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Kortegaard AS, Rokkjær RB, Harboe HMH, Lund S, Andersen A, Bohl M. A group-based intervention for diabetes-related emotional distress among emerging adults with type 1 diabetes: A pilot study. Eur J Intern Med 2024:S0953-6205(24)00241-3. [PMID: 38852025 DOI: 10.1016/j.ejim.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
AIMS To assess diabetes-related emotional distress (DD) in emerging adults with type 1 diabetes (T1D) and assess a group-based intervention's impact. METHODS To investigate DD we used data from the Problem Areas in Diabetes Questionnaire comprising 20 items (PAID-20). Furthermore, changes in the WHO Well-Being Index comprising five items (WHO-5) and glycated haemoglobin (HbA1c) were analysed. The intervention was evaluated using follow-up data from the emerging adults who participated. RESULTS From 2021 to 2023, we screened 180 emerging adults using PAID-20. DD (PAID-20≥30) was prevalent in 25.0 % (95 % CI 18.9; 32.0 %), and associated with the female sex, higher HbA1c and WHO-5 < 50. Continuous subcutaneous insulin infusion at baseline was associated with PAID-20<30. 21 individuals attended a group-based intervention. At one-week follow up PAID-20 was reduced (29.1 ± 15.4 vs. 41.3 ± 12.1 at baseline, p = 0.003), and at nine-twelve months' follow-up HbA1c was reduced (59.3 ± 15.3 mmol/mol vs. 68.0 ± 17.4 mmol/mol at baseline, p = 0.012). CONCLUSIONS This pilot study demonstrated that 25 % of the investigated emerging adults with T1D experienced DD (PAID-20≥30) associated with four clinical factors. We found a reduction in HbA1c and a short-term reduction in PAID-20 following the group-based intervention.
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Affiliation(s)
- Anne-Sofie Kortegaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark.
| | - Rikke B Rokkjær
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Hanne Marie H Harboe
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - Sten Lund
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Anette Andersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Mette Bohl
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; Department of Clinical Medicine - Medical Diagnostic Centre, Regional Hospital Central Jutland, Heibergs Allé 4, 8800 Viborg, Denmark.
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2
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Deng C, Xie Y, Liu F, Tang X, Fan L, Yang X, Chen Y, Zhou Z, Li X. Simplified integration of optimal self-management behaviors is associated with improved HbA1c in patients with type 1 diabetes. J Endocrinol Invest 2024:10.1007/s40618-024-02357-8. [PMID: 38602658 DOI: 10.1007/s40618-024-02357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/04/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE Living with type 1 diabetes requires burdensome and complex daily diabetes self-management behaviors. This study aimed to determine the association between integrated behavior performance and HbA1c, while identifying the behavior with the most significant impact on HbA1c. METHODS A simple and feasible questionnaire was used to collect diabetes self-management behavior in patients with type 1 diabetes (n = 904). We assessed six dimensions of behavior performance: continuous glucose monitor (CGM) usage, frequent glucose testing, insulin pump usage, carbohydrate counting application, adjustment of insulin doses, and usage of apps for diabetes management. We evaluated the association between these behaviors and HbA1c. RESULTS In total, 21.3% of patients performed none of the allotted behavior, while 28.5% of patients had a total behavior score of 3 or more. 63.6% of patients with a behavior score ≥ 3 achieved HbA1c goal, contrasting with only 30.4% of patients with a behavior score of 0-1. There was a mean 0.54% ± 0.05% decrease in HbA1c for each 1-unit increase in total behavior score after adjustment for age, family education and diabetes duration. Each behavior was independently correlated with a lower HbA1c level, with CGM having the most significant effect on HbA1c levels. CONCLUSIONS Six optimal self-management behaviors, especially CGM usage, were associated with improved glycemic control, emphasizing the feasibility of implementing a simplified version of DSMES in the routine clinical care. REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT03610984.
