The impact of formal diabetes education on the preventive health practices and behaviors of persons with type 2 diabetes

Paper-Based Screen-Printed Ionic-Liquid/Graphene Electrode Integrated with Prussian Blue/MXene Nanocomposites Enabled Electrochemical Detection for Glucose Sensing

As glucose biosensors play an important role in glycemic control, which can prevent the diabetic complications, the development of a glucose sensing platform is still in needed. Herein, the first proposal on the in-house fabricated paper-based screen-printed ionic liquid/graphene electrode (SPIL-GE) modified with MXene (Ti₃C₂T_x), prussian blue (PB), glucose oxidase (GOx), and Nafion is reported. The concentration of PB/Ti₃C₂T_x was optimized and the optimal detection potential of PB/Ti₃C₂T_x/GOx/Nafion/SPIL-GE is -0.05 V. The performance of PB/Ti₃C₂T_x/GOx/Nafion modified SPIL-GE was characterized by cyclic voltammetry and chronoamperometry technique. This paper-based platform integrated with nanomaterial composites were realized for glucose in the range of 0.0-15.0 mM with the correlation coefficient R² = 0.9937. The limit of detection method and limit of quantification were 24.5 μM and 81.7 μM, respectively. In the method comparison, this PB/Ti₃C₂T_x/GOx/Nafion/SPIL-GE exhibits a good correlation with the reference hexokinase method. This novel glucose sensing platform can potentially be used for the good practice to enhance the sensitivity and open the opportunity to develop paper-based electroanalytical devices.

‘Analogy-Based Comprehensive Diabetes Education’ (ABCDE) Improves Glycemic Control of Diabetic Patients in an Underserved Population: Results of a Retrospective Chart Analysis

Diabetes is the leading global cause for blindness, kidney failure and amputations. Preventing these complications requires optimal glycemic control, and it is imperative that diabetic patients understand the fundamental concepts of diabetes care. Although patients attend formal diabetes education classes, many do not comprehend basic concepts of diabetes, and are often noncompliant with diet, exercise and medications. A novel approach termed ‘analogy-based comprehensive diabetes education’ (ABCDE) was developed to educate HIV-patients with diabetes about basic concepts of diabetes care. The object of this manuscript is to report the results of a retrospective chart review on the impact of ABCDE on glycemic outcomes in 24 patients who had failed usual care (including formal diabetes education, physician visits, and diabetic medications), and were non-adherent with diet and medications. They received only the ABCDE without any changes in pharmacotherapy. The impact on glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG) was assessed at subsequent visits. HbA1c was found to decline by 22% and 33% after 3 and 6 months, respectively, with corresponding declines in FBG by 53% and 59%, respectively. These results suggest that ABCDE in outpatient diabetes clinics could be effective in behavior modification toward improving glycemic control, and warrants additional investigation.

Acceptance rate of influenza vaccination among patients with type II diabetes

Background:

Methodology:

Results:

Conclusion:

The Association of Family Support and Health Education with the Status of Overweight and Obesity in Patients with Type 2 Diabetes Receiving Outpatient Treatment: Evidence from a Hospital in Vietnam

This study aims to establish the association of family support and nutrition and health education by health workers with the status of overweight and obesity among patients with type 2 diabetes mellitus (T2DM) receiving outpatient treatment at a hospital. This descriptive cross-sectional study was conducted on 280 outpatients with type 2 diabetes at Bach Mai hospital from December 2019 to September 2020 by using assessments of anthropometric parameters and examining dietary habits and family support, as well as nutrition and health education and counseling by health workers. The prevalence of overweight and obesity in patients with T2DM was 35.4% (51.2% in men and 22.2% in women; P < .05). Patients never or rarely supported by their families or counseled by health workers were more vulnerable to overweight and obesity than those who frequently received support and counseling (OR = 1.41 vs 2.06; P < .05). Family support and counseling from health workers play a crucial role in promoting and sustaining healthy dietary habits and proper physical exercise in diabetic patients, contributing to their lowered risk of overweight and obesity.

Understanding information behavior of diabetic patients: a case of the diabetic's institute Pakistan

Purpose

Pakistan is a developing country where one of the rapidly growing diseases is diabetes. Well-informed diabetic patients are expected to improve the quality of life, self-care behaviors and better cooperation with the health care team. The present study is designed to investigate the information behavior of diabetic patients, and to investigate the role of one institution that is working for diabetes management, treatment, education and counseling in Pakistan i.e. Diabetic's Institute Pakistan (DIP).

Design/methodology/approach

The “Embedded Design” based on the mixed methods research approach was adopted to carry out the current research. The study was mainly based on quantitative research design, quantitative data were collected through an adapted questionnaire, the supportive/supplementary qualitative data was collected through an in-depth interview of the medical director, observation record sheets and analysis of the available relevant documents i.e. prescription (prescription notepad with information), brochure and the website was applied.

Findings

Diabetic patients want to know about how to control diabetes and mostly rely on humans particularly health professionals and interpersonal networks. The use of books, journals, seminars, libraries is comparatively low. It is an important finding that health-related information is mostly required in national language by Pakistani patients. Lack of computer literacy and information overload were among the barriers that were reported by diabetic patients.

Practical implications

Health information seeking channels, formats and language preferences should be considered to design patients' cantered information services. Health information service providers i.e. government, health practitioners, health-related institutions and libraries should work in a liaison for creating health awareness. Identified barriers faced by diabetic patients are important to consider for designing health-related information services.

Originality/value

Investigating health information behavior is crucial particularly of the patients from developing countries. The study is first of its kind that is reported from Pakistan. The results of the study may help libraries, health professionals and diabetes-related organizations to design patient's centered policies and information-based services. These institutions may work together to create awareness and to help patients in managing their disease. The study findings are maybe helpful for other developing countries also.

