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Zainudin AM, Ghulam Rasool AH, Mat Nor MZ, Hassan NB, Muhamad R, Wan Mohamed WMI. Development and Validation of USM-Insulin Adherence Module for Patients with Type 2 Diabetes Mellitus. Malays J Med Sci 2024; 31:98-112. [PMID: 38694587 PMCID: PMC11057828 DOI: 10.21315/mjms2024.31.2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/16/2023] [Indexed: 05/04/2024] Open
Abstract
Background Many patients with type 2 diabetes mellitus (T2DM) do not achieve the desired glycaemic control despite being treated with insulin. Studies found this due to an improper understanding of insulin function, its intensification process and patients' negative perspective on insulin. We developed an education module to enhance adherence to insulin therapy. Methods This study applied a mixed design. It was conducted in three phases: i) Phase I: literature search and focus group discussions (FGDs), ii) Phase II: module development and iii) Phase III: content and face validation of Universiti Sains Malaysia-Insulin Adherence Module (USM-IAM). FGDs were used to gather patients' opinions. All researchers repeatedly discussed about the module content and arrangement, the words and images used, and the grammar in producing the final draft. Specialists and target audience performed content and face validation of the module. Results Thirty-six participants were involved in the FGDs. Data saturation was achieved at the 4th FGD. Three themes emerged from qualitative data analysis and were incorporated into the module. USM-IAM was finalised with five units. The content validity index (CVI) was 0.92, while face validity agreements were between 86% and 97%. Conclusion The CVI and face agreement for USM-IAM exceed the cut-off point for a sound module. It has good potential to be used as a resource for educating patients in enhancing insulin adherence.
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Affiliation(s)
- Aida Maziha Zainudin
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Aida Hanum Ghulam Rasool
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Zarawi Mat Nor
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Norul Badriah Hassan
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Rosediani Muhamad
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Wan Mohd Izani Wan Mohamed
- Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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Adu FA, Poku CA, Adu AP, Owusu LB. The role of social support and self-management on glycemic control of type 2 diabetes mellitus with complications in Ghana: A cross-sectional study. Health Sci Rep 2024; 7:e2054. [PMID: 38650722 PMCID: PMC11033339 DOI: 10.1002/hsr2.2054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 02/08/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
Background and Aims Diabetes mellitus (DM) can result in detrimental complications which are connected with long-term impairments and disabilities. Chronic complications are well-known consequences of type 2 diabetes mellitus (T2DM) progression, which reduce patient quality of life, place a burden on the healthcare system, and increase mortality. Measures to promote health outcomes for people with DM are scanty; the study therefore aimed at determining the effects of self-management and social support on glycemic control of T2DM with complications in Ghana. Methods A cross-sectional design using convenience sampling was conducted on 400 T2DM patients using Hensarling's Diabetes Family Support Scale and Summary of Diabetes Self‑Care Activities scale. Data analysis was conducted using descriptive, Pearson Moment Product Correlation and Binary Logistic Regression on self-management, social support, and glycemic control in T2DM patients. Results Social support among participants was high and there was a positive correlation or relationship between social support and T2DM self-management. There was a correlation between social support and self-management (r = 0.149, p < 0.05) and diet control (r = 0.221, p < 0.05). The results also showed a significant correlation between medication adherence and glycemic management (r = 0.116, p < 0.05) while female T2DM participants, individuals with at least primary education were less likely to have low self-management relative to T2DM. Conclusion Though the level of T2DM self-management was high it does not translate to good glycemic control. Focused health education programs should be incorporated into patients' care plans which will be particularly relevant for patients with T2DM and will contribute to positive physiological and psychological outcomes. Furthermore, a more robust monitoring and follow-up scheme should be scaled up or instituted for patients with T2DM.