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Affiliation(s)
- C Deng
- Department of Metabolism and Endocrinology, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Y Xie
- Department of Metabolism and Endocrinology, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, China
| | - F Liu
- Department of Metabolism and Endocrinology, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, China
| | - X Tang
- Department of Metabolism and Endocrinology, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, China
| | - L Fan
- Department of Metabolism and Endocrinology, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, China
| | - X Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Y Chen
- Department of Metabolism and Endocrinology, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Z Zhou
- Department of Metabolism and Endocrinology, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, China.
| | - X Li
- Department of Metabolism and Endocrinology, Key Laboratory of Diabetes Immunology, Ministry of Education, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, China.
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3
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An L, Yeh KC, Liu Y, Wang D, Li X, Tang Q, Lu J. An Online Structured Diabetes Self-Management Education and Support Programme Improves Glycaemic Control in Young Adults with Type 1 Diabetes. J Multidiscip Healthc 2023; 16:2641-2654. [PMID: 37701178 PMCID: PMC10494863 DOI: 10.2147/jmdh.s414102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/15/2023] [Indexed: 09/14/2023] Open
Abstract
Objective We explore the effect of a structured online DSMES program on glycaemic control and the self-management behaviour of adolescents and young adults with T1DM. Methods We used a pre-post uncontrolled intervention design over a period of 6 months. A total of 37 youths with T1DM aged 10-45 years were enrolled. The intervention comprised 11 structured online DSMES course sessions; these were video-based and delivered by a diabetes specialist, nurses and a dietitian. The primary outcome was a change in (glycated hemoglobin) HbA1c. The secondary outcomes were changes in hypoglycaemia frequency, time in target range (TIR) among patients using a continuous glucose monitoring (CGM) system and self-management behaviour; the latter was measured using a T1DM self-management scale for Chinese adults (SMOD-CA) and the Chinese version of the diabetic behaviour rating scale in adolescents with T1DM (DBRS). Results Twenty-three (85.2%) participants attended ≥8 of the online sessions. There was a significant reduction in HbA1c (from 6.92% to 6.47%, P = 0.002), hypoglycaemic episodes (from 6.0 to 4.0 during the preceding month, P = 0.026) and a significant increase in TIR (from 74.0% to 80.5%, P = 0.027) and an increase in the SMOD-CA score (from 79.6 to 84.6, P = 0.026) in young adults. No significant change in glucose control, hypoglycaemic events or DBRS score were found among children and adolescents. The score of the 12-item version of the Barrett-Lennard Relationship Inventory (B-L RI:mini) indicated that more than half of the participants experienced congruence, positive regard, and an empathic understanding in this programme. Conclusion The online structured DSMES programme was effective in improving the glycaemic control and self-management behaviour of young adults with T1DM; however, integrating offline visits or appointments with online consultations may be necessary for youth patients.
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Affiliation(s)
- Lingwang An
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
| | - Kuei-Chun Yeh
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
| | - Yunxia Liu
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
| | - Dandan Wang
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
| | - Xianglan Li
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
| | - Qi Tang
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
| | - Juming Lu
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
- Department of Endocrinology, The General Hospital of the People’s Liberation Army, Beijing, 100853, People’s Republic of China
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4
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Diabetes Management after a Therapeutic Education Program: A Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10081375. [PMID: 35893197 PMCID: PMC9394246 DOI: 10.3390/healthcare10081375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/18/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Structured education has been used in patients treated with insulin, promoting their ability to adhere to and self-manage their treatment. We aimed to know the perception and adherence to the recommendations on the management of diabetes in type 1 diabetes patients after participating in a therapeutic education program. (2) Methods: A descriptive qualitative study followed the Standards for Reporting Qualitative Research guidelines. Patients with type 1 diabetes participating in a therapeutic education program were recruited from February to April 2022. Semi-structured, in-depth interviews were used, and transcriptions were analyzed using the inductive qualitative content analysis method. The final sample consisted of 18 type 1 diabetes mellitus patients. (3) Results: A number of patients with type 1 diabetes said that they had improved their glycemic control after participating in the therapeutic education program. Some patients recognized that the chronic disease and the complications complexity generated stress and anxiety. This influenced their usual life, at work, and their interpersonal relationships. (4) Conclusions: In terms of satisfaction, the majority of patients reported a good perception of the quality of the organization, the professionals involved, and the contents of the program. The physical and psychosocial benefits of self-care training have been demonstrated.
