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Li D, Pan E, Sun Z, Wen J, Su M, Wu M, Su J, Zhou J, Fan H, Shen C. Associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with type 2 diabetes under the national essential public health services program. BMC Public Health 2024; 24:1964. [PMID: 39044169 PMCID: PMC11265356 DOI: 10.1186/s12889-024-19538-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 07/19/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The rising prevalence of Type 2 diabetes (T2D) in China poses a critical health challenge, necessitating effective management strategies. The National Essential Public Health Services Program (NEPHSP), initiated in 2009, focuses on equitable access to health services, including T2D management. This study investigates the associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with T2D under NEPHSP, particularly examining the mediating role of self-care behaviors. METHODS Conducted from April to November 2020 in Huai'an City, Jiangsu Province, this study involved 1,577 T2D patients enrolled in NEPHSP. We assessed perceived care quality using the Patient Assessment of Chronic Illness Care (PACIC) scale and developed a comprehensive self-care behavior score, covering nine essential health practices. Glycemic control was evaluated using HbA1c levels. Linear regression models were used to explore these associations, adjusting for demographic and clinical factors, while causal mediation analyses examined the role of intermediate variables. RESULTS Higher PACIC scores significantly correlated with improved self-care behaviors (β = 0.294, 95% CI: 0.233 to 0.354) and were negatively associated with HbA1c levels (β=-0.109, 95% CI: -0.192 to -0.026). The self-care behavior score inversely related to HbA1c levels (β=-0.197, 95% CI: -0.263 to -0.132). Notably, self-care behaviors mediated 50.41% (P < 0.05) of the effect of perceived care quality on HbA1c levels. CONCLUSIONS This study demonstrates a substantial association between perceived care quality and better glycemic control in Chinese adults with T2D under NEPHSP, with self-care behaviors playing a crucial mediating role. These findings suggest that patient-centered care and comprehensive self-care practices are essential for effective T2D management within NEPHSP.
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Affiliation(s)
- Dianjiang Li
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Enchun Pan
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an, China
| | - Zhongming Sun
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an, China
| | - Jinbo Wen
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an, China
| | - Ming Su
- Huai'an District Center for Disease Control and Prevention, Huai'an, China
| | - Ming Wu
- Department of Chronic Disease Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jian Su
- Department of Chronic Disease Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jinyi Zhou
- Department of Chronic Disease Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hong Fan
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Chong Shen
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
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Oliveira D, Costa A, Henriques A, Curado MA, Schmitt A, Nogueira P. Validation of the Portuguese version of the diabetes self-management questionnaire-revised (DSMQ-R) in people with type 2 diabetes mellitus. BMC Psychol 2024; 12:405. [PMID: 39044279 PMCID: PMC11267859 DOI: 10.1186/s40359-024-01900-9] [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] [Received: 05/20/2024] [Accepted: 07/11/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Reflecting people with diabetes' self-management activities is often required in both research and clinical practice. This study evaluated the measurement properties of the Portuguese version of the Diabetes Self-Management Questionnaire-Revised (DSMQ-R) on a sample of people with type 2 diabetes mellitus (T2DM). METHODS Translation and cultural adaptation were conducted according to guidelines for cross-cultural adaptation and validation of healthcare measurement instruments. A cross-sectional study was performed including 365 people with T2DM in primary care. Reliability, construct validity, and criterion validity were analyzed. RESULTS The total scale of the translated DSMQ-R revealed sufficient internal consistency (alpha = 0.82), and most of the subscales performed adequately. The exploratory factor structure was robust, and confirmatory analysis showed a good model fit with the scale structure of the original scale. The scale scores correlated with the participants' last HbA1c estimates, supporting convergent validity, and convergence was confirmed by the adequate average variance extracted. CONCLUSIONS The Portuguese version of the DSMQ-R is a reliable and valid tool for gauging self-management behaviors in people with T2DM and their relationship with glycemic values.
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Affiliation(s)
- Dulce Oliveira
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), School of Nursing of Lisbon (ESEL), Lisbon, Portugal.
- Local Health Unit of Amadora/Sintra, E.P.E., Primary Health Care of Amadora, Amadora, Portugal.
- Istituto de Saúde Ambiental (ISAMB), Lisbon University, Lisbon, Portugal.
| | - Andreia Costa
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), School of Nursing of Lisbon (ESEL), Lisbon, Portugal
- Istituto de Saúde Ambiental (ISAMB), Lisbon University, Lisbon, Portugal
- School of Nursing of Lisbon (ESEL), Lisbon, Portugal
| | - Adriana Henriques
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), School of Nursing of Lisbon (ESEL), Lisbon, Portugal
- Istituto de Saúde Ambiental (ISAMB), Lisbon University, Lisbon, Portugal
- School of Nursing of Lisbon (ESEL), Lisbon, Portugal
| | - Maria Alice Curado
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), School of Nursing of Lisbon (ESEL), Lisbon, Portugal
- Istituto de Saúde Ambiental (ISAMB), Lisbon University, Lisbon, Portugal
- School of Nursing of Lisbon (ESEL), Lisbon, Portugal
| | - Andreas Schmitt
- Diabetes Center Mergentheim, Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
| | - Paulo Nogueira
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), School of Nursing of Lisbon (ESEL), Lisbon, Portugal
- Istituto de Saúde Ambiental (ISAMB), Lisbon University, Lisbon, Portugal
- School of Nursing of Lisbon (ESEL), Lisbon, Portugal
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Ibeneme SC, Mah J, Omeje C, Fortwengel G, Nwosu AO, Irem FO, Ibeneme GC, Myezwa H, Nweke M. Effectiveness of pedometer-based walking programmes in improving some modifiable risk factors of stroke among community-dwelling older adults: a systematic review, theoretical synthesis and meta-analysis. BMC Geriatr 2024; 24:516. [PMID: 38872081 PMCID: PMC11177376 DOI: 10.1186/s12877-024-05069-z] [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] [Received: 01/04/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Pedometer-based walking programs hold promise as a health promotion strategy for stroke prevention in community-dwelling older adults, particularly when targeted at physical activity-related modifiable risk factors. The question arises: What is the effectiveness of pedometer-based walking program interventions in improving modifiable stroke risk factors among community-dwelling older adults? METHOD Eight databases were searched up to December 2nd, 2023, following the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol. Inclusion criteria focused on randomized controlled trials (RCTS) involving community-dwelling older adults and reported in English. Two independent reviewers utilized Physiotherapy Evidence Database (PEDro) tool to extract data, assess eligibility, evaluate study quality, and identify potential bias. Standardized mean difference (SMD) was employed as summary statistics for primary -physical activity level -and secondary outcomes related to cardiovascular function (blood pressure) and metabolic syndrome, including obesity (measured by body mass index and waist circumference), fasting blood sugar, glycated hemoglobin, high-density lipoprotein cholesterol (HDL-C), and triglycerides. A random-effects model was used to generate summary estimates of effects. RESULTS The review analyzed eight studies involving 1546 participants aged 60-85 years, with 1348 successfully completing the studies. Across these studies, pedometer-based walking programs were implemented 2-3 times per week, with sessions lasting 40-60 minutes, over a duration of 4-26 weeks. The risk of bias varied from high to moderate. Our narrative synthesis revealed positive trends in HDL-C levels, fasting blood sugar, and glycated hemoglobin, suggesting improved glycemic control and long-term blood sugar management. However, the impact on triglycerides was only marginal. Primary meta-analysis demonstrated significantly improved physical activity behavior (SMD=0.44,95%CI:0.26, 0.61,p=<0.00001;I2=0%;4 studies; 532 participants) and systolic blood pressure (SMD=-0.34,95%CI:-0.59,-0.09;p=<0.008;I2=65%,2 studies;249 participants), unlike diastolic blood pressure (SMD=0.13,95%CI:-0.13,-0.38,p=0.33; I2=91%; 2 studies; 237 participants). Interventions based on social cognitive, self-efficacy, and self-efficiency theory(ies), and social cognitive theory applied in an ecological framework, were linked to successful physical activity behavior outcomes. CONCLUSION Pedometer-based walking programs, utilizing interpersonal health behavior theory/ecological framework, enhance physical activity behavior and have antihypertensive effects in community-dwelling older adults. While they do not significantly affect diastolic blood pressure, these programs potentially serve as a primary stroke prevention strategy aligning with global health goals. TRIAL REGISTRATION Registration Number: INPLASY202230118.
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Affiliation(s)
- Sam Chidi Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria.
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies,University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, Gauteng, South Africa.
- Department of Physiotherapy, Faculty of Health Sciences & Technology, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria.
- Department of physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Juliet Mah
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria
- Department of Physiotherapy, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Enugu, Nigeria
| | - Chidimma Omeje
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria
| | - Gerhard Fortwengel
- Faculty III, Hochschule Hannover University of Applied Sciences & Arts, 30159, Hannover, Lower Saxony, Germany
| | - Akachukwu Omumuagwula Nwosu
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria
| | - Frank Onyemaechi Irem
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria
| | - Georgian Chiaka Ibeneme
- Department of Nursing Sciences, Faculty of Health Sciences & Technology, College of Health Sciences, Ebonyi State University, Ebonyi State, Abakaliki, Nigeria
- Department of Nursing Science, Faculty of Health Sciences & Technology, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria
| | - Hellen Myezwa
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies,University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, Gauteng, South Africa
| | - Martins Nweke
- Department of Physiotherapy, Faculty of Health Sciences & Technology, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria
- Department of physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Zhang ZC, Du QH, Jia HH, Li YM, Liu YQ, Li SB. A qualitative study on inner experience of self-management behavior among elderly patients with type 2 diabetes in rural areas. BMC Public Health 2024; 24:1456. [PMID: 38822296 PMCID: PMC11140989 DOI: 10.1186/s12889-024-18994-w] [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] [Received: 02/05/2024] [Accepted: 05/29/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND As a chronic metabolic disease, diabetes poses a serious threat to human health and has become a major public health problem in China and worldwide. In 2020, 30% of Chinese people (aged ≥ 60 years) reported having diabetes mellitus. Moreover, individuals with diabetes living in rural areas face a significantly higher mortality risk compared to those in urban areas. In this study, we explored the inner experience of self-management behaviors in elderly patients with type 2 diabetes in rural areas to inform targeted interventions. METHODS A phenomenological research design was used to explore the inner experience of self-management in rural elderly diabetes. Ten elderly diabetic patients were sampled from December 2022 to March 2023 in rural areas of Yangcheng County, Jincheng City, ShanXi Province, China. The seven-step Colaizzi phenomenological was used to analyze the interview data and generate themes. RESULTS Four themes emerged: "Insufficient self-management cognition", "Negative self-management attitude", "Slack self-management behavior", and "No time for self-management". CONCLUSION The level of self-management among elderly patients with type 2 diabetes in rural areas is low. Healthcare professionals should develop targeted interventions aimed at enhancing their cognitive levels, modifying their coping styles, and improving their self-management abilities to improve their quality of life.
