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An L, Yeh KC, Liu Y, Wang D, Li X, Tang Q, Lu J. An Online Structured Diabetes Self-Management Education and Support Programme Improves Glycaemic Control in Young Adults with Type 1 Diabetes. J Multidiscip Healthc 2023; 16:2641-2654. [PMID: 37701178 PMCID: PMC10494863 DOI: 10.2147/jmdh.s414102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/15/2023] [Indexed: 09/14/2023] Open
Abstract
Objective We explore the effect of a structured online DSMES program on glycaemic control and the self-management behaviour of adolescents and young adults with T1DM. Methods We used a pre-post uncontrolled intervention design over a period of 6 months. A total of 37 youths with T1DM aged 10-45 years were enrolled. The intervention comprised 11 structured online DSMES course sessions; these were video-based and delivered by a diabetes specialist, nurses and a dietitian. The primary outcome was a change in (glycated hemoglobin) HbA1c. The secondary outcomes were changes in hypoglycaemia frequency, time in target range (TIR) among patients using a continuous glucose monitoring (CGM) system and self-management behaviour; the latter was measured using a T1DM self-management scale for Chinese adults (SMOD-CA) and the Chinese version of the diabetic behaviour rating scale in adolescents with T1DM (DBRS). Results Twenty-three (85.2%) participants attended ≥8 of the online sessions. There was a significant reduction in HbA1c (from 6.92% to 6.47%, P = 0.002), hypoglycaemic episodes (from 6.0 to 4.0 during the preceding month, P = 0.026) and a significant increase in TIR (from 74.0% to 80.5%, P = 0.027) and an increase in the SMOD-CA score (from 79.6 to 84.6, P = 0.026) in young adults. No significant change in glucose control, hypoglycaemic events or DBRS score were found among children and adolescents. The score of the 12-item version of the Barrett-Lennard Relationship Inventory (B-L RI:mini) indicated that more than half of the participants experienced congruence, positive regard, and an empathic understanding in this programme. Conclusion The online structured DSMES programme was effective in improving the glycaemic control and self-management behaviour of young adults with T1DM; however, integrating offline visits or appointments with online consultations may be necessary for youth patients.
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Affiliation(s)
- Lingwang An
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
| | - Kuei-Chun Yeh
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
| | - Yunxia Liu
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
| | - Dandan Wang
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
| | - Xianglan Li
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
| | - Qi Tang
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
| | - Juming Lu
- Department of Endocrinology, Beijing Ruijing Diabetes Hospital, Beijing, 100079, People’s Republic of China
- Department of Endocrinology, The General Hospital of the People’s Liberation Army, Beijing, 100853, People’s Republic of China
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Limbert C, Tinti D, Malik F, Kosteria I, Messer L, Jalaludin MY, Benitez-Aguirre P, Biester S, Corathers S, von Sengbusch S, Marcovecchio ML. ISPAD Clinical Practice Consensus Guidelines 2022: The delivery of ambulatory diabetes care to children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1243-1269. [PMID: 36537530 DOI: 10.1111/pedi.13417] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Catarina Limbert
- Unit of Paediatric Endocrinology and Diabetes, Hospital Dona Estefânia, Lisbon, Portugal.,Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Davide Tinti
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Faisal Malik
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Ioanna Kosteria
- Department of Endocrinology, Growth & Development, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Laurel Messer
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Paul Benitez-Aguirre
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Biester
- Diabetes-Center for Children and Adolescents, Children's Hospital "Auf der Bult", Hannover, Germany
| | - Sarah Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Simone von Sengbusch
- Division of Pediatric Endocrinology and Diabetology, Campus Lübeck, University Medical Centre Schleswig-Holstein, Lübeck, Germany
| | - M Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Benjamin Horvath L, Böhm M, Kuniss N, Bleidorn J, Schulz S. [Participation rate of diabetes patients in structured education programs and reasons for non-participation: A cross-sectional survey among patients with diabetes mellitus in Thuringia]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 173:49-55. [PMID: 35715322 DOI: 10.1016/j.zefq.