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5
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Sathyanarayanan A, Crabtree T, Choudhary P, Elliott J, Evans ML, Lumb A, Wilmot EG. Delivering evidence-based interventions for type 1 diabetes in the virtual world - A review of UK practice during the SARS-CoV-2 pandemic. Diabetes Res Clin Pract 2022; 185:109777. [PMID: 35157943 PMCID: PMC8831709 DOI: 10.1016/j.diabres.2022.109777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 12/05/2022]
Abstract
AIMS This review considers the impact of the SARS-CoV-2 pandemic on access to interventions for those living with type 1 diabetes and discusses the solutions which have been considered and actioned to ensure ongoing access care. METHODS We performed a focussed review of the published literature, and the guidelines for changes that have been effected during the pandemic. We also drew from expert recommendations and information about local practice changes for areas where formal data have not been published. RESULTS Evidence based interventions which support the achievement of improved glucose levels and/or reduction in hypoglycaemia include group structured education to support self-management, insulin pump therapy and continuous glucose monitoring. The SARS-CoV-2 pandemic had impacted the ability of diabetes services to deliver these intervention. Multiple adaptations have been put in place - transition to online delivery of education and care, and usage of diabetes technology. CONCLUSIONS Although various adaptations have been made during the pandemic that have positively influenced uptake of services, there are many areas of delivery that need immediate improvement in the UK. We recommend a proactive approach in recognising the digital divide and inequity in distribution of these changes and we recommend introducing measures to reduce them.
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Affiliation(s)
| | - T Crabtree
- University Hospitals of Derby and Burton NHS FT, DE22 3NE, UK; Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, NG7 2RD, UK.
| | - P Choudhary
- Diabetes Research Centre, Leicester Diabetes Centre - Bloom, University of Leicester, LE1 7RH, UK.
| | - J Elliott
- Department of Oncology and Metabolism, University of Sheffield, S10 2TN, UK.
| | - M L Evans
- Wellcome Trust/ MRC Institute of Metabolic Science and Department of Medicine, University of Cambridge, CB2 1TN, UK.
| | - A Lumb
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford OX3 7LE, UK; NIHR Oxford Biomedical Research Centre, Oxford OX4 2PG, UK.
| | - E G Wilmot
- University Hospitals of Derby and Burton NHS FT, DE22 3NE, UK; Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, NG7 2RD, UK
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Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, Dennison M, Francis T, Hughes PJ, Jaime S, Lau KHK, McArthur T, McAvoy K, Magee M, Newby O, Ponder SW, Quraishi U, Rawlings K, Socke J, Stancil M, Uelmen S, Villalobos S. 2022 National Standards for Diabetes Self-Management Education and Support. Diabetes Care 2022; 45:484-494. [PMID: 35050365 DOI: 10.2337/dc21-2396] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 02/03/2023]
Affiliation(s)
| | | | - Joni Beck
- The University of Oklahoma Health Science Center, Oklahoma City, OK
| | | | | | - Jo Ellen Condon
- Anne Arundel Medical Center, Annapolis, MD
- Diabetes Alliance Network, Naples, FL
| | | | | | | | | | | | | | | | - Michelle Magee
- 15MedStar Diabetes and Research Institutes, Georgetown University School of Medicine, Washington, D.C
| | - Olivia Newby
- 16The Healthy Living Center Diabetes Education Program, Norfolk, VA
| | | | | | | | | | | | - Sacha Uelmen
- 22Association of Diabetes Care & Education Specialists, Chicago, IL
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7
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Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, Dennison M, Francis T, Hughes PJ, Jaime S, Lau KHK, McArthur T, McAvoy K, Magee M, Newby O, Ponder SW, Quraishi U, Rawlings K, Socke J, Stancil M, Uelmen S, Villalobos S. 2022 National Standards for Diabetes Self-Management Education and Support. Sci Diabetes Self Manag Care 2022; 48:44-59. [PMID: 35049403 DOI: 10.1177/26350106211072203] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The National Standards for Diabetes Self-Management Education and Support (DSMES) provide guidance and evidence-based, quality practice for all DSMES services. Due to the dynamic nature of health care and diabetes research, the National Standards are reviewed and revised approximately every 5 years by key stakeholders and experts within the diabetes care and education community. For each revision, the Task Force is charged with reviewing the current National Standards for appropriateness, relevance, and scientific basis and making updates based on current evidence and expert consensus. In 2021, the group was tasked with reducing