Predictors for self-management in older adults with type 2 diabetic nephropathy

Rural and remote pharmacists' perspectives of grey nomads with diabetes travelling in Australia

OBJECTIVE

The objective of the research was to explore rural and remote pharmacists' experiences of encountering grey nomads with diabetes.

DESIGN

A qualitative Interpretive Description design was used to explore and capture the experiences of rural and remote pharmacists interacting with grey nomads who had diabetes. Data from the interviews were analysed thematically.

SETTING

The Pharmacy Guild of Australia was approached and through their membership rural and remote pharmacists were invited to participate in the research.

PARTICIPANTS

Nine rural and remote pharmacists who had encounters and provided services to grey nomads with diabetes responded to be interviewed.

RESULTS

The analysed findings established four major themes including: the influence of rural and remote locations on services; common problems encountered by the pharmacists; preparation for travel by grey nomads with diabetes; and pharmacists' preparedness to support grey nomads with diabetes.

CONCLUSION

The findings of this study identified that pharmacists needed remuneration for services provided to grey nomads with diabetes. Also, further development of the My Health record and telehealth to include pharmacists would be advantageous for grey nomads who have diabetes. Pharmacists stated there was a need for further education and a continuing professional development module specifically designed for pharmacists on diabetes self-management that moved beyond medications. A pre-travel checklist for grey nomads with diabetes travelling in rural and remote Australia would benefit all stakeholders through better preparation of travellers with diabetes to self-manage, thereby reducing the demand for health services including pharmacies.

Psychological insulin resistance and its impact on self-management in type II diabetes mellitus patients treated with insulin therapy

AIMS

Psychological insulin resistance is a common barrier to initiation and persistence with insulin therapy that affects approximately 42.7% of people living with type II diabetes mellitus, which may negatively impact self-management. This study aimed to assess patients' levels of psychological insulin resistance and to identify factors associated with self-management in patients with type II diabetes mellitus treated with insulin therapy.

METHODS

We adopted a cross-sectional design. Subjects from the metabolism and endocrinology outpatient departments of a regional teaching hospital in central Taiwan were recruited by consecutive sampling. Patients were assessed for psychological insulin resistance and self-management using the barriers to insulin treatment questionnaire and the partners in health scale.

RESULTS

A total of 222 patients with type II diabetes mellitus were recruited. Patients had an average psychological insulin resistance score of 3.14 (maximum of 8). Positive self-management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin-related outcomes, no diabetes-related complications, less fear of injection and self-testing, no hypoglycaemia within the previous year, and younger age.

CONCLUSION

Insulin therapy injection by patient and no diabetes-related complications were the most common factors associated with overall self-management and with each domain of self-management in patients with type II diabetes mellitus treated with insulin therapy. Insulin therapy education should be offered to improve patients' beliefs about insulin therapy and enhance patients' ability to perform self-management.

External validation of the risk prediction model for early diabetic kidney disease in Taiwan population: a retrospective cohort study

OBJECTIVES

This study aims to independently and externally validate the Risk Prediction Model for Diabetic Kidney Disease (RPM-DKD) in patients with type 2 diabetes mellitus (T2DM).

DESIGN

This is a retrospective cohort study.

SETTING

Outpatient clinics at Lee's United Clinics, Taiwan, China.

PARTICIPANTS

A total of 2504 patients (average age 55.44 years, SD, 7.49 years) and 4455 patients (average age 57.88 years, SD, 8.80 years) were included for analysis in the DKD prediction and progression prediction cohorts, respectively.

EXPOSURE

The predicted risk for DKD and DKD progression for each patient were all calculated using the RPM-DKD.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was overall incidence of DKD. Secondary outcomes included DKD progression. The discrimination, calibration and precision of the RPM-DKD score were assessed.

RESULTS

The DKD prediction cohort and progression prediction cohort consisted of patients with 2504 and 4455 T2DM, respectively. The RPM-DKD examined in this study showed moderately discriminative ability with area under the curve ranged from 0.636 to 0.681 for the occurrence of DKD and 0.620 to 0.654 for the progression of DKD. The Hosmer-Lemeshow χ² test indicted the RPM-DKD was not well calibrated for predicting the occurrence of DKD and overestimated the progression of DKD. The precision for predicting the occurrence and progression of DKD were 43.2% and 42.2%, respectively.

CONCLUSIONS

On external validation, the RPM-DKD cannot accurately predict the risk of DKD occurrence and progression in patients with T2DM.

Clinical Effects of Primary Nursing on Diabetic Nephropathy Patients Undergoing Hemodialysis and Its Impact on the Inflammatory Responses

Objective

To assess the clinical effects of primary nursing on diabetic nephropathy patients undergoing hemodialysis and its impact on inflammatory responses.

Methods

Between July 2019 and April 2021, 80 patients with diabetic nephropathy who underwent hemodialysis in our institution were recruited and assigned at a ratio of 1 : 1 to receive either routine nursing (routine group) or primary nursing (primary group). The outcome measures included nursing outcomes, inflammatory factor levels, and psychological status.

Results

Primary nursing resulted in lower levels of blood creatinine, fasting glucose, urea nitrogen, and proteinuria versus routine nursing (P < 0.05). Patients receiving primary nursing showed significantly lower levels of interleukin (IL)-6, high-sensitivity C-reactive protein (hs-CRP), and tumor necrosis factor-alpha (TNF-α) versus those given routine nursing (P < 0.05). The patients in the primary group had significantly lower scores on the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) versus those in the routine group (P < 0.05).

