Improving quality of life in diabetes: how effective is education?

Patient education program for Brazilians living with diabetes and prediabetes: findings from a development study

Background

Globally, the incidence of diabetes is increasing and strategies to reach a comprehensive approach of care are needed, including education in self-management. This is particularly true in low and middle-income countries where the number of people living with diabetes is higher than in the high-income ones. This article describes the development of a structured patient education program for Brazilians living with diabetes or prediabetes.

Methods

These steps were undertaken: 1) a 4-phase needs assessment (literature search of local diabetes guidelines, environmental scan, evaluation of information needs of patients identified by diabetes experts, and patient focus groups); and, 2) the translation and cultural adaptation of the patient guide (preparation, translation, back-translation, back-translation review, harmonization, and proofreading).

Results

Four of the seven guidelines identified include educational aspects of diabetes management. No structured education program was reported from the environmental scan. Regarding the information needs, 15 diabetes experts identified their patients’ needs, who referred that they have high information needs for topics related to their health condition. Finally, results from six patient focus groups were clustered into six themes (self-management, physical activity, eating habits, diabetes medication, psychosocial being, and sleep), all embedded into the new education program. Constructive theory, adult learning principles, and the Health Action Process Approach model were used in program development and will be used in delivery. The developed program consists of 18 educational sessions strategically mapped and sequenced to support the program learning outcomes and a patient guide with 17 chapters organized into five sections, matched with weekly lectures.

Conclusions

This program is a sequential and theoretical strategic intervention that can reach programs in Brazil to support diabetes and prediabetes patient education.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11300-y.

Effect of diabetes self-management education on glycemic control in Latino adults with type 2 diabetes: A systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis evaluated the effectiveness of diabetes self-management education (DSME) in reducing glycosylated hemoglobin (A1C) levels in adult Latinos with type 2 diabetes (T2DM).

METHODS

Five databases were searched for DSME randomized controlled trials or quasi-experimental trials published between January 1997 and March 2019. A random effects model was utilized to calculate combined effect sizes. Subgroup analyses were performed to explore possible sources of heterogeneity between studies.

RESULTS

Twenty-three unique studies met criteria for this systematic review and of these, 18 were included in the meta-analysis. Pooled estimate effect of DSME on A1C from the random effect model was -0.240 (95% confidence interval = -0.345, -0.135, p <  0.001). There was moderate heterogeneity (Cochrane Q=30.977, P=0.020, I^2 = 45.121) between the studies. Subgroup analyses demonstrated greater A1C reductions in studies with intervention duration ≤6 months, initial A1C baseline values >8.0 [69 mmol/mol], and team-based approach.

CONCLUSIONS

Meta-analysis results showed that culturally tailored DSME interventions significantly reduce AIC in Latinos with T2DM despite the heterogeneity across the studies.

IMPLICATIONS

The heterogeneity in the study methodologies reinforce the need for additional studies to better understand DSME interventions to reduce disparities in Latino adults with T2DM.

Evaluation of the UCL Diabetes Self-management Programme (UCL-DSMP): A Randomized Controlled Trial

Self-management has been described as the cornerstone of care for diabetes. Many self-management studies are limited by poor methodology and poor descriptions of the intervention. The current study developed a theoretically based self-management programme for patients with type 2 diabetes, which was evaluated via a randomized controlled trial. At immediate post-intervention and three-month follow-up the intervention group showed significant improvement relative to controls on self-management behaviours, quality of life and illness beliefs. A trend towards improved HbA1c was also observed. Documentation in a manual and development of a training programme for facilitators ensures the programme is replicable.

Promoting physical activity for persons with diabetes

PURPOSE

The purpose of this study was to evaluate the effectiveness of a self-help physical activity program for persons with type 2 diabetes. Effectiveness was measured by cardiovascular indicators, hemoglobin A1C, anthropometric indicators, and activity levels.

METHODS

This intervention study included 53 individuals with type 2 diabetes. Participants were randomly assigned. Participants in the intervention group attended the usual Diabetes Self-Management Education Program (DSMEP) and received a copy of the book, Manpo-kei; a concise handout summarizing the key points of Manpo-kei; and a pedometer. Participants not assigned to the intervention attended the usual DSMEP only. Data collection was completed at the beginning of the study and 3 months later using a lifestyle and diabetes questionnaire, a physical activity questionnaire, and cardiovascular and anthropometric measures.

RESULTS

Those who participated in the intervention demonstrated a significant decrease in hemoglobin A1C, weight, and body fat. In addition, they increased their number of daily steps as measured by the pedometer. The control group also demonstrated a significant decrease in hemoglobin A1C and weight. Both groups demonstrated increases in their regular weekly activity. At the end of the study period, the intervention group had a significantly lower diastolic blood pressure than the control group.