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Affiliation(s)
- Frank Amankwah Adu
- Medical Technology in the Xiangya School of NursingCentral South UniversityChangshaChina
- Department of NursingKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Collins Atta Poku
- Department of NursingKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Amanda Parko Adu
- Department of NursingKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Lydia Boampong Owusu
- Department of NursingKwame Nkrumah University of Science and TechnologyKumasiGhana
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Liu Z, Annarapu G, Yazdani HO, Wang Q, Liu S, Luo JH, Yu YP, Ren B, Neal MD, Monga SP, Mota Alvidrez RI. Restoring glucose balance: Conditional HMGB1 knockdown mitigates hyperglycemia in a Streptozotocin induced mouse model. Heliyon 2024; 10:e23561. [PMID: 38187339 PMCID: PMC10770459 DOI: 10.1016/j.heliyon.2023.e23561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Diabetes mellitus (DM) poses a significant global health burden, with hyperglycemia being a primary contributor to complications and high morbidity associated with this disorder. Existing glucose management strategies have shown suboptimal effectiveness, necessitating alternative approaches. In this study, we explored the role of high mobility group box 1 (HMGB1) in hyperglycemia, a protein implicated in initiating inflammation and strongly correlated with DM onset and progression. We hypothesized that HMGB1 knockdown will mitigate hyperglycemia severity and enhance glucose tolerance. To test this hypothesis, we utilized a novel inducible HMGB1 knockout (iHMGB1 KO) mouse model exhibiting systemic HMGB1 knockdown. Hyperglycemic phenotype was induced using low dose streptozotocin (STZ) injections, followed by longitudinal glucose measurements and oral glucose tolerance tests to evaluate the effect of HMGB1 knockdown on glucose metabolism. Our findings showed a substantial reduction in glucose levels and enhanced glucose tolerance in HMGB1 knockdown mice. Additionally, we performed RNA sequencing analyses, which identified potential alternations in genes and molecular pathways within the liver and skeletal muscle tissue that may account for the in vivo phenotypic changes observed in hyperglycemic mice following HMGB1 knockdown. In conclusion, our present study delivers the first direct evidence of a causal relationship between systemic HMGB1 knockdown and hyperglycemia in vivo, an association that had remained unexamined prior to this research. This discovery positions HMGB1 knockdown as a potentially efficacious therapeutic target for addressing hyperglycemia and, by extension, the DM epidemic. Furthermore, we have revealed potential underlying mechanisms, establishing the essential groundwork for subsequent in-depth mechanistic investigations focused on further elucidating and harnessing the promising therapeutic potential of HMGB1 in DM management.
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Affiliation(s)
- Zeyu Liu
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Gowtham Annarapu
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Hamza O. Yazdani
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Qinge Wang
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Silvia Liu
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jian-Hua Luo
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Yan-Ping Yu
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Baoguo Ren
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Matthew D. Neal
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Satdarshan P. Monga
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Roberto Ivan Mota Alvidrez
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, 87131, USA
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Davis TME, Davis W. The relationship between glycated haemoglobin and blood glucose-lowering treatment trajectories in type 2 diabetes: The Fremantle Diabetes Study Phase II. Diabetes Obes Metab 2024; 26:283-292. [PMID: 37795655 DOI: 10.1111/dom.15314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/14/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023]
Abstract
AIMS To examine the relationships between glycaemia and treatment complexity over 6 years in well-characterized community-based people with type 2 diabetes. MATERIALS AND METHODS Fremantle Diabetes Study Phase II participants who had type 2 diabetes with glycated haemoglobin (HbA1c) and blood glucose-lowering therapy (BGLT) data over 6 years were included. Group-based multi-trajectory modelling identified combined HbA1c/BGLT trajectory subgroups for diabetes durations of ≤1.0 year (Group 1; n = 160), >1.0 to 10.0 years (Group 2; n = 382;) and >10.0 years (Group 3; n = 357). Multinomial regression was used to identify baseline associates of subgroup membership. RESULTS The optimum numbers of trajectory subgroups were three in Group 1 (low, medium, high) and four in Groups 2 and 3 (low, low/high medium, high). Each low trajectory subgroup maintained a mean HbA1c concentration of <53 mmol/mol (<7.0%) on lifestyle measures, or monotherapy (Group 3). All five medium subgroups had stable HbA1c trajectories at <58 mmol/mol (<7.5%) but required increasing oral BGLT, or insulin (Group 3, high medium). The Group 1 high subgroup showed a falling then increasing HbA1c with steady progression to insulin. The high subgroups in Groups 2 and 3 showed stable HbA1c profiles at means of approximately 64 mmol/mol (8.0%) and 86 mmol/L (10.0%), respectively, on insulin. Non-Anglo Celt ethnicity, central obesity and hypertriglyceridaemia were strongly associated with Group 1 high subgroup membership. Younger age at diagnosis and central obesity were independent associates of the most adverse HbA1c trajectories in Groups 2 and 3. CONCLUSIONS These data demonstrate diabetes duration-dependent heterogeneity in glycaemic and treatment profiles and related clinical and laboratory variables, which have implications for management.
