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Ji J, Zhu M, Bao M, Xu L, Yuan H. Application value of DSMB-O scale in self-management of elderly patients with type 2 diabetes mellitus. Technol Health Care 2024:THC240138. [PMID: 38875061 DOI: 10.3233/thc-240138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
BACKGROUND To enhance the self-management ability of elderly diabetes mellitus (DM) patients, priority should be given to the accurate evaluation of their current self-management ability, and then provide corresponding guidance. OBJECTIVE To explore the application value of Diabetes Self-Management Behaviors among Older Koreans (DSMB-O) in self-management of elderly patients with type 2 diabetes mellitus (T2DM). METHODS Using convenient sampling, this study retrospectively collected the clinical data of 215 elderly patients with T2DM who were admitted to our hospital from June 2020 to June 2022. Enrolled patients were divided into an effective-control group (n= 80) and an ineffective-control group (n= 135) based on whether the glycated hemoglobin (HbA1C) was < 7.5% for further comparison of the collected data. RESULTS There were statistically significant differences in the comparison of the proportion of diabetes mellitus (DM) course (χ2= 26.000, P< 0.001), DSMB-O score (17.67 ± 4.07 VS 14.67 ± 4.70 points, t= 4.582, P< 0.001), and Summary Diabetes Self Care Activity (SDSCA) score (43.16 ± 11.17 VS 37.58 ± 12.47 points, t= 5.492, P< 0.001) between the two groups. The total score of DSMB-O was negatively correlated with both HbA1c (r=-0.281, P< 0.001) and complications (r=-0.193, P= 0.004); moreover, the total score of SDSCA was also negatively correlated with both HbA1c (r=-0.234, P< 0.001) and complications (r=-0.153, P= 0.025). Among various dimensions of DSMB-O, active exercise (OR= 0.699, 95%CI: 0.541 ∼ 0.902) and blood glucose monitoring (OR= 0.603, 95%CI: 0.431 ∼ 0.817) were protective factors for T2DM patients with HbA1c levels < 7.5%. The area under the curve (AUC) of SDSCA score and DSMB-O score predicting self-management level in elderly T2DM patients was 0.643 (95%CI: 0.611 ∼ 0.756) and 0.716 (95%CI: 0.689∼ 0.774), respectively. CONCLUSION DSMB-O exhibits a higher accuracy in predicting the self-management level of elderly patients with T2DM than that of SDSCA. Regular exercise, medication, blood glucose monitoring, and reducing the risk of complications are all intimately associated with the control of blood glucose.
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Affiliation(s)
- Jiajia Ji
- Hepatobiliary Center, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Zhu
- Department of Endocrinology, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Mengqian Bao
- Department of Plastic Surgery and Burn, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lamei Xu
- Department of Plastic Surgery and Burn, Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hui Yuan
- Jiangsu Province Hospital and The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
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Kaveh MH, Faradonbeh MR, Kaveh S. Telehealth impact on biomedical, psychosocial, and behavioural outcomes in patients with diabetes older than 50 years: A systematic synthesis without meta-analysis. J Telemed Telecare 2024; 30:285-304. [PMID: 34792400 DOI: 10.1177/1357633x211052222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Elderly people with diabetes are among high-risk groups that require more attention. With the increasing use of technology in healthcare, much emphasis has been placed on telehealth because of its potential to reduce unnecessary healthcare services consumption. We aimed to review and analyse the evidence of various interventions on the effect of using telehealth on biomedical, behavioural, and psychosocial outcomes in patients with diabetes over 50 years. METHODS The search method of this systematic synthesis without meta-analysis was guided by the preferred reporting items for systematic reviews (PRISMA) and the new reporting guideline synthesis without meta-analysis (SWiM) in systematic reviews. A coherent search strategy was designed to retrieve articles in databases such as PubMed, Embase, Scopus, Web of Science, and ClinicalTrials.gov from inception to June 2020. We excluded articles with eligibility criteria of the age of under 50 years old and studies conducted on patients with gestational diabetes. The outcomes were categorized into biomedical, behavioural, and psychosocial outcomes. The methodology of articles was evaluated by the Standard Cochrane Collaboration risk of bias tool in Revman 5.3 software. FINDINGS Overall, 18 studies with 8273 patients with diabetes over the age of 50 were included in this systematic review. Biomedical outcomes such as blood sugar tests and cholesterol tests had significant improvement by using telehealth. Frequency of self-monitored blood glucose (SMBG) and self-efficacy were behavioural outcomes that increased by telehealth utilization. Telehealth had a positive impact on psychosocial outcomes like depression, quality of life (QoL), cognitive decline, and social support. INTERPRETATION Telehealth has the ability to improve multiple outcomes such as behavioural and psychosocial outcomes in health services consumers. Due to varied telehealth interventions and follow-up durations, firm conclusions cannot be reached. As the research investigations studied in the present study were of different kinds and had used different follow-up periods, there is a need for further rigorous studies which consider socio-economic, cultural, and clinical differences.