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Affiliation(s)
- Zi-Chen Zhang
- Department of Nursing, Harbin Medical University (Daqing), Xinyang Road No. 39, Daqing, 163319, China
| | - Qiu-Hui Du
- Department of Nursing, Harbin Medical University (Daqing), Xinyang Road No. 39, Daqing, 163319, China
| | - Hong-Hong Jia
- Department of Nursing, Harbin Medical University (Daqing), Xinyang Road No. 39, Daqing, 163319, China.
| | - Yu-Min Li
- Department of Nursing, Harbin Medical University (Daqing), Xinyang Road No. 39, Daqing, 163319, China
| | - Yu-Qin Liu
- Department of Nursing, Harbin Medical University (Daqing), Xinyang Road No. 39, Daqing, 163319, China
| | - Shao-Bo Li
- Department of Nursing, Harbin Medical University (Daqing), Xinyang Road No. 39, Daqing, 163319, China
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de Frel DL, Schroijen MA, Aardoom JJ, van Gils W, Huisman SD, Janssen VR, Versluis A, Kleinsmann MS, Atsma DE, Pijl H. Participatory Development of an Integrated, eHealth-Supported, Educational Care Pathway (Diabetes Box) for People With Type 2 Diabetes: Development and Usability Study. JMIR Hum Factors 2024; 11:e45055. [PMID: 38819880 PMCID: PMC11179029 DOI: 10.2196/45055] [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] [Received: 12/15/2022] [Revised: 09/17/2023] [Accepted: 11/20/2023] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) tremendously affects patient health and health care globally. Changing lifestyle behaviors can help curb the burden of T2D. However, health behavior change is a complex interplay of medical, behavioral, and psychological factors. Personalized lifestyle advice and promotion of self-management can help patients change their health behavior and improve glucose regulation. Digital tools are effective in areas of self-management and have great potential to support patient self-management due to low costs, 24/7 availability, and the option of dynamic automated feedback. To develop successful eHealth solutions, it is important to include stakeholders throughout the development and use a structured approach to guide the development team in planning, coordinating, and executing the development process. OBJECTIVE The aim of this study is to develop an integrated, eHealth-supported, educational care pathway for patients with T2D. METHODS The educational care pathway was developed using the first 3 phases of the Center for eHealth and Wellbeing Research roadmap: the contextual inquiry, the value specification, and the design phase. Following this roadmap, we used a scoping review about diabetes self-management education and eHealth, past experiences of eHealth practices in our hospital, focus groups with health care professionals (HCPs), and a patient panel to develop a prototype of an educational care pathway. This care pathway is called the Diabetes Box (Leiden University Medical Center) and consists of personalized education, digital educational material, self-measurements of glucose, blood pressure, activity, and sleep, and a smartphone app to bring it all together. RESULTS The scoping review highlights the importance of self-management education and the potential of telemonitoring and mobile apps for blood glucose regulation in patients with T2D. Focus groups with HCPs revealed the importance of including all relevant lifestyle factors, using a tailored approach, and using digital consultations. The contextual inquiry led to a set of values that stakeholders found important to include in the educational care pathway. All values were specified in biweekly meetings with key stakeholders, and a prototype was designed. This prototype was evaluated in a patient panel that revealed an overall positive impression of the care pathway but stressed that the number of apps should be restricted to one, that there should be no delay in glucose value visualization, and that insulin use should be incorporated into the app. Both patients and HCPs stressed the importance of direct automated feedback in the Diabetes Box. CONCLUSIONS After developing the Diabetes Box prototype using the Center for eHealth and Wellbeing Research roadmap, all stakeholders believe that the concept of the Diabetes Box is useful and feasible and that direct automated feedback and education on stress and sleep are essential. A pilot study is planned to assess feasibility, acceptability, and usefulness in more detail.
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Affiliation(s)
| | - Mariëlle A Schroijen
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Jiska J Aardoom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Wesley van Gils
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Sasja D Huisman
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Veronica R Janssen
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Maaike S Kleinsmann
- Department of Design, Organization and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Douwe E Atsma
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
- Department of Design, Organization and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Hanno Pijl
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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Gulbahar Eren M, Celik S, Celik M, Yon B, Can Ozturk F. Spiritual Well-being, Diabetes Burden, Self-management, and Glycemic Control Among Patients with Type 2 Diabetes in Turkey: A Descriptive and Correlational Study. JOURNAL OF RELIGION AND HEALTH 2023; 62:4363-4381. [PMID: 36871283 DOI: 10.1007/s10943-023-01783-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
Spiritual well-being is considered a significant factor in helping to manage chronic diseases and cope with the disease process. This descriptive-correlational study aimed to investigate the relationship between spiritual well-being, diabetes burden, self-management, and among 300 outpatients with type 2 diabetes in Turkey. A significant relationship was found between the diabetes burden and self-management levels and the spiritual well-being of patients with diabetes (p < 0.005). Multiple linear regression analyses found that a high diabetes burden (ß = -0.106) decreased well-being, and high self-management increased well-being (ß = 0.415). Additionally, the results revealed that marital status, household members, performing daily life activities alone, hospitalization due to complications, diabetes burden, self-management, glycemic control, and blood lipid parameters explained 29% of the total variance in the spiritual well-being level. Accordingly, the present study recommended that health professionals should consider spiritual well-being to support disease management with a holistic approach to diabetes patients.
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Affiliation(s)
- Merve Gulbahar Eren
- Internal Medicine Nursing Department, Faculty of Health Science, Sakarya University, Sakarya, Turkey
| | - Selda Celik
- Hamidiye Faculty of Nursing, University of Health Sciences Turkey, Istanbul, Turkey.
| | - Melike Celik
- Internal Medicine Nursing Department, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Burcu Yon
- Vocational School of Health Services, Düzce University, Düzce, Turkey
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Dietz CJ, Sherrill WW, Ankomah S, Rennert L, Parisi M, Stancil M. Impact of a community-based diabetes self-management support program on adult self-care behaviors. HEALTH EDUCATION RESEARCH 2023; 38:1-12. [PMID: 36367205 DOI: 10.1093/her/cyac034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/17/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
Diabetes is a chronic condition that has reached epidemic proportions in the United States, affecting nearly 34 million adults, and disproportionately affecting vulnerable populations, such as ethnic minorities, the elderly and individuals with low socioeconomic status. This study addresses the impact of the Health Extension for Diabetes (HED) program, a community-based diabetes self-management support program, on adult diabetes self-care behaviors. The Summary of Diabetes Self-Care Activities (SDSCA) was utilized to evaluate improvement in diabetes self-care behaviors. Descriptive statistics, univariate and multivariable regression models were conducted. Significant increases were observed among program participants (N = 149) in all five subscales of the SDSCA (general diet, specific diet, blood glucose testing, exercise and foot care; P-values < 0.001). A priority of this diabetes education program was helping underserved populations; over half (62%) of participants self-identified as Black/African Americans. After program participation, scores on all SDSCA subscales increased significantly among Black/African Americans (n = 93) by approximately 1 day per week. White/other races (n = 56) showed similar increases in four of the SDSCA subscales post-HED program participation. This study shows that increasing participation in community-based, diabetes self-management support programs, such as HED, can increase engagement in diabetes self-care behaviors among underserved groups.
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Affiliation(s)
- C J Dietz
- Department of Public Health Sciences, Clemson University, 521 Edwards Hall, Clemson, SC 29634, USA
| | - W W Sherrill
- Department of Public Health Sciences, Clemson University, 521 Edwards Hall, Clemson, SC 29634, USA
| | - S Ankomah
- Department of Public Health Sciences, Clemson University, 521 Edwards Hall, Clemson, SC 29634, USA
| | - L Rennert
- Department of Public Health Sciences, Clemson University, 521 Edwards Hall, Clemson, SC 29634, USA
| | - M Parisi
- Cooperative Extension Service, Clemson University, 103 Barre Hall, Clemson, SC 29634, USA
| | - M Stancil
- Diabetes Self-Management Program, Prisma Health-Upstate, 875 W Faris Rd, Greenville, SC 29605, USA
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Wascher TC, Stechemesser L, Harreiter J. [Blood glucose self monitoring]. Wien Klin Wochenschr 2023; 135:143-146. [PMID: 37101035 PMCID: PMC10133076 DOI: 10.1007/s00508-023-02172-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
Self monitoring of blood glucose contributes to the integrated management of diabetes mellitus. It, thus, should be available for all patients with diabetes mellitus. Self monitoring of blood glucose improves patients safety, quality of life and glucose control. The current article represents the recommendations of the Austrian Diabetes Association for the use of blood glucose self monitoring according to current scientific evidence.
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Affiliation(s)
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I, Paracelsus Medizinische Privatuniversität - Landeskrankenhaus, Salzburg, Österreich
| | - Jürgen Harreiter
- Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Spitalgasse 23, 1090, Wien, Österreich.
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Al-Ozairi A, Taghadom E, Irshad M, Al-Ozairi E. Association Between Depression, Diabetes Self-Care Activity and Glycemic Control in an Arab Population with Type 2 Diabetes. Diabetes Metab Syndr Obes 2023; 16:321-329. [PMID: 36777315 PMCID: PMC9911899 DOI: 10.2147/dmso.s377166] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/20/2023] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Poor self-care behavior and depression are associated with worse glycemic control, but the relationship between these variables is poorly reported. The present study aimed to describe self-care behaviors and explore the association between depression, self-care and glycemic control in people with type 2 diabetes in an Arab population. PATIENTS AND METHODS This study recruited 446 patients with type-2 diabetes from an outpatient clinic in Kuwait and completed assessments of diabetes self-care using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire and depression using the Patients Health Questionnaire-9 (PHQ-9) scales. Multiple linear regression models were used to determine the associations between depression, self-care behaviors and glycemic control. RESULTS Self-care behaviors were highest for medication taking (92.9%), an average for foot care (61.4%), blood glucose testing (60%) and healthy diet (55.7%), and lowest for exercise (27.1%). Depression, poor self-care activities and poor HbA1c levels were inter-correlated in univariate analysis (p< 0.03). In regression analysis, following healthful eating (B= -0.27, p< 0.001), general eating plan (B= -0.21, p= 0.01), more space carbohydrates evenly throughout the day (B= - 0.17, p= 0.03) and exercise at least 30 minutes (B= -0.17, p= 0.02) behaviors were associated with better HbA1c levels. However, depression was associated with poor scores of following a general eating plan (B= -0.20, p= 0.03), space carbohydrates evenly throughout the day (B= -0.21, p= 0.05), and exercising at least 30 minutes (B= -0.24, p= 0.03) behaviors. Depression scores were also associated with poor HbA1c levels (B= 0.32, p= 0.03). However, this association no longer persists after mutual adjustment with following a healthy diet (B= 0.14, p= 0.38) and exercise (B = 0.26, p = 0.08) behaviors. CONCLUSION Self-care activity was less than fifty percent in people with type 2 diabetes and higher activity was associated with better glycemic control. However, depression adversely affects self-care behaviors. To maintain and achieve glycemic control, diabetes educators might motivate people with type 2 diabetes to enhance their self-care activities, particularly those with depression symptoms and poor compliance with self-care activities.
