Distance education and diabetes empowerment: A single-blind randomized control trial

The effect of using mobile health on self-management of type 2 diabetic patients: A systematic review in Iran

Type 2 diabetes, as one of the most common chronic diseases, requires ongoing management and support from the patient; therefore, patient participation and self-management play a pivotal role in controlling and preventing this disease. The increasing use of smartphones has provided a good opportunity for controlling and managing patients with type 2 diabetes. This study aimed to investigate the effect of mobile health on the self-management of patients with type 2 diabetes in Iran. A systematic review study was conducted from 2010 to 2021. Searches in Persian and English scientific databases, IranDoc, MagIran, SID Web of science, and PubMed, were performed using keywords such as diabetes and mobile health. The process of reviewing and selecting articles based on inclusion and exclusion criteria was performed by two researchers independently. The study evaluation was performed by using a standard tool. After selecting articles, data extraction was performed using a data extraction form. Data analysis was performed with a content analysis approach. Finally, 23 articles were included from the 7767 articles found in the initial search stage, which examined patients' self-care in 11 areas using mobile health. Fourteen studies (61%) considered mobile health to be effective in increasing hemoglobin control. Other studies also found the use of mobile health in increasing adherence to exercise (n = 10), increasing adherence to medication (n = 9), increasing adherence to diet (n = 11), increasing care for diabetic foot ulcers (n = 8), increasing self-efficacy and empowerment (n = 5), increasing cholesterol control (n = 4), increasing awareness and attitude (n = 4), increasing control of insulin dose (n = 2), increasing adherence to education (n = 1), and increasing control of blood urea (n = 1), which were considered effective. The use of m-health effectively controls the disease and promotes self-management in type 2 diabetic patients. Considering the high cost of diabetes treatment, policymakers should implement appropriate interventions and strategies in the field of using mobile health to improve adherence to self-management of the disease.

Empowerment interventions designed for persons living with chronic disease - a systematic review and meta-analysis of the components and efficacy of format on patient-reported outcomes

BACKGROUND

Empowerment approaches are essential for building the capacity of individuals with chronic disease to be in control of their health. Reviews of empowerment interventions have been focused on specific chronic diseases, thereby limiting the scope of findings. This study had three aims: 1) to describe the characteristics of empowerment interventions covering a broad range of chronic diseases, 2) to clarify consistency with the World Health Organization`s (WHO) definition of empowerment as a process composed of four fundamental components and 3) to summarize outcome measures and estimate the effects in group and individual intervention formats.

METHODS

Systematic literature review and meta-analysis. CINAHL, Medline, Embase, PsycINFO, Web of Science, COCHRANE and Central Register of Controlled Trials were searched using Chronic Disease, NCD, Empowerment, as MeSH terms. Eligible randomized and quasi randomized controlled trials were included. Review Manager 5.4 was used to conduct the meta-analysis. Risk of bias was assessed with the Cochrane risk-of-bias tool (ROB 2).

RESULTS

Thirty-nine articles representing 8,011 participants were included in the review. A majority (82%) of studies reported robust evidence for changes on study-defined outcome measures in favor of interventions. Intervention content was assessed against WHO's four fundamental components of empowerment, showing that all studies incorporated one component, but none targeted all components. Components reflecting knowledge acquisition, patient engagement with their health care providers and facilitating environment were scarcely reported. Meta-analyses found evidence for positive effects of group-format interventions measuring empowerment, HbA1c, and self-efficacy. Effects on empowerment were also found in some individual-format interventions. High levels of heterogeneity and variability among the conceptual frameworks were identified.

CONCLUSION

Empowerment interventions in group-format were most efficient, however, considerable conceptual inconsistencies were identified. Future studies should consolidate conceptual understandings by using WHO's empowerment framework to ensure that fundamental components of empowerment are explicitly included in intervention design. Furthermore, there is a need to clarify the role of empowerment through pathways that include patient activation, self- management, and clinical outcomes. This systematic review will inform the clinicians and researchers who aim to develop novel empowerment interventions to assist patients in the process of gaining control of their health.

TRIAL REGISTRATION

PROSPERO: International Prospective register of systematic reviews ID=CRD42020178286.