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Affiliation(s)
- Mohammad Hossein Kaveh
- Research Center for Health Sciences, Department of Health Promotion, School of Health, Institute of Health, Shiraz University of Medical Sciences, Iran
| | | | - Sara Kaveh
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Iran
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Velázquez-Jurado H, Flores-Torres A, Pérez-Peralta L, Salinas-Rivera E, Valle-Nava MD, Arcila-Martinez D, Hernández-Jiménez S. Cognitive behavioral treatment to improve psychological adjustment in people recently diagnosed with type 2 diabetes: Psychological treatment in type 2 diabetes. Health Psychol Behav Med 2023; 11:2179058. [PMID: 36846199 PMCID: PMC9946322 DOI: 10.1080/21642850.2023.2179058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic disease that affects a person's general well-being. Current evidence sets an association between psychological well-being and controlled metabolic parameters. People newly diagnosed with T2DM show higher prevalence of depression and anxiety symptoms. Cognitive behavioral therapy (CBT) has effectively improved psychological adjustment, but most studies do not specifically address recently diagnosed people nor usually include long-term follow-up measures. Objective We sought to assess changes in psychological variables in people with newly diagnosed diabetes who received a cognitive-behavioral intervention, within a comprehensive care program. Method 1208 adults with T2DM (≤5 years) who attended a national health institute in Mexico received a cognitive-behavioral intervention aimed at improving quality of life and reducing emotional distress that often interferes with diabetes control, as well as evaluating cognitive and emotional resources and social support. Measures of quality of life, diabetes-related distress, anxiety and depression questionnaires were compared at pre-test, post-test and follow up using Friedman's ANOVAs. Multiple logistic regression models evaluated glycosylated hemoglobin (HbA1c) and triglycerides control at post-test and follow up. Results Questionnaire measures and metabolic variables significantly decreased symptomatology at post-test and these changes maintained at follow-up. Significant associations were found between quality-of-life scores and HbA1c and triglycerides levels in post-test and follow-up. Diabetes-related distress scores increased the odds of having adequate HbA1c control at post-test. Conclusion This study contributes to the evidence on the importance of considering psychological factors as part of comprehensive diabetes care to improve quality of life and emotional burden and facilitate the achievement of metabolic goals.