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/30/2022] [Accepted: 04/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIM Structured education programs for patients with diabetes mellitus are an important and effective component of therapy. The aim of this survey is to assess the rate of participation in education programs in selected practices in Thuringia. Furthermore, we intend to identify factors that influence participation in order to derive strategies to increase participation. METHODS Survey of patients with diabetes in Thuringian general practices and a diabetology practice using a newly developed questionnaire regarding "patient characteristics", "diabetes characteristics", "DMP and education programs" as well as reasons for non-participation in education programs and the wishes of non-educated patients. Data were analyzed using binary logistic regression analysis and other descriptive statistics in SPSS (IBM). RESULTS Of the 1,254 questionnaires sent out, 637 (51%) were returned. Participation rate in education programs was 68% (n=405). HbA1c > 7.5%, diabetes sequelae, DMP participation and the awareness of education programs were significantly associated with participation in education programs. Recommendation/invitation to education programs, complex treatment regimes, long diabetes duration and urban practice led to a significant increase in the odds of attending an education program. Non-educated patients subjectively mentioned lack of need for training, lack of information, logistical reasons, and lack of time as reasons for non-participation. They expressed the wish for more information and recommendations from their general practitioner, shorter duration of education programs and online offerings. DISCUSSION The participation rate in education programs was in the range of the evaluation reports on DMP programs for diabetes. Lower participation rates in rural areas may be explained by the lower physician density and especially education program offers as well as the more difficult accessibility. The factors and reasons for non-participation underline the need for comprehensive care and the general practitioner's key role in motivating, coordinating and educating patients. CONCLUSION General practitioners play a central role in the care of patients with diabetes, and there is a need for comprehensive care and education programs. Telemedicine and digital applications can complement DMP and education programs.
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Affiliation(s)
| | - Markus Böhm
- Universitätsklinikum Jena, Institut für Medizinische Statistik, Informatik und Datenwissenschaften, Jena, Deutschland
| | - Nadine Kuniss
- Universitätsklinikum Jena, Klinik für Innere Medizin III, FB Endokrinologie und Stoffwechselerkrankungen, Jena, Deutschland; Ambulante Medizinische Versorgung Dr. med. Kielstein, Erfurt, Deutschland
| | - Jutta Bleidorn
- Universitätsklinikum Jena, Institut für Allgemeinmedizin, Jena, Deutschland
| | - Sven Schulz
- Universitätsklinikum Jena, Institut für Allgemeinmedizin, Jena, Deutschland
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4
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Kariyawasam D, Soukup T, Parsons J, Sevdalis N, Baldellou Lopez M, Forde R, Ismail K, Jones M, Ford-Adams M, Yemane N, Pender S, Thomas S, Murrells T, Silverstien A, Forbes A. Protocol for a feasibility study and process evaluation of a psychosocially modelled diabetes education programme for young people with type 1 diabetes: the Youth Empowerment Skills (YES) programme. BMJ Open 2022; 12:e062971. [PMID: 35680254 PMCID: PMC9185576 DOI: 10.1136/bmjopen-2022-062971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Adolescence is a challenging period for young people with type 1 diabetes, associated with worsening glycaemia and care disengagement. Educational interventions in this period tend to focus on diabetes-specific skills, with less emphasis on the psychosocial challenges associated with diabetes experienced by young people. To address this limitation, we codesigned with young people a psychosocially modelled programme of diabetes education, named 'Youth Empowerment Skills' (YES). The programme aims to facilitate a positive adaptation to life with diabetes and engagement with diabetes care through peer-based learning, immersive simulations and support from an outreach youth worker. Here, we present a protocol for a feasibility study of the YES programme. METHODS AND ANALYSIS The study was designed following the Medical Research Council Complex Intervention Evaluation Framework to: test the feasibility (acceptance, implementability, recruitment and completion) of the YES programme; and estimate its efficacy in relation to metabolic and psychosocial outcomes. The study will take place in diabetes centres serving socioculturally diverse populations. We will conduct a feasibility randomised controlled trial (waiting-list design) with integrated process evaluation. Fifty young people with type 1 diabetes (aged 14-19 years) will be randomly allocated to either the YES intervention or a waiting-list control. Randomisation acceptability will be assessed with provision for a preference allocation. Outcomes will be evaluated at 6 months, at which point the waiting list participants will be exposed to the YES programme with further follow-up to 12 months. A simultaneous process evaluation will use a mixed-methods approach collecting qualitative and quantitative data. Study findings will be used to optimise the intervention components, outcome measures and recruitment methods to inform a subsequent definitive trial. ETHICS AND DISSEMINATION The protocol has ethical approval from the UK Health Research Authority (approval IRAS project ID: 279877). Findings will be disseminated in multiple formats for lay and professional audiences. PROTOCOL DATE AND VERSION 7 April 2021, V.1.1. TRIAL REGISTRATION NUMBER NCT04670198.