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Affiliation(s)
- Abdullah Al-Ozairi
- Department of Psychiatry, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Etab Taghadom
- Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
- Dasman Diabetes Institute, Dasman, Kuwait
| | | | - Ebaa Al-Ozairi
- Dasman Diabetes Institute, Dasman, Kuwait
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Correspondence: Ebaa Al-Ozairi, Dasman Diabetes Institute, PO Box 1180, Dasman, 15462, Kuwait, Email
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Efficacy of Self-Management on Glucose Control in Type 2 Diabetes Mellitus Patients Treated with Insulin. Healthcare (Basel) 2022; 10:healthcare10102080. [PMID: 36292529 PMCID: PMC9601748 DOI: 10.3390/healthcare10102080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Diabetes mellitus (DM) is a chronic metabolic disease. If blood glucose is poorly controlled, it will cause a variety of chronic complications. Therefore, the issue of healthcare in diabetic patients is a problem that cannot be ignored. In this study, we aim to investigate the correlation between sociodemographic characteristics, self-management, and glycated hemoglobin (HbA1c) values in patients with type 2 diabetes treated with insulin. A total of 300 type 2 diabetic patients treated with insulin were enrolled. Type 2 diabetic patients treated with insulin had a significant negative correlation of HbA1c value to self-management total score. The lower the HbA1c value, the better the self-management of type 2 diabetic patients treated with insulin is. It is recommended that scale assessment tools be used to identify problems, improve the self-management ability of type 2 diabetic patients, and problem solve in patients in order to facilitate the effectiveness of blood glucose control of type 2 diabetic patients.
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Nguyen VB, Thi KHP, Nguyen TX, Pham NTL, Nguyen VVH, Van Le C. Diabetes self-management and its associated factors among patients with diabetes in central Vietnam: A cross-sectional study. PLoS One 2022; 17:e0270901. [PMID: 35802719 PMCID: PMC9269929 DOI: 10.1371/journal.pone.0270901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/19/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Diabetes self-management (DSM) enables maintenance of optimal individualized glycemic control for patients with diabetes through comprehensive lifestyle, medication adherence, and self-monitoring glucose level. This study aimed to evaluate DSM and to find associated factors among Vietnamese diabetes patients by using the Vietnamese version of Diabetes Self-Management Instrument (DSMI). Methods A cross-sectional study was conducted at a single hospital in the central Vietnam. DSM was assessed using the DSMI. The participant’s socio-demographic and clinical features were obtained through face-to-face interviews and medical records. Multivariate linear regression was used to determine independent factors associated with total DSMI. Results The mean total DSM score based on DSMI self-administered questionnaire scores was 88.4 ± 22.1, with a range of 47 to 140. The mean self-integration, self-regulation, interaction with health professionals, self-monitoring blood glucose, and adherence to the prescribed regime were 24.8, 22.3, 21.6, 10.2, and 9.5, respectively. 48.1% of DM patients had good HbA1c control. Sex, educational status, BMI, waist circumference, medical nutrition therapy, and sufficient physical activities were factors independently predictive of DSMI total score. Conclusion This study emphasizes that the DSM situation is seen to be average among DM patients with mean DSMI score 88.4 ± 22.1 and sex, educational status, BMI, waist circumference, medical nutrition therapy, and sufficient physical activities were independently predictive factors of DSMI total score. This evidence suggests that there is a need to enhance the effectiveness of DSM education programs among diabetic patients.
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Affiliation(s)
- Van Bang Nguyen
- Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam
| | | | - Thi Xuan Nguyen
- Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam
| | | | - Van Vy Hau Nguyen
- Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam
| | - Chi Van Le
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
- * E-mail:
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Schmitt A, Kulzer B, Ehrmann D, Haak T, Hermanns N. A Self-Report Measure of Diabetes Self-Management for Type 1 and Type 2 Diabetes: The Diabetes Self-Management Questionnaire-Revised (DSMQ-R) – Clinimetric Evidence From Five Studies. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 2:823046. [PMID: 36994332 PMCID: PMC10012087 DOI: 10.3389/fcdhc.2021.823046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022]
Abstract
AimsMeasurement tools to evaluate self-management behavior are useful for diabetes research and clinical practice. The Diabetes Self-Management Questionnaire (DSMQ) was introduced in 2013 and has become a widely used tool. This article presents a revised and updated version, DSMQ-R, and evaluates its properties in assessing self-management practices in type 1 diabetes (T1D) and type 2 diabetes (T2D).MethodsThe DSMQ-R is a multidimensional questionnaire with 27 items regarding essential self-management practices for T1D and T2D (including diabetes-adjusted eating, glucose testing/monitoring, medication taking, physical activity and cooperation with the diabetes team). For the revised form, the original items were partially amended and the wording was updated; eleven items were newly added. The tool was applied as part of health-related surveys in five clinical studies (two cross-sectional, three prospective) including a total of 1,447 people with T1D and T2D. Using this data base, clinimetric properties were rigorously tested.ResultsThe analyses showed high internal and retest reliability coefficients for the total scale and moderate to high coefficients for the subscales. Reliability coefficients for scales including the new items were consistently higher. Correlations with convergent criteria and related variables supported validity. Responsiveness was supported by significant short to medium term changes in prospective studies. Significant associations with glycemic outcomes were observed for DSMQ-R-assessed medication taking, glucose monitoring and eating behaviors.ConclusionsThe results support good clinimetric properties of the DSMQ-R. The tool can be useful for research and clinical practice and may facilitate the identification of improvable self-management practices in individuals.
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Affiliation(s)
- Andreas Schmitt
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Diabetes Center Mergentheim (DZM), Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- *Correspondence: Andreas Schmitt,
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Diabetes Center Mergentheim (DZM), Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Diabetes Center Mergentheim (DZM), Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Thomas Haak
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Diabetes Center Mergentheim (DZM), Bad Mergentheim, Germany
| | - Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Diabetes Center Mergentheim (DZM), Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
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Evaluating Effectiveness of Outpatient Monitoring in Type 2 Diabetes: The One-Year Experience in an Italian Group of Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111540. [PMID: 34770054 PMCID: PMC8583604 DOI: 10.3390/ijerph182111540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022]
Abstract
Nowadays, chronic disease management is the primary challenge of the healthcare system. From 2015, in the Veneto region (Italy), patients with a diagnosis of type 2 diabetes mellitus (T2DM) have been included in the diagnostic-therapeutic pathway (PDTA) program, and their clinical condition has been continuously monitored. The aim of this retrospective study is to determine the effectiveness of PDTA intervention, alone or in combination with a specialized one, in subjects with diagnosis of T2DM. Clinical and behavioral characteristics were collected at baseline and after 1 year of follow-up. Two subgroups were considered: subjects enrolled in PDTA only and subjects enrolled in both the PDTA program and in the care plan proposed by the specialized medical center (CAD group). Longitudinal analysis showed a relevant positive effect of time on diastolic blood pressure, while CAD enrollment appears to be related to higher levels of glycated hemoglobin. When included together in the same model, interaction between time and CAD covariates results in completely nonsignificant effects. As long-term management of chronic disorders, such as T2DM, is often difficult due to disease characteristics and problems in healthcare organization, monitoring programs, such as PDTA, and specialized care programs, such as CAD, do not show a clinically relevant effect in the first year of follow-up. Therefore, they should be analyzed over a longer period. However, they should also carefully consider the need for adequate tools for data collection and sharing, in addition to the context of application, patient expectations and the need for a long-term educational program.
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Velázquez-López L, Segura Cid Del Prado P, Colín-Ramírez E, Muñoz-Torres AV, Escobedo-de la Peña J. Adherence to non-pharmacological treatment is associated with the goals of cardiovascular control and better eating habits in Mexican patients with type 2 diabetes mellitus. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2021; 34:88-96. [PMID: 34103182 DOI: 10.1016/j.arteri.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify the association of diabetes education or medical nutrition therapy with the goals of control of cardiovascular risk indicators and dietary habits in patients with type 2 diabetes mellitus. METHODS Analytical cross-sectional study in 395 primary care patients. HbA1c, fasting glucose and lipid profile, blood pressure, weight, waist circumference, and body composition were measured. Dietary habits were measured using the «Instrument for measuring lifestyle in patients with type 2 diabetes mellitus» (IMEVID), in the nutrition dimension. Medical nutrition therapy (MNT) and diabetes education (DE) were considered as received by the patient when provided in their healthcare clinic. RESULTS Women comprised 68% of the patients, with a median of 6 years from diabetes diagnosis. Of the patients, 21% received DE and MNT, 28% DE or MNT, and 51% received neither. The HbA1c was lower in the patients with DE and MNT (7.7% ± 1.9% vs. 8.7% ± 2.3%, 8.4% ± 2.2%; p = .003) respectively. In the patients with DE and MNT, a higher proportion took physical exercise, consumed less tobacco, and had better dietary habits (p < .05). Patients who received DE and MNT achieved HbA1c and HDL-c control levels. A greater risk of HbA1c > 7% was identified when they only received DE or MNT or neither, a longer time since diagnosis of the disease and less frequent adherence to a diet to control the disease (p < .05). CONCLUSION Diabetes education and medical nutritional therapy favour the goal of cardiovascular risk control and better dietary habits in the patient with type 2 diabetes.
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Affiliation(s)
- Lubia Velázquez-López
- Unidad de Investigación en Epidemiología Clínica. Hospital Carlos MacGregor Sánchez Navarro. Instituto Mexicano del Seguro Social, Ciudad de México, México.
| | | | - Eloísa Colín-Ramírez
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac, Huixquilucan, Estado de México, México
| | - Abril Violeta Muñoz-Torres
- Departamento de Salud Pública. Facultad de Medicina. Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Jorge Escobedo-de la Peña
- Unidad de Investigación en Epidemiología Clínica. Hospital Carlos MacGregor Sánchez Navarro. Instituto Mexicano del Seguro Social, Ciudad de México, México
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Jiwani R, Dennis B, Bess C, Monk S, Meyer K, Wang J, Espinoza S. Assessing acceptability and patient experience of a behavioral lifestyle intervention using fitbit technology in older adults to manage type 2 diabetes amid COVID-19 pandemic: A focus group study. Geriatr Nurs 2021; 42:57-64. [PMID: 33248357 PMCID: PMC7933081 DOI: 10.1016/j.gerinurse.2020.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 01/01/2023]
Abstract
Type 2 diabetes (T2D) contributes to reduced quality of life in older adults, especially in those with comorbidities such as being overweight or obese. Personal fitness technology (Fitbit ®) has the potential to improve the management of T2D. Using a semi-structured interview guide, focus groups were conducted to explore participants' acceptability and experiences following a behavioral lifestyle intervention that integrated Fitbit in overweight/obese older adults with T2D amid the COVID-19 pandemic which began during the time of this study. Focus group transcripts were transcribed and analyzed using thematic analysis. Eighteen (18) of the 20 participants completed the program and focus group interviews. Overall, we observed high acceptability of the program, and participants reported favorable experiences such as increased knowledge of health behaviors, improved diabetes management, and improved quality of life following the behavioral lifestyle intervention, even under stressful life circumstances from COVID-19.