Global prevalence of sexual dysfunction among diabetic patients from 2008 to 2022: Systematic review and meta-analysis

Background

Both men and women can have a wide range of physical, emotional, and sexual issues as a result of diabetes. One of them is sexual dysfunction, which has an effect on marital relationships as well as the effectiveness of therapy and can develop into a serious social and psychological condition. As a result, the purpose of this study was to identify the global prevalence of sexual dysfunction among diabetic patients.

Methods

Science Direct, Scopus, Google Scholar, and PubMed were all searched for information. Data were extracted using Microsoft Excel (v. 14), STATA statistical software, and STATA. Publication bias was investigated by a forest plot, rank test, and Egger's regression test. To detect heterogeneity, I² was calculated and an overall estimated analysis was performed. Subgroup analysis was done by study region and sample size. The pooled odds ratio was also computed.

Results

The study was able to include 15 of the 654 publications that were evaluated since they met the criteria. 67,040 people participated in the survey in all. The pooled global prevalence of sexual dysfunction among diabetic patients was 61.4% (95% CI: 51.80, 70.99), I2 = 71.6%. The frequency of sexual dysfunction was highest in the European region (66.05%). For males, the prevalence of sexual dysfunction was 65.91%, while for females, it was 58.81%. Patients with type 2 diabetes mellitus were more likely (71.03%) to experience sexual dysfunction.

Conclusion

Finally, sexual dysfunction was fairly common all across the world. There were variations in the prevalence of sexual dysfunction depending on the sex, type of diabetes, and location of the study participant. Our findings imply that screening and appropriate treatment are required for diabetes persons exhibiting sexual dysfunction.

Design, development, and usability evaluation of a smartphone-based application for nutrition management in patients with type II diabetes

Purpose

Information technology (IT)-based interventions, especially mobile health (mHealth), possess a great potential for promoting self-management in patients with chronic diseases, including diabetes type II. The present study was aimed to design and develop a smartphone-based application (app) for nutrition management in patients with type II diabetes and evaluation of its usability.

Methods

In this study, a three-phase research approach was followed; (1) To determine the information content and functionalities of the app, a five-point Likert scale checklist including six parts was developed based on reviews of clinical practice guidelines and specialized databases. The checklist was then given to ten experts in endocrinology and metabolism, internal medicine, and nutrition, and those items with a mean score higher than 3.75 were approved. (2) In Android Studio, the app was designed and developed using Java language. (3) The Questionnaire for User Interaction Satisfaction (QUIS) was used to assess the app's usability by 21 patients with type II diabetes, ten IT experts, and seven endocrinologists, internal medicine practitioners, and nutritionists over one month. Mean scores were divided into three levels: weak (0-3), average (3-6), and good (6-9).

Results

According to experts' view, 17 out of 22 educational content and 17 out of 27 functionalities were approved. The app's most important educational content was the timing of meals for insulin patients and the definition of diabetes and its complications. The designed app had the following functionalities: providing educational information, recording information, performing calculations, representing data graphically, setting reminders, and communicating with physicians. The most important features of the app were the insulin dose calculation, reminders for doctors' appointments, setting times for tests and blood glucose measurements, and also tracking weight, blood glucose levels, and blood pressure. In terms of usability evaluation, the app was rated "good" level by diabetic patients (7.83 ± 0.74), IT experts (8.1 ± 0.66), and physicians (8.03 ± 0.95).

Conclusion

Given the desirable evaluation of the app by patients, physicians, and IT experts, it can be concluded that the developed app has the required functionalities for nutrition management of patients with type II diabetes. Smartphone-based apps appear to be able to improve self-management, the quality of care and health in patients with diabetes, and reduce many of their unnecessary visits to healthcare centers, and costs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-022-01140-x.

The Effectiveness of Telemedicine Solutions for the Management of Type 2 Diabetes: A Systematic Review, Meta-Analysis, and Meta-Regression

BACKGROUND

Previous systematic reviews have aimed to clarify the effect of telemedicine on diabetes. However, such reviews often have a narrow focus, which calls for a more comprehensive systematic review within the field. Hence, the objective of the present systematic review, meta-analysis, and meta-regression is to evaluate the effectiveness of telemedicine solutions versus any comparator without the use of telemedicine on diabetes-related outcomes among adult patients with type 2 diabetes (T2D).