administrative burden related to DSMES implementation across diverse care settings. CONCLUSION The evidence supporting the 2022 National Standards clearly identifies the need to provide person-centered services that embrace cultural differences, social determinants of health, and the ever-increasing technological engagement platforms and systems. Payers are invited to review the National Standards as a tool to inform and modernize DSMES reimbursement requirements and to align with the evolving needs of people with diabetes (PWD) and physicians/other qualified health care professionals. The American Diabetes Association and the Association of Diabetes Care & Education Specialists strongly advocate for health equity to ensure all PWD have access to this critical service proven to improve outcomes both related to and beyond diabetes. The 2022 National Standards update is meant to be a universal document that is easy to understand and can be implemented by the entire health care community. DSMES teams in collaboration with primary care have been shown to be the most effective approach to overcome therapeutic inertia.
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Affiliation(s)
| | | | - Joni Beck
- The University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | | | | | - Jo Ellen Condon
- Anne Arundel Medical Center, Annapolis, Maryland, and Diabetes Alliance Network, Naples, Florida
| | | | | | | | - Stephen Jaime
- El Centro Regional Medical Center, El Centro, California
| | | | | | - Karen McAvoy
- Yale New Haven Health System, New Haven, Connecticut
| | - Michelle Magee
- MedStar Diabetes and Research Institutes, Georgetown University School of Medicine, Washington, DC
| | - Olivia Newby
- The Healthy Living Center Diabetes Education Program, Norfolk, Virginia
| | | | | | | | | | | | - Sacha Uelmen
- Association of Diabetes Care & Education Specialists, Chicago, Illinois
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8
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Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, Dennison M, Francis T, Hughes PJ, Jaime S, Lau KHK, McArthur T, McAvoy K, Magee M, Newby O, Ponder SW, Quraishi U, Rawlings K, Socke J, Stancil M, Uelmen S, Villalobos S. 2022 National Standards for Diabetes Self-Management Education and Support. Diabetes Spectr 2022; 35:137-149. [PMID: 35668879 PMCID: PMC9160547 DOI: 10.2337/ds22-ps02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Joni Beck
- The University of Oklahoma Health Science Center, Oklahoma City, OK
| | | | | | - Jo Ellen Condon
- Anne Arundel Medical Center, Annapolis, MD
- Diabetes Alliance Network, Naples, FL
| | | | | | | | | | | | | | | | - Michelle Magee
- MedStar Diabetes and Research Institutes, Georgetown University School of Medicine, Washington, DC
| | - Olivia Newby
- The Healthy Living Center Diabetes Education Program, Norfolk, VA
| | | | | | | | | | | | - Sacha Uelmen
- Association of Diabetes Care & Education Specialists, Chicago, IL
- Corresponding author: Sacha Uelmen,
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9
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Botero JF, Vásquez LM, Blanco VM, Cuesta DP, Ramírez-Rincón A, Bedoya J, Palacio A. The effectiveness of a comprehensive diabetes program for glycemic control and adherence, and the selection of candidates for sensor-augmented insulin pump therapy. ENDOCRINOL DIAB NUTR 2021; 68:735-740. [PMID: 34924162 DOI: 10.1016/j.endien.2021.12.002] [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: 08/17/2020] [Accepted: 11/06/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study aimed to estimate the effectiveness of a comprehensive diabetes program (CDP) in terms of glycemic control, adherence, and the selection of candidates for sensor-augmented insulin pump therapy (SAP). METHODS We compared diabetes control before and 6 months after CDP. The program was based on disease management using a logical model dealing with the following: case management, education and coaching, nutritional assessment, and mental health. RESULTS The CDP improved glycemic control, HbA1c decreased by 0.56% (p-value=0.004; 95% CI: 0.14-0.98) and 19.1% of the patients reached the HbA1c goal without hypoglycemia. The CDP reduced by 52.4% the indication for SAP due to better glycemic control (36.4%) or non-adherence issues (63.6%); the remaining 47.6% persisted with poor glycemic control despite good adherence and were scaled to SAP. Among the 30 suitable candidates for SAP therapy, 60% did not reach the HbA1c goal and 40% had either hypoglycemic episodes (severe or persistent) or dawn phenomenon. The overall non-adherence rate was 33.3%. CONCLUSIONS CDP optimized the selection of suitable candidates for SAP by improving glycemic control and identifying adherence issues early. These results provide evidence of the impact of the implementation of patient selection and educational protocols in the real-life setting of a highly experienced clinic.