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Affiliation(s)
- Rozmin Jiwani
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; Geriatric Research, Education & Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, Texas, USA.
| | - Brittany Dennis
- Graduate School of Biomedical Sciences, University of Texas Health Science Center at San Antonio, San Antonio,Texas, USA; Center on Smart and Connected Health Technologies at University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Chandler Bess
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Siler Monk
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Kylie Meyer
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jing Wang
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; Center on Smart and Connected Health Technologies at University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Sara Espinoza
- Geriatric Research, Education & Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, Texas, USA; Department of Medicine, Division of Geriatrics, Gerontology & Palliative Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; Sam & Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Hurst CP, Rakkapao N, Hay K. Impact of diabetes self-management, diabetes management self-efficacy and diabetes knowledge on glycemic control in people with Type 2 Diabetes (T2D): A multi-center study in Thailand. PLoS One 2021; 15:e0244692. [PMID: 33382799 PMCID: PMC7774854 DOI: 10.1371/journal.pone.0244692] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022] Open
Abstract
We investigate the relationship of diabetes knowledge, diabetes management self-efficacy and diabetes self-management with blood glucose control among people with Thai type 2 diabetes mellitus (T2D). Seven hundred outpatients from diabetes clinics from large university and small community hospitals in two provinces of Thailand (Khon Kaen and Bangkok) were interviewed to evaluate their diabetes knowledge (DK), diabetes management self-efficacy (DMSE) and diabetes self-management (DSM). In addition, patient medical records were accessed to obtain other patient characteristics including patients’ HbA1c levels. Bivariate and multivariable logistic regression modelling was conducted and unadjusted and adjusted odds ratios obtained, respectively. Over half (52.4%) of the patients in our sample failed to control their blood glucose (HbA1c > 7%). All three psychometric measures (DK, DMSE and DSM) were identified as associated with blood glucose control in the bivariate analysis (ORDK(unadj) = 0.89, 95%CI: 0.82, 0.96; ORDSM(unadj) = 1.64, 95%CI: 1.46, 1.82; ORDMSE(unadj) = 2.84; 95%CI: 2.43, 3.32). However, after mutual adjustment and adjustment for other patient characteristics, of the three psychometric measures, only diabetes management self-efficacy remained associated with blood glucose control (ORDMSE(adj) = 2.67; 95%CI: 2.20, 3.25). Diabetes management self-efficacy is shown to be strongly associated with blood glucose control in the Thai Type 2 diabetes population. Current early diabetes interventions in Thailand tend to focus on disease knowledge. A stronger emphasis on enhancing patients’ disease management self-efficacy in these interventions is likely to lead to substantial improvement in both diabetes self-management and blood glucose control, thereafter reducing the risk, or prolonging the development, of chronic diabetes complications.
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Affiliation(s)
- Cameron P. Hurst
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Faculty of Public Health, Thammasat University, Muang, Lampang, Thailand
| | - Nitchamon Rakkapao
- Faculty of Public Health, Thammasat University, Muang, Lampang, Thailand
- * E-mail:
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Short-term improvements in diet quality in people newly diagnosed with type 2 diabetes are associated with smoking status, physical activity and body mass index: the 3D case series study. Nutr Diabetes 2020; 10:25. [PMID: 32661234 PMCID: PMC7359342 DOI: 10.1038/s41387-020-0128-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/09/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023] Open
Abstract
Background Dietary intake impacts glycaemic control through its effect on weight and glucose-insulin homeostasis. Early glycaemic control is associated with improved outcomes and reduced mortality for people with type 2 diabetes (T2D). To date, the diet quality of people with T2D has only been studied cross-sectionally. The objective of this paper is to quantify short-term improvements in diet quality and to identify factors associated with improvements after T2D diagnosis among participants in the 3D study. Methods This paper presents data from the 3D study of 225 Australian adults, newly diagnosed with T2D. Telephone interviews collected demographic, diet, physical and health data at baseline and 3 months. Diet quality was assessed using the Dietary Approaches to Stop Hypertension (DASH) tool to examine short-term changes in diet quality after diagnosis. Participants were categorised into two groups: those who improved their diet quality by 3 months (increase in DASH score of 3 or more) and those who did not. Factors associated with change in DASH scores were clinically and statistically evaluated. Results The 3D cohort was comparable to Australian cohorts with diabetes by gender and body mass index (BMI) but differed by age, remoteness and socioeconomic status. Mean (SD) baseline DASH score was 24.4 (4.7), in the midrange of possible scores between 8 and 40. One third of participants improved their DASH score by 3-months. This group had lower diet quality (p < 0.001), lower BMI (p = 0.045), higher physical activity levels (p = 0.028) and were less likely to smoke (p = 0.018) at baseline. Conclusions Diet quality changes after diagnosis do not appear to be associated with demographic characteristics but were associated with lifestyle behaviours. Strategies targeted at better supporting smokers, those with low physical activity and higher BMI are required. Future research should investigate how the diet quality changes people make around time of diagnosis are related to long-term health outcomes.
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Karl FM, Holle R, Schwettmann L, Peters A, Meisinger C, Rückert‐Eheberg I, Laxy M. Association between unrealistic comparative optimism and self-management in individuals with type 2 diabetes: Results from a cross-sectional, population-based study. Health Sci Rep 2020; 3:e157. [PMID: 32377577 PMCID: PMC7200875 DOI: 10.1002/hsr2.157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/17/2020] [Accepted: 03/25/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND AIMS Unrealistic comparative optimism (UO), as the erroneous judgement of personal risks to be lower than the risks of others, could help explain differences in diabetes self-management. The present study tested the hypothesis that individuals with type 2 diabetes who underestimate their comparative heart attack risk, have a lower adherence regarding recommended self-management. METHODS We used data from individuals with type 2 diabetes participating in the German KORA (Cooperative Health Research in the Region of Augsburg) GEFU 4 (self-administered health questionnaire 2016) study. UO was estimated by comparing participants' subjective comparative risk for having a heart attack within the next 5-years (ie, "higher than others," "average," "lower than others"), with their objective comparative 10-year cardiovascular disease risk based on the Framingham equations. We estimated binary logistic and linear regression models to analyze which characteristics were associated with UO and to test the association between UO and participants' self-management behaviors (ie, regular self-monitoring of body weight, blood sugar, and blood pressure, regular foot care, keeping a diabetes diary, and having a diet plan), and their sum score, respectively. All models were adjusted for socio-demographic and disease-related variables. RESULTS The studied sample included n = 633 individuals with type 2 diabetes (mean age 70.7 years, 45% women). Smokers and males were more likely to show UO than nonsmokers and females. Furthermore, a higher blood pressure and a higher body mass index were associated with a higher likelihood of UO regarding heart attack risk. However, UO was not significantly associated with patient self-management. CONCLUSIONS Unfavorable health behavior and risk factors are associated with UO. However, our results suggest that UO with regard to perceived heart attack risk may not be a relevant factor for patient self-management in those with type 2 diabetes.
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Affiliation(s)
- Florian M. Karl
- Institute of Health Economics and Healthcare ManagementHelmholtz Zentrum München (GmbH)NeuherbergGermany
- German Center for Diabetes Research (DZD)NeuherbergGermany
| | - Rolf Holle
- Institute of Health Economics and Healthcare ManagementHelmholtz Zentrum München (GmbH)NeuherbergGermany
- Department of Medical Informatics, Biometry and EpidemiologyUniversity of MunichMunichGermany
| | - Lars Schwettmann
- Institute of Health Economics and Healthcare ManagementHelmholtz Zentrum München (GmbH)NeuherbergGermany
| | - Annette Peters
- German Center for Diabetes Research (DZD)NeuherbergGermany
- Institute of EpidemiologyHelmholtz Zentrum München, GmbH, German Research Center for Environmental HealthNeuherbergGermany
| | - Christa Meisinger
- Institute of EpidemiologyHelmholtz Zentrum München, GmbH, German Research Center for Environmental HealthNeuherbergGermany
| | - Ina‐Maria Rückert‐Eheberg
- Institute of EpidemiologyHelmholtz Zentrum München, GmbH, German Research Center for Environmental HealthNeuherbergGermany
| | - Michael Laxy
- Institute of Health Economics and Healthcare ManagementHelmholtz Zentrum München (GmbH)NeuherbergGermany
- German Center for Diabetes Research (DZD)NeuherbergGermany
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Shrestha M, Ng AH, Gray RJ. Association between subthreshold depression and self-care behaviours in adults with type 2 diabetes: A protocol for a cross-sectional study. J Clin Nurs 2020; 30:2453-2461. [PMID: 32415880 DOI: 10.1111/jocn.15250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/05/2020] [Accepted: 03/14/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To examine the association between subthreshold depression and self-care behaviours in adults with type 2 diabetes (T2D) attending a tertiary healthcare service. BACKGROUND Diabetes is a global public health problem. Self-care behaviours are a fundamental element in managing diabetes as adherence to self-care activities is associated with improved glycaemic control. Depression in T2D is associated with decreased adherence to self-care behaviours. Adults with subthreshold depression in diabetes may have difficulties in achieving metabolic control. Further, people with subthreshold depression have an increased risk of developing major depression. Few studies have examined the association between subthreshold depression and self-care behaviours. DESIGN A cross-sectional study. METHODS The study will be conducted among 384 adults diagnosed with T2D for at least a year attending their routine outpatient appointment at Tribhuvan University Teaching Hospital in Nepal. Convenience sampling will be used to recruit study participants. Data will be collected via face-to-face interviews and a medical record review. Self-care behaviours will be assessed using the Summary of Diabetes Self-care activities and subthreshold depression will be determined using the Patient Health Questionnaire- 9. Covariates in the study include sociodemographic and clinical factors, diabetes knowledge, perceived social support and self-efficacy. This paper complies with the STROBE reporting guideline for cross-sectional studies. RESULTS We will use multiple linear regression to examine the association between subthreshold depression and each self-care behaviours (i.e. diet, physical activity, foot care, blood glucose testing and medication) and total self-care behaviour. CONCLUSIONS Effective management of diabetes requires adherence to self-care behaviours. The findings of the study will help in identifying an effective way to improve diabetes self-care. RELEVANCE TO CLINICAL PRACTICE Our observations will inform nursing research and practice by providing evidence about how subthreshold depression may influence self-care behaviours.
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Affiliation(s)
- Monika Shrestha
- School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
| | - Ashley H Ng
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Bundoora, Australia
| | - Richard J Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
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Conway C, Kelechi T, Gregoski M. Measuring Medication Adherence Among Type 2 Diabetes: An Integrative Review. J Nurs Meas 2020; 28:JNM-D-18-00091. [PMID: 32179724 DOI: 10.1891/jnm-d-18-00091] [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: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The literature indicates there is a lack of evidence of a standard for diabetes medication adherence (MA) measures. The purpose of this integrative review (IR) was to identify instruments appropriate to measure MA among adults with T2DM. METHODS The IR was conducted according to Whittemore and Knafl (2005) methodology. The databases CINAHL, OVID, PubMed, and Scopus were searched for manuscripts published between 2006 and 2016 using the keywords "adherence," "diabetes," "instrument," and "measure." Ten manuscripts reflecting the psychometric properties of twelve published instruments were reviewed. RESULTS The most commonly used instrument was the Morisky Medication Adherence 8 item. Reliability and validity varied among studies. CONCLUSION The findings suggest the need for continued psychometric testing of diabetes MA instruments.
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Affiliation(s)
- Cheryl Conway
- Medical University of South Carolina, Charleston, South Carolina
| | - Teresa Kelechi
- Medical University of South Carolina, Charleston, South Carolina
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Walker RJ, Garacci E, Campbell JA, Harris M, Mosley-Johnson E, Egede LE. Relationship Between Multiple Measures of Financial Hardship and Glycemic Control in Older Adults With Diabetes. J Appl Gerontol 2020; 40:162-169. [PMID: 32167406 DOI: 10.1177/0733464820911545] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Aim: To examine the relationship between multiple measures of financial hardship and glycemic control in older adults with diabetes. Methods: Using data from Health and Retirement Study (HRS), we investigated four measures of financial hardship: difficulty paying bills, ongoing financial strain, decreasing food intake due to money, and taking less medication due to cost. Using linear regression models, we investigated the relationship between each measure, and a cumulative score of hardships per person, on glycemic control (HbA1c). Results: After adjustment, a significant relationship existed with each increasing number of hardships associated with increasing HbA1c (0.09, [95%CI 0.04, 0.14]). Difficulty paying bills (0.25, [95%CI 0.14, 0.35]) and decreased medication usage due to cost (0.17, [95%CI 0.03, 0.31]) remained significantly associated with HbA1c. Conclusion: In older adults, difficulty paying bills and cost-related medication nonadherence is associated with glycemic control, and every additional financial hardship was associated with an increased HbA1c by nearly 0.1%.