METHODS

This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We considered telemedicine randomized controlled trials (RCT) including adults (≥18 years) diagnosed with T2D. Change in glycated hemoglobin (HbA1c, %) was the primary outcome. PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials (CENTRAL) were searched on October 14, 2020. An overall treatment effect was estimated using a meta-analysis performed on the pool of included studies based on the mean difference (MD). The revised Cochrane risk-of-bias tool was applied and the certainty of evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

RESULTS

The final sample of papers included a total of 246, of which 168 had sufficient information to calculate the effect of HbA1c%. The results favored telemedicine, with an MD of -0.415% (95% confidence interval [CI] = -0.482% to -0.348%). The heterogeneity was great (I² = 93.05%). A monitoring component gave rise to the higher effects of telemedicine.

CONCLUSIONS

In conclusion, telemedicine may serve as a valuable supplement to usual care for patients with T2D. The inclusion of a telemonitoring component seems to increase the effect of telemedicine.

Defining an enabling environment for those with chronic disease: an integrative review

BACKGROUND

Health policies are currently being implemented to cope with the 37% of those affected by chronic disease and 63% of deaths worldwide. Among the proposals, there is accelerating support for greater autonomy for patients, which incorporates several concepts, including empowerment. To achieve this, develop an environment to increase an individual's capacity for action seems to be a fundamental step. The aim of this study is to characterize an enabling environment for patients in the context of chronic disease management.

METHODS

An integrative review design was applied. Medline, CINAHL, and Web of Science databases were searched to identify relevant literature published between 2009 and 2019. Overall, the review process was guided by the PRISMA 2020 checklist. The Mixed Methods Appraisal Tool for quality evaluation was used.

RESULTS

A total of 40 articles were analyzed, divided into 18 quantitative studies, 11 qualitative studies, two mixed studies, seven expert opinions, one theory and one conference report. The following characteristics defining an enabling environment were taken from the literature relating to those with a chronic condition: Needs assessment-adaptation of responses, supporting "take care", involvement in support, knowledge improvement, engagement with professionals, use of information and communication technologies, and organization of care. Beyond that, the interactions highlighted between these seven categories characterize an enabling environment.

CONCLUSION

This review specifies the essential elements of an enabling environment for patients with chronic conditions. It encompasses the partnership between the healthcare professional, such as the advanced practice nurse, and the individual for whom interventions and care strategies must be devised.

Health education interventions to promote health literacy in adults with selected non-communicable diseases living in low-to-middle income countries: A systematic review and meta-analysis

RATIONALE, AIMS AND OBJECTIVES

Health illiteracy is an important contributor to the burden of non-communicable diseases (NCDs); in particular in settings where health illiteracy is part of a perpetuating system of risk factors. Interventions that promote health literacy may provide an important tool in the primary and secondary prevention of NCDs. The objective of this systematic review was to evaluate the effectiveness of health literacy interventions on health literacy in the management of patients with selected NCDs living in low-to-middle income countries (LMIC).

METHODS

Seven electronic databases were searched (October 29, 2020) for RCTs aimed at improving health literacy in adults with NCDs in LMICs. Eligible NCDs included those pertaining to cancer, cardiovascular disease (CVD), chronic respiratory disease (CRD) or Diabetes. Studies were included that explicitly focussed on improving health literacy, and reported comprehensive measures of health literacy, or components thereof (ie, knowledge, attitude or behaviour). Random-effect meta-analyses were conducted for continuous outcome measures (Hedges-g).

RESULTS

The completed search yielded 2573 unique results of which 53 unique studies met the inclusion criteria. Studies included patients with cancer (n = 1, 2%), CRD (n = 8, 15%), CVD (n = 11, 21%) or Diabetes (n = 33, 62%). A significant (P < .01) summary effect was found for disease knowledge (SES = 1.27 [n = 23, 95%CI = 1.05-1.49]), attitude (SES = 1.17 [n = 20, 95%CI = 0.88-1.47]), and behaviour (SES = 1.20 [n = 31, 95%CI = 0.94-1.46]).