Determinants of Awareness on Diabetes and its Complications

INTRODUCTION

Diabetes mellitus is a chronic disease that requires continuous medical care. Raising awareness and determining the factors affecting awareness about diabetes and its complications have an important role in achieving glycemic control and preventing complications.

OBJECTIVE

In this study, we aimed to determine the sociodemographic properties of participants, the status of patients' awareness, and the factors affecting awareness. We also aimed to determine the relationships between these factors and diabetes regulation.

MATERIALS AND METHODS

A total of 404 patients with diabetes who had presented to Istanbul Okmeydanı Research and Training Hospital, Internal Medicine and Diabetes Outpatient Clinic were included in the study. They were requested to fill in a questionnaire about diabetes awareness. Data about their survey results, sociodemographic facts, glycemic control, treatment methods, and complications were analyzed.

RESULTS

61.6% of the participants were female and 38.4% were male. Mean age was 54.5±11.4 years. 55.2% of patients were graduated from primary school and 22.8% had no education. Mean HbA1c value of the participants was 8%±1.9%. The mean score of the questionnaire, consisting of 23 questions, was 16.1±3.6. The ratio of patients who replied to 50% or more of the survey was 90.3%. The knowledge score was found to be positively correlated with education and income level, negatively correlated with age. There was no significant relationship between awareness and glycemic control (p>0.05).

CONCLUSION

Most of the participants had an adequate level of awareness on diabetes and its complications. However, the study showed that better awareness was not associated with regulation of the disease. It was observed that not only raising awareness but also methods for implementing knowledge to daily life are needed.

Etiology of Above-knee Amputations in the United States: Is Periprosthetic Joint Infection an Emerging Cause?

BACKGROUND

Above-knee amputation (AKA) is a morbid procedure and is performed for a number of conditions. Although AKA is usually performed for dysvascular disease, trauma, and malignancy, AKA is also considered in patients who have failed multiple salvage attempts at treating periprosthetic joint infection (PJI) of TKA. Although aggressive measures are being taken to treat PJI, the huge volume of TKAs might result in a large number of AKAs being performed for PJI in the United States. However, the national trends in the incidence of AKAs from different etiologies and the relative contribution of different etiologies to AKA are yet to be studied.

QUESTIONS/PURPOSES

(1) What are the temporal trends in the incidence of AKAs (from all causes) in the US population from 1998 to 2013? (2) What are the temporal trends in the incidence of AKAs by etiology (dysvascular disease, trauma, malignancy, and PJI)? (3) What are the temporal trends in the relative contribution of different etiologies to AKA?

METHODS

Using the Nationwide Inpatient Sample (NIS) from 1998 to 2013, AKAs were identified using International Classification of Diseases, 9 Revision (ICD-9) procedure code 84.17. The NIS database is the largest all-payer database in the United States containing information on approximately 20% of all the hospital admissions in the country. As a result of its sampling design, it allows for estimation of procedural volumes at the national level. All AKAs were grouped into one of the following five etiologies in a sequential manner using ICD-9 diagnosis codes: malignancy, PJI, trauma, dysvascular disease (peripheral vascular disease, diabetic, or a combination), and others. All of the numbers were converted to national estimates using sampling weights provided by the NIS, and the national incidence of AKAs resulting from various etiologies was calculated using the US population as the denominator. Poisson and linear regression analyses were used to analyze the annual trends.

RESULTS

From 1998 to 2013, the incidence of AKAs decreased by 47% from 174 to 92 AKAs per 1 million adults (incidence rate ratio [IRR]; change in the number of AKAs per 1 million adults per year; 0.96; 95% confidence interval [CI], 0.96-0.96; p < 0.001). The incidence of AKAs resulting from PJI increased by 263% (IRR, 1.07; 95% CI, 1.06-1.07; p < 0.001). An increase was also observed for AKAs from malignancy (IRR, 1.01; 95% CI, 1.00-1.02; p = 0.007), although to a smaller extent. AKAs from dysvascular causes (IRR, 0.96; 95% CI, 0.95-0.96; p < 0.001) and other etiologies (IRR, 0.97; 95% CI, 0.96-0.97; p < 0.001) decreased. There was no change in the incidence of AKAs related to trauma (IRR, 1.00; 95% CI, 0.99-1.00; p = 0.088). The proportion of AKAs resulting from PJI increased by 589% from 1998 to 2013 (coefficient = 0.18; 95% CI, 0.15-0.22; p < 0.001). The proportion of AKAs resulting from dysvascular causes decreased (coefficient = 0.18; 95% CI, 0.15-0.22; p < 0.001), whereas that resulting from malignancy (coefficient = 0.04; 95% CI, 0.03-0.05; p < 0.001) and trauma (coefficient = 0.13; 95% CI, 0.09-0.18; p < 0.001) increased.

CONCLUSIONS

The incidence of AKAs has decreased in the United States. AKAs related to dysvascular disease and other etiologies such as trauma and malignancy have either substantially decreased or remained fairly constant, whereas that resulting from PJI more than tripled. Given the increased resource utilization associated with limb loss, the results of this study suggest that national efforts to reduce disability should prioritize PJI. Further studies are required to evaluate the risk factors for AKA from PJI and to formulate better strategies to manage PJI.

LEVEL OF EVIDENCE

Level III, therapeutic study.

Participation in a Diabetes Self-Management Class Among Adults With Diabetes, New Jersey 2013-2015

Identifying patient groups with low participation in diabetes self-management education can inform efforts to improve its use. Data from the 2013–2015 Behavioral Risk Factor Surveillance System were used to assess variation in participation in a diabetes self-management class in New Jersey. Nonparticipation varied significantly by race/ethnicity (P < .001), education (P < .001), health care coverage (P = .04), county (P < .001), years since diagnosis (P < .001), and whether a diabetes provider visit occurred in the past year (P = .002). Attention is warranted in identifying participation barriers among patients who live in certain counties, have less education, are without health care coverage, have been diagnosed with diabetes more recently, visit a provider less often, or belong to certain racial/ethnic minority groups.