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Affiliation(s)
- José Fernando Botero
- Clínica Integral de Diabetes (CLID), Medellín, Colombia; Universidad Pontificia Bolivariana, Medellín, Colombia.
| | | | | | | | | | - Jorge Bedoya
- Clínica Integral de Diabetes (CLID), Medellín, Colombia
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Due-Christensen M, Joensen LE, Sarre S, Romanczuk E, Wad JL, Forde R, Robert G, Willaing I, Forbes A. A co-design study to develop supportive interventions to improve psychological and social adaptation among adults with new-onset type 1 diabetes in Denmark and the UK. BMJ Open 2021; 11:e051430. [PMID: 34728449 PMCID: PMC8565545 DOI: 10.1136/bmjopen-2021-051430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To develop supportive interventions for adults with new-onset type 1 diabetes (T1D) to facilitate positive adaptive strategies during their transition into a life with diabetes. DESIGN The study used a co-design approach informed by Design Thinking to stimulate participants' reflections on their experiences of current care and generate ideas for new supportive interventions. Visual illustrations were used to depict support needs and challenges. Initial discussions of these needs and challenges were facilitated by researchers and people with diabetes in workshops. Data comprising transcribed audio recordings of the workshop discussions and materials generated during the workshops were analysed thematically. SETTINGS Specialised diabetes centres in Denmark and the United Kingdom. PARTICIPANTS Adults with new-onset T1D (n=24) and healthcare professionals (HCPs) (n=56) participated in six parallel workshops followed by four joint workshops with adults (n=29) and HCPs (n=24) together. RESULTS The common solution prioritised by both adults with new-onset T1D and HCP participants was the development of an integrated model of care addressing the psychological and social elements of the diagnosis, alongside information on diabetes self-management. Participants also indicated a need to develop the organisation, provision and content of care, along with the skills HCPs need to optimally deliver that care. The co-designed interventions included three visual conversation tools that could be used flexibly in the care of adults with new-onset T1D to support physical, psychological and social adaptation to T1D. CONCLUSION This co-design study has identified the care priorities for adults who develop T1D, along with some practical conversational tools that may help guide HCPs in attending to the disruptive experience of the diagnosis and support adults in adjusting into a life with diabetes.