CONCLUSIONS

Pedometers can be a helpful strategy to motivate persons with diabetes to increase physical activity. However, it appears that attendance at DSMEP alone may be enough to increase physical activity for persons with type 2 diabetes.

Meta-analysis of quality of life outcomes following diabetes self-management training

PURPOSE

The purpose of this meta-analysis was to meet the need to quantify the influence of diabetes self-management training on quality of life (QOL) of adult diabetes patients.

METHODS

Extensive literature searching located published and unpublished diabetes self-management intervention studies that measured QOL outcomes among at least 5 subjects with type 1 or 2 diabetes. Data were extracted from primary study reports which included interventions designed to improve diabetes self-management and adequate data to calculate effect sizes. Random-effects meta-analytic procedures were used to estimate overall effects between treatment and control groups at outcome assessment and between baseline and outcome data for both treatment subjects and control subjects.

RESULTS

Exhaustive searching yielded 20 comparisons across 1892 subjects. The comparisons between treatment and control group outcomes following interventions yielded an effect size of 0.281. The comparisons between treatment group at baseline and outcome measurement yielded an effect size of 0.312 to 0.313. Each of these effect sizes were statistically significant, meaning that the hypothesis that interventions to improve diabetes self-management results in increased QOL was supported. Control subjects did not experience improved QOL while participating in studies.

CONCLUSIONS

These findings document that people with diabetes experience improved QOL from participation in diabetes self-management training programs. Future diabetes self-management intervention studies should include quality of life outcomes so that this important outcome can be further studied. After more primary studies are available, future meta-analyses can explore important moderator analyses.

[Preoperative pain training. No influence on postoperative pain perception in patients undergoing cardiac surgery]

BACKGROUND

The present research was performed to investigate the influence of preoperative information on pain given by the nursing staff on postoperative pain perception in patients.

METHODS

A randomized controlled interventional study was conducted in 93 patients undergoing cardiac surgery at the University Hospital Erlangen. One day before the surgery all participants were evaluated using the Eysenck Personality Questionnaire, patients of the treatment group were additionally trained by a member of the nursing staff in pain behaviour. After discharge from the intensive care unit the pain experience of the patients was evaluated using standardized questionnaires.

RESULTS

Of the 93 patients, 73 finished the study protocol and were analyzed. The pain experience was not significantly different between the two study groups. Patients with increased levels of neuroticism (characterized by emotional lability) regardless of study group more frequently reported pain values above 3/10.

CONCLUSION

No significant modulation of postoperative pain experience was achieved by preoperative information on pain. However, it cannot be ruled out that this intervention, particularly in view of the reduction in anxiety, may form a significant element of perioperative pain management.

Development and evaluation of a patient-oriented education system for diabetes management

PURPOSE

To develop and evaluate a Web-based, patient-orientated diabetic education management (POEM) system.

METHODS

The POEM system has been developed to extend hospital patient education by integrating patients' medical care data into their education program components and presenting them on the Web. Since most patients are concerned about their medical care data, the POEM system can provide the incentives for patients to continuously and persistently log in and learn the required knowledge and skills, improving their clinical outcomes. A quasi-experimental method that uses control groups and pretests was used to evaluate the outcomes of the system intervention. We recruited patients with type-2 diabetes and alternatively assigned them to intervention and control groups. We compared laboratory test results including fasting blood glucose, HbA1c, total cholesterol, triglyceride (TG), and HDL between the two groups from the first visit through each follow-up visit. The study period progressed from September 2003 to May 2004 at the Metabolism Center of a medical teaching hospital in Taipei.

RESULTS

In this study, we recruited 274 participants: 134 (57% males and 43% females) in the intervention group and 140 (46% males and 54% females) in the control group. The patients' laboratory test results from the first visit for fasting blood glucose, HbA1c, total cholesterol level, TG, and HDL in the intervention and control groups were respectively 187.54+/-77.10 and 189.99+/-73.49 mg/dl, 9.03 +/- 2.79% and 8.95 +/- 2.23%, 193.29 +/- 47.93 and 202.52 +/- 58.45 mg/dl, 152.48 +/- 70.85 and 157.37 +/- 74.88 mg/dl, and 44.97 +/- 12.09 and 45.32 +/- 12.08 mg/dl. There were three follow-up visits during the study period. We collected laboratory test results of the two groups through each of the following visits and analyzed them using ANCOVA. We discovered a significant difference in fasting blood glucose levels between intervention and control group as early as the first follow-up. At the second follow-up, both fasting blood glucose and HBA1c levels were significantly different between intervention and control group. At the third follow-up, there was a significant difference in fasting blood glucose, HBA1c, and total cholesterol between intervention and control group. We also monitored the number of logins for the patients in the intervention group during the follow-up period. The result showed the patients had consistently logged into the POEM system (about 8.5 +/- 3.7 logins per person per month after 3 months enrollment). Thus, the patients in the intervention group had better control of their fasting blood glucose, HbA1c and total cholesterol levels than those in the control group due to the assistance of the system.