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Affiliation(s)
- Dulmini Kariyawasam
- Department of Diabetes and Endocrinology, Guy's and St.Thomas 'NHS foundation Trust, London, UK
| | - Tayana Soukup
- Health Service and Population Research Department, King's College London, London, UK
| | - Judith Parsons
- Division of Care Long-term Conditions, King's College London Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Nick Sevdalis
- Health Service and Population Research Department, King's College London, London, UK
| | - Maria Baldellou Lopez
- Health Service and Population Research Department, King's College London, London, UK
| | - Rita Forde
- Division of Care Long-term Conditions, King's College London Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Khalida Ismail
- Health Service and Population Research Department, King's College London, London, UK
| | - Marie Jones
- Department of Diabetes and Endocrinology, Guy's and St.Thomas 'NHS foundation Trust, London, UK
| | - Martha Ford-Adams
- Paediatric Diabetes Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Nardos Yemane
- Department of Diabetes and Endocrinology, Guy's and St.Thomas 'NHS foundation Trust, London, UK
| | - Siobhan Pender
- Department of Diabetes and Endocrinology, Guy's and St.Thomas 'NHS foundation Trust, London, UK
| | - Stephen Thomas
- Department of Diabetes and Endocrinology, Guy's and St.Thomas 'NHS foundation Trust, London, UK
| | - Trevor Murrells
- National Nursing Research Unit, King's College London, London, UK
| | - Alex Silverstien
- Division of Care Long-term Conditions, King's College London Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Angus Forbes
- Division of Care Long-term Conditions, King's College London Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
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5
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Walton DV, Edmonds ME, Bates M, Vas PRJ, Petrova NL, Manu CA. People living with diabetes are unaware of their foot risk status or why they are referred to a multidisciplinary foot team. J Wound Care 2021; 30:598-603. [PMID: 34382842 DOI: 10.12968/jowc.2021.30.8.598] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM People with active diabetic foot disease should be rapidly referred by health professionals along a pathway of care to a multidisciplinary foot team. The aim was to investigate patients' self-reported understanding of their foot risk status and reasons for their referral to a multidisciplinary foot team. METHOD This seven-month service evaluation included consecutive newly referred patients. Participants completed a questionnaire which asked firstly about their understanding of their foot risk status, secondly about their pathway of care before presentation to the multidisciplinary foot team, and thirdly about their interest in diabetes-related foot education and preferred learning style. RESULTS There were 202 participants; 65% were male, mean age was 64±15 years (mean±standard deviation (SD)), 86% had type 2 diabetes, and mean HbA1c was 65±23mmol/mol (8.3±3.7%). Only 4% of participants knew their current foot risk status and 52% did not know why their care had been escalated to a multidisciplinary foot clinic. Participants with type 2 diabetes more readily expressed an interest in further foot education compared with participants with type 1 diabetes, (70% versus 29%, p=0.001). CONCLUSIONS These findings show that people with diabetes and foot disease are less aware of their foot risk status or why they are referred to a multidisciplinary team. Participants indicated a variable interest in further learning about foot complications. These findings indicate possible communication and educational barriers between patients and health professionals which may contribute to delayed presentation or suboptimal engagement.