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Affiliation(s)
- Mette Due-Christensen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Lene Eide Joensen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Sophie Sarre
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Ewa Romanczuk
- Steno Diabetes Center Odense, Odense Universitetshospital, Odense, Denmark
| | - Julie Lindberg Wad
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Rita Forde
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Ingrid Willaing
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Botero JF, Vásquez LM, Blanco VM, Cuesta DP, Ramírez-Rincón A, Bedoya J, Palacio A. The effectiveness of a comprehensive diabetes program for glycemic control and adherence, and the selection of candidates for sensor-augmented insulin pump therapy. ENDOCRINOL DIAB NUTR 2021; 68:S2530-0164(21)00073-2. [PMID: 33812905 DOI: 10.1016/j.endinu.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/23/2020] [Accepted: 11/06/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to estimate the effectiveness of a comprehensive diabetes program (CDP) in terms of glycemic control, adherence, and the selection of candidates for sensor-augmented insulin pump therapy (SAP). METHODS We compared diabetes control before and 6 months after CDP. The program was based on disease management using a logical model dealing with the following: case management, education and coaching, nutritional assessment, and mental health. RESULTS The CDP improved glycemic control, HbA1c decreased by 0.56% (p-value=0.004; 95% CI: 0.14-0.98) and 19.1% of the patients reached the HbA1c goal without hypoglycemia. The CDP reduced by 52.4% the indication for SAP due to better glycemic control (36.4%) or non-adherence issues (63.6%); the remaining 47.6% persisted with poor glycemic control despite good adherence and were scaled to SAP. Among the 30 suitable candidates for SAP therapy, 60% did not reach the HbA1c goal and 40% had either hypoglycemic episodes (severe or persistent) or dawn phenomenon. The overall non-adherence rate was 33.3%. CONCLUSIONS CDP optimized the selection of suitable candidates for SAP by improving glycemic control and identifying adherence issues early. These results provide evidence of the impact of the implementation of patient selection and educational protocols in the real-life setting of a highly experienced clinic.
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Affiliation(s)
- José Fernando Botero
- Clínica Integral de Diabetes (CLID), Medellín, Colombia; Universidad Pontificia Bolivariana, Medellín, Colombia.
| | | | | | | | | | - Jorge Bedoya
- Clínica Integral de Diabetes (CLID), Medellín, Colombia
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12
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Benioudakis ES, Georgiou ED, Barouxi ED, Armagos AM, Koutsoumani V, Anastasiou-Veneti F, Koutsoumani E, Brokalaki M. The diabetes quality of life brief clinical inventory in combination with the management strategies in type 1 diabetes mellitus with or without the use of insulin pump. Diabetol Int 2020; 12:217-228. [PMID: 33786276 DOI: 10.1007/s13340-020-00477-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
Aims The aims of this study are to evaluate any differences in the Quality of life among Continuous Subcutaneous Insulin Infusion (CSII) and Multiple Dose Injection (MDI) insulin delivery, applying the Diabetes Quality of life Brief Clinical Inventory (DQoL-BCI) questionnaire, and assess the diabetes management strategies between the two groups. Methods One hundred and ten adult participants (male/female ratio 1:2.7) with type 1 diabetes were recruited in this online survey. Forty-eight of them were using CSII and the rest 62 (were using) MDI insulin delivery. A 23-item socio-demographic/diabetes management strategies questionnaire and the 15-item DQoL-BCI were administered. Results CSII users scored statistically, significantly better at the satisfaction treatment subscale (p = 0.032) of the DQoL-BCI and emerged that they were implemented more management strategies such as dietician guidance services (p = 0.002), carbohydrate education seminars (p = 0.03). Predictive factors were also detected regarding the HbA1c < 7% (53 mmol/mol) and β-coefficients in relation to DQoL-BCI questionnaire with the subscales of a negative impact and satisfaction treatment. Conclusion Diabetes self-management education plays a key role to a better compliance with the treatment. Client-centered multidisciplinary centers in T1DM education are essential so that they be applicable for all T1DM patients irrespective of the type of insulin delivery they used.