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Affiliation(s)
- Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
| | - Emma Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
| | - Jennifer A Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
| | - Melissa Harris
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
| | - Elise Mosley-Johnson
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA
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Shrestha M, Ng A, Al-Ghareeb A, Alenazi F, Gray R. Association between subthreshold depression and self-care behaviors in people with type 2 diabetes: a systematic review of observational studies. Syst Rev 2020; 9:45. [PMID: 32113485 PMCID: PMC7049390 DOI: 10.1186/s13643-020-01302-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/19/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Self-care behaviors in people living with type 2 diabetes are important to achieving optimal glycemic control. Major depression in type 2 diabetes is associated with decreased adherence to self-care behaviors. The association between subthreshold depression and self-care behaviors, however, has not previously been systematically reviewed. The objective of this review is to determine the association between subthreshold depression and self-care behaviors. METHODS A systematic search was performed in five electronic databases that included MEDLINE, EMBASE, PsycINFO, Emcare, and CINAHL. Any observational studies in adults with type 2 diabetes, investigating the association between subthreshold depression and any self-care behaviors, were included in the review. Qualitative studies, review articles, and gray literature were excluded. Two reviewers independently completed the title and abstract and full-text screening, appraised the study quality, and extracted the data. A third reviewer resolved any discrepancies between the reviewers if needed. Included articles were critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Meta-analyses were not conducted because criteria for conducting such analyses were not met. RESULTS A total of 6408 articles were identified through the database searching. After the abstract and full-text review, two articles met the inclusion criteria. One of the included study was cross-sectional while the other was a longitudinal study. Both studies showed inconsistent findings in the association between subthreshold depression and self-care behaviors. Important risks of bias were identified in the included studies. DISCUSSION The evidence from the two included studies on a possible association between subthreshold depression and self-care behaviors in adults with type 2 diabetes was not consistent and potentially biased. Our review established a gap in knowledge and suggests that further high-quality studies are needed to examine the association between subthreshold depression and self-care behaviors in people with type 2 diabetes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018116373.
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Affiliation(s)
- Monika Shrestha
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia. .,Global Institute for Interdisciplinary Studies (GIIS), Kathmandu, Nepal.
| | - Ashley Ng
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Melbourne, Australia
| | | | - Fatimah Alenazi
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.,University of South Australia, Adelaide, Australia.,University of Essex, Colchester, Essex, UK
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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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24
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Almutairi N, Hosseinzadeh H, Gopaldasani V. The effectiveness of patient activation intervention on type 2 diabetes mellitus glycemic control and self-management behaviors: A systematic review of RCTs. Prim Care Diabetes 2020; 14:12-20. [PMID: 31543458 DOI: 10.1016/j.pcd.2019.08.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/13/2019] [Accepted: 08/29/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus T2DM is a major health challenge and associated with several complications and mortality. Self-management behaviors SMBs such as healthy diet, physical activity, blood glucose self-monitoring, foot care and medication adherence are critical part of diabetic care. Empowered or activated patients, are more likely to practice better SMBs. However, the effectiveness of patient activation intervention on T2DM glycemic control and SMBs is not totally well understood. AIM To assess the effectiveness of patient activation intervention on T2DM glycemic control and SMBs. METHOD A systematic search was undertaken through five databases to find relevant studies published between 2004 and 2018. We included randomized controlled trials with sample size ≥120 and follow up period of ≥12 months and assess the effectiveness of patient activation intervention on T2DM glycemic control and SMBs. RESULTS 10 RCTs were identified for analysis. The total sample size is 3728 and the combined mean age is 57.3 years. The combined mean BMI is 31.2kg/m2 (obese). Seven intervention demonstrated a significant reduction in HbA1c, ranged from 0.36 to 0.80%. All interventions presented an improvement in at least one self-management behavior. DISCUSSION AND CONCLUSION Patient activation intervention showed a significant positive effect on T2DM glycemic control and SMBs, particularly physical activity, healthy diet, foot care and blood glucose self-monitoring. The effectiveness on SMBs was seen across different intervention strategies, modes of delivery, length of intervention, and number of providers. Better effectiveness on HbA1c was associated with poorly controlled participants, culturally tailored-intervention, and in-person sessions intervention combined with telephone calls follow up.
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Affiliation(s)
- Nasser Almutairi
- School of Health & Society, University of Wollongong, NSW, Australia
| | | | - Vinod Gopaldasani
- School of Health & Society, University of Wollongong, NSW, Australia
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25
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Shrestha M, Al-Ghareeb A, Alenazi F, Gray R. Association between subthreshold depression and self-care behaviour in people with type 2 diabetes: a protocol for systematic review of observational studies. Syst Rev 2019; 8:167. [PMID: 31300045 PMCID: PMC6624905 DOI: 10.1186/s13643-019-1084-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 07/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is a common comorbidity in type 2 diabetes. Studies have consistently shown that major depression is associated with decreased diabetic self-care behaviour. People with subthreshold depression experience greater functional impairment, have a poorer quality of life and use health services more than those without depressive symptoms. Although subthreshold depression impacts self-care behaviour, the relationship between subthreshold depression and diabetes self-care behaviour has not been systematically reviewed. The objective of this systematic review is to determine the association between subthreshold depression and self-care behaviour in adults with type 2 diabetes. METHODS This protocol will follow the guideline of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 (PRISMA-P-2015). A systematic search of literature will be conducted for observational studies reporting the association between subthreshold depression and self-care behaviour in adults aged 18 years or over and diagnosed with type 2 diabetes. Electronic databases including MEDLINE, EMBASE, PsycINFO, Emcare and CINAHL will be searched using predefined search terms. Title and abstract, full-text screening and data extraction of identified articles will be done by two reviewers independently. Discrepancies will be resolved by a third author. The methodological quality of the included studies will be assessed using The Joanna Briggs Institute (JBI) risk of bias tools. The review results will be presented in the form of narrative synthesis, and if sufficient studies are available and variability among the studies is low, a random effects meta-analysis will be done to quantify the result. DISCUSSION This review will synthesise evidence on the association between subthreshold depression and self-care behaviour in type 2 diabetic adults. The findings will be useful to researchers and policymakers to determine the most effective approach to overall diabetes management. The review will also identify research gaps in the current literature and provide direction for future research in this area of study. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018116373.
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Affiliation(s)
- Monika Shrestha
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
- Nepal Diabetic Society, Kathmandu, Nepal
| | - Amal Al-Ghareeb
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Fatimah Alenazi
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
- Qassim University, Buraydah, Kingdom of Saudi Arabia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
- University of South Australia, Adelaide, Australia
- University of Essex, Colchester, Essex, UK
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Liu YT, Lin LY, Tuan CW, Yang CY, Tang PL. Analyzing the Association HbA1c control by Depression, social participation and Utilizing Self-management Questionnaire. Diabetes Res Clin Pract 2019; 153:103-110. [PMID: 31175913 DOI: 10.1016/j.diabres.2019.05.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
AIMS In Taiwan, 24.7% of the population aged ≥65 years has been diagnosed with type 2 diabetes. Only 23% of diabetes patients effectively conduct self-management. This study focused on the effects of self-management among type 2 diabetes patients aged ≥65 years on the effectiveness of their HbA1c control. METHODS This cross-sectional study enrolled patients aged ≥65 years with type 2 diabetes who were admitted to a metabolic clinic at a medical center and treated over six months. 192 patients were recruited, and data were recorded using structured questionnaires. The HbA1c level of the recruited subjects was measured for statistical analysis. RESULTS Older age, education, living alone, and an above-average level of self-management were associated with increased HbA1c control effectiveness; patients who used insulin had worse HbA1c control effectiveness. CONCLUSION That cohabitants living with diabetes patients affected the effectiveness of HbA1c control, suggesting that family members should also participate in self-management education programs. Given the advances in information networks, a lively and interactive mode of health education animation for uneducated diabetes patients should be developed, and medical teams should be encouraged to establish a two-way communication channel with patients improve the effectiveness of HbA1c control in diabetes patients aged >65 years.
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Affiliation(s)
- Yun-Ting Liu
- Department of Nursing, Kaohsiung Veterans General Hospital, Taiwan, ROC.
| | - Li-Ying Lin
- Department of Nursing, Kaohsiung Veterans General Hospital, Taiwan, ROC; Department of Nursing, Meiho University, Kaohsiung, Taiwan, ROC.
| | - Chi-Wei Tuan
- Department of Nursing, Kaohsiung Veterans General Hospital, Taiwan, ROC.
| | - Chun-Ying Yang
- Department of Nursing, Kaohsiung Veterans General Hospital, Taiwan, ROC.
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan, ROC; College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
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Blutzuckerselbstkontrolle (Update 2019). Wien Klin Wochenschr 2019; 131:115-118. [DOI: 10.1007/s00508-018-1436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cheng LJ, Wang W, Lim ST, Wu VX. Factors associated with glycaemic control in patients with diabetes mellitus: A systematic literature review. J Clin Nurs 2019; 28:1433-1450. [PMID: 30667583 DOI: 10.1111/jocn.14795] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 11/19/2018] [Accepted: 01/14/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To perform a systematic review search and critically review the empirical evidence concerning the factors affecting glycaemic control in patients with type 1 or 2 diabetes mellitus. BACKGROUND Previous primary studies have investigated the factors associated with glycaemic control among patients with type 1 or 2 diabetes, but attempts to amalgamate these evidences have been methodologically limited. Hence, a robust review of the evidence is essential to explore factors that can be addressed to promote good glycaemic control in patients with diabetes. DESIGN Mixed-method systematic review using the Preferred Reporting Items for Systematic review and Meta-Analysis 2009 flow diagram, integrating evidence from qualitative and quantitative studies (see Supporting Information File S1). METHODS A systematic review of the literature published between 2006-2017 was conducted in seven electronic databases (CINAHL, MEDLINE, Scopus, EMBASE, PsycINFO, PubMed and ScienceDirect) using the search terms "diabetes mellitus," "glycemic control," "self-concept," "knowledge," "self-efficacy," "empowerment," "race," "ethnicity," "duration," "medication," "obesity" and "comorbidity." RESULTS A total of 1,582 articles were initially retrieved, and 24 of these articles were included in this systematic literature review. The overall empirical evidence suggested that higher socio-economic status, greater dietary knowledge, and higher self-efficacy and empowerment improve glycaemic control among patients with diabetes mellitus. CONCLUSIONS This review presented the factors associated with glycaemic control that may pose significant socio-economic problems to most nations worldwide and impede development nationally, regionally and even globally. Greater emphasis needs to be placed on implementing lifestyle changes on a societal level to stem the tide of the epidemic. RELEVANCE TO CLINICAL PRACTICE There is a need to implement self-management initiatives, that incorporate dietary knowledge, to empower patients with diabetes in their own care. Future public health policy must be geared towards increasing the capability of dealing with the rising incidence of diabetes and implementing primary prevention.