CONCLUSIONS

These results support the conclusion that there is compelling evidence, in particular, for patients with Diabetes, that health-literacy interventions are effective in promoting disease knowledge, attitude and behaviour across four chronic conditions that drive the burden of NCDs.

Smartphone-Based mHealth and Internet of Things for Diabetes Control and Self-Management

In patients with chronic diseases condition, mobile health monitoring facility proves to play a significant role in providing significant assistance toward personal management. This research examined the use of smartphones by diabetes patients and their intentions to apply them for self-care and monitoring as well as management. This cross-sectional survey-based study was conducted in Jul-Aug 2021 with 200 diabetic patients (especially type 2) who were visiting specialized clinics and hospitals of Gujrat state, India. A validated questionnaire survey was designed to collect data, which included questions about demographics, information pertaining to other, use of cellphones, the Internet, and the intention to implement smartphones for diabetes monitoring, self-care, and self-management. A highest number of studied participants have mobile phone (97.5%) and smartphones (87%) and access the Internet on daily basis (83.5%). Younger participants were more inclined to use smartphone apps and have also shown more interest for continuous use in the future (p < 0.01). The majority of participants used apps for nutritional planning (85.5%), to monitor glucose control (76.5%), and for scheduling of diabetes appointments on the calendar (90.5%). Recommendations to use mobile app by doctors or healthcare profession were reported by 20.5% of the participants and attitude and future intention to use mobile apps were reported by the majority of participants. The majority of type 2 diabetes patients choose to use their cellphones and the internet or mobile phone reminder system for medication as well as to plan their diets, monitor their blood sugar levels, and communicate with their doctors. The findings of this research can be used to develop strategies and implement mHealth-based therapies to assist patients with type 2 diabetes to efficiently manage their health and might contribute to reducing patients' out-of-pocket expenditure as well as reducing disability-adjusted life years (DAILY) attributed by DM.

Mobile-Based and Cloud-Based System for Self-management of People With Type 2 Diabetes: Development and Usability Evaluation

Background

As the use of smartphones and mobile apps is increasing, mobile health (mHealth) can be used as a cost-effective option to provide behavioral interventions aimed at educating and promoting self-management for chronic diseases such as diabetes. Although many mobile software apps have been developed for this purpose, they usually lack a theoretical foundation and do not follow the guidelines suggested for evidence-based practice. Therefore, this study aimed to develop a theory-based self-management app for people with type 2 diabetes and provide an app based on a needs assessment analysis.

Objective

This paper describes the development and usability evaluation of a cloud-based and mobile-based diabetes self-management app designed to help people with diabetes change their health behavior and also enable remote monitoring by health care providers.

Methods

The development of this mHealth solution comprises 3 phases. Phase I: feature extraction of the Android apps that had a user rating of 4 stars or more and review of papers related to mHealth for diabetes self-management were performed followed by seeking expert opinions about the extracted features to determine the essential features of the app. Phase II: design and implementation included selecting which behavioral change and structural theories were to be applied the app and design of the website. Phase III: evaluation of the usability and user experience of the mobile app by people with diabetes and the portal by health care providers using the User Experience Questionnaire.

Results

The developed mobile app includes modules that support several features. A person’s data were entered or collected and viewed in the form of graphs and tables. The theoretical foundation of behavioral intervention is the transtheoretical model. Users were able to receive customized messages based on the behavioral change preparation stage using the Kreuter algorithm. The clinician’s portal was used by health care providers to monitor the patients. The results of the usability evaluation revealed overall user satisfaction with the app.

Conclusions

Mobile- and cloud-based systems may be an effective tool for facilitating the modification of self-management of chronic care. The results of this study showed that the usability of mobile- and cloud-based systems can be satisfactory and promising. Given that the study used a behavioral model, assessment of the effectiveness of behavior change over time requires further research with long-term follow-up.