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Affiliation(s)
- Emmanouil S Benioudakis
- Department of Psychology, University of Crete, Rethimno, Greece.,Psychiatric Clinic, General Hospital of Chania, Chania, Greece
| | - Evangelos D Georgiou
- Statistical Methods in Medicine and Pharmacy, Athens University of Economics and Business, Athens, Greece.,Department of Psychology, University of Cyprus Centre for Field Studies, University of Cyprus, Nicosia, Cyprus
| | | | - Athanasios M Armagos
- Health Psychology, University of Crete, Rethimno, Greece.,Psychiatric Clinic, Naval Hospital of Athens (NNA), Athens, Greece
| | | | | | | | - Maria Brokalaki
- Nutrition and Dietetics, Technological Educational Institute of Crete, Sitia, Greece
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13
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Ehrmann D, Kulzer B, Roos T, Haak T, Al-Khatib M, Hermanns N. Risk factors and prevention strategies for diabetic ketoacidosis in people with established type 1 diabetes. Lancet Diabetes Endocrinol 2020; 8:436-446. [PMID: 32333879 DOI: 10.1016/s2213-8587(20)30042-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 01/02/2023]
Abstract
Diabetic ketoacidosis (DKA) is a serious acute complication of type 1 diabetes, which is receiving more attention given the increased DKA risk associated with SGLT inhibitors. Sociodemographic and modifiable risk factors were identified with strong evidence for an increased risk of DKA, including socioeconomic disadvantage, adolescent age (13-25 years), female sex, high HbA1c, previous DKA, and psychiatric comorbidities (eg, eating disorders and depression). Possible prevention strategies, which include the identification of people at risk based on non-modifiable sociodemographic risk factors, are proposed. As a second risk mitigation strategy, structured diabetes self-management education that addresses modifiable risk factors can be used. Evidence has found that structured education leads to reduced DKA rates. Knowledge of these risk factors and potent risk mitigation strategies are important to identify subgroups of people with an elevated DKA risk. This knowledge should also be used when adjunct therapy options with an increased DKA risk are considered. Prevention of DKA in people with type 1 diabetes is an important clinical task, which should also be addressed when SGLT inhibitors are part of therapy.
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Affiliation(s)
- Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany; Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - Timm Roos
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
| | - Thomas Haak
- Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - Mohammed Al-Khatib
- HealthPlus Diabetes & Endocrinology Centre, Abu Dhabi, United Arab Emirates
| | - Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany; Diabetes Clinic Mergentheim, Bad Mergentheim, Germany.
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14
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Heller SR, Gianfrancesco C, Taylor C, Elliott J. What are the characteristics of the best type 1 diabetes patient education programmes (from diagnosis to long-term care), do they improve outcomes and what is required to make them more effective? Diabet Med 2020; 37:545-554. [PMID: 32034796 DOI: 10.1111/dme.14268] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 12/17/2022]
Abstract
The last 20 years have witnessed a marked change in approaches to the management of type 1 diabetes in the UK. This is exemplified by National Institute of Health and Care Excellence (NICE) guidance which acknowledges that reaching and maintaining target glucose depends on people with type 1 diabetes effectively implementing flexible intensive insulin therapy. The guidance emphasizes that successful self-management requires the acquisition of complex skills and is best achieved by participation in high-quality structured education. Controlled trials and other research have shown that programmes teaching self-management can lower glucose levels while reducing hypoglycaemia, improve psychological outcomes and are highly cost-effective. An important principle of successful programmes is therapeutic education in which learning becomes a partnership between the professional and the person with diabetes who learns to fit diabetes into his/her everyday life. Other recommended elements of programmes include a written curriculum, group teaching by a professional multidisciplinary team and quality assurance. Yet many participants struggle post-course to implement and maintain skills, and overall HbA1c levels, particularly in the UK, remain far from target. Recent studies have identified the barriers to sustained effective self-management and concluded that even high-quality programmes generally lack critical components. These include incorporating evidence from behaviour change research, exploiting the promise of new technologies in reducing the burden of self-management, and providing structured professional support once people have completed the training. Studies are currently underway to evaluate structured training courses which have added these elements and examine whether they can lower glucose to levels closer to target without impairing quality of life.