A Retrospective Cross-sectional Analysis of Health Education Disparities in Patients With Diabetes Using Data From the National Ambulatory Medical Care Survey

Purpose

The purpose of this study was to determine if there was an association between receipt of diet/nutrition, exercise, and weight loss education in adult patients with a primary diagnosis of diabetes with various demographic and socioeconomic variables using data from the National Ambulatory Medical Care Survey (NAMCS) for the years 2008 to 2011.

Methods

This retrospective, cross-sectional, observational study design included patients ≥ 18 years of age with diabetes in the NAMCS between 2008 and 2011, inclusive. A series of weighted multivariable logistic regression models was constructed to evaluate predictors of diet/nutrition, exercise, and weight loss education. Odds ratios and 95% confidence intervals were reported.

Results

Among patients included in this study (n = 3027), 35.6% received diet/nutrition education, 21.8% received exercise education, and 13.6% received weight loss education. From the multivariable analyses, visits using “other” payment type, visits with Medicaid, and visits occurring in non-Metropolitan Statistical Areas were significantly less likely to receive diet/nutrition education; visits using other payment type, visits in non-Metropolitan Statistical Areas, and visits by those ≥ 65 and 45-64 years of age were significantly less likely to receive exercise education. No significant disparities in the receipt of weight loss education were found.

Conclusion

These findings indicate that although only approximately one third or fewer patients diagnosed with diabetes were receiving diet/nutrition, exercise, or weight loss education, there appeared to be limited disparities among the groups studied. Education rates appear to be trending upward over time, to be slightly improved as compared with previous studies, and to include fewer disparities.

Improving Diabetes Knowledge and Self-Care Practices

BACKGROUND

This study sought to identify the nature and extent of diabetes-related knowledge and self-care practices in people living with type 2 diabetes who attend primary-care clinics and to determine whether a correlation between the two exists.

METHODS

In a nonexperimental prospective study, the Diabetes Knowledge Questionnaire and the Summary of Diabetes Self-care Activities were used to assess knowledge and self-management in 50 patients.

RESULTS

The mean diabetes knowledge score was 14.40 out of a total of 24 and the mean self-care activities score was 2.89 out of a total of 7, indicating a deficit in a number of key areas in the management of diabetes. There was no statistically significant correlation between diabetes knowledge score and diabetes self-care activities (r = 0.190, P = 0.187). On analysis of the individual subscales, a significant relationship resulted between diabetes knowledge score and diet (r = 0.324, P = 0.022) but physical activity (r = 0.179, P = 0.214), blood sugar testing (r = 0.231, P = 0.107) and footcare (r = 0.189, P = 0.189) gave no significant results. On further analysis, education level was significantly correlated to diabetes knowledge score (r = 0.374, P = 0.007) and self-care activities score (r = 0.317, P = 0.025) while age was significantly correlated to diabetes knowledge score (P = 0.008) and self-care activities score (P = 0.035).

CONCLUSIONS

Integrating theories of behavior change into educational interventions at the primary-care level may translate to improved care, reduced long-term complications, and better quality of life.

Picture Good Health: A Church-Based Self-Management Intervention Among Latino Adults with Diabetes

BACKGROUND

Churches may provide a familiar and accessible setting for chronic disease self-management education and social support for Latinos with diabetes.

OBJECTIVE

We assessed the impact of a multi-faceted church-based diabetes self-management intervention on diabetes outcomes among Latino adults.

DESIGN

This was a community-based, randomized controlled, pilot study.

SUBJECTS

One-hundred adults with self-reported diabetes from a Midwestern, urban, low-income Mexican-American neighborhood were included in the study.

INTERVENTIONS

Intervention participants were enrolled in a church-based diabetes self-management program that included eight weekly group classes led by trained lay leaders. Enhanced usual care participants attended one 90-minute lecture on diabetes self-management at a local church.

OUTCOME MEASURES

The primary outcome was change in glycosylated hemoglobin (A1C). Secondary outcomes included changes in low-density lipoproteins (LDL), blood pressure, weight, and diabetes self-care practices.

KEY RESULTS

Participants' mean age was 54 ± 12 years, 81 % were female, 98 % were Latino, and 51 % were uninsured. At 3 months, study participants in both arms decreased their A1C from baseline (-0.32 %, 95 % confidence interval [CI]: -0.62, -0.02 %). The difference in change in A1C, LDL, blood pressure and weight from baseline to 3-month and 6-month follow-up was not statistically significant between the intervention and enhanced usual care groups. Intervention participants reported fewer days of consuming high fat foods in the previous week (-1.34, 95 % CI: -2.22, -0.46) and more days of participating in exercise (1.58, 95 % CI: 0.24, 2.92) compared to enhanced usual care from baseline to 6 months.

CONCLUSIONS

A pilot church-based diabetes self-management intervention did not reduce A1C, but resulted in decreased high fat food consumption and increased participation in exercise among low-income Latino adults with diabetes. Future church-based interventions may need to strengthen linkages to the healthcare system and provide continued support to participants to impact clinical outcomes.