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Affiliation(s)
- Ling Jie Cheng
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, Singapore City, Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Suan Tee Lim
- National University Hospital, National University Health System, Singapore City, Singapore
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
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Bukhsh A, Khan TM, Sarfraz Nawaz M, Sajjad Ahmed H, Chan KG, Goh BH. Association of diabetes knowledge with glycemic control and self-care practices among Pakistani people with type 2 diabetes mellitus. Diabetes Metab Syndr Obes 2019; 12:1409-1417. [PMID: 31616171 PMCID: PMC6698595 DOI: 10.2147/dmso.s209711] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/29/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study explored the relationship of disease knowledge with glycemic control and self-care practices in adult Pakistani people diabetes (PWD). METHODS People diagnosed with type 2 diabetes (n=218) were selected from three health care centers, located in different cities of Pakistan. Disease knowledge and self-care practices were assessed by Urdu versions of Diabetes Knowledge Questionnaire (DKQ) and Diabetes Self-Management Questionnaire (DSMQ), using a cross-sectional design. Chi-square and correlation analysis were applied to explore the relationship of disease knowledge with glycemic control and self-care practices. Linear regression was used to explore the predictors for disease knowledge. RESULTS Majority of the sample was >45-60 years old (48.8%), suffering from type 2 diabetes mellitus for <5 years (49.5%) and had poor glycemic control (HbA1C≥7%; n=181 participants). Disease knowledge was significantly associated (p<0.05) with patient's gender, level of education, family history of diabetes, nature of euglycemic therapy, and glycemic control. Correlation matrix showed strongly inverse correlations of DKQ with glycated hemoglobin levels (r=-0.62; p<0.001) and strongly positive with DSMQ sum scale (r=0.63; p<0.001). PWD having university-level education (β=0.22; 95% Confidence Interval (CI) 0.189, 0.872; p<0.01), doing job (β=0.22; 95% CI 0.009, 0.908]; p=0.046), and use of oral hypoglycemic agents in combination with insulin (β=-0.16; 95% CI [-1.224, -0.071]; p=0.028) were the significant predictors for disease knowledge. CONCLUSION Disease knowledge significantly correlated with glycated hemoglobin levels and self-care activities of PWD. These findings will help in designing patient-tailored diabetes educational interventions for yielding a higher probability of achieving target glycemic control.
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Affiliation(s)
- Allah Bukhsh
- School of Pharmacy, Monash University, Bandar Sunway, Selangor, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
- Correspondence: Allah BukhshSchool of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway47500, Selangor, MalaysiaTel +60 113 362 3703Fax +60 35 514 6364 Email
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Bandar Sunway, Selangor, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | | | | | - Kok Gan Chan
- International Genome Centre, Jiangsu University, Zhenjiang, People’s Republic of China
- Division of Genetics and Molecular Biology, Faculty of Science, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Kok Gan ChanInternational Genome Centre, Jiangsu University, Zhenjiang, People’s Republic of ChinaTel +60 37 967 7748 Email
| | - Bey-Hing Goh
- School of Pharmacy, Monash University, Bandar Sunway, Selangor, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
- Biofunctional Molecule Exploratory (BMEX) Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor Darul Ehsan, Malaysia
- Health and Well-being Cluster, Global Asia in the 21st Century Platform, Monash University Malaysia, Bandar Sunway, Malaysia
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Cheng LJ, Wu VX, Dawkes S, Lim ST, Wang W. Factors influencing diet barriers among outpatients with poorly-controlled type 2 diabetes: A descriptive correlational study. Nurs Health Sci 2018; 21:102-111. [PMID: 30264523 DOI: 10.1111/nhs.12569] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 07/06/2018] [Accepted: 07/27/2018] [Indexed: 01/06/2023]
Abstract
The aim of the present descriptive correlational study was to investigate diet barriers and their influencing factors among outpatients with poorly-controlled type 2 diabetes in Singapore. One hundred and ten patients with poorly-controlled type 2 diabetes were recruited from a tertiary hospital in Singapore. The Personal Diabetes Questionnaire and Appraisal of Diabetes Scale were used to measure the study variables. Our participants reported that the most common diet barriers were eating out, followed by food cravings. Eating problems and negative diabetes appraisal were identified as significant predictors of diet barriers. The findings laid the groundwork with preliminary findings for the development of culturally-tailored and patient-centered education programs to enhance eating behaviors and promote positive appraisal.
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Affiliation(s)
- Ling Jie Cheng
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, Singapore
| | - Vivien Xi Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Susan Dawkes
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | - Suan Tee Lim
- National University Hospital, National University Health System, Singapore
| | - Wenru Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Bijlsma-Rutte A, Rutters F, Elders PJM, Bot SDM, Nijpels G. Socio-economic status and HbA 1c in type 2 diabetes: A systematic review and meta-analysis. Diabetes Metab Res Rev 2018; 34:e3008. [PMID: 29633475 DOI: 10.1002/dmrr.3008] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 01/12/2023]
Abstract
Up until now, differences in HbA1c levels by socio-economic status (SES) have been identified, but not yet quantified in people with type 2 diabetes. The aim of this study was therefore to assess the difference in HbA1c levels between people with type 2 diabetes of different SES in a systematic review and meta-analysis. A systematic literature search was conducted in MEDLINE, Embase, Ebsco, and the Cochrane Library until January 14, 2018. Included studies described adults with type 2 diabetes in whom the association between SES and HbA1c levels was studied. Studies were rated for methodological quality and data were synthesized quantitatively (meta-analysis) and qualitatively (levels of evidence), stratified for type of SES variable, i.e., education, income, deprivation, and employment. Fifty-one studies were included: 15 high, 27 moderate, and 9 of low methodological quality. Strong evidence was provided that people of low SES have higher HbA1c levels than people of high SES, for deprivation, education, and employment status. The pooled mean difference in HbA1c levels between people of low and high SES was 0.26% (95% CI, 0.09-0.43) or 3.12 mmol/mol (95% CI, 1.21-5.04) for education and 0.20% (95% CI, -0.05 to 0.46) or 2.36 mmol/mol (95%CI, -0.61 to 5.33) for income. In conclusion, our systematic review and meta-analysis showed that there was an inverse association between SES and HbA1c levels in people with type 2 diabetes. Future research should focus on finding SES-sensitive strategies to reduce HbA1c levels in people with type 2 diabetes.
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Affiliation(s)
- Anne Bijlsma-Rutte
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Femke Rutters
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Sandra D M Bot
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
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Askari A, Jeihooni AK, Kashfi SM, Marzban A, Khiyali Z. The Effect of Educational Program Based on Belief, Attitude, Subjective Norm, and Enabling Factors Model on Changing the Metabolic Indices in Elderly Patients with Type II Diabetes. Int J Prev Med 2018; 9:74. [PMID: 30210739 PMCID: PMC6124220 DOI: 10.4103/ijpvm.ijpvm_308_16] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/09/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetes is the most common disease related to metabolism disorders. Today, diabetes in the elderly is one of the major epidemics of the century. This study aimed to investigate the effect of nutrition and jogging-based Belief, Attitude, Subjective Norm, and Enabling Factors (BASNEF) model in changes in metabolic parameters that performed in elderly patients with type II diabetes in Fasa city. METHODS This study was a randomized clinical trial on 108 elderly patients with type II diabetes (54 patients in the experimental group and 54 in control group) referred to the diabetes center in Fasa City, Fars Province, Iran, in 2016. Data were collected using a valid self-reported questionnaire including demographic variables and BASNEF Model (knowledge, attitudes, subjective norms, and enabling factors), checklist for patient's practices nutrition and jogging based on self-reporting patients, assess the level of fasting blood sugar (FBS), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), and HbAlc patients which was completed by both groups before and 3 months after the intervention. The experimental group received the training in eight sessions; each session lasted for 70 min. Then, the data were entered into the SPSS 22 software (SPSS Inc., IBM, Chicago, IL, USA) and were analyzed using descriptive statistics, Chi-square test, independent t-test, and paired t-test. P <0.05 was considered as statistically significant. RESULTS The results showed that the mean scores of the BASNEF components (knowledge, attitudes, subjective norms, and enabling factors) in two experimental and control groups after intervention were a significant difference. After training program, nutritional and jogging performance in the experimental group was better than the control group. Furthermore, FBS (P < 0.001), LDL (P < 0.001), HDL (P < 0.001), TG (P < 0.001), and HbAlc (P < 0.001) improved significantly in the experimental group compared to the control group. CONCLUSIONS Plan and implement nutrition and jogging education using the BASNEF model to improve metabolic parameters in diabetic patients are very effective and beneficial. Moreover, in the implementation of these programs, control, monitoring, and follow-up educational are recommended.
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Affiliation(s)
- Alireza Askari
- Department of Orthopedic, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Khani Jeihooni
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa, Iran
| | - Seyyed Mansour Kashfi
- Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Atefeh Marzban
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa, Iran
| | - Zahra Khiyali
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa, Iran
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Bhagavathula AS, Gebreyohannes EA, Abegaz TM, Abebe TB. Perceived Obstacles Faced by Diabetes Patients Attending University of Gondar Hospital, Northwest Ethiopia. Front Public Health 2018; 6:81. [PMID: 29637064 PMCID: PMC5881243 DOI: 10.3389/fpubh.2018.00081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/05/2018] [Indexed: 12/29/2022] Open
Abstract
Background Diabetes mellitus (DM) is a non-communicable, chronic, and progressive disease that can lead to serious complications and even to premature death. A closer understanding of the DM patients’ specific obstacles will provide a greater clarity of the factors influencing their disease-related quality of life and coping with daily life. The study aimed to evaluate the obstacles of DM patients attending ambulatory clinic of the University of Gondar Hospital (UOGH), Northwest Ethiopia. Methods A cross-sectional study was conducted from February to April 2017 at ambulatory clinic of the UOGH. A validated short version of the diabetic obstacle questionnaire was used. The internal reliability of the questionnaire was checked using Cronbach’s alpha and was found to be 92.5%. To determine any association between each of the nine sections of the questionnaire and age, sex, residence, educational status, and DM type, a binary logistic regression was performed. Results The mean age of respondents was 38.69 ± 15.39 years. Compared with patients with type 1 DM, patients with type 2 DM reported poorer relationships with medical professionals (adjusted odds ratio (AOR): 2.191, p-value = 0.027) and less support from families and friends (AOR: 1.913, p-value = 0.049). Patients coming from rural areas (AOR: 2.947, p = 0.002) and having no formal education (AOR: 2.078, p = 0.029) also received less support from families and friends. Conclusion DM patients in UOGH reported several obstacles related to patients’ relationship with health professionals, lack of support from their friends, lack of knowledge about DM, and lack of motivation to exercise. Effective efforts should be initiated to improve healthier environment to educate, care and preventive services for people with DM.