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Affiliation(s)
- S R Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - C Gianfrancesco
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - C Taylor
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - J Elliott
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
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15
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Xie Y, Liu F, Huang F, Lan C, Guo J, He J, Li L, Li X, Zhou Z. Establishment of a type 1 diabetes structured education programme suitable for Chinese patients: type 1 diabetes education in lifestyle and self adjustment (TELSA). BMC Endocr Disord 2020; 20:37. [PMID: 32151245 PMCID: PMC7063731 DOI: 10.1186/s12902-020-0514-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Various guidelines recommend that all adults diagnosed with type 1 diabetes (T1D) should be offered an evidence based, structured education programme (SEP) to optimize self-management care. China has a 13,000 annual increase in newly diagnosed T1D cases, of which 65% are adults. However, there is yet no validated SEP targeted to T1D patients in China. The purpose of this study is to establish a structured T1D self-management education programme-'Type 1 Diabetes Education in Lifestyle and Self Adjustment' (TELSA) that is adapted to medical and cultural practices in China. METHODS TELSA programme was developed based on the ADDIE model, following three steps: i) Semi-structured interviews were administered to 10 healthcare professionals (HCPs) and 13 T1D patients. Different topic guides, focusing on 4 dimensions including goals, contents, format of delivery, and quality assurance, were designed for either HCPs or patients. The interviews were recorded and analysed with thematic analysis. ii) Extracted themes were modified according to Delphi consultation. iii) Preliminary courses were conducted as pilot study to evaluate the effects of TELSA and optimization of the curriculum was finalized accordingly. RESULTS A total of 18 themes in 4 dimensions of the programme design were identified in the final version: i) goals: 'behaviour modification' and 'outcome improvement'; ii) contents: 'living with T1D', 'self-monitoring of blood glucose', 'knowing insulin', 'insulin dose adjustment', 'carbohydrates and carbohydrate counting', 'hypoglycaemia', 'complications of diabetes', 'managing psychological issues', 'physical activity', and 'question-and-answer'; iii) format: 'multidisciplinary team combined with peer support', 'face-to-face education followed by remote learning', and '2-day programme held on weekends'; and iv) quality assurance: 'after-class quiz', 'patients' feedback', and 'long-term evaluation on effectiveness'. CONCLUSIONS A type 1 diabetes structured education programme in China was set up and shown to be applicable under local medical, social, and cultural environment. TRIAL REGISTRATION NCT03610984. Date of registration: August 2, 2018.
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Affiliation(s)
- Yuting Xie
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, China
- National Clinical Research Center for Metabolic Diseases, and Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China
| | - Fang Liu
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, China
- Clinic Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fansu Huang
- Department of Clinical Nutrition, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chunna Lan
- Department of Rehabilitation, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Jing He
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, and Medical Psychological Institute of Central South University, Changsha, China
| | - Lezhi Li
- Clinic Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xia Li
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, China.
- National Clinical Research Center for Metabolic Diseases, and Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, China
- National Clinical Research Center for Metabolic Diseases, and Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China
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16
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Choudhary P, Campbell F, Joule N, Kar P. A Type 1 diabetes technology pathway: consensus statement for the use of technology in Type 1 diabetes. Diabet Med 2019; 36:531-538. [PMID: 30773681 DOI: 10.1111/dme.13933] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 01/11/2023]
Abstract
In both adults and children with diabetes, technologies such as continuous subcutaneous insulin infusion using insulin pumps and continuous glucose monitoring can help improve diabetes control, reduce hypoglycaemia and improve quality of life. Access to these technologies in the UK is very variable. Some technologies are recommended by the National Institute for Health and Care Excellence, while others have not been appraised, and new technologies are emerging all the time. Additionally, different guidelines for adults and children further complicate access to diabetes technology in the transition from paediatric to adult care. Against this background, Diabetes UK and NHS England have brought together a multidisciplinary group of experts, including clinicians and people with diabetes, to develop this consensus guideline, combining the different technologies into a common pathway to aid clinical and policy decision-making. We created a pathway that supports the incremental addition of technology as monotherapy and then dual therapy in the same way that we incrementally add in therapeutic agents to support people with Type 2 diabetes to achieve their personalized glycaemic targets. The pathway emphasizes the importance of structured education, specialist support and appropriate access to psychological therapies, as essential pillars for optimized use of diabetes-related technology, and recommends the re-evaluation of its use when the individual is unable either to use the technology appropriately or to achieve the intended outcomes. This pathway is endorsed by UK-wide clinical and patient associations and we recommend that providers and commissioners use it to ensure the right individual with diabetes has access to the right technology in a timely way to help achieve better outcomes.
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Affiliation(s)
| | - F Campbell
- St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - P Kar
- Diabetes, NHS England, London, UK
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