Care Utilization Patterns and Diabetes Self-Management Education Duration

Objective. Previous studies have shown that receiving diabetes self-management education (DSME) is associated with increased care utilization. However, the relationship between DSME duration and care utilization patterns remains largely unexamined. Our purpose is to characterize DSME duration and examine the relationship between DSME duration and clinical- and self-care utilization patterns. Methods. The study sample included 1,446 adults who were ≥18 years of age, had diabetes, and had participated in the 2008 Florida Behavioral Risk Factor Surveillance System survey. Clinical- and self-care outcomes were derived using responses to the survey's diabetes module and were based on minimum standards of care established by the American Diabetes Association. The outcomes examined included self-monitoring of blood glucose at least once per day; receiving at least one eye exam, one foot exam, A1C tests, and an influenza vaccination in the past year; and ever receiving a pneumococcal vaccination. DSME duration was categorized as no DSME, >0 to <4 hours, 4-10 hours, and >10 hours. Results. After adjusting for sociodemographic variables, compared to those who did not receive DSME, those who had 4-10 or 10+ hours of DSME were more likely to receive two A1C tests (odds ratio [95% CI] 2.69 [1.30-5.58] and 2.63 [1.10-6.31], respectively) and have a pneumococcal vaccination (1.98 [1.03-3.80] and 1.92 [1.01-3.64], respectively). Those receiving 10+ hours of DSME were 2.2 times (95% CI 1.18-4.09) as likely to have an influenza vaccination. Conclusion. These data reveal a positive relationship between DSME duration and utilization of some diabetes clinical care services.

Diabetes self-management interventions for adults with type 2 diabetes living in rural areas: a systematic literature review

In rural communities, high rates of diabetes and its complications are compounded by limited access to health care and scarce community resources. We systematically reviewed the evidence for the impact of diabetes self-management education interventions designed for patients living in rural areas on glycemic control and other diabetes outcomes. Fifteen studies met inclusion criteria. Ten were randomized controlled trials. Intervention strategies included in-person diabetes (n = 9) and telehealth (n = 6) interventions. Four studies demonstrated between group differences for biologic outcomes, four studies demonstrated changes in behavior, and three studies demonstrated changes in knowledge. Intervention dose was associated with improved A1c or weight loss in two studies and session attendance in one study. Interventions that included collaborative goal-setting were associated with improved metabolic outcomes and self-efficacy. Telehealth and face-to-face diabetes interventions are both promising strategies for rural communities. Effective interventions included collaborative goal-setting. Intervention dose was linked to better outcomes and higher attendance.

The Relationship Between Hope and Religious Coping Among Patients With Type 2 Diabetes

Background and Purpose:

Globally, diabetes is one of the most common non-contagious diseases resulting in severe complications. Fostered hope facilitates coping and improves self-care and one of the Factors affecting hope is religious beliefs. This research investigated the level of hope and its relationship with religious coping among Type 2 diabetes patients.

Material and Methods:

This correlation, cross-sectional study was conducted on 150 patients with Type 2 diabetes, who had been referred to the Karaj Diabetes Association during the period, March–June 2011, and selected through purposive sampling. A three-part questionnaire including demographic data, the Herth Hope Index, and a short form of religious coping, was used for data collection. The data were analyzed using descriptive and analytic statistics, including Pearson’s correlation coefficient, the t-test, a one-way ANOVA, and a multiple regression analysis. The set significance level was p<0.05.

Results:

The mean hope score was 34.89 (SD±8.75); most of the subjects (46.7%) showed high levels of hope. Positive religious coping, marital status, and social support significantly affected hope fostering (r=0.897, p =0.000). A significant negative relationship was found between hope and age (r=-0.373, p=0.000), and between hope and negative religious coping (r=-0.749, p=0.000).

Conclusion:

Positive religious coping, married life, and social support significantly affected the development of hope. Moreover, there was a significant positive relationship between positive religious coping and social support. So, strengthening social support could lead to increased levels of positive religious coping and fostering of hope.

The impact of diabetes self-management education on glucose management and empowerment in ethnic Armenians with type 2 diabetes

PURPOSE

The purpose of this study was to investigate the impact of diabetes self-management education on glycemic control and perceptions of empowerment in Armenian American immigrants diagnosed with type 2 diabetes.

METHODS

A quasi-experimental pre and post design was used to investigate the impact of using education on self-management as measured by A1C levels and empowerment scores. Nine hours of diabetes self-management education classes were offered in the Armenian language to 75 clients at 2 adult health day care centers over 6 weeks. The participants were mostly first-generation Armenian immigrants aged 65 years and older. A1C results, the 8-item Diabetes Empowerment Scale (DES), and the 15-item Armenian Ethnic Orientation Questionnaire-Revised (AEOQ-R) were used to determine the impact of education on self-care management.

RESULTS

After institutional review board approval was obtained, 75 participants completed the study. A paired t test indicated that the postintervention mean A1C level was significantly lower than the preintervention mean A1C level. The postintervention mean DES score was significantly greater than the preintervention mean DES score. No mediating effects of age, gender, acculturation, and number of years with the disease were identified for either A1C or DES score.

CONCLUSIONS

The findings demonstrate the efficacy of the diabetes self-management education classes in improving diabetes self-care management skills.

Self-reported health beliefs, lifestyle and health behaviours in community-based patients with diabetes and hypertension

OBJECTIVE

This study describes self-reported health and lifestyle behaviours and health risk beliefs among community patients diagnosed with type 2 diabetes and hypertension.

METHODS

Patients with both type 2 diabetes and hypertension were recruited from community family practices across 3 Canadian Maritime provinces. Patients completed a survey targeting health risk beliefs, and health and lifestyle behaviours. Analyses examined differences in patient beliefs by age and sex, as well by health and lifestyle behaviour.

RESULTS

Overall, 90.8% of patients believed that controlling both blood pressure and blood glucose were important, particularly women (p<0.01), and 92.8% felt that having both conditions put them at high risk for cardiovascular problems. Older patients reported higher antihypertensive medication adherence (p<0.0001). Most (90.8%) believed that prescription drug use was most helpful for controlling blood pressure, and this belief was associated with medication adherence (p<0.0001). Overall, patients who believed in the benefits of a given lifestyle behaviour were more likely to demonstrate the behaviour.