Do the patient education program and nurse-led telephone follow-up improve treatment adherence in hemodialysis patients? A randomized controlled trial

BACKGROUND

End-Stage Renal Disease (ESRD) is the final and permanent stage of Chronic Kidney Disease (CKD). Hemodialysis (HD) is the most common treatment for CKD. To have desirable therapeutic outcomes, patients have to adhere to a specific therapeutic regimen that reduces the hospitalization rate and side-effects of HD. The present study aimed to determine the effects of the patient education program and nurse-led telephone follow-up on adherence to the treatment in hemodialysis patients.

METHODS

This is a randomized controlled trial in which a total of 66 patients were recruited using convenience sampling and then randomly assigned to two groups of control (n = 33) and intervention (n = 33). Data were collected using a demographic questionnaire, the laboratory results record sheet, and the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), which included four dimensions of HD attendance, medication use, fluid restrictions, and diet recommendations. The intervention group received a patient education program and nurse-led follow-up services through telephone communication and the Short Message Service (SMS) for 3 months. All participants filled in the questionnaire before and after the intervention. Data were analyzed using IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, N.Y., USA).

RESULTS

The results showed a significant difference in the mean scores of HD attendance, medication use, fluid restrictions, and diet recommendations between the two groups immediately, 1 month, and 3 months after the intervention (p < .001). The results also indicated a significant difference in the mean scores of four dimensions during the four-time points of measurement in the intervention group (P < 0.0005). Therefore, the level of treatment adherence in the intervention group was higher than in the control group. Moreover, there was a significant difference in the mean score of laboratory values between the two groups after the intervention, except for the level of serum sodium (P = 0.130).

CONCLUSION

Implementation of the patient education program and nurse-led follow-up can lead to better adherence to hemodialysis in four dimensions of HD attendance, medication use, fluid restrictions, and dietary recommendations in HD patients.

TRIAL REGISTRATION

IRCT registration number: IRCT20190127042512N1 ; Registration date: 2020-09-12; Registration timing: retrospectively registered: Last update: 2020-09-12.

Effect of Empowerment Program with and without Telenursing on Self-efficacy and Glycosylated Hemoglobin Index of Patients with Type-2 Diabetes: A Randomized Clinical Trial

Introduction: Developing new training methods for improving the health of diabetic patients has always been a concern for nurses. The present study aims to investigate the effects of empowerment-based interventions with or without telenursing on self-efficacy and HbA1c level in diabetic patients.

Methods: In this randomized clinical trial, 156 patients with type-2 diabetes were randomly assigned into two intervention groups (empowerment with/without telenursing) and one control group. All subjects in the intervention groups participated in two sessions of the empowerment program. However, only the group of empowerment with telenursing received telephone counseling for 12 weeks. The patients in the control group did not receive any intervention programs. Self-efficacy was measured by diabetes-specific self-efficacy scale. The HbA1c level was measured using Bionic kit. Data were analyzed using SPSS Statistics for Windows, version 13.0 (SPSS Inc., Chicago, Ill., USA).

Results: After 14 weeks, while the changes in self-efficacy scores of the control group were not statistically significant, they were significant in the two intervention groups. Comparison of the two intervention groups showed that self-efficacy was higher in the group of empowerment with telenursing. It was only in the empowerment with telenursing group that the reduction of HbA1 c was significant.

Conclusion: Training based on empowerment models and emphasis on the strengths of clients in solving their own problems can play a major role in increasing self-efficacy and reduction of HbA1c level. In addition, a continuous training program, along with telephone follow-ups can result in higher self-efficacy and lower HbA1c level.

The effectiveness of a smartphone-based online peer group on type II diabetes mellitus patients self-empowerment in a primary healthcare center in Indonesia

