Methods

A total of 352 type 2 diabetes mellitus (T2DM) patients from two public tertiary hospitals in Saudi Arabia participated in this study. All T2DM patients were recruited and interviewed by a researcher between January to April 2018 from the outpatient diabetes clinics. All respondents answered a four-part questionnaire which includes demographics data, Diabetes Self-Management Questionnaire (DSMQ). Linear Regression was performed to assess the significance of predictors and compute the coefficient of determination.

Results

The mean age of the participants was 51.89 ± 10.94. Of the 352 participants, 52% were obese (BMI: ≥30 kgm²) and 77% of the participants had glycated haemoglobin (HbA1c) over 7%. The analysis showed that subscale of Glucose management was the strongest predictor of Hba1c levels of participants’ followed by physical activity. Gender and marital status emerged as significant predictors for their self-care management practices. Female patients had more self-care management practices than male patients (B 0.20; 95CI 0.10– 0.96 (p = 0.015).

Conclusion

This study provides an evidence on the self-care management of T2DM patients in Saudi Arabia. The high self-care management found in the study highlights that the patients are aware of the severity of and possible complications associated with T2DM.

Investigating Health-Related Features and Their Impact on the Prediction of Diabetes Using Machine Learning

Diabetes Mellitus (DM) is one of the most common chronic diseases leading to severe health complications that may cause death. The disease influences individuals, community, and the government due to the continuous monitoring, lifelong commitment, and the cost of treatment. The World Health Organization (WHO) considers Saudi Arabia as one of the top 10 countries in diabetes prevalence across the world. Since most of its medical services are provided by the government, the cost of the treatment in terms of hospitals and clinical visits and lab tests represents a real burden due to the large scale of the disease. The ability to predict the diabetic status of a patient with only a handful of features can allow cost-effective, rapid, and widely-available screening of diabetes, thereby lessening the health and economic burden caused by diabetes alone. The goal of this paper is to investigate the prediction of diabetic patients and compare the role of HbA1c and FPG as input features. By using five different machine learning classifiers, and using feature elimination through feature permutation and hierarchical clustering, we established good performance for accuracy, precision, recall, and F1-score of the models on the dataset implying that our data or features are not bound to specific models. In addition, the consistent performance across all the evaluation metrics indicate that there was no trade-off or penalty among the evaluation metrics. Further analysis was performed on the data to identify the risk factors and their indirect impact on diabetes classification. Our analysis presented great agreement with the risk factors of diabetes and prediabetes stated by the American Diabetes Association (ADA) and other health institutions worldwide. We conclude that by performing analysis of the disease using selected features, important factors specific to the Saudi population can be identified, whose management can result in controlling the disease. We also provide some recommendations learned from this research.

A theory of planned behavior-enhanced intervention to promote health literacy and self-care behaviors of type 2 diabetic patients

Background

Improved health literacy and awareness could help type 2 diabetic patients to control the disease complications.

Objective

The current study aimed to evaluate the impact of theory-based educational intervention on health literacy and self-care behaviors of type 2 diabetic patients in Tonekabon city.

Methods

This randomized controlled trial study was conducted at health care centers in Tonekabon city, Iran, from April 5, 2017, to October 22, 2018. Using multistage random sampling, 166 patients with type 2 diabetes divided into two groups: theory-based intervention (n = 83) and custom education (n = 83). The data collection tools consisted of demographic information, Theory of Planned Behavior (TPB) measures, health literacy for Iranian adults (HELIA) and summary of diabetes self-care activities (SDSCA). The five 45-minute group training sessions based on the baseline assessment and model constructs along with the targeted pamphlet and m-health strategy were designed for the experimental group. Data were analyzed using chi-square, independent and paired t-test and Analysis of covariance (ANCOVA).