CONCLUSION

The majority of patients surveyed were knowledgeable about their increased risk for cardiovascular problems. Patient lifestyle behaviours tended to mirror their health beliefs. These results provide important insight into the health beliefs and lifestyle behaviours of patients who receive the majority of their care in the community.

Is diabetes patients' knowledge of laboratory tests for monitoring blood glucose levels associated with better glycaemic control?

AIM

To determine if there is any difference in indices of glycaemic control between type-2 diabetes patients who knew the laboratory tests for monitoring blood glucose and their peers who did not know.

METHODS

Eighty-nine type-2 diabetes patients were studied after an overnight fast. The patients' bio-data, blood pressure, anthropometric indices and baseline biochemical parameters and glycated haemoglobin A₁c (HbA₁c) were measured. After a breakfast of stewed boiled rice, a 2-hour postprandial blood glucose was measured and a questionnaire administered.

RESULTS

The patients' mean ± SD HbA1c level was 8.6 ± 2.4% and none of the patients knew about HbA1c test for monitoring glycaemic control. Interestingly, patients who knew about fasting blood glucose test had significantly lower HbA₁c values than their counterparts who did not know (8.1 ± 2.2 vs. 9.1 ± 2.5%, p < 0.05).

CONCLUSION

Diabetes self-management education incorporating laboratory-based information may assist to prevent poor glycaemic control in developing countries with increasing reports of hyperglycaemic emergencies.

Partnering with diabetes educators to improve patient outcomes

Diabetes is a chronic, progressive disease that affects millions worldwide. The paradigm of diabetes management has shifted to focus on empowering the person with diabetes to manage the disease successfully and to improve their quality of life. Diabetes self-management education is a collaborative process through which people with diabetes gain the knowledge and skills needed to modify their behavior and to self-manage successfully the disease and its related conditions. Diabetes educators are health care professionals who apply in-depth knowledge and skills in the biological and social sciences, communication, counseling, and pedagogy to enable patients to manage daily and future challenges. Diabetes educators are integral in providing individualized education and promoting behavior change, using a framework of seven self-care behaviors known as the AADE7 Self-Care Behaviors™, developed by the American Association of Diabetes Educators. The iterative process of promoting behavior change includes assessment, goal setting, planning, implementation, evaluation, and documentation. Diabetes educators work as part of the patient's health care team to engage with the patient in informed, shared decision making. The increasing prevalence of diabetes and the growing focus on its prevention require strategies for providing people with knowledge, skills, and strategies they need and can use. The diabetes educator is the logical facilitator of change. Access to diabetes education is critically important; incorporating diabetes educators into more and varied practice settings will serve to improve clinical and quality of life outcomes for persons with diabetes.

Analysis of Behavior Risk Factor Surveillance System Data to Assess the Health of Hispanics With Diabetes in US-Mexico Border Communities

Purpose

The purpose of this study is to describe and compare personal characteristics, health care access and utilization, and self-management behaviors of Hispanic American adults diagnosed with diabetes who reside in 3 US-Mexico border counties in Arizona, New Mexico, and Texas. This study also examines the status of this population in attaining Healthy People (HP) 2020 diabetes target goals.

Methods

Data were extracted from the 2005-2009 Selected Metropolitan/Micropolitan Area Risk Trends (SMART): Behavioral Risk Factor Surveillance System (BRFSS) to analyze behavioral and health system factors associated with diabetes management among Hispanic American adults who reside in the border counties (N = 600). Data were analyzed using descriptive statistics and compared using chi-square and one-way analysis of variance.

Results

There were significant differences in health care access and utilization and in 1 self-management behavior (daily feet checks) across the counties. The majority of participants (83.4%) had a care provider, however the HP 2020 diabetes target goals for A1C monitoring or foot exams conducted by a care provider were not met. Participants in all counties met the target goal for dilated eye exams.

Conclusions

Improvement of diabetes management among this population should focus on border health system barriers to attaining HP 2020 diabetes target goals.

The role of peer support in diabetes care and self-management

In light of the growing prevalence and healthcare costs of diabetes mellitus, it is critically important for healthcare providers to improve the efficiency and effectiveness of their diabetes care. A key element of effective disease management for diabetes is support for patient self-management. Barriers to care exist for both patients and healthcare systems. As a result, many people with diabetes do not get the care and support needed to successfully manage their diabetes.Disease management approaches that incorporate peer support may be a promising way to help provide self-management support to patients with diabetes. Trained peers provide emotional support, instrumental (tangible or material) support, education, and skills training to those they serve, and outreach and care coordination for provider systems. They play a unique role that complements and supports clinical care.To describe how peers are currently supporting diabetes care, a number of databases were searched for studies describing the roles of peers using relevant key words. This paper reviews current literature that describes the roles and duties of peers in interventions to improve diabetes care, with a focus on their contributions to six essential elements of self-management support: (i) access to regular, high-quality clinical care; (ii) an individualized approach to assessment and treatment; (iii) patient-centered collaborative goal setting; (iv) education and skills training; (v) ongoing follow-up and support; and (vi) linkages to community resources.Peers worked under a variety of titles, which did not define their duties. The scope of their work ranged from assisting health professionals to playing a central role in care. Providing education and follow-up support were the two most common roles. In all but one study, these roles were carried out during face-to-face contact, most frequently in community sites.A growing body of literature supports the value of peer models for diabetes management. Additional research can answer remaining questions related to such issues as cost effectiveness, sustainability, integration of peers into health and social service delivery systems, and recruitment, training, and support of peers. Continuing to develop and evaluate innovative models for more effectively mobilizing and integrating peers into diabetes care has great potential for improving diabetes outcomes worldwide.