Objective: Self-empowerment is an important factor that influences a person's ability to perform effective diabetes management. One effort that can be done to improve self-empowerment is by providing a smartphone-based online peer-group. This research determined the effect of smartphone-based online peer groups on type 2 diabetes mellitus (T2DM) patients self-empowerment in four primary healthcare centers in Indonesia. Methods: This quasi-experimental research was conducted in four healthcare centers in Indonesia. The total sample was 71 divided into two groups (control and intervention). The control group received standard education from the healthcare center, whereas the intervention group underwent an online peer-group. Self-empowerment was measured before and after intervention using the Diabetes Empowerment Scale-Short Form (DES-SF) questionnaire (Indonesian version). General Linear Model was used in statistical analysis. Results: The mean age of respondents was 56.4 ± 8.8 and 56.9 ± 7.1 years old, 59.5%, and 76.5% had good family support, and 70.3% and 50% of respondents had not received diabetes education for the control and intervention groups, respectively. The average pretest self-empowerment score was 27.03 ± 3.73 and 27.59 ± 3.53 (diff. 0.56; 95%CI -1.16; 2.29), and the post-test score was 27.43 ± 4.13 and 32.76 ± 4.38 (diff. 5.33; 95%CI 3.32; 7.35) for the control and intervention groups, respectively. Online peer-group improve self-empowerment significantly in the intervention group. Conclusion: Smartphone-based online peer-group can improve self-empowerment in patients with T2DM.

Mobile phone usage in patients with type II diabetes and their intention to use it for self-management: a cross-sectional study in Iran

BACKGROUND

Mobile health has potential for promotion of self-management in patients with chronic diseases. This study was conducted to investigate smartphone usage in patients with type II diabetes and their intention to use it for self-management.

METHODS

This cross-sectional study was conducted in 2018 with 176 patients with type II diabetes visiting a specialized diabetes clinic or one of two endocrinology and metabolism specialists in north of Iran. Data were collected using a validated questionnaire containing items on demographic characteristics, disease information, use of mobile phones, smartphones and the internet, and intention to use mobile phones for diabetes self-management.

RESULTS

The majority of the participants had mobile phones (94.9%), smartphones (61.1%), and daily access to the internet (81.3%), and used phones two hours per day on average (80.1%). They mostly used mobile phones to contact friends (89.2%) and search for information (50.6%), and their greatest intention for using smartphones and the internet for self-management was related to dietary planning (96%), checking blood glucose (90.9%), and contacting specialists (87.5%). Younger participants were more interested in using smartphone applications (apps) (P < 0.001). About half of the participants argued that using apps can be interesting (54%) and useful (50%) for diabetes management, and intended to use apps much more in future (48.3%).

CONCLUSIONS

The majority of patients with type II diabetes are inclined to use mobile phone and the Internet, especially to plan their diet, check blood glucose, and contact their doctors. The present study provides valuable information for designing and implementing interventions based on mHealth to promote self-management in type II diabetes.

DM-calendar app as a diabetes self-management education on adult type 2 diabetes mellitus: a randomized controlled trial

Purpose

Era Disruption 4.0 demands development in the management of Diabetes Mellitus (DM) by using application-based intervention that can facilitate nursing intervention. The aim was to evaluate the effect of diabetes mellitus calendar app as a Diabetes Self-Management Education (DSME) program on self-efficacy, HbA1c levels, lipid profile, and insulin in adult type 2 diabetes mellitus (T2DM).

Methods

It was randomized experimental design - simple random sampling used with a total sample of 30 respondents. The instruments used diabetes management self-efficacy scales and standard of operational procedure blood sampling. The statistical tests used were a Paired t-test, Wilcoxon, and an Independent t-test.

Results

DSME with an Android-based DM calendar affected self-efficacy (p < 0.001), HbA1c levels (p = 0.005), cholesterol (p = 0.009), triglyceride (p = 0.000), HDL-c (p = 0.048), LDL-c (p = 0.010), and insulin (p = 0.000) compared with the control group. Education with these electronic media has increased the perception of self-efficacy and improved the behavior of good self-management that can be seen from changes in controlled HbA1c level, lipid profile and insulin.

Conclusion

The results of this study can be used as a reference for providing educational experimental in patients with Type 2 Diabetes Mellitus (T2DM).

Comparison of In-Person and MMS -Based Education in Telegram on Self-care and Fasting Blood Sugar of Patients with Diabetes Mellitus: A Randomized Clinical Trials

Introduction: Diabetes is a disease whose control requires effective self-care and patient education. Multimedia Messaging Service-based (MMS) education is one of the new methods for education. The purpose of this study was to investigate the effect of two types of in-person and MMS-based education in the Telegram application on self-care and weekly fasting blood sugar levels in patients with insulin-dependent diabetes.

Methods: In this clinical trial, a sample of 66 patients with diabetes who referred to the Sina hospital in Tabriz, were randomly assigned into two groups: in person and MMSM-based education. Data gathering tools included a demographic form, Toobert’s self-care activities questionnaire (as primary outcome), and a checklist to record fasting blood sugar weekly measured by a glucometer. Data were analyzed using independent and paired sample t-tests, chi-square, and repeated measures ANOVA.

Results: After the education the mean scores of self-care in terms of diet, exercise, foot care, and blood sugar testing activity significantly increased in both groups and results of ANCOVA of the scores for all dimensions revealed no significant difference between two groups. Reduction in the fasting weekly blood sugar levels over a 12-week period were statistically significant in both groups. But there was no significant difference between the two groups.

Conclusion: MMS-based education same as in-person, improves self-care in patients with diabetes. Given the disadvantages of in-person education, this new educational strategy can be used to facilitate the patient education process and improve its quality.

Evaluation of sexual dysfunction and female sexual dysfunction indicators in women with type 2 diabetes: a systematic review and meta-analysis

Type 2 diabetes is one of the most common chronic diseases worldwide, and one of the long-term complications of this disease is sexual dysfunction in women with type 2 diabetes, which has been studied in fewer studies. The aim of this study is to determine the overall prevalence of sexual dysfunction in women with type 2 diabetes and its indicators with systematic and meta-analysis approach. The present meta-analysis study reviewed articles published foreign journals by searching the MEDLINE, Cochrane Library, Science direct, Embase, Proquest and Persian databases, including Iranmedex, Magiran, and SID between January 2000 to December 2018. The heterogeneity of studies was studied using the I2 index and data analysis was carried out in Comprehensive Meta-Analysis software. The Meta-analysis review of 25 studies and 3892 individuals aged 70-18 years showed that the overall prevalence of sexual dysfunction in women with type 2 diabetes was 68.6% (95% CI 61.1-75.3%). The highest and lowest prevalence of sexual dysfunction was 94.4% in Iranian women with type 2 diabetes (95% CI 91.9%-96.3%) in 2014 and 17% in Italian women with diabetes Type 2 (95% CI 6.4-36.9%) in 2015. Results of meta-regression showed that with the increase in sample size and year of study, the overall prevalence of sexual dysfunction decreased and increased, respectively and the differences were statistically significant (P < 0.05). Regarding the high prevalence of sexual dysfunction in women with type 2 diabetes, health policymakers need to take appropriate measures to address this disorder in patients with type 2 diabetes.

Effects of Face-To-Face and Online Training on Self-Care of Middle-Aged and Elderly People with Type 2 Diabetes: A Comparative Study

BACKGROUND:

Self-care training is one of the strategies used to control diabetes. There is some ambiguity about the appropriate method for educating middle-aged and older adults about self-care.

AIM:

This study aimed to compare the effects of face-to-face and online training on self-care levels in middle-aged and older adults with type 2 diabetes.

MATERIAL AND METHODS:

In a randomised clinical trial, 84 middle-aged and older adults with type 2 diabetes who had been referred to the Diabetes Clinic of Esfarayen in Iran, were evaluated. Patients who meet the inclusion criteria were randomly assigned into two groups. Diabetes self-care education (DSCE) was provided using a face-to-face training method in one group and using online training method in the other group. The summary of diabetes self-care activities (SDSCA) questionnaire was completed at baseline and 1 month after training.

RESULTS:

The mean and standard deviation of self-care scores before and 1 month after training were 43.16 ± 14.94 and 65.76 ± 10.65 in the face-to-face training group, and 37 ± 10.75 and 56.82 ± 12.06 in the online training group, respectively. The differences in the self-care scores were significant both before and after the intervention in the two groups (p < 0.05). Although the difference was greater in the face-to-face training group than in the online training group, it was not statistically significant (P > 0.05).

CONCLUSION:

Both face-to-face and online training had a similar effect on the self-care levels in middle-aged and older adults with type 2 diabetes. Therefore, both training methods could be used as effective techniques to meet the needs and educational requirements of middle-aged and older adults with type 2 diabetes.