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Affiliation(s)
- Héctor Velázquez-Jurado
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico,Postgraduate Studies Division, National Autonomous University of Mexico (UNAM), Mexico City, Mexico, Héctor Velázquez-Jurado Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico; National Autonomous University of Mexico, Mexico City, Mexico; Av. Vasco de Quiroga #15, Col. Belisario Dominguez, Sección XVI, Alc. Tlalpan, C.P. 14080, Ciudad de Mexico
| | - Athena Flores-Torres
- Postgraduate Studies Division, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Liliana Pérez-Peralta
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Edgar Salinas-Rivera
- Department of Educational Psychology, National Pedagogic University (UPN), Mexico City, Mexico
| | - Marianne Daniela Valle-Nava
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico,Postgraduate Studies Division, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Denise Arcila-Martinez
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Sergio Hernández-Jiménez
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - for the CAIPaDi Study Group
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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Orben K, Ritholz MD, McCalla M, Beverly EA. Differences and similarities in the experience of living with diabetes distress: A qualitative study of adults with type 1 and type 2 diabetes. Diabet Med 2022; 39:e14919. [PMID: 35842933 DOI: 10.1111/dme.14919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/30/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Abstract
AIMS To explore the lived experiences of diabetes distress (DD) in adults with type 1 and type 2 diabetes, and to identify similarities and differences in these experiences. METHODS We conducted in-depth interviews with people with type 1 (n = 19) and type 2 diabetes (n = 29). We conducted thematic analysis using NVivo 12 software. RESULTS We identified three themes: (1) Experiencing Diabetes Distress as a Lack of Control - Similarities: All participants voiced a perceived lack of control with their glucose levels and other peoples' misconceptions about diabetes. Differences: Nearly all type 1 participants described a "lack of control" over emotional reactions to hypo- and hyperglycaemia as opposed to only one type 2 participant. (2) Experiencing Diabetes Distress as a Burden of Constant Management - Similarities: All participants emphasized the nonstop, relentless nature of diabetes management. Differences: type 1 participants described self-care as vital, with life-threatening consequences if not performed, while type 2 participants did not perceive such dangerous consequences. (3) Understanding the Value of Social Support in Diabetes Distress - Similarities: All participants acknowledged the importance of having others recognize the difficulties of living with diabetes. Differences: type 1 participants noted actual experiences where peers and health care professionals acknowledged that burden, whereas type 2 participants expressed a desire for this support that was not present in their lives. CONCLUSIONS Findings revealed subtle differences in perceptions of DD among adults with type 1 and type 2 diabetes, which suggest a need to tailor treatment for people with each type of diabetes.
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Affiliation(s)
- Kimberlee Orben
- School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Dublin, Ohio, USA
- The Graduate College, Translational Biomedical Sciences Program, Ohio University, Athens, Ohio, USA
| | - Marilyn D Ritholz
- Behavioral Health, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Monet McCalla
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
| | - Elizabeth A Beverly
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
- The Diabetes Institute, Ohio University, Athens, Ohio, USA
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Strikwerda M, Beulens JW, Remmelzwaal S, Schoonmade LJ, van Straten A, Schram MT, Elders PJ, Rutters F. The Association of Burnout and Vital Exhaustion With Type 2 Diabetes: A Systematic Review and Meta-Analysis. Psychosom Med 2021; 83:1013-1030. [PMID: 34334726 DOI: 10.1097/psy.0000000000000995] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the association of burnout and vital exhaustion with measures of glycemic control and type 2 diabetes (T2D) in a systematic review and meta-analysis. METHODS PubMed, Embase, and PsycINFO were searched from inception to April 2, 2020. Data extraction and quality assessment were performed using the Effective Public Health Practice Project tool. When possible, results were meta-analyzed using random-effects models and rated using the Grading of Recommendations, Assessment, Development and Evaluation. RESULTS A total of 5317 titles/abstracts were screened, 140 articles were read full text, of which 29 studies were included. Eighteen studies were cross-sectional, three prospective and eight were case-control studies. Burnout and vital exhaustion were significantly associated with T2D, with a pooled odds ratio of 1.8 (95% confidence interval [CI] = 1.4 to 2.4, I2 = 79%; 9 studies). Glycated hemoglobin A1c levels were not significantly higher in people with burnout and vital exhaustion, compared to those without, with a pooled standardized mean difference of 0.35 (95% CI = -0.62 to 1.33, I2 = 98%; 7 studies). In addition, no differences in glucose levels were observed (standardized mean difference = 0.02, 95% CI = -0.26 to 0.30, I2 = 90%; 9 studies). Sensitivity analyses showed no decrease in heterogeneity when excluding studies with low quality (I2glucose = 89%) or studies with a study n < 40 population (I2T2D = 77%). The level of Grading of Recommendations, Assessment, Development and Evaluation evidence was moderate to low quality because of 18 studies having a cross-sectional design. CONCLUSIONS Burnout and vital exhaustion might be associated with a higher risk of T2D, but not with glycemic control. Methodological shortcomings and high heterogeneity of the studies included complicate the interpretation of our results.
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Affiliation(s)
- Marije Strikwerda
- From the Amsterdam UMC, location VUmc, Department of Epidemiology and Data Science (Strikwerda, Beulens, Remmelzwaal, Rutters), Amsterdam Public Health Research Institute (Strikweda, Beulens, Remmelzwaal, Elders); Julius Centre for Health Sciences and Primary Care (Beulens), University Medical Centre Utrecht, Utrecht; the University Library (Schoonmade), VU, Amsterdam; Faculty of Behavioural and Movement Sciences and Amsterdam Public Health Research Institute (van Straten), Vrije Universiteit, HV Amsterdam; Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), MHeNS School for Mental Health and Neuroscience (Schram), Maastricht University Medical Center+, Maastricht; and Amsterdam UMC, location VUmc, Department of General Practice (Elders), Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Kuo HJ, Huang YC, García AA. An integrative review of fatigue in adults with type 2 diabetes mellitus: Implications for self-management and quality of life. J Clin Nurs 2021; 31:1409-1427. [PMID: 34585452 DOI: 10.1111/jocn.16058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/15/2021] [Accepted: 09/12/2021] [Indexed: 01/19/2023]
Abstract
AIMS AND OBJECTIVES To synthesise empirical studies on factors related to fatigue and its impact on diabetes self-management (DSM) and quality of life (QOL) in adults with type 2 diabetes mellitus (T2DM). BACKGROUND Fatigue is commonly reported in people with T2DM, a chronic condition that is highly prevalent worldwide. However, a holistic understanding of the consequences and factors related to fatigue in adults with T2DM is not well synthesised. DESIGN This integrative review used Whittemore and Knafl's methodology and was reported according to the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. METHODS The theory of unpleasant symptoms (TOUS) was used as a conceptual model to guide the review. The PubMed, PsychINFO and CINAHL databases were searched to identify studies that recruited adults with T2DM, were peer-reviewed, written in English and investigated fatigue as a primary or secondary outcome. Two investigators independently appraised the quality of the studies and extracted the data. RESULTS Twenty-nine articles met the inclusion criteria: 23 observational studies, two randomised controlled trials, one quasi-experimental study and three qualitative studies. All articles were of high quality. Physiological (e.g. T2DM duration, complications and inflammatory biomarkers), psychological (e.g. diabetes distress, depression and sleep quality) and situational factors (e.g. race/ethnicity, education and social support) were related to fatigue. Studies reported fatigue as a barrier to physical activity, healthy eating behaviours and the physical aspect of QOL. CONCLUSIONS Multiple factors are related to fatigue in adults with T2DM. Gaps in the literature include the multiple dimensions of fatigue, the effectiveness of interventions to alleviate fatigue and fatigue experiences in under-represented populations. RELEVANCE TO CLINICAL PRACTICE This integrative review supports the complex origin of fatigue and its impact on adults with T2DM. Nurses should evaluate modifiable factors related to fatigue and provide support to help improve DSM and QOL in this population.
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Affiliation(s)
- Hsuan-Ju Kuo
- The University of Texas at Austin School of Nursing, Austin, Texas, USA
| | - Ya-Ching Huang
- Texas State University St. David's School of Nursing, Round Rock, Texas, USA
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Lewinski AA, Shapiro A, Bosworth HB, Crowley MJ, McCant F, Howard T, Jeffreys AS, McConnell E, Tanabe P, Barcinas S, Coffman CJ, King HA. Veterans' Interpretation of Diabetes Distress in Diabetes Self-Management: Findings From Cognitive Interviews. Sci Diabetes Self Manag Care 2021; 47:391-403. [PMID: 34559032 DOI: 10.1177/26350106211043487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this project was to identify additional facets of diabetes distress (DD) in veterans that may be present due to the veteran's military-related experience. METHODS The study team completed cognitive interviews with veterans with type 2 diabetes mellitus (T2DM) to examine how they answered the Diabetes Distress Scale (DD Scale), a tool that assesses DD. The DD Scale was used because of its strong associations with self-management challenges, physician-related distress, and clinical outcomes. RESULTS The veterans sample (n= 15) was 73% male, mean age of 61 (SD = 8.6), 53% Black, 53% with glycosylated hemoglobin level <9%, and 67% with prescribed insulin. The DD Scale is readily understood by veterans and interpreted. Thematic analysis indicated additional domains affecting DD and T2DM self-management, including access to care, comorbidities, disruptions in routine, fluctuations in emotions and behaviors, interactions with providers, lifelong nature of diabetes, mental health concerns, military as culture, personal characteristics, physical limitations, physical pain, sources of information and support, spirituality, and stigma. CONCLUSIONS This study describes how a veteran's military experience may contribute to DD in the context of T2DM self-management. Findings indicate clinicians and researchers should account for additional domains when developing self-management interventions and discussing self-management behaviors with individuals with T2DM.
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Affiliation(s)
- Allison A Lewinski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.,School of Nursing, Duke University, Durham, North Carolina
| | - Abigail Shapiro
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.,School of Nursing, Duke University, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Department of Medicine, Division of General Internal Medicine, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Matthew J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, North Carolina
| | - Felicia McCant
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Teresa Howard
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Amy S Jeffreys
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Eleanor McConnell
- School of Nursing, Duke University, Durham, North Carolina.,Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Paula Tanabe
- School of Nursing, Duke University, Durham, North Carolina.,Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Heather A King
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Skovlund SE, Troelsen LH, Klim L, Jakobsen PE, Ejskjaer N. The participatory development of a national core set of person-centred diabetes outcome constructs for use in routine diabetes care across healthcare sectors. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:62. [PMID: 34507618 PMCID: PMC8434700 DOI: 10.1186/s40900-021-00309-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/31/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND This study sought to utilise participatory research methods to identify the perspectives of people with diabetes regarding which diabetes outcomes were most important to them. These findings were then used to support an expert working group representing multiple health sectors and healthcare disciplines and people with diabetes to establish a core set of patient-important outcome constructs for use in routine diabetes care. METHODS 26 people with diabetes and family members were recruited through purposive sampling to participate in interviews, focus groups, voting and plenary activities in order to be part of identifying outcome constructs. Content and qualitative analysis methods were used with literature reviews to inform a national multi-stakeholder consensus process for a core set of person-centred diabetes outcome constructs to be used in routine diabetes care across health care settings. RESULTS 21 people with diabetes and 5 family members representing type 1 and 2 diabetes and a range of age groups, treatment regimens and disease burden identified the following patient-reported outcome constructs as an important supplement to clinical indicators for outcome assessment in routine diabetes care: self-rated health, psychological well-being, diabetes related emotional distress and quality of life, symptom distress, treatment burden, blood sugar regulation and hypoglycemia burden, confidence in self-management and confidence in access to person-centred care and support. Consensus was reached by a national multi-stakeholder expert group to adopt measures of these constructs as a national core diabetes outcome set for use in routine value-based diabetes care. CONCLUSIONS We found that patient-reported outcome (PRO) constructs and clinical indicators are needed in core diabetes outcome sets to evaluate outcomes of diabetes care which reflect key needs and priorities of people with diabetes. The incorporation of patient-reported outcome constructs should be considered complementary to clinical indicators in multi-stakeholder value-based health care strategies. We found participatory research methods were useful in facilitating the identification of a core prioritised set of diabetes outcome constructs for routine value-based diabetes care. The use of our method for involving patients may be useful for similar efforts in other disease areas aimed at defining suitable outcomes of person-centred value-based care. Future research should focus on developing acceptable and psychometrically valid measurement instruments to evaluate these outcome constructs as part of routine diabetes care.
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Affiliation(s)
- Soren Eik Skovlund
- Department of Clinical Medicine, Aalborg University, Sønderskovvej 15, 9000, Aalborg, Denmark.
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark.
| | - Lise H Troelsen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Lotte Klim
- Danish Group for European Patients' Academy on Therapeutic Innovation (EUPATI), Copenhagen, Denmark
| | - Poul Erik Jakobsen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Ejskjaer
- Department of Clinical Medicine, Aalborg University, Sønderskovvej 15, 9000, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
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9
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Wang YC, Wang C, Shih PW, Tang PL. Analysis of the relationship between lifestyle habits and glycosylated hemoglobin control based on data from a Health Management Plan. Nutr Res Pract 2020; 14:218-229. [PMID: 32528629 PMCID: PMC7263898 DOI: 10.4162/nrp.2020.14.3.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/20/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/OBJECTIVES Type 2 Diabetes mellitus (T2DM) is a hereditary disease that is also strongly dependent on environmental factors, lifestyles, and dietary habits. This study explored the relationship between lifestyle habits and glycosylated hemoglobin management in T2DM patients to provide empirical outcomes to improve T2DM management and patient health literacy. SUBJECTS/METHODS This study enrolled 349 diabetic patients with more than 5 care visits to a Diabetes Mellitus care network under the Health Management Plan led by Taiwan Department of Health (DOH). Based on relevant literature, an Outpatient Record Form of Diabetes Mellitus Care was designed and lipid profile tests were conducted for data collection and analysis. RESULTS When modeling the data, the results showed that the odds for HbA1c > 7.5% in T2DM patients duration over 10 years was 3.785 (P = 0.002) times that in patients with disease duration of fewer than 3 years. The odds of HbA1c > 7.5% in illiterate patients was 3.128 (P = 0.039) times that in patients with senior high school education or above. The odds of HbA1c > 7.5% in patients with other chronic illness was 2.207 (P = 0.019) times that in participants without chronic illness. Among 5 beneficial lifestyle habits, the odds of HbA1c > 7.5% in patients with 2 or 3 good habits were 3.243 (P = 0.003) and 3.424 (P = 0.001) times that in patients with more than 3 good habits, respectively. CONCLUSION This empirical outcome shows that maintaining a good lifestyle improves T2DM management and patients' knowledge, motivation, and ability to use health information. Patients with longer disease duration, education, or good lifestyle habits had optimal HbA1c management than those in patients who did not. Thus, effective self-management and precaution in daily life and improved health literacy of diabetic patients are necessary to increase the quality of T2DM care.
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Affiliation(s)
- Ya-Chun Wang
- Nutrition and Food Service Department, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC).,Department of Food Science and Nutrition, Meiho University, Pingtung 91202, Taiwan (ROC)
| | - Chi Wang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC)
| | - Ping-Wen Shih
- Nutrition and Food Service Department, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC)
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC).,Department of Health-Business Administration, Fooyin University, Kaohsiung City 83102, Taiwan (ROC).,College of Nursing, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan (ROC)
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10
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Fritschi C, Park C, Quinn L, Collins EG. Real-Time Associations Between Glucose Levels and Fatigue in Type 2 Diabetes: Sex and Time Effects. Biol Res Nurs 2020; 22:197-204. [PMID: 32008368 DOI: 10.1177/1099800419898002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Fatigue is a pervasive and serious complaint among aging adults with type 2 diabetes. Anecdotally, hyperglycemia was thought to cause fatigue, but prior cross-sectional analyses failed to find any relationship between glucose levels and fatigue. However, study methodology may have caused this relationship to be missed. Our aim was to use concurrent and continuous data across 5 days to examine real-time momentary relationships between glucose and fatigue levels by week, day, and time of day. Additionally, we explored how these relationships differed by sex. METHOD Participants (N = 54, 51% male, 54% non-White) wore continuous glucose monitors and wrist actigraphy into which they inputted fatigue ratings 6-8 times daily during waking hours across 5 days. Generalized estimation equation models were used to explore the relationship between glucose and fatigue when averaged by week, day, and time of day. Differences by sex were also explored. RESULTS HbA1c and baseline and real-time fatigue were higher in women than in men. Baseline HbA1c and self-reported general fatigue were unrelated. Fatigue levels averaged by day and time of day were higher in women than in men (p < .05). Glucose and fatigue were significantly related at all levels of data (weekly, daily, and time of day) in women but not men. CONCLUSIONS Our findings suggest that, when measured concurrently, glucose excursions may affect fatigue levels in women.
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Affiliation(s)
- Cynthia Fritschi
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Chang Park
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Laurie Quinn
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Eileen G Collins
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.,Research & Development, Edward Hines, Jr. VA Hospital, Hines, IL, USA
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