Does availability of expanded point-of-care services improve outcomes for rural diabetic patients?

AIMS

The purpose of this study was to assess compliance with American Diabetes Association screening recommendations at Salina Family Healthcare (SFHC) in Salina, Kansas, a large rural town, and to evaluate the impact of point-of-care (POC) dilated eye exams for uninsured patients. POC exams are those performed in the location where patients are treated.

METHODS

There were 462 type II diabetic (DM2) patients seen at SFHC in 2009 and 537 DM2 patients seen in 2010. A chart review of all patients with DM2 was done to assess rates of recommended screening exams, including dilated eye exams and foot exams.

RESULTS

In 2009/2010 urine microalbumin was checked in 57%/75% of DM2 patients. HbA1c and low density lipoprotein (LDL) levels at goal were 46%/48% and 58%/58%, respectively. 47%/67% of DM@ patients received foot exams and 21%/30% received eye exams. In 2009, 23% of the 155 uninsured diabetic patients at SFHC received a dilated eye exam. The following year, after implementation of on-site ophthalmologic services, rates of dilated eye exams increased 1.6 fold to 37% of the 196 uninsured patients.

CONCLUSIONS

SFHC performed similarly to national rates on some diabetic screening exams, but there is room for improvement in all recommended screening exams. The implementation of a novel approach to increasing dilated eye exam rates indicates that expanded POC services can improve outcomes for diabetic patients.

A metasynthesis of the self-management of type 2 diabetes

Type 2 diabetes is a metabolic disorder characterized by chronically elevated blood glucose and high risk of comorbidities. In this article we report a metasynthesis of the 21st-Century qualitative research concerning the self-management of type 2 diabetes. We identified 38 relevant articles (sample size range 6 to 175), which were synthesized through a process of iterative reading and theory development. In this literature, authors argued and assumed that diabetes management is influenced by multiple, complex, competing factors, including interpersonal relations, gender, and sociocultural context. Conversely, self-management was sometimes construed as a facet of individual agency and was accepted uncritically, placing accountability for health with patients themselves. We conclude that a satisfactory account of diabetes care would pay attention to the "inner" world, while acknowledging the social and political conditions in which diabetes-related experiences unfold.

Diabetes care and outcomes: disparities across rural America

We examined differences in receipt of diabetes care and selected outcomes between rural and urban persons living with diabetes, using nationally representative data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS). "Rural" was defined as living in a non-metropolitan county. Diabetes care variables were physician visit, HbA1c testing, foot examination, and dilated eye examination. Outcome variables were presence of foot sores and diabetic retinopathy. Analysis was limited to persons 18 and older self-reporting a diagnosis of diabetes (n = 29,501). A lower proportion of rural than urban persons with diabetes reported a dilated eye examination (69.1 vs. 72.4%; P = 0.005) or a foot examination in the past year (70.6 vs. 73.7%; P = 0.016). Conversely, a greater proportion of rural than urban persons reported diabetic retinopathy (25.8 vs. 22.0%; P = 0.007) and having a foot sore taking more than four weeks to heal (13.2 vs. 11.2%; P = 0.036). Rural residence was not associated with receipt of services after individual characteristics were taken into account in adjusted analysis, but remained associated with an increased risk for retinopathy (OR = 1.20, 95% CI = 1.02-1.42). Participation in Diabetes Self-Management Education (DSME) was positively associated with all measures of diabetes care included in the study. Availability of specialty services and travel considerations could explain some of these differences.

A cross-sectional survey of self-perceived health status and metabolic control values in patients with type 2 diabetes

BACKGROUND

The prevalence of diabetes is increasing worldwide. Diabetes and other chronic disorders play an important role in how patients perceive their health status, this perception being an important component of general health.

OBJECTIVES

The purpose of this study is to determine self-perceived health status and metabolic control in patients with type 2 diabetes and to understand the relationship between perceived health status and metabolic control in diabetic participants.

DESIGN

This is a cross-sectional survey.

SETTING

The research population was diabetes sufferers registered with the Turkish Diabetes Society in Denizli Province, Turkey.

PARTICIPANTS

A convenience sample composed of 110 patients with type 2 diabetes mellitus.

METHODS

The research data were collected using three tools. The first of these was a "Socio-demographic Data Form" to gather information on the diabetes patients. The second was a survey on the patients' self-perceived health (how do rate your state of health in general) in which the patients were asked to rate their own health in one of five categories: very good, good, fair, bad and very bad. For the statistical analysis, the study group was divided into two groups: "good", consisting of those who classified their health as either very good or good; and "poor", those who gave other responses. The third type of data was collected by measuring metabolic control outcomes [glycosylated hemoglobin (HbA(1C)), fasting blood sugar (FBS), non-fasting blood sugar, total cholesterol, high-density lipoproteins (HDL) and triglycerides] for each participant.

RESULTS

Approximately half of the diabetic participants surveyed have poor self-perceived health. In terms of the values of HbA(1C), an important indicator of metabolic control levels, it was found that only 24.5% of the participants surveyed had good metabolic control. There was found to be a statistically significant difference between self-perceived health and levels of HbA(1C); 68% of participants who had high HbA(1C) values evaluated their health as good, whereas 63.9% of those who had poor HbA(1C) values evaluated their health as bad. Age, level of education, mode of treatment, adherence to treatment and level of exercise were factors that were found to have statistically significant differences from, and therefore an influence on, self-reported health.

CONCLUSION

When working with diabetes patients, as soon as the diagnosis has been made, it is recommended that information both on subjective perceptions of health and on perceptions of the illness (health perceptions, health beliefs related to the illness) are evaluated and objective data (metabolic control values) are gathered.

Reducing risks in diabetes self-management: a systematic review of the literature

OBJECTIVE

The purpose of this systematic review was to review published literature on risk-reducing interventions as part of diabetes self-management.