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Affiliation(s)
- Daina V Walton
- Diabetes Foot Clinic, King's College Hospital, London, UK.,Diabetes UK Clinical Champion 2017-2019
| | - Michael E Edmonds
- Diabetes Foot Clinic, King's College Hospital, London, UK.,Department of Diabetes, Faculty of Life Sciences & Medicine, King's College London, UK
| | - Maureen Bates
- Diabetes Foot Clinic, King's College Hospital, London, UK
| | - Prashanth R J Vas
- Diabetes Foot Clinic, King's College Hospital, London, UK.,Department of Diabetes, Faculty of Life Sciences & Medicine, King's College London, UK
| | - Nina L Petrova
- Diabetes Foot Clinic, King's College Hospital, London, UK.,Department of Diabetes, Faculty of Life Sciences & Medicine, King's College London, UK
| | - Chris A Manu
- Diabetes Foot Clinic, King's College Hospital, London, UK
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6
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Thomas JJ, Moring J, Bowen A, Rings JA, Emerson T, Lindt A. The influence of stress and coping on diabetes self-care activities among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021:1-6. [PMID: 34133266 DOI: 10.1080/07448481.2021.1928142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/31/2021] [Accepted: 05/02/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The purpose of this pilot study was to examine relationships between perceived stress, coping, and diabetes self-care activities among college students with type 1 diabetes. PARTICIPANTS College students, self-reported as diagnosed with type 1 diabetes. METHODS Students responded to an online self-report questionnaire (Perceived Stress Scale, Brief COPE, Summary of Diabetes Self-Care Activities). RESULTS ANOVA analysis showed significant differences between levels of perceived stress for healthy diet and foot care. Simple linear regression analysis showed significant relationships between healthy diet and active coping, positive reframing, and planning; between exercise and humor; between blood glucose testing and active coping, planning, and acceptance; and between foot care and active coping and positive reframing. CONCLUSIONS Our results indicate that effective stress management and coping skills will positively impact diabetes self-care. Educational programs for college students with type 1 diabetes should address self-care activities as well as psychosocial factors that affect health.
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Affiliation(s)
- Jenifer J Thomas
- Fay W. Whitney School of Nursing, University of Wyoming, Laramie, Wyoming, USA
| | - John Moring
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Anne Bowen
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Jeffrey A Rings
- Department of Applied Psychology and Counselor Education, University of Northern Colorado, Greeley, Colorado, USA
| | - Tori Emerson
- Fay W. Whitney School of Nursing, University of Wyoming, Laramie, Wyoming, USA
| | - Adara Lindt
- Fay W. Whitney School of Nursing, University of Wyoming, Laramie, Wyoming, USA
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7
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Xie Y, Liu F, Huang F, Lan C, Guo J, He J, Li L, Li X, Zhou Z. Establishment of a type 1 diabetes structured education programme suitable for Chinese patients: type 1 diabetes education in lifestyle and self adjustment (TELSA). BMC Endocr Disord 2020; 20:37. [PMID: 32151245 PMCID: PMC7063731 DOI: 10.1186/s12902-020-0514-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Various guidelines recommend that all adults diagnosed with type 1 diabetes (T1D) should be offered an evidence based, structured education programme (SEP) to optimize self-management care. China has a 13,000 annual increase in newly diagnosed T1D cases, of which 65% are adults. However, there is yet no validated SEP targeted to T1D patients in China. The purpose of this study is to establish a structured T1D self-management education programme-'Type 1 Diabetes Education in Lifestyle and Self Adjustment' (TELSA) that is adapted to medical and cultural practices in China. METHODS TELSA programme was developed based on the ADDIE model, following three steps: i) Semi-structured interviews were administered to 10 healthcare professionals (HCPs) and 13 T1D patients. Different topic guides, focusing on 4 dimensions including goals, contents, format of delivery, and quality assurance, were designed for either HCPs or patients. The interviews were recorded and analysed with thematic analysis. ii) Extracted themes were modified according to Delphi consultation. iii) Preliminary courses were conducted as pilot study to evaluate the effects of TELSA and optimization of the curriculum was finalized accordingly. RESULTS A total of 18 themes in 4 dimensions of the programme design were identified in the final version: i) goals: 'behaviour modification' and 'outcome improvement'; ii) contents: 'living with T1D', 'self-monitoring of blood glucose', 'knowing insulin', 'insulin dose adjustment', 'carbohydrates and carbohydrate counting', 'hypoglycaemia', 'complications of diabetes', 'managing psychological issues', 'physical activity', and 'question-and-answer'; iii) format: 'multidisciplinary team combined with peer support', 'face-to-face education followed by remote learning', and '2-day programme held on weekends'; and iv) quality assurance: 'after-class quiz', 'patients' feedback', and 'long-term evaluation on effectiveness'. CONCLUSIONS A type 1 diabetes structured education programme in China was set up and shown to be applicable under local medical, social, and cultural environment. TRIAL REGISTRATION NCT03610984. Date of registration: August 2, 2018.