CONCLUSIONS

The POEM system can help patients control their glucose, HbA1c and total cholesterol levels to manage their diabetes, providing an easy and inexpensive way to extend hospital-based patient education services for community-based continuous patient education.

Improving self-management in insulin-treated adults participating in diabetes education. The role of overprotection by the partner

AIMS

To examine the role of overprotection by the partner--i.e. excessive protection, unnecessary help, excessive praise for accomplishments, or attempts to restrict activities as a consequence of underestimating the patient's capabilities--in changes in patient self-management in the context of diabetes education.

METHODS

Sixty-seven insulin-treated patients with a partner completed questionnaires on admission to a Multidisciplinary Intensive Education Programme (MIEP) and 3 months after completing the core module of MIEP. Factors assessed were overprotection by their partner and three aspects of diabetes self-management, namely internal locus of control, diabetes-related distress and HbA1c. Regression analyses were used to test the independent associations of patient sex, baseline overprotection and the interaction between sex and overprotection with diabetes self-management at the follow-up stage, controlling for the baseline value of the dependent variable.

RESULTS

The increase in internal locus of control and decrease in HbA1c were both significantly less for female patients who perceived their partner to be rather overprotective than for female patients who did not perceive their partner to be overprotective. The more patients, both male and female, perceived their partner to be overprotective, the less their diabetes-related distress decreased.

CONCLUSIONS

Overprotection by the partner showed a negative association with improvement in diabetes self-management, especially for female patients. Thus, an intervention programme with the aim of reducing overprotection by the partner, or the perception of this, may enhance self-management in patients participating in diabetes education.

Patient satisfaction with diabetes care

AIM

The aim of this paper is to report the findings of a study that elucidated the experiences and reflections of people with type 2 diabetes about clinical encounters.

BACKGROUND

Several patient satisfaction surveys have focused on privacy, cheerfulness and amenities rather than on how the care was delivered. A great deal of research has also focused on communication and various consultation styles, particularly within health promotion and diabetes care, but how these factors tie up with patient satisfaction has rarely been discussed. This study was performed in order to elucidate patients' perspectives about clinical encounters in diabetes care.

METHOD

Interviews were carried out during 2001 with 44 patients with diabetes. The transcribed interviews were analysed using qualitative content analysis.

RESULTS

Five themes were connected to patient satisfaction and dissatisfaction, namely 'being in agreement vs. in disagreement about the goals'; 'autonomy and equality vs. feeling forced into adaptation and submission'; 'feeling worthy as a person vs. feeling worthless'; 'being attended to and feeling welcome vs. ignored'; and, lastly, 'feeling safe and confident vs. feeling unsafe and lacking confidence'.

CONCLUSION

Despite efforts to individualize diabetes care and find ways to communicate with patients, many people have experiences of clinical encounters that they find dissatisfying. Experiences of dissatisfying encounters have elements that may threaten their perception of self and identity, while elements included in satisfying encounters are those characterizing patient-centred care.

Development of a questionnaire to measure heart disease risk knowledge in people with diabetes: the Heart Disease Fact Questionnaire

This paper describes a paper and pencil questionnaire that measures heart disease risk knowledge in people with diabetes. The Heart Disease Fact Questionnaire (HDFQ) is a 25-item questionnaire that was developed to tap into respondents' knowledge of major risk factors for the development of CHD. Approximately half of these items specifically address diabetes-related CHD risk factors. Based on extensive pilot data, the current study analyzed responses from 524 people with diabetes to assess the psychometric properties. The HDFQ is readable to an average 13-year old and imposes little burden. It shows good content and face validity. It demonstrates adequate internal consistency, with Kuder-Richardson-20 formula = 0.77 and good item-total correlations. Item analysis showed a desirable range in P-values. In discriminant function analyses, HDFQ scores differentiated respondents by knowledge of their own cardiovascular health, use of lipid lowering medications, health insurance status, and educational attainment, thus indicating good criterion related validity. This measure of heart disease risk knowledge is brief, understandable to respondents, and easy to administer and score. Its potential for use in research and practice is discussed. Future research should establish norms as well as investigate its test-retest reliability and predictive validity.