DATA SOURCES

Medline (1990-2007), CINAHL (1990-2007), and Cochrane Central Register of Controlled Trials (first quarter 2007) databases were searched. Reference lists from included studies were reviewed to identify additional studies.

STUDY SELECTION

Intervention studies that addressed reducing risks to help prevent or minimize diabetes complications were included.

DATA EXTRACTION

Study design, sample characteristics, interventions, and outcomes were extracted.

DATA SYNTHESIS

Thirty-three studies, represented by 39 articles, met the criteria for inclusion and were classified as smoking cessation (n = 3), eye examination (n = 2), foot care (n = 10), oral health (n = 2), vaccination (n = 1), cardiovascular risk reduction (n = 9), and comprehensive risk reduction (n = 6). Only 46.3% of the 283 outcomes measured in the 33 studies were significantly improved.

CONCLUSIONS

Reducing risks involves implementing effective risk reduction behaviors to prevent or slow the progression of diabetes complications. Recognizing risk factors for complications and what constitutes optimal preventive care is an important part of managing diabetes. Intervention studies are lacking in some areas of reducing risks. Further studies are needed to test specific interventions to reduce the risks of diabetes complications.

Computerized learning technologies for diabetes: a systematic review

BACKGROUND

The objective of this study was to evaluate computerized learning technology interventions that can empower patients in the self-management of diabetes and support diabetes education over a distance.

METHODS

We searched Medline (1966-2006), CINAHL (1982-2006), and the Cochrane Central Register of Controlled Trials (first quarter 2007) databases. We also reviewed reference lists from included studies to identify additional studies. We included 25 articles representing 21 randomized controlled trials that evaluated a computerized learning technology and measured the outcome of patient care. We extracted patient sample, intervention, educational content topics, outcome measures, and statistical significance.

RESULTS

Of 21 eligible trials, 18 trials (85.7%) reported significant positive outcomes. Almost 44% (43.8%) of the outcomes demonstrated significant improvements (49 of 112 outcomes).

CONCLUSIONS

Patient self-management behaviors are important in chronic disease management, and initial evidence suggests that computerized learning technology interventions can play a significant role in the future.

Patient factors associated with attrition from a self-management education programme

OBJECTIVE

To examine utilization patterns of diabetes self-management training (DSME) and identify patient factors associated with attrition from these services at an ambulatory diabetes education centre (DEC).

METHODS

A retrospective medical chart review of first time visits (536) to the centre between 1 August 2000 and 31 July 2001 was conducted for patients with type 2 diabetes. Descriptive analyses were conducted to examine utilization patterns over a 1-year period. Multivariable logistic regression was used to identify patient factors associated with attrition from DSME and non-use of group education among new patients.

RESULTS

Almost 50% of new patients withdrew prematurely from recommended DSME services over the 1-year period, and only 24.8% attended group education. Patient variables such as being older than 65 years of age, primarily speaking English, or working full or part-time were associated with attrition from DSME and non-use of group education when compared with middle aged, non-English-speaking, and non-working patients.

CONCLUSIONS

High DSME attrition rates indicate that retention needs to become a focus of programme policy, planning and evaluation to improve programme effectiveness. DSME tailored to the cultural and linguistic characteristics of the community, and convenient and accessible to working and older patients will potentially increase retention in and accessibility to these services.

Validity and reliability study of the Turkish version of Health Belief Model Scale in diabetic patients

BACKGROUND

Diabetes mellitus (DM) is an important health problem that leads to severe complications, is the cause of early death, and is showing an increase in frequency. The development of positive health behaviors is extremely important in the treatment of diabetic patients. There are various models that examine the health behaviors of individuals. One of these is the Health Belief Model. This model is very beneficial in explaining factors that affect patients' compliance with their disease.

PURPOSE

This research was planned to measure the validity and reliability of the Health Belief Model Scale in diabetic patients in the Turkish population.

DESIGN

Questionnaire Survey.

SETTINGS

The research population was all of the diabetic patients (4,125) registered with the Turkish Diabetes Society, Denizli Province, Turkey.

PARTICIPANTS

A convenience sample was composed of 352 patients with Type 2 DM.

METHODS

The research data were collected with three tools, a "sociodemographic data form" related to the diabetic patients, the "Health Belief Model Scale in Diabetic Patients," and the "Diabetes Management Self-Efficacy Scale."For validity studies: language validity, content validity, concurrent validity and construct validity were examined. For reliability studies: the tool's internal consistency reliability, Cronbach alpha reliability coefficient, test-retest reliability were examined.

RESULTS

The tool's internal consistency reliability subscales' Cronbach alpha coefficient values ranged from 0.73 to 0.86. For the total tool a Cronbach alpha value of 0.89 was found. In the tool's internal consistency reliability total item correlation the three items that were below 0.30 were removed and the 36 items were reduced to 33 items. The tool's test-retest reliability was 0.90. According to factor analysis the tool contains five subscales of perceived susceptibility, perceived severity, perceived benefits, perceived barriers and recommended healthy behaviors.

CONCLUSION

The Health Belief Model Scale in diabetic patients was determined to be valid and reliable for use in the Turkish population.

Responsibility for control; ethics of patient preparation for self-management of chronic disease

Patient self-management (SM) of chronic disease is an evolving movement, with some forms documented as yielding important outcomes. Potential benefits from proper preparation and maintenance of patient SM skills include quality care tailored to the patient's preferences and life goals, and increase in skills in problem solving, confidence and success, generalizable to other parts of the patient's life. Four central ethical issues can be identified. 1) insufficient patient/family access to preparation that will optimize their competence to SM without harm to themselves, 2) lack of acknowledgement that an ethos of patient empowerment can mask transfer of responsibility beyond patient/family competency to handle that responsibility, 3) prevailing assumptions that preparation for SM cannot result in harm and that its main purpose is to deliver physician instructions, and 4) lack of standards for patient selection, which has the potential to exclude individuals who could benefit from learning to SM. Technology assessment offers one framework through which to examine available data about efficacy of patient SM and to answer the central question of what conditions must be put in place to optimize the benefits of SM while assuring that potential harms are controlled.