Results

After controlling for pre-test effect, there was a significant difference between the two groups in terms of mean scores of attitudes, subjective norms, perceived behavior control and intention in post-test (P < 0.001). Also, after controlling for the pre-test effect, the results showed a significant difference in the self-care domain in the post-test (P < 0.001). Finally, after controlling for the pre-test variable effect, covariance analysis reflects significant difference in total health literacy score and its dimension at posttest (P < 0.001).

Conclusions

Applying TPB based education is suggested to maintain and improve self-care behaviors and health literacy in type 2 diabetic patients and other chronic diseases.

The association of illness perceptions and God locus of health control with self-care behaviours in patients with type 2 diabetes in Saudi Arabia

Objective: To investigate the associations between illness perceptions, God locus of health control (GLHC) beliefs, and self-care behaviours in Saudi patients with type 2 diabetes (T2D). Design: A cross-sectional study was conducted with 115 adults with T2D in a Saudi Arabian diabetes clinic. Illness perceptions, GLHC beliefs, and self-care behaviours were assessed using the Arabic versions of the Brief Illness Perception Questionnaire, God Locus of Health Control, and Summary of Diabetes Self-Care Activities. Logistic and linear regressions were conducted. Results: Greater perceptions of personal control (OR = 2.07, p = .045) and diet effectiveness (OR =   2.73, p = .037) were associated with higher odds of adhering to general diet. Greater perceptions of diet effectiveness (β = 0.27, p = .034) and better understanding of T2D (β = 0.54, p < .001) were significant independent predictors of fruit and vegetables intake and exercise respectively. Patients with lower GLHC beliefs (OR =  4.40, p = .004) had higher odds of adhering to foot care than those with higher GLHC beliefs. Illness perceptions and GLHC beliefs did not predict adherence to a low-fat diet, self-monitoring of blood glucose, or not smoking. Conclusion: Greater perceptions of personal control, coherence, diet effectiveness, and lower GLHC beliefs were associated with higher adherence to self-care behaviours in Saudi patients with T2D. Interventions designed to promote self-care behaviours in Saudi patients with T2D could focus on addressing these perceptions.

Impact of Diabetes-related Self-management on Glycemic Control in Type II Diabetes Mellitus

INTRODUCTION

 Self-care activities are behaviors adopted in order to enhance one's health. Self-care behaviors and activities are studied in their role to enhance glycemic control, reduce diabetes-related complications, and contribute to enhancing overall quality of life in people with diabetes. The aim of this observational study was to evaluate the impact of diabetes self-care activities and behaviors on glycemic control in people with diabetes.

METHODS

 This observational, cross-sectional study was conducted at the outpatient department of a secondary care hospital in Karachi, Pakistan from 1st September 2019 till 30th November 2019. Patients with known type II diabetes of age ≥45 years visiting the hospital for routine follow-up visit were included. Diabetes Self-Management Questionnaire (DSMQ) in Urdu version was used to assess their status of self-management. For data entry and statistical analysis SPSS for Windows version 21.0 was used.

RESULTS

 There were 174 (54.9%) males and 152 (47.9%) were of age 45-60 years. Glycemic control was good (HbA1c <7%) in 125 (39.4%) and poor (HbA1c ≥7%) in 192 (60.6%) patients. Patients with good glycemic control scored significantly better on DSMQ overall (5.53 ± 0.35 vs. 4.32 ± 0.61; p<0.0001), and on three sub-scales - dietary control (4.24 ± 1.04 vs. 3.63 ± 0.98; p<0.0001), physical activity (4.16 ± 0.56 vs. 3.47 ± 1.17; p<0.0001), and healthcare use (4.22 ± 0.78 vs. 3.98 ± 0.65; p=0.003).  Conclusions: The self-care activities that impact glycemic control in patients with diabetes include dietary control, physical activity, and healthcare use.

Factors Related to Self-care in Patients with Type 2 Diabetes

Purpose:

The prevalence of diabetes and the personal and national burden from diabetes, a serious health issue around the globe, continues to increase. The purpose of this study was to identify factors influencing self-care among patients with type 2 diabetes.