Conclusion

Primary nursing improves the renal function of diabetic nephropathy patients undergoing hemodialysis, reduces the inflammatory response, and eliminates their negative emotions, which shows great potential for clinical application.

Effects of sociodemographic and health factors on the self-management of non-communicable diseases among Chilean adults during the Covid-19 pandemic

Individuals with non-communicable diseases (NCDs) are potentially at increased vulnerability during the Covid-19 pandemic and require additional help to reduce risk. Self-management is one effective strategy and this study investigated the effect of sociodemographic and health factors on the self-management of some non-communicable diseases, namely hypertension, type 2 diabetes mellitus and dyslipidemia, among Chilean adults during the Covid-19 pandemic. A cross-sectional telephone survey was carried out on 910 participants with NCDs, from Santiago, Chile. An adapted and validated version of the "Partners in Health" scale was used to measure self-management. Exploratory Factor analysis yielded five dimensions of this scale: Disease Knowledge, Healthcare Team Relationship, General Self-Management and Daily Routines, Drug Access and Intake, and Monitoring and Decision-Making. The average of these dimensions was calculated to create a new variable Self-Management Mean, which was used as a dependent variable together with the five separate dimensions. Independent variables included age, gender, years of schooling, number of diseases, the percentage of Multidimensional Poverty Index in the commune of residence, and self-rated health status. Beta regressions and ANOVA for the Beta regression residuals were utilized for analyses. Beta regression model explained 8.1% of the variance in Self-Management Mean. Age, years of schooling, number of diseases and self-rated health status were statistically associated with Self-Management Mean and dimensions related to daily routines and health decision making, such as Disease Knowledge, General Self-Management and Daily Routines, and Monitoring and Decision-Making. Gender and the percentage of Multidimensional Poverty Index in the commune of residence were insignificant. Strategies for self-management of NCDs during a crisis should consider age, years of schooling, number of diseases, and self-rated health status in their design.

Evaluation of Functional Magnetic Resonance Imaging under Artificial Intelligence Algorithm on Plan-Do-Check-Action Home Nursing for Patients with Diabetic Nephropathy

This study aimed to evaluate the effect of functional magnetic resonance imaging (fMRI) under the fuzzy C-means (FCM) clustering algorithm on plan-do-check-action (PDCA) home nursing for patients with diabetic nephropathy (DN). As the characteristics of fMRI image data were combined, the FCM algorithm was improved and applied into the clustering processing of fMRI activation regions of patients. 64 patients with DN were chosen as the research objects and were divided into the research group with PDCA home nursing and the control group with routine home nursing. The patients were randomly divided into the research group (n = 32) and the control group (n = 32). The curative effect, nursing satisfaction, and quality of life of patients after nursing were compared. The results showed that the coverage of fMRI activation points was significantly higher as being detected by the FCM algorithm, and the running time was shortened by 33.6 min. After nursing, the total effective rates in the research group and the control group were 87.5% vs. 34.4% in 3 months, 93.8% vs. 68.8% in 6 months, and 96.9% vs. 75.0% in 12 months, respectively; those in the research group were significantly higher than those in the control group (P < 0.05). The nursing satisfaction score (91.3 ± 4.5 vs. 80.9 ± 5.2) and nursing service quality score (89.7 ± 6.6 vs. 80.3 ± 7.1) in the research group were also significantly higher than those in the control group (P < 0.05). Meanwhile, the scores of each item after nursing in the research group were significantly higher than those in the control group (P < 0.05). The improved FCM algorithm detected the activation regions in the fMRI images more effectively, which could provide help for diagnosis and reduce error and misdiagnosis. At the same time, the PDCA home nursing also offered great help to the recovery of patients with DN, which was more superior for the curative effect of hospitalization, the promotion of recovery, and the improvement of patients' quality of life.

Intelligent Algorithm-Based Ultrasound Image for Evaluating the Effect of Comprehensive Nursing Scheme on Patients with Diabetic Kidney Disease

This study was aimed at exploring the effect of ultrasound image evaluation of comprehensive nursing scheme based on artificial intelligence algorithms on patients with diabetic kidney disease (DKD). 44 patients diagnosed with DKD were randomly divided into two groups: group A (no nursing intervention) and group B (comprehensive nursing). In the same period, 32 healthy volunteers were selected as the control group. Ultrasonographic images based on the $K$ non-local-means (KNL-Means) filtering algorithm were used to perform imaging examinations in healthy people and DKD patients before and after care. The results suggested that compared with those of the SAE reconstruction algorithm and KAVD reconstruction algorithm, the PSNR value of artificial bee colony algorithm reconstruction of image was higher and the MSE value was lower. The resistant index (RI) of DKD patients in group B after nursing was $0.63\pm 0.06$ , apparently distinct from the RI of the healthy people (controls) in the same group ( $0.58\pm 0.06$ ) and the RI of DKD patients in group A ( $0.68\pm 0.07$ ) ( $P<0.05$ ). The incidence rate of complications in DKD patients in group B was apparently inferior to that in group A. After comprehensive nursing intervention (CNI), the scores of all dimensions of quality of life (QoL) in DKD patients in group B were obviously superior versus those in DKD patients in group A. It suggests that implementation of nursing intervention for DKD patients can effectively help patients improve and control the level of renal function, while ultrasound images based on intelligent algorithm can dynamically detect the changes in the level of renal function in patients, which has the value of clinical promotion.