Assessment of two culturally competent diabetes education methods: individual versus individual plus group education in Canadian Portuguese adults with type 2 diabetes

OBJECTIVE

To examine the impact of two culturally competent diabetes education methods, individual counselling and individual counselling in conjunction with group education, on nutrition adherence and glycemic control in Portuguese Canadian adults with type 2 diabetes over a three-month period.

DESIGN

The Diabetes Education Centre is located in the urban multicultural city of Toronto, Ontario, Canada. We used a three-month randomized controlled trial design. Eligible Portuguese-speaking adults with type 2 diabetes were randomly assigned to receive either diabetes education counselling only (control group) or counselling in conjunction with group education (intervention group). Of the 61 patients who completed the study, 36 were in the counselling only and 25 in the counselling with group education intervention. We used a per-protocol analysis to examine the efficacy of the two educational approaches on nutrition adherence and glycemic control; paired t-tests to compare results within groups and analysis of covariance (ACOVA) to compare outcomes between groups adjusting for baseline measures. The Theory of Planned Behaviour was used to describe the behavioural mechanisms that influenced nutrition adherence.

RESULTS

Attitudes, subjective norms, perceived behaviour control, and intentions towards nutrition adherence, self-reported nutrition adherence and glycemic control significantly improved in both groups, over the three-month study period. Yet, those receiving individual counselling with group education showed greater improvement in all measures with the exception of glycemic control, where no significant difference was found between the two groups at three months.

CONCLUSIONS

Our study findings provide preliminary evidence that culturally competent group education in conjunction with individual counselling may be more efficacious in shaping eating behaviours than individual counselling alone for Canadian Portuguese adults with type 2 diabetes. However, larger longitudinal studies are needed to determine the most efficacious education method to sustain long-term nutrition adherence and glycemic control.

Use of diabetes resources in adults attending a self-management education program

OBJECTIVE

To identify the types of resources used to acquire information or assistance in the management of diabetes, and to identify persons who are more or less likely to use a variety of diabetes resources.

METHODS

Through the use of a questionnaire and review of patient records, sociodemographic, clinical, and health care service utilization characteristics were obtained for 267 individuals with type 2 diabetes from a culturally diverse diabetes education centre. Descriptive analyses were performed to provide information on the types of diabetes resources used by age, sex and primary language spoken. Multivariable Poisson regression was used to predict low from high users of a variety of diabetes resources.

RESULTS

On average, most patients used four different resources. The most commonly cited were physicians or endocrinologists; diabetes educators; and magazines, newspapers, books or television. Those who did not speak English, were born outside of Canada, had a lower level of education, or who were older used fewer diabetes resources.

CONCLUSION

Notably, the characteristics of individuals who are less likely to use resources or a variety of resources reflect the basic determinants of health (i.e., age, sex, ethnicity or primary language spoken, and education).

PRACTICE IMPLICATIONS

We need to develop resources that are equitably accessible and of interest to all patients, particularly for individuals who do not speak English, who have lower education and literacy levels, and who are older. Furthermore, imparting the skills on how to find and utilize currently existing resources to assist in chronic disease self-management should be promoted as a core aspect of self-management education.

Behavioral Interventions for Diabetes Self-Management

This article synthesizes the research on behavioral interventions aimed at diabetes self-management, describes current trends in diabetes self-management, and proposes future directions for diabetes self-management care and research. Interventions that are multifaceted, tailored to the individual, and provided six months or longer demonstrate modest effects in improving diabetes-related outcomes. Improving access to behavioral interventions, maintaining the effects of behavioral interventions, and addressing the more complex social and environmental factors that contribute to behavior change are current challenges in diabetes self-management that warrant further attention and research.

Low-carbohydrate and high-fat intake among adult patients with poorly controlled type 2 diabetes mellitus

OBJECTIVE

This study examined baseline dietary intake, body weight, and physiologic status in patients enrolled in a dietary intervention for type 2 diabetes mellitus (T2DM).

METHODS

Dietary, physiologic, and demographic information were collected at baseline from 40 adult patients with poorly controlled T2DM (glycosylated hemoglobin >7%) who participated in a clinical trial at an academic medical center in Worcester, Massachusetts, USA.

RESULTS

The average age at enrollment was 53.5 y (SD 8.4), average body mass index was 35.48 kg/m(2) (SD 7.0), and glycosylated hemoglobin was 8.3% (SD 1.2). Participants were predominantly white, married, and employed full time. Forty-eight percent were men. Seventy-eight percent had hyperlipidemia, and 68% had hypertension. Reported baseline daily average energy intake was 1778 kcal (SD 814), daily carbohydrate was 159 g (SD 71.5), and dietary fiber was 11.4 g (SD 5.2). The dietary composition was 35% carbohydrate, 45% fat (15% saturated fat), and 20% protein. The American Diabetes Association (ADA) guidelines recommends 45-65% of energy from carbohydrate, 20-35% from fat (<7% saturated), and 20% from protein.

CONCLUSION

These patients reported a low-carbohydrate, low-fiber, high-fat (especially saturated) diet, although they stated they are not following any of the popular low-carbohydrate diets. Patients with T2DM may find the current trend toward reducing weight through low-carbohydrate diets attractive for control of blood glucose, despite ADA recommendations. This dietary pattern may represent a popular trend that extends beyond our particular study and, if so, has serious cardiovascular implications in this vulnerable population of T2DM patients.