Methods:

We conducted a cross-sectional descriptive survey of 118 outpatients with type 2 diabetes in national university hospital C in Korea. Data were collected from self-report questionnaires covering information on demographics, self-care, and self-efficacy. Additional data were collected from medical records including information on HbA1c, fasting blood glucose levels, and cholesterol levels. Collected data were analyzed using descriptive statistics, Pearson’s correlation coefficient, and multiple regression using SPSS/WIN version 22.0 software.

Results:

Factors affecting self-care were the following four: self-efficacy, HbA1c, occupation status, and smoking status. Higher engagement in self-care was associated with higher self-efficacy (β = .53, p < .001), lower HbA1c (β = -0.33, p < .001), unemployment (β = -0.20, p < .001), and non-smoking status (β = -0.15, p = .011). The regression model of self-care among the type 2 diabetes patients was statistically significant (F = 67.15, p < .001), and the explanatory power of the adjusted R2 was 69%.

Conclusion:

Type 2 diabetes patients with high self-efficacy and self-care scores showed good glycemic control. Therefore, this finding suggests that nursing interventions should be developed to enhance self-efficacy, which is the greatest influencing factor for self-care.

Mediating role of self-efficacy in the relationship between family social support and hypertension self-care behaviours: A cross-sectional study of Saudi men with hypertension

BACKGROUND

Self-efficacy and family social support are significantly associated with hypertension self-care behaviours. However, little is known about their mechanism in Saudi Arabia. This cross-sectional study aimed to examine the relationships among family social support, self-efficacy, and self-care behaviours among men with hypertension in Saudi Arabia.

METHODS

Data were collected from May to August of 2018. The Hypertension Self-Care Profile and the Perceived Social Support from Friends and Family scales were used to measure the study variables. Multiple linear regression was used to analyse the relationships between the variables, and the Baron and Kenny test was used to assess if self-efficacy mediated the relationship between family social support and hypertension self-care behaviours.

RESULTS

Respondents (N = 158) from the Jizan and Al-Sharqia regions of Saudi Arabia completed the survey. Family social support and self-efficacy were significantly associated with hypertension self-care behaviours. In regression, self-efficacy was the only variable significantly associated with hypertension self-care behaviours. Self-efficacy fully mediated the relationship between family social support and hypertension self-care behaviours.

CONCLUSIONS

Interventions to enhance hypertension self-care behaviours among Saudi men could focus on increasing individual's self-confidence to perform specific healthy behaviours. Family support can also contribute to the performance of hypertension self-care behaviours.

Challenges in the management of Type 2 Diabetes among native women in the United Arab Emirates

AIM

To investigate Type 2 Diabetes mellitus (T2DM) management in native female patients in the United Arab Emirates (UAE).

METHODS

Ninety women from the outpatient diabetes clinic at Tawam Hospital, UAE, were interviewed face-to-face about how they manage their disease, using a structured questionnaire. Clinical values of the patients were extracted from medical records.

RESULTS

The mean age of the women was 57.5 (SD: 12.7) years and half of them were illiterates. Two-third of the participants had hypertension and/or high cholesterol. A majority reported to have received information about lifestyle modification but admitted low physical activity and unhealthy diet. Mean weight and BMI were 80.0 (SD: 17.2) kg and 33.5 (SD: 6.3) kg/m², respectively. Although the majority were taught how to measure blood glucose, 46% considered self-measurement difficult. Oral antihyperglycemic drugs were used by 96% of participants, and 31% were also taking injections. Forty-nine percent had HbA1c values below 7% and the average was 7.7% (range: 4.9-14.1). Two-third had systolic blood pressure (SBP) and low-density lipoprotein (LDL) values within the target range.

CONCLUSION

Despite major challenges in T2DM management among native female patients in UAE, this study shows that one in two patients had an overall glycemic control that was acceptable.