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Affiliation(s)
- Akshaya Srikanth Bhagavathula
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar-College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Eyob Alemayehu Gebreyohannes
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar-College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Tadesse Melaku Abegaz
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar-College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Tamrat Befekadu Abebe
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar-College of Medicine and Health Sciences, Gondar, Ethiopia.,Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Sweden
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Burch E, Ball L, Somerville M, Williams LT. Dietary intake by food group of individuals with type 2 diabetes mellitus: A systematic review. Diabetes Res Clin Pract 2018; 137:160-172. [PMID: 29329777 DOI: 10.1016/j.diabres.2017.12.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/08/2017] [Accepted: 12/21/2017] [Indexed: 01/04/2023]
Abstract
AIMS To synthesize peer-reviewed literature that investigates the dietary intake by food group of individuals with type 2 diabetes mellitus (T2DM) and compare intakes to national and international dietary guidelines. METHODS Four electronic databases (MEDLINE, EMBASE, CINAHL and Web of Sciences) were searched for studies that investigated the dietary intake of adults (≥18 years) with T2DM using the five main food groups (fruit, vegetables, dairy, grains and meat/meat alternatives). Food group intake in serves was compared against national guidelines and fruit and vegetable intake in grams was compared against the World Health Organization (WHO) guidelines. RESULTS After screening 13,662 publications, 11 studies were included. All reported cross-sectional data. Majority of participants were consuming less than the recommended serves of fruit, vegetables, grains and dairy and were meeting or exceeding the recommended serves for meat/meat alternatives. Two of six studies reported fruit and vegetable recommendations were being met, two reported dairy recommendations were being met and two reported grain recommendations were being met. Of the five studies reporting intake in grams, four met the WHO minimum intake for fruit and vegetables. CONCLUSIONS Individuals with T2DM do not comply with food group recommendations; particularly for fruit, vegetables, dairy and grains. Longitudinal research is required to better understand how food group intake changes over time after diagnosis.
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Affiliation(s)
- Emily Burch
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
| | - Mari Somerville
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
| | - Lauren T Williams
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
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Laine MK, Kauppila T, Honkasalo M, Raina M, Eriksson JG. Impact of intervention on metabolic outcomes among dropouts with type 2 diabetes. Adv Med Sci 2018; 63:5-8. [PMID: 28763676 DOI: 10.1016/j.advms.2017.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 03/19/2017] [Accepted: 05/21/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of an individual intervention given by health care professionals to dropouts with type 2 diabetes (T2D) on their metabolic profile. MATERIALS/METHODS In 2010, we identified 356 T2D dropouts in Vantaa Health Centre, Finland. At the baseline visit the participants' status was assessed including laboratory tests. Diabetes counseling was given, and drug treatment was enhanced when needed. The follow-up visit was performed 13 to 30 months later including the same assessments as performed at the baseline visit. The dropouts who attended the follow-up visit formed the study group. One third (n=115) of the dropouts participated in the follow-up visit. RESULTS The study participants (mean age 61.4 years) were older than the non-participants (mean age 58.5 years) (p=0.009). After the intervention the proportion of participants with hemoglobin A1c≥9% (75mmol/mol) decreased from 15.5% to 5.2% (p=0.004). Improvements were also observed in general in hemoglobin A1c, from 6.6% (49mmol/mol) to 6.3% (45mmol/mol) (p=0.001), in total cholesterol, from 4.9mmol/l to 4.5mmol/l (p=0.011), in low-density lipoprotein cholesterol, from 2.9mmol/l to 2.6mmol/l (p=0.015) and in diastolic blood pressure, from 90mmHg to 84mmHg (p=0.001). CONCLUSIONS Dropouts with T2D were difficult to bring back to the public health care system, especially men under the age of 60 years. Dropouts who participated in the intervention showed improvements in several metabolic outcomes.
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Affiliation(s)
- Merja K Laine
- Department of General Practice and Primary Healthcare, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Vantaa Health Center, Vantaa, Finland.
| | - Timo Kauppila
- Department of General Practice and Primary Healthcare, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Vantaa Health Center, Vantaa, Finland.
| | - Mikko Honkasalo
- Department of General Practice and Primary Healthcare, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Nurmijärvi Health Center, Nurmijärvi, Finland.
| | | | - Johan G Eriksson
- Department of General Practice and Primary Healthcare, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland.
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Bukhsh A, Khan TM, Nawaz MS, Ahmed HS, Chan KG, Lee LH, Goh BH. Association of diabetes-related self-care activities with glycemic control of patients with type 2 diabetes in Pakistan. Patient Prefer Adherence 2018; 12:2377-2385. [PMID: 30519003 PMCID: PMC6235006 DOI: 10.2147/ppa.s177314] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Association of various self-care activities on glycemic control of people with diabetes (PWD) in Pakistan is yet to be explored. The current study aimed to evaluate the association of various diabetes-related self-care activities with glycated hemoglobin (HbA1c) levels and to examine the predictive relationship of patients' demographic variables with their self-care activities. PATIENTS AND METHODS A cross-sectional study was conducted on adult PWD (N=218) who were diagnosed with type 2 diabetes mellitus of at least 1 year duration. Self-care activities were examined by using the Urdu version of Diabetes Self-management Questionnaire. Linear regression analysis was conducted to examine the significant predictors for diabetes-related self-care activities and glycemic control. RESULTS Mean age of the patients was 50.77±13.3 years. Poor glycemic control (HbA1c $7%) was observed in majority of the patients (83%). Linear regression analysis revealed that glucose management (β=-0.44; 95% CI -0.438, -0.209; P<0.001) was the strongest predictor for low levels of patients' HbA1c, followed by dietary control (β=-0.19; 95% CI -0.248, -0.018; P=0.024) and physical activity (β=-0.17; 95% CI -0.165, -0.023; P=0.010), respectively. Linear regression analysis showed that use of oral hypoglycemic agents only (β=-0.218; 95% CI -0.956, -0.200; P=0.003) and higher education level (β=0.204; 95% CI 0.138, 0.777; P=0.005) were significant predictors for higher scores of patients' self-care activities. CONCLUSION The findings support that PWD having better self-reported self-care activities achieve better glycemic control. Patients' self-care activities should be monitored on a regular basis, especially for those who are at risk of poor glycemic control.
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Affiliation(s)
- Allah Bukhsh
- School of Pharmacy, Monash University, Jalan Lagoon Selatan 45700, Selangor, Malaysia,
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, 54000, Lahore, Pakistan,
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Jalan Lagoon Selatan 45700, Selangor, Malaysia,
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, 54000, Lahore, Pakistan,
| | | | | | - Kok Gan Chan
- International Genome Centre, Jiangsu University, Zhenjiang, China,
- Division of Genetics and Molecular Biology, Faculty of Science, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia,
| | - Learn-Han Lee
- School of Pharmacy, Monash University, Jalan Lagoon Selatan 45700, Selangor, Malaysia,
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, 54000, Lahore, Pakistan,
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
- Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- Center of Health Outcomes Research and Therapeutic, Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Mueang Phayao, Thailand
| | - Bey-Hing Goh
- School of Pharmacy, Monash University, Jalan Lagoon Selatan 45700, Selangor, Malaysia,
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, 54000, Lahore, Pakistan,
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
- Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
- Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- Center of Health Outcomes Research and Therapeutic, Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Mueang Phayao, Thailand
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Ferrari M, Dal Cin M, Steele M. Self-compassion is associated with optimum self-care behaviour, medical outcomes and psychological well-being in a cross-sectional sample of adults with diabetes. Diabet Med 2017; 34:1546-1553. [PMID: 28799282 DOI: 10.1111/dme.13451] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2017] [Indexed: 11/30/2022]
Abstract
AIM To investigate the role of self-compassion in diabetes outcomes. Self-compassion is a construct which may be relevant to chronic conditions, given its focus on compassion toward oneself, especially in times of difficulty. METHODS In this cross-sectional study we collected data online from 310 adults diagnosed with diabetes. The questionnaire measured three primary outcomes: self-management behaviours; HbA1c levels and psychological well-being. Potential predictors were also assessed, including self-compassion, locus of control, social support and demographics. RESULTS Multiple regression analyses showed that self-compassion had the most consistent association with better outcomes, including all forms of self-management behaviour, HbA1c levels and psychological well-being. Self-compassion was independently associated with 55.1% of the variance in well-being. Internal locus of control was also significantly associated with better well-being and HbA1c outcomes. Chance and external locus of control and social support were generally associated with poorer outcomes. CONCLUSIONS Higher levels of self-compassion are typically associated with improved self-management behaviour, medical outcomes and psychological well-being in adults with diabetes mellitus. The present findings suggest that self-compassion may be a parsimonious and suitable intervention target. Future interventions and consultations with medical professionals may benefit from fostering self-compassion in adults with diabetes mellitus.
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Affiliation(s)
- M Ferrari
- School of Psychology, Australian Catholic University, Strathfield, New South Wales, Australia
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - M Dal Cin
- School of Psychology, Australian Catholic University, Strathfield, New South Wales, Australia
| | - M Steele
- School of Allied Health, Australian Catholic University, Brisbane, Queensland, Australia
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Wilson AL, McNaughton D, Meyer SB, Ward PR. Understanding the links between resilience and type-2 diabetes self-management: a qualitative study in South Australia. ACTA ACUST UNITED AC 2017; 75:56. [PMID: 28944055 PMCID: PMC5607493 DOI: 10.1186/s13690-017-0222-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/17/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Research conducted by Ward, Muller, Tsourtos, et al. (Soc Sci Med 72(7):1140-1148, 2011) has led to the development of the psycho-social interactive model of resilience, which reveals the interaction between individual resilience factors (i.e. coping, confidence and self esteem) and external resilience environments (i.e. employment, supportive family environments and health promoting policies) in facilitating the development of resilience. This present study explored the utility of this model of resilience for understanding how people self-manage type-2 diabetes. METHODS Data were collected via 14 semi-structured life-history interviews with women and men living with type-2 diabetes mellitus (T2DM). Participants varied according to socio-demographics (gender, age, education level, income) and were recruited based on their self-reported management (or lack thereof) of T2DM. RESULTS The inter-play of internal traits and external resources with additive and subtractive resilience strategies were consistent with the psycho-social interactive model of resilience. Self-management was influenced by life history. Differences in self-management and material disadvantage were also identified. Alongside increased disadvantage are higher levels of external barriers to self-management practices. CONCLUSIONS This paper supports the concepts of additive and subtractive resilience strategies for use with diabetes populations; providing health professionals and policy makers with an increased understanding of how to recognize and foster patient resilience for the improvement of self-care, disease management and ultimately health outcomes.
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Affiliation(s)
- A L Wilson
- Flinders University, Bedford Park, Australia
| | | | - S B Meyer
- University of Waterloo, Waterloo, Canada
| | - P R Ward
- Discipline of Public Health, Flinders University, Bedford Park, Australia
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Claude Mbanya J, Aschner P, Chan JCN, Jose Gagliardino J, Saji J. Self-monitoring of blood glucose (SMBG) and glycaemic control in Cameroon: Results of the International Diabetes Management Practices Study (IDMPS). Diabetes Res Clin Pract 2017; 126:198-201. [PMID: 28259009 DOI: 10.1016/j.diabres.2016.11.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 11/20/2022]
Abstract
This study examined the relationship between self-monitoring of blood glucose (SMBG) and glycaemic control among patients from Cameroon. A minority of patients with diabetes owned a blood glucose meter; of these patients, most performed SMBG inconsistently. The lack of SMBG may be a contributing factor to the poor glycaemic control in the country.
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Affiliation(s)
- Jean Claude Mbanya
- Faculty of Medicine and Biomedical Sciences and Laboratory for Molecular Medicine and Metabolism, The Biotechnology Centre, University of Yaoundé 1, Yaoundé, Cameroon; Health of Population in Transition Medical Research Group, P.O. Box 8046, Yaoundé, Cameroon.
| | - Pablo Aschner
- Endocrinology Unit, Javeriana University, Bogotá, Colombia.
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
| | - Juan Jose Gagliardino
- Center of Experimental and Applied Endocrinology, National Scientific and Technical Research Council, Pan American Health Organization/World Health Organization Collaborating Centre for Diabetes, School of Medicine, National University of La Plata, La Plata, Argentina.
| | - Jude Saji
- Faculty of Medicine and Biomedical Sciences and Laboratory for Molecular Medicine and Metabolism, The Biotechnology Centre, University of Yaoundé 1, Yaoundé, Cameroon.