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Affiliation(s)
- Yuting Xie
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, China
- National Clinical Research Center for Metabolic Diseases, and Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China
| | - Fang Liu
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, China
- Clinic Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fansu Huang
- Department of Clinical Nutrition, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chunna Lan
- Department of Rehabilitation, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Jing He
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, and Medical Psychological Institute of Central South University, Changsha, China
| | - Lezhi Li
- Clinic Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xia Li
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, China.
- National Clinical Research Center for Metabolic Diseases, and Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, China
- National Clinical Research Center for Metabolic Diseases, and Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China
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8
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Robertson E. Making a difference for people living with diabetes: Diabetes UK-funded publications in Diabetic Medicine between 2016 and 2019. Diabet Med 2020; 37:9-10. [PMID: 31828828 DOI: 10.1111/dme.14185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Liu F, Guan Y, Li X, Xie Y, He J, Zhou ZG, Li L. Different Effects of Structured Education on Glycemic Control and Psychological Outcomes in Adolescent and Adult Patients with Type 1 Diabetes: A Systematic Review and Meta-Analysis. Int J Endocrinol 2020; 2020:9796019. [PMID: 32184823 PMCID: PMC7061135 DOI: 10.1155/2020/9796019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/30/2019] [Indexed: 12/16/2022] Open
Abstract
AIM This systematic review aimed at investigating the effectiveness of structured education (SE) in improving glycemic control and psychological outcomes in adolescent and adult patients with type 1 diabetes. METHODS Electronic databases (EMBASE, Medline, PubMed, and the Cochrane Library) and the reference lists of included studies were searched from the beginning of the database through April 2019. Randomized controlled trials comparing SE with a control condition and reporting a change in glycosylated hemoglobin (HbA1c) level were included. The primary outcome was glycemic control measured by HbA1c. Secondary outcomes were diabetes-related distress, well-being, depression, and quality of life. RESULTS Eighteen studies representing 2759 patients were included. Twelve studies targeted adolescents and six targeted adults. Adolescent patients who were randomized to the intervention group did not show significant improvement of HbA1c in the short (SMD = -0.04; 95% CI: -0.14 to 0.06; P=0.41), medium (SMD = -0.03; 95% CI: -0.13 to 0.07; P=0.41), medium (SMD = -0.03; 95% CI: -0.13 to 0.07; P=0.41), medium (SMD = -0.03; 95% CI: -0.13 to 0.07; P=0.41), medium (SMD = -0.03; 95% CI: -0.13 to 0.07; P=0.41), medium (SMD = -0.03; 95% CI: -0.13 to 0.07. CONCLUSIONS Development of more efficient SE programs according to the patients' personal characteristics is needed.
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Affiliation(s)
- Fang Liu
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
- Department of Metabolism and Endorinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yuzhu Guan
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Xia Li
- Department of Metabolism and Endorinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yuting Xie
- Department of Metabolism and Endorinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jing He
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Zhi-Guang Zhou
- Department of Metabolism and Endorinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- National Clinical Research Center for Metabolic Disease, Changsha, China
| | - Lezhi Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
- Clinic Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
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10
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Ng AH, Crowe TC, Ball K, Rasmussen B. A mHealth Support Program for Australian Young Adults with Type 1 Diabetes: A Mixed Methods Study. Digit Health 2019; 5:2055207619882179. [PMID: 31662880 PMCID: PMC6796202 DOI: 10.1177/2055207619882179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 09/20/2019] [Indexed: 11/16/2022] Open
Abstract
Aims and Objectives Young adulthood is a life stage comprised of many turning points. For young adults with type 1 diabetes (T1DM), diabetes self-management support is crucial during this period. There is a lack of diabetes education programs and services tailored to this population. This paper presents the findings, according to the STROBE guidelines, on the usability and acceptability of a patient-informed mHealth support program (Diabetes YES) that was developed for young adults with T1DM. Methods A total of 34 young adults aged 18-35 years with T1DM participated in the Diabetes YES program over 12 weeks. Google analytics was used to tracked website use, while a website usability survey measured ease of use. Facebook analytics was used to measure peer support engagement. Evaluation of the program was completed using Likert scales and open-ended questions. Results Participants rated the website favourably for its ease of navigation and easy to understand information. Web page visits declined sharply while peer support group engagement through Facebook remained consistent throughout the intervention period. Participants utilised weekly discussion topics to generate conversation within the peer support group. Emotional support from peers was the highest regarded benefit reported by participants. Conclusions Diabetes YES is an example of an mHealth support program that was readily accepted by young adults living with T1DM. Feasibility studies are an important formative step in the implementation of mHealth programs within mainstream healthcare. Future work should focus on the adaptability of such programs to fit within larger consumer or healthcare organisations.
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Affiliation(s)
- Ashley H Ng
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Bundoora, Australia
| | - Timothy C Crowe
- School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Bodil Rasmussen
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Australia
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11
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Nass EMA, Marcon SS, Teston EF, Reis PD, Peruzzo HE, Monteschio LVC, Bega AG, Haddad MDCFL. Perspectiva de jovens com diabetes sobre intervenção educativa na rede social Facebook®. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Apreender a perspectiva de jovens com diabetes mellitus sobre a participação em um grupo de estimulo ao autocuidado na rede social Facebook®. Métodos Estudo descritivo e exploratório, junto a 35 jovens com diabetes mellitus tipo 1 que participaram de um grupo no Facebook®. Os dados foram coletados por meio de entrevista semi-esturuada e após submetidos à análise de conteúdo, modalidade temática. Resultados Foram identificadas três categorias: assistência convencional oferecida aos jovens com diabetes mellitus; vantagens da utilização do Facebook® para inovação da assistência à saúde, e espírito de comunidade e fortalecimento a partir do Facebook®, as quais mostram que, na perspectiva de jovens com diabetes, a participação no grupo favoreceu o desenvolvimento do espírito de comunidade e o fortalecimento de vínculo entre os pares, além de auxiliar no processo de aceitação da doença e na formação de uma rede de suporte. Além disso, observou-se avaliação positiva sobre a participação, uma vez que os jovens manifestaram o desejo de que outros grupos com características semelhantes fossem implementados. Conclusão Ações educativas na rede social Facebook® são bem aceitas por jovens e pode constituir uma estratégia importante para aproximá-los dos serviços de saúde e auxiliá-los nas ações de autocuidado.
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The Empowerment of Adolescents with Type 1 Diabetes Is Associated with Their Executive Functions. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5184682. [PMID: 31183368 PMCID: PMC6515027 DOI: 10.1155/2019/5184682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/16/2019] [Indexed: 12/24/2022]
Abstract
Background Adolescence is a difficult period for young people with type 1 diabetes mellitus (T1DM), both in psychological and clinical terms. Empowerment therapy may support these patients, provided they are ready to change and have adequate executive functions to facilitate this change. Therefore, we hypothesise that the readiness of adolescents with T1DM to change is related to clinical features and/or their executive functions. Methods Using the Diabetes Empowerment Scale and the Behavioural Rating Inventory of Executive Function, we evaluated patients with T1DM duration of more than one year from three Polish diabetes centres of the PolPeDiab study group (N = 146). We related the data to features associated with disease and treatment and compared the results to those of adolescents without diabetes (N = 110). Results We observed that adolescents with T1DM had a higher rate of abnormal results in executive function tests than their peers without diabetes (p > 0.05). Diabetes empowerment in this group of patients decreased with disease duration (r = -0.25, p = 0.006) and increased with deteriorating metabolic control (HbA1c; r = 0.25, p = 0.006). The greater the deficiencies in executive functions among adolescents with T1DM, the greater their readiness to change. The relationship between executive functions and diabetes empowerment is partially gender-differentiated. Conclusions To conclude, we propose individualized diabetes education in this group of patients based on the assessment of readiness to change and executive functions.
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Coates V, Horigan G, Carey M, Davies M. Using qualitative data to enhance our understanding of the reasons young people decline Structured Diabetes Education programmes. J Clin Nurs 2018; 27:3139-3147. [PMID: 29752855 DOI: 10.1111/jocn.14508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2018] [Indexed: 11/27/2022]
Abstract
AIM To explore the reasons young people with type 1 diabetes decline Structured Diabetes Education from the perspectives of the young people themselves, their parents and diabetes educators. BACKGROUND Structured Diabetes Education programmes that are evidence based and quality assured are a key component to empowering people with diabetes to self-manage effectively. However, research reveals that uptake of structured education programmes is disappointingly low. DESIGN Qualitative cross-sectional study involving participants from Northern Ireland and England. METHODS Twenty young people with type 1 diabetes (13-22 years) who had declined Structured Diabetes Education within the past 2 years, 17 parents of a young person with type 1 diabetes and 16 diabetes educators participated in semistructured interviews and focus groups. RESULTS Three main themes emerged from across all three groups: timing, access and communication issues. In addition, a lack of understanding by the referrer was cited by some young people and their parents. Diabetes educators were sympathetic and understood many of the reasons why Structured Diabetes Education was declined. Solutions were proposed to overcome expressed barriers. CONCLUSIONS Although the expressed reasons for declining might suggest that the young people simply did not prioritise education, this study adds a more nuanced scenario to the debate. The interviews revealed the tensions that exist between people's daily commitments and their need to self-manage their diabetes. The young people and their parents must be given a much stronger sense of the importance of Structured Diabetes Education and ways to accommodate attendance must be sought. Diabetes educators must be able to better promote the importance of Structured Diabetes Education. RELEVANCE TO CLINICAL PRACTICE As optimal glycaemic control is so vital for long-term health, there is an urgent need to understand how to respond more fully to the needs of young people who have type 1 diabetes.
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Affiliation(s)
- Vivien Coates
- Western Health and Social Care Trust, Ulster University, Coleraine, UK
| | | | - Marian Carey
- Diabetes Research Centre, University of Leicester, Leicester.,Kairos Communications & Research Ltd
| | - Mark Davies
- Belfast Health and Social Care Trust, Belfast, UK
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Tascini G, Berioli MG, Cerquiglini L, Santi E, Mancini G, Rogari F, Toni G, Esposito S. Carbohydrate Counting in Children and Adolescents with Type 1 Diabetes. Nutrients 2018; 10:E109. [PMID: 29361766 PMCID: PMC5793337 DOI: 10.3390/nu10010109] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 11/16/2022] Open
Abstract
Carbohydrate counting (CC) is a meal-planning tool for patients with type 1 diabetes (T1D) treated with a basal bolus insulin regimen by means of multiple daily injections or continuous subcutaneous insulin infusion. It is based on an awareness of foods that contain carbohydrates and their effect on blood glucose. The bolus insulin dose needed is obtained from the total amount of carbohydrates consumed at each meal and the insulin-to-carbohydrate ratio. Evidence suggests that CC may have positive effects on metabolic control and on reducing glycosylated haemoglobin concentration (HbA1c). Moreover, CC might reduce the frequency of hypoglycaemia. In addition, with CC the flexibility of meals and snacks allows children and teenagers to manage their T1D more effectively within their own lifestyles. CC and the bolus calculator can have possible beneficial effects in improving post-meal glucose, with a higher percentage of values within the target. Moreover, CC might be integrated with the counting of fat and protein to more accurately calculate the insulin bolus. In conclusion, in children and adolescents with T1D, CC may have a positive effect on metabolic control, might reduce hypoglycaemia events, improves quality of life, and seems to do so without influencing body mass index; however, more high-quality clinical trials are needed to confirm this positive impact.
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Affiliation(s)
- Giorgia Tascini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Maria Giulia Berioli
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Laura Cerquiglini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Elisa Santi
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Giulia Mancini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Francesco Rogari
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Giada Toni
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
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