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Affiliation(s)
- Timothy M E Davis
- University of Western Australia, Medical School, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Wendy Davis
- University of Western Australia, Medical School, Fremantle Hospital, Fremantle, Western Australia, Australia
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Liang W, Lo SHS, Chow KM, Zhong J, Ni X. Perception of self-management and glycaemic control in people with type 2 diabetes receiving insulin injection therapy: A qualitative study. Prim Care Diabetes 2023; 17:587-594. [PMID: 37658019 DOI: 10.1016/j.pcd.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/16/2023] [Accepted: 08/28/2023] [Indexed: 09/03/2023]
Abstract
AIM The aim of this study was to explore the experience of self-management and glycaemic control in Chinese people with type 2 diabetes receiving insulin injection therapy. METHODS A qualitative descriptive design was adopted with individual, semi-structured interviews. Participants were selected by purposive sampling. All face-to-face interviews were conducted between December 2020 and January 2021. The interviews were audio recorded and transcribed verbatim. Content analysis was used to analyse the interview data. RESULTS A total of 27 participants were recruited and individually interviewed. Three themes were generated: integrating insulin injection therapy into daily self-management; experiencing uncertainty when coping with suboptimal glycaemic control; and self-management programmes for optimal diabetes control. CONCLUSION All of our findings increase the understanding of self-management and glycaemic control in people with T2D receiving insulin injection therapy. Healthcare professionals should recognise the unmet needs of this cohort to promote their diabetes management. Appropriate and effective self-management programmes should be developed and implemented to alleviate the negative impacts of insulin injection therapy on diabetes management with consideration of cultural and personal context.
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Affiliation(s)
- Wei Liang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Ka Ming Chow
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China.
| | - Jie Zhong
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Xiaoying Ni
- Xidu Street Community Health Service Centre, Fengxian District, Shanghai, China
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Skriver LKL, Nielsen MW, Walther S, Nørlev JD, Hangaard S. Factors associated with adherence or nonadherence to insulin therapy among adults with type 2 diabetes mellitus: A scoping review. J Diabetes Complications 2023; 37:108596. [PMID: 37651772 DOI: 10.1016/j.jdiacomp.2023.108596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/20/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND AND AIM One of the greatest barriers to the treatment of T2DM is nonadherence which particularly applies to insulin therapy. There is a need for a comprehensive overview of all factors associated with nonadherence to insulin therapy. The aim of this study was to identify factors associated with adherence or nonadherence to insulin therapy among adults with T2DM. METHODS A scoping review was conducted in accordance with the PRISMA 2020 statement. A systematic search was performed in PubMed, Cinahl, and Web of Science (January 2013 to March 2023). RESULTS A final sample of 48 studies was included in the scoping review. The synthesis revealed 30 factors associated with adherence or nonadherence. The factors were grouped into 6 themes: demographics, attitude and perceptions, management of diabetes, impact on daily living, disease and medication, and healthcare system. CONCLUSION The most prominent factors identified were age, cost of healthcare, personal beliefs towards insulin therapy, social stigma, patient education, complexity of diabetes treatment, impact of insulin therapy on daily life, and fear of side effects. The results indicate a need for further research to determine threshold values for the factors associated with adherence or nonadherence.
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Affiliation(s)
| | | | - Simone Walther
- Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | | | - Stine Hangaard
- Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark; Steno Diabetes Center North Jutland, 9000 Aalborg, Denmark
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Ong CY, Lee WCD, Low SG, Low LL, Vasanwala FF. Attitudes and perceptions of people with diabetes mellitus on patient self-management in diabetes mellitus: a Singapore hospital's perspective. Singapore Med J 2023; 64:467-474. [PMID: 35083371 PMCID: PMC10395802 DOI: 10.11622/smedj.2022006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 11/11/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Chong Yau Ong
- Department of Medicine, Newcastle University Medicine Malaysia, Johor, Malaysia
| | | | - Sher Guan Low
- Post-Acute & Continuing Care, SingHealth Community Hospitals, Singapore
| | - Lian Leng Low
- Post-Acute & Continuing Care, SingHealth Community Hospitals, Singapore
- Department of Family Medicine Continuing Care, Singapore General Hospital, Singapore
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Husin M, Teh XR, Ong SM, Lim YMF, Ang SH, Chan CL, Lim MT, Shanmugam S, Khamis N, Jaafar FSA, Ibrahim NI, Nasir NH, Kusuma D, Wagner AK, Ross-Degnan D, Atun R, Sivasampu S. The Effectiveness of Enhanced Primary Healthcare (EnPHC) interventions on Type 2 diabetes management in Malaysia: Difference-in-differences (DID) analysis. Prim Care Diabetes 2023; 17:260-266. [PMID: 36932012 DOI: 10.1016/j.pcd.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/23/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
AIMS To evaluate the effectiveness of the Enhanced Primary Healthcare (EnPHC) interventions on process of care and intermediate clinical outcomes among type 2 diabetes patients. METHODS This was a quasi-experimental controlled study conducted in 20 intervention and 20 control public primary care clinics in Malaysia from November 2016 to June 2019. Type 2 diabetes patients aged 30 years and above were selected via systematic random sampling. Outcomes include process of care and intermediate clinical outcomes. Difference-in-differences analyses was conducted. RESULTS We reviewed 12,017 medical records of patients with type 2 diabetes. Seven process of care measures improved: HbA1c tests (odds ratio (OR) 3.31, 95% CI 2.13, 5.13); lipid test (OR 4.59, 95% CI 2.64, 7.97), LDL (OR 4.33, 95% CI 2.16, 8.70), and urine albumin (OR 1.99, 95% CI 1.12, 3.55) tests; BMI measured (OR 15.80, 95% CI 4.78, 52.24); cardiovascular risk assessment (OR 174.65, 95% CI 16.84, 1810.80); and exercise counselling (OR 1.18, 95% CI 1.04, 1.33). We found no statistically significant changes in intermediate clinical outcomes (i.e. HbA1c, LDL, HDL and BP control). CONCLUSIONS EnPHC interventions was successful in enhancing the quality of care, in terms of process of care, by changing healthcare providers behaviour.
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Affiliation(s)
- Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia.
| | - Xin Rou Teh
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Su Miin Ong
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Yvonne Mei Fong Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Swee Hung Ang
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Chee Lee Chan
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Ming Tsuey Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Sunita Shanmugam
- Institute for Health Management, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Noraziani Khamis
- Institute for Health Management, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Faeiz Syezri Adzmin Jaafar
- Institute for Health Management, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
| | - Nor Idawaty Ibrahim
- Family Health Development Division, Ministry of Health Malaysia, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62590 Putrajaya, Malaysia
| | - Nazrila Hairizan Nasir
- Family Health Development Division, Ministry of Health Malaysia, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62590 Putrajaya, Malaysia
| | - Dian Kusuma
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States; Department of Health Services Research and Management, School of Health & Psychological Sciences, City University of London, London, United Kingdom
| | - Anita Katharina Wagner
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Dr #401, Boston, MA 02215, United States
| | - Dennis Ross-Degnan
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Dr #401, Boston, MA 02215, United States
| | - Rifat Atun
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, No. 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, 40170 Shah Alam, Selangor, Malaysia
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Puvvada RK, Tang CY, Thomas J, Kay M, Higgs P, Jois M, Madhan R, Gupta S. Using 17 th century medication for modern diabetes management: Doctors' perceptions of self-medication practices - A qualitative study. J Diabetes Metab Disord 2023; 22:375-383. [PMID: 37255776 PMCID: PMC10225456 DOI: 10.1007/s40200-022-01154-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/27/2022] [Indexed: 06/01/2023]
Abstract
Purpose This study was conducted to explore doctors' perceptions and understanding of the self-medication practices of people living with type 2 diabetes. Methods A qualitative research design incorporating 20 semi-structured, face-to-face interviews were conducted with doctors treating people with type 2 diabetes in Mysuru, India, between July 2019 and January 2020. All the interviews were conducted in doctors' clinics, audio-recorded and thematically analyzed. Results Three themes were identified from these interviews- i) Doctors' beliefs towards their patients' use of traditional medicine and environmental factors influencing prescription practices, ii) Doctors reported little faith in traditional medicines, iii) Limited strategies implemented by doctors to overcome barriers to self-medications. Doctors reported greater belief in western medications over traditional medications and expressed concern that their patients favored traditional medications over western. Multiple factors such as social media, accessibility of healthcare facilities and pill burden influenced adherence to western medications. Also, lack of knowledge about traditional medications and trust in western medications available under government schemes have influenced prescription practices among doctors. It appears that doctors implemented strategies such as educating patients on the detrimental effects of self-medication and insisting on patients to take only western medications to achieve desired blood glucose levels when managing self-medication practices among people with diabetes. Conclusion These results suggest that doctors have limited strategies to implement to prevent self-medication practices among people with diabetes. Increasing knowledge amongst doctors about JAS medication effectiveness and thereby garnering greater trust in generic medications. In addition, efforts should be made to identify the best ways to integrate traditional and western medicine into patient-centered care delivery. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-022-01154-5.
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Affiliation(s)
- Rahul Krishna Puvvada
- Department of Microbiology Anatomy Physiology and Pharmacology (MAPP), School of Agriculture Biomedicine and Environment (SABE), La Trobe University, Melbourne, Australia
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru, Karnataka India
| | - Clarice Y. Tang
- Department of Physiotherapy, School of Health Sciences, Western Sydney University, Sydney, Australia
- Allied Health Department, South Western Sydney Local Health District, Sydney, Australia
| | - Jency Thomas
- Department of Microbiology Anatomy Physiology and Pharmacology (MAPP), School of Agriculture Biomedicine and Environment (SABE), La Trobe University, Melbourne, Australia
| | - Mitch Kay
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Peter Higgs
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Burnet Institute, Melbourne, Australia
| | - Markandeya Jois
- Department of Microbiology Anatomy Physiology and Pharmacology (MAPP), School of Agriculture Biomedicine and Environment (SABE), La Trobe University, Melbourne, Australia
| | - Ramesh Madhan
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru, Karnataka India
| | - Sabrina Gupta
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Integrated Diabetes Self-Management (IDSM) mobile application to improve self-management and glycemic control among patients with Type 2 Diabetes Mellitus (T2DM) in Indonesia: A mixed methods study protocol. PLoS One 2022; 17:e0277127. [PMID: 36441733 PMCID: PMC9704669 DOI: 10.1371/journal.pone.0277127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 10/21/2022] [Indexed: 11/29/2022] Open
Abstract
The number of patients with diabetes in Indonesia reach 19,47 million in 2021, mostly is caused by the adoption of sedentary and unhealthy lifestyles. Continuous self-management is important in diabetes care. It requires optimal coordination and communication between patients, families, and health care provider. The use of communication technology could be solution to the problem. This study aims to initiate an android-based mobile apps technology as a tool for patient, family, and healthcare provider to optimize patient with T2DM treatment. This study will be conducted in Public Health Centers (PHCs) in Yogyakarta using an exploratory sequential mixed-methods design which is divided into three phases. The first phase will use qualitative descriptive methods. Patients with T2DM, families, nurses, physicians and Health Social Security Agency officers in Indonesia will be involved in a focus group discussion (FGD) and in-depth interviews to understand their needs in optimizing the treatment. The second phase will be the development of an android-based application on the first phase results. The apps will be usability tested by involving experts (heuristic evaluation) and users (think aloud method) to ensure that the apps really meet targeted user's need. In the third phase, we will collect feedback from user after using this apps for three months. The effectiveness of the apps will be measured by self-management improvement and glycemic control of patients with T2DM. The non-equivalent control group design will be applied using a pre-repeated post-test control group. The result of this study will be an Android-based Application which will be called Integrated Diabetes Self-Management (IDSM) app to optimize the implementation of diabetes self-management which can improve glycemic control of patients with T2DM as one of the indicators of the Indonesian Chronic Disease Management Program at PHCs.
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11
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Langerman C, Forbes A, Robert G. The experiences of insulin use among older people with Type 2 diabetes mellitus: A thematic synthesis. Prim Care Diabetes 2022; 16:614-626. [PMID: 36089508 DOI: 10.1016/j.pcd.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus is common in older people. Managing diabetes in older people can be challenging due to comorbidities and age-related disabilities, particularly in the context of insulin therapy. The purpose of this review is to explore older people's experiences of insulin use and to consider how these experiences might inform healthcare delivery. REVIEW METHODS A systematic review with thematic synthesis was conducted and reported in accordance with the PRISMA and ENTREQ statements. MEDLINE, Embase, PsycInfo, CINAHL and Web of Science were searched from 1985 to September 2019 with subsequent updates in December 2019 and June 2022. Included studies were quality appraised, findings tabulated, and results used to inform an integrated thematic synthesis. RESULTS Fourteen studies that reported insulin experiences with 274 patients aged 60 years and over were included; nine of the studies were qualitative and five used questionnaires surveys. Seven themes emerged that were grouped into treatment-related factors (physical impact of insulin, physical capacity to administer insulin, insulin self-management behaviours) and person-centred factors (emotional factors, social factors, daily living, and personal knowledge/beliefs). Three analytical themes to guide clinical practice were derived from the data: addressing physical capacity and ability, supporting social and emotional issues and improving interactions with healthcare professionals. CONCLUSION The review indicates issues surrounding the technical aspects of insulin administration, side effects of treatment and reactions to insulin administration are common amongst older people. However, research evidence is limited, and there is an urgent need for empirical, participatory research with older insulin dependent adults with type 2 diabetes. IMPLICATIONS FOR PRACTICE Healthcare professionals need to ensure that older type 2 diabetes people on insulin are actively involved in their own care, to allow their insulin regimens to be personalised and aligned with their goals and expectations. Tailored educational interventions to reduce treatment hazards and promote physical and psychological wellbeing are also needed for this population.
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Affiliation(s)
- Chaya Langerman
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom.
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom
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Bayked EM, Kahissay MH, Workneh BD. Patients' perceptions, associations, and justifications for the causes of diabetes in North-East Ethiopia: A qualitative study. Diabetes Metab Syndr 2022; 16:102502. [PMID: 35597056 DOI: 10.1016/j.dsx.2022.102502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Diabetes management is strongly influenced by patients' beliefs about its causes. The study examined type 2 diabetes patients' perceptions of the causes of their illness in North-East Ethiopia. METHODS The study used a phenomenological approach triangulated with modified grounded theory based on the Causative Dimension of Self-Regulated Model, and was conducted from July 2019 to January 2020. Purposive sampling was used to select the participants. Semi-structured in-depth face-to-face interviews with twenty-four (11 males and 13 females) participants were used to collect data until saturation. QDA Miner Lite v2.0.8 was used to perform analysis, which was then discussed based on the themes that emerged. RESULTS The patients expressed and justified the causes of their illness by evidencing the temporal proximity of the onset of symptoms or indicators and specific misfortune. As such, diabetes has been attributed to emotional reactions, psycho-economic situations, supernatural evil spirits, substance use, nutritional problems, and other illness; emotional reactions, with psycho-economic and supernatural spirits being the most common. These causes were justified by referring to a specific earlier misfortune that related to the onset of the indicators. CONCLUSION Patients' perceptions for attributing their illness were linked with emotional, psycho-economic, and supernatural evil spirits and justified by a specific life calamity by establishing the temporal association of symptoms with that adversity; which entails culture-specific psycho-social and educational interventions in diabetes care. Moreover, the finding necessitates that the causality justifications and linkages to misfortunes be included in the Causality Dimension of the Self-Regulated Model.
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Affiliation(s)
- Ewunetie Mekashaw Bayked
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia.
| | - Mesfin Haile Kahissay
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Birhanu Demeke Workneh
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
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13
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Zahmatkeshan N, Khademian Z, Zarshenas L, Rakhshan M. Experience of adherence to treatment among patients with coronary artery disease during the COVID-19 pandemic: A qualitative study. Health Promot Perspect 2022; 11:467-475. [PMID: 35079592 PMCID: PMC8767076 DOI: 10.34172/hpp.2021.59] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/12/2021] [Indexed: 12/11/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has caused patients with chronic diseases to face various challenges. The present qualitative study aimed to explore adherence to treatment in patients with coronary artery disease (CAD) during the COVID-19 pandemic. Methods: This qualitative content analysis was conducted from September 2020 to February 2021. Online in-depth interviews were conducted with 15 patients with CAD after discharge from Nemazi and Al-Zahra heart hospitals, Shiraz, Iran. Data management was done via MAXQDA 12 software using conventional content analysis based on the method proposed by Graneheim and Lundman. Results: The results revealed three main categories, nine subcategories, and 431 primary codes. The first category was 'improved self-care in the shadow of COVID-19' (Improving self-care due to fear of COVID-19, 'utilization of alternative strategies, and reinforcement of self-care beliefs). The second category was 'redefinition of support systems' (need for a support system, seeking for alternative support systems, and changes in social interactions). The last category was 'barriers to treatment adherence' (shortage of financial resources, need to adjust with working conditions, and mental conflicts). Conclusion: The results indicated that the COVID-19 threats encouraged the patients with CAD to adhere to their care principles. Nonetheless, the restrictions resulting from the pandemic caused problems in adherence to treatment. Thus, redefinition of the support systems in accordance with the present conditions are recommended.
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Affiliation(s)
- Nasrin Zahmatkeshan
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Khademian
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ladan Zarshenas
- Department of Nursing, School of Nursing and Midwifery, Community based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahnaz Rakhshan
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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14
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Amdie FZ, Sawhney M, Woo K. The Weakness of Will: The Role of Free Will in Treatment Adherence. Patient Prefer Adherence 2022; 16:1131-1139. [PMID: 35517044 PMCID: PMC9064064 DOI: 10.2147/ppa.s362706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
Chronic disease prevention and management requires a lifelong commitment and adherence to lifestyