Barriers and facilitators to diabetes self-management in a primary care setting - Patient perspectives

Effectiveness of a pharmacist-led, community group-based education programme in enhancing diabetes management: A multicentre randomised control trial

Aims

This study presents a protocol for the Pharmacy Integrated Community Care (PICC) program, meticulously designed to enhance Hemoglobin A1c (HbA1c) levels and augment knowledge about diabetes mellitus (DM) among individuals diagnosed with Type 2 Diabetes Mellitus (T2DM) in the Sarawak State of Malaysia.

Methods

From 1 May to December 31, 2023, a prospective, multicenter, parallel-design randomised controlled trial will be conducted with two groups, each consisting of 47 participants. The intervention group will receive a structured, four-session group-based program guided by experienced pharmacists, focusing on medication adherence and diabetes management. The control group will follow the standard Diabetes Mellitus Adherence Clinic program. The primary outcomes of this study encompass enhancements in knowledge regarding diabetes medication management and adherence, followed by subsequent changes in HbA1c levels.

Conclusions

The successful implementation of the PICC program holds promise for enhancing health outcomes in the T2DM population, potentially leading to more effective diabetes management initiatives and better health practices in the community.

Trial registration clinicaltrialsgov identifier

NCT05106231.

Type 2 diabetes

Type 2 diabetes accounts for nearly 90% of the approximately 537 million cases of diabetes worldwide. The number affected is increasing rapidly with alarming trends in children and young adults (up to age 40 years). Early detection and proactive management are crucial for prevention and mitigation of microvascular and macrovascular complications and mortality burden. Access to novel therapies improves person-centred outcomes beyond glycaemic control. Precision medicine, including multiomics and pharmacogenomics, hold promise to enhance understanding of disease heterogeneity, leading to targeted therapies. Technology might improve outcomes, but its potential is yet to be realised. Despite advances, substantial barriers to changing the course of the epidemic remain. This Seminar offers a clinically focused review of the recent developments in type 2 diabetes care including controversies and future directions.

Counting, Coping, and Navigating the Flux: A Focused Ethnographic Study of HIV and Diabetes Self-Management

Approximately 10-15% of people living with HIV are also diagnosed with diabetes. To manage their two chronic conditions, people must undertake certain activities and adopt behaviors. Due to overlapping symptoms, complex medication regimens, and heavy patient workloads, implementing these self-management practices can be difficult. In this focused ethnography, data were collected from semi-structured interviews and limited participant-observation with a selected subset of participants to gain insight into self-management challenges and facilitators. We conducted interviews and multiple observations with 22 participants with HIV+T2DM over the period of 9 months. Participants experienced numerous barriers to self-management in the areas of diet, medication adherence, and mental health. Social and familial support, as well as consistent access to care, were facilitators for optimal self-management. At the same time participants' lives were in a unique flux shaped by the dual diagnoses, and therefore, required constant mental and physical adjustments, thus illustrating challenges of managing chronicity.

Factors affecting the health status of patients with type 2 diabetes mellitus receiving insulin treatments: A multi-mediation path analysis: Influences on insulin-treated diabetes

AIMS AND OBJECTIVES

To validate a hypothetical path model estimating the health status of patients with insulin-treated type 2 diabetes and to verify the mediating effects of diabetes management self-efficacy, diabetes self-management behaviour and haemoglobin A1c using a multi-mediation model.

BACKGROUND

Diabetes knowledge, personal and social motivations, diabetes management self-efficacy and health behaviours may be interrelated and may directly or indirectly affect the objective and subjective health outcomes of patients with type 2 diabetes mellitus receiving insulin treatments.

DESIGN

Model testing correlational design.

METHODS

The participants were 193 outpatients with insulin-treated type 2 diabetes. Data were collected between July and November 2019. The collected data were analysed using SPSS version 25.0^® and AMOS 23.0. This study is based on STROBE guidelines.

RESULTS

The model's fit indices were adequate. Diabetes-related knowledge, psychological insulin resistance, family support for diabetes management, diabetes self-care activities and haemoglobin A1c had significant direct effects on subjective health status. Diabetes management self-efficacy had significant indirect effects on subjective health status via diabetes self-care activities and haemoglobin A1c, and mediated the path through which diabetes knowledge, psychological insulin resistance and family support for diabetes management indirectly affect subjective health status. These variables explained 55.0% of the total variance of subjective health status.

CONCLUSION

Diabetes knowledge, psychological insulin resistance, diabetes management family support, diabetes management self-efficacy and diabetes self-care activities were found to be related to the subjective and objective health status.

RELEVANCE TO CLINICAL PRACTICE

The findings can help health professionals improve diabetes self-care activities and haemoglobin A1c, which will influence subjective health status in patients with type 2 diabetes mellitus, receiving insulin treatments.

Glycemic Variability, Oxidative Stress, and Impact on Complications Related to Type 2 Diabetes Mellitus

Chronic hyperglycemia is an established risk factor for the development of complications in both type 1 and type 2 diabetes, but glycemic variability has emerged as a possible independent risk factor for diabetes complications, possibly through oxidative stress. In this review, methods to access glycemic variability and oxidative stress, as well as their correlations, are discussed. Non-pharmacological and pharmacological strategies are also debated to achieve better glycemic control, not only by HbA1c target but also with reduced glycemic fluctuations, possibly minimizing the risk of diabetes complications.

Predictive analytics for blood glucose concentration: an empirical study using the tree-based ensemble approach

Purpose

The primary objective of this study was to recognize critical indicators in predicting blood glucose (BG) through data-driven methods and to compare the prediction performance of four tree-based ensemble models, i.e. bagging with tree regressors (bagging-decision tree [Bagging-DT]), AdaBoost with tree regressors (Adaboost-DT), random forest (RF) and gradient boosting decision tree (GBDT).

Design/methodology/approach

This study proposed a majority voting feature selection method by combining lasso regression with the Akaike information criterion (AIC) (LR-AIC), lasso regression with the Bayesian information criterion (BIC) (LR-BIC) and RF to select indicators with excellent predictive performance from initial 38 indicators in 5,642 samples. The selected features were deployed to build the tree-based ensemble models. The 10-fold cross-validation (CV) method was used to evaluate the performance of each ensemble model.

Findings

The results of feature selection indicated that age, corpuscular hemoglobin concentration (CHC), red blood cell volume distribution width (RBCVDW), red blood cell volume and leucocyte count are five most important clinical/physical indicators in BG prediction. Furthermore, this study also found that the GBDT ensemble model combined with the proposed majority voting feature selection method is better than other three models with respect to prediction performance and stability.

Practical implications

This study proposed a novel BG prediction framework for better predictive analytics in health care.

Social implications

This study incorporated medical background and machine learning technology to reduce diabetes morbidity and formulate precise medical schemes.

Originality/value

The majority voting feature selection method combined with the GBDT ensemble model provides an effective decision-making tool for predicting BG and detecting diabetes risk in advance.

Readiness for weight change and its association with diet knowledge and skills, diet decision making and diet and exercise barriers in patients with type 2 diabetes

AIMS

this study aimed to investigate stages of weight change in type 2 diabetics and its associations with diet knowledge and skills, diet decision making, diet and exercise barriers.

MATERIALS AND METHODS

This was a cross-sectional study of 1139 patients with type 2 diabetes aged>18 years in East Azerbaijan, Iran. Data were collected using the Personal Diabetes Questionnaire (PDQ) and were analyzed using SPSS software (version 22) and descriptive statistics, Chi-square and one-way ANOVA tests.

RESULTS

48.1% of the patients were in the pre-contemplation stage. 7.5%, 14.6% and 29.8% of patients were in the stages of contemplation, preparation and action, respectively. Patients with a higher score in diet knowledge and skills and diet decision making were more likely to be involved in the action stage of weight loss process, while those who had more eating problems and exercise barriers were less likely to be involved in the action stage of weight loss.

CONCLUSION

The results of this study showed that a substantial percentage of patients are at the pre-contemplation stage, so proper measures are needed to inform patients about the consequences of obesity and overweight. It is also necessary to focus on people with poor incomes and education status and those living in rural areas. Improve diet knowledge and skills and diet decision making and the reduction of barriers to exercise can help patients to take action to lose weight.

Readiness for diet change and its association with diet knowledge and skills, diet decision making and diet barriers in type 2 diabetic patients

AIMS

to investigate stages of change for dietary in type 2 diabetics and its associations with diet knowledge and skills, diet decision making and diet barriers.

MATERIALS AND METHODS

This was a cross-sectional study which was conducted on 1139 diabetics aged>18 years in East Azerbaijan, Iran. Data were collected through a Personal Diabetes Questionnaire (PDQ) and analyzed through SPSS version 22 software using descriptive statistics, Chi-square and one-way ANOVA tests. Tukey's HSD post hoc tests were applied to illustrate ANOVA findings.

RESULTS

59.3% of patients do not follow a diet plan to control their blood glucose. 44.7%, 5.5%, 13%, and 36.8% of patients, respectively, were in the stages of pre-contemplation, contemplation, preparation and action. Patients who had shorter disease duration and those whose current treatment was lifestyle change were more likely within the action stage. Also, patients who had a higher score in diet knowledge and skills and diet decision making and those who had a lower score in diet barriers were more likely in the action stage of change.

CONCLUSION

Based on the results of this study, a considerable proportion of diabetic patients were in the pre-contemplation stage. Diet knowledge and skills, diet decision making and diet barriers were factors contributing to diet readiness to change. Therefore, taking necessary measures to increase diet knowledge, skills and diet decision-making and a reduction in diet barriers can help people with type 2 diabetes to change diet.

Pilot and Feasibility of Combining a Medication Adherence Intervention and Group Diabetes Education for Patients with Type-2 Diabetes

Introduction: Controlling diabetes typically requires self-management and medications. Community pharmacists are positioned to support patients with both. Methods: This study assessed the feasibility and potential benefit of combining pharmacist-provided group diabetes education (up to eight sessions) and medication synchronization using a three-group design. Data were collected using pre-post paper surveys and electronic health record data. One group received both education and synchronization services, another group received medication synchronization only, and a third served as control. Results: Of 300 contacted patients, eighteen patients participated in group diabetes education, 14 had medication synchronization only, and 12 comprised a control group. There was little change in HbA1c over the study period. Medication adherence appeared to be positively aided by medication synchronization, although all groups started with high adherence. Some medication beliefs and self-care activities may have been positively impacted by group diabetes education. Both groups receiving medication synchronization were satisfied. Conclusions: Participants strongly agreed they would recommend group diabetes education from the study pharmacy to a friend and were satisfied with medication synchronization; however, it was difficult to tell if there was a synergistic effect by combining the two services. Reimbursement for diabetes education was not obtained despite multiple attempts, hindering sustainability.