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Gonzalez JS, Tanenbaum ML, Commissariat PV. Psychosocial factors in medication adherence and diabetes self-management: Implications for research and practice. ACTA ACUST UNITED AC 2017; 71:539-551. [PMID: 27690483 DOI: 10.1037/a0040388] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Diabetes is a chronic illness that places a significant self-management burden on affected individuals and families. Given the importance of health behaviors-such as medication adherence, diet, physical activity, blood glucose self-monitoring-in achieving optimal glycemic control in diabetes, interventions designed and delivered by psychologists hold promise in assisting children, adolescents, and adults with diabetes in improving their health status and lowering their risk of serious complications. This article first provides an overview of diabetes self-management and associated challenges and burdens. Socioeconomic status factors that may influence diabetes management and outcomes are briefly highlighted. We then review the evidence base for select psychosocial factors that may be implicated in diabetes self-management. Modifiable targets of psychological intervention are presented across 3 overarching domains: (a) knowledge, beliefs, and related cognitive constructs; (b) emotional distress and well-being; and (c) behavioral skills and coping. Important methodological issues facing future research are discussed, along with opportunities for psychologists in improving the care and treatment outcomes of individuals and families living with diabetes. In conclusion, we advocate for continued research emphasis on improving psychosocial aspects of living with diabetes, with greater attention to the situational context in which the self-regulatory processes underlying self-management occur. Psychologists have important roles to play in reducing emotional distress, improving patient knowledge, and providing training in behavioral skills to promote successful self-management and to support patient-centered diabetes care. (PsycINFO Database Record
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Dao-Tran TH, Anderson DJ, Chang AM, Seib C, Hurst C. Vietnamese Version of Diabetes Self-Management Instrument: Development and Psychometric Testing. Res Nurs Health 2016; 40:177-184. [PMID: 27933635 DOI: 10.1002/nur.21777] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 11/08/2022]
Abstract
Self-management plays a vital role in diabetes management for adults with type 2 diabetes (T2DM). While there are many people with T2DM in Vietnam, clinical understanding of diabetes self-management (DSM) in this context is limited due to the lack of a valid measurement instrument. Translation and back-translation processes were used to translate the Diabetes Self-Management Instrument (DSMI) into Vietnamese. Then, translation equivalence, face validity, construct validity, and internal consistency were assessed in a sample of 198 Vietnamese adults with T2DM. The Cronbach's alpha of the V-DSMI was .92, with a number of significant inter-item correlations. The Vietnamese version of the Diabetes Self-Management Instrument (V-DSMI) retained the meaning of the original English version, and the language of the V-DSMI was clearly understandable to adults with T2DM in Vietnam. Confirmatory factor analysis supported the goodness of fit between the data and the previously identified factor structure. These results indicated that the V-DSMI is acceptable for use with Vietnamese adults with T2DM in further practice and research. However, future studies would be beneficial to determine the test-retest reliability and criterion validity of the V-DSMI. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Tiet-Hanh Dao-Tran
- Lecturer, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.,PhD candidate, School of Nursing, Queensland University of Technology N602, Kelvin Grove Campus, Brisbane, QLD4059, Australia
| | - Debra J Anderson
- Professor, School of Nursing and Midwifery, Faculty of Health Science, Griffith University, Brisbane, Australia
| | - Anne M Chang
- Professor, School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Charrlotte Seib
- Research Fellow, School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Cameron Hurst
- Associate Professor, Clinical Epidemiology and Biostatistics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Meunier S, Coulombe S, Beaulieu MD, Côté J, Lespérance F, Chiasson JL, Bherer L, Lambert J, Houle J. Longitudinal testing of the Information-Motivation-Behavioral Skills model of self-care among adults with type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2016; 99:1830-1836. [PMID: 27373961 DOI: 10.1016/j.pec.2016.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 05/19/2016] [Accepted: 06/16/2016] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The study's aim was to test prospective associations between information, motivation, and behavioral skills (IMB model) and self-care behaviors (diet, exercise, and blood glucose testing) among patients with type 2 diabetes. METHODS 295 participants were surveyed one (T1), six (T2), and 12 (T3) months after a diabetes course. Cross-lagged panel analyses were performed to test unidirectional and bidirectional relationships between IMB model variables and self-care behaviors. RESULTS Blood-glucose testing at T1 was positively related to information at T2, which in turn was positively related to blood-glucose testing at T3. Controlled motivation at T1 was positively related to exercise at T2. Autonomous motivation at T2 was positively associated with exercise at T3. There was a positive bidirectional relationship across time between behavioral skills and general diet. CONCLUSION Patterns of prospective associations between IMB model variables and diabetes self-care depend on the self-care behavior considered. This model offers an interesting framework for examining how diabetes self-care behaviors evolve. PRACTICE IMPLICATIONS Diabetes education programs should provide information about current health status and promote experiential learning to help patients realize the impact of their behaviors on glycemic control; should foster autonomous motivation for long-term change; and should build on patients' strengths and skills.
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Affiliation(s)
- Sophie Meunier
- Department of Psychology, Université du Québec à Montréal, Montréal, Canada.
| | - Simon Coulombe
- Department of Psychology, Université du Québec à Montréal, Montréal, Canada.
| | - Marie-Dominique Beaulieu
- CHUM Research Center, Montréal, Canada; Department of Family and Emergency Medicine, Université de Montréal, Montréal, Canada.
| | - José Côté
- CHUM Research Center, Montréal, Canada; Faculty of Nursing, Université de Montréal, Montréal, Canada.
| | - François Lespérance
- CHUM Research Center, Montréal, Canada; Department of Psychiatry, Université de Montréal, Montréal, Canada.
| | - Jean-Louis Chiasson
- CHUM Research Center, Montréal, Canada; Department of Medicine, Université de Montréal, Montréal, Canada.
| | - Louis Bherer
- PERFORM Centre, Concordia University, Montréal, Canada; Institut universitaire de gériatrie de Montréal, Montréal, Canada.
| | - Jean Lambert
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Canada.
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, Montréal, Canada; CHUM Research Center, Montréal, Canada.
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Measuring insulin adherence among adults with type 2 diabetes. J Behav Med 2016; 39:633-41. [PMID: 27062271 DOI: 10.1007/s10865-016-9741-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/30/2016] [Indexed: 10/22/2022]
Abstract
Non-adherence to insulin is common and associated with suboptimal health. We adapted the Morisky Medication Adherence Scale to specify insulin adherence (MIAS) and compared it to the Adherence to Refills and Medication Scale for Diabetes (ARMS-D) and the Summary of Diabetes Self-Care Activities medications subscale (SDSCA-MS) and an insulin-specific (SDSCA-IS) version. A sample of 144 insulin-treated adults (58 % African American/Black, 34 % Caucasian/White, 8 % Other/Mixed race; 6.9 % Hispanic) completed these measures along with a HbA1C test. The internal consistency and factor structure of the MIAS were adequate; 59 % of participants forgot to take insulin and 46 % reported non-adherence. The MIAS was associated with the ARMS-D, SDSCA-MS, and SDSCA-IS (p < 0.001), and higher MIAS scores were marginally associated with better self-rated health (p = 0.057), but significantly associated with fewer emergency room visits (p = 0.001), and better HbA1C (p = 0.001). The MIAS is a valid and reliable insulin adherence assessment tool for practice and research applications.
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Wascher TC, Stechemesser L. Blutzuckerselbstkontrolle. Wien Klin Wochenschr 2016; 128 Suppl 2:S137-40. [DOI: 10.1007/s00508-015-0927-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Osborn CY, Mayberry LS, Kim JM. Medication adherence may be more important than other behaviours for optimizing glycaemic control among low-income adults. J Clin Pharm Ther 2016; 41:256-9. [PMID: 26939721 DOI: 10.1111/jcpt.12360] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN Patients with type 2 diabetes mellitus (T2DM) are required to perform multiple self-care behaviours to achieve and maintain optimal glycaemic control (HbA1c), which prevents complications and premature mortality. Patients with T2DM and low socioeconomic status (SES) are more likely to have suboptimal HbA1c, often due to being less adherent to recommended self-care activities than their higher-SES counterparts. OBJECTIVE Although studies support performing certain diabetes self-care behaviours for optimizing glycaemic control, there is limited research on the relative importance of each behaviour for this purpose. Identifying what behaviours are most important for HbA1c among low-SES patients with T2DM would be particularly useful for informing policy and intervention efforts for this high-risk group. METHODS In a cross-sectional study of 314 adults with T2DM and low SES, we used the Summary of Diabetes Self-Care Activities to assess self-care behaviours and multivariate models to test which behaviours were associated with lower HbA1c. RESULTS AND DISCUSSION Only medication adherence was significantly associated with lower HbA1c after adjusting for the other self-care behaviours (β = -0·14, P = 0·028) and further adjusting for demographic and diabetes characteristics (β = -0·16, P = 0·024). WHAT IS NEW Medication adherence may be the most important self-care behaviour for glycaemic control among adults with T2DM and low SES. CONCLUSION Focused efforts to improve medication adherence among low-SES patient populations may improve glycaemic control.
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Affiliation(s)
- C Y Osborn
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - L S Mayberry
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - J M Kim
- Texas A&M Health Science Center, Bryan, TX, USA
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Houle J, Lauzier-Jobin F, Beaulieu MD, Meunier S, Coulombe S, Côté J, Lespérance F, Chiasson JL, Bherer L, Lambert J. Socioeconomic status and glycemic control in adult patients with type 2 diabetes: a mediation analysis. BMJ Open Diabetes Res Care 2016; 4:e000184. [PMID: 27239316 PMCID: PMC4873951 DOI: 10.1136/bmjdrc-2015-000184] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/27/2016] [Accepted: 03/22/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The purpose of this study is to examine the contribution of health behaviors (self-management and coping), quality of care, and individual characteristics (depressive symptoms, self-efficacy, illness representations) as mediators in the relationship between socioeconomic status (SES) and glycemic control. METHODS A sample of 295 adult patients with type 2 diabetes was recruited at the end of a diabetes education course. Glycemic control was evaluated through glycosylated hemoglobin (HbA1c). Living in poverty and education level were used as indicators of SES. RESULTS Bootstrapping analysis showed that the significant effects of poverty and education level on HbA1c were mediated by avoidance coping and depressive symptoms. The representation that diabetes is unpredictable significantly mediated the relationship between living in poverty and HbA1c, while healthy diet mediated the relationship between education level and HbA1c. CONCLUSIONS To improve glycemic control among patients with low SES, professionals should regularly screen for depression, offering treatment when needed, and pay attention to patients' illness representations and coping strategies for handling stress related to their chronic disease. They should also support patients in improving their self-management skills for a healthy diet.
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Affiliation(s)
- Janie Houle
- Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
- CRCHUM, Montréal, Québec, Canada
| | | | - Marie-Dominique Beaulieu
- CRCHUM, Montréal, Québec, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Sophie Meunier
- Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Simon Coulombe
- Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
| | - José Côté
- CRCHUM, Montréal, Québec, Canada
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
| | - François Lespérance
- CRCHUM, Montréal, Québec, Canada
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Louis Chiasson
- CRCHUM, Montréal, Québec, Canada
- Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Louis Bherer
- PERFORM Centre, Concordia University, Montréal, Québec, Canada
- Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Jean Lambert
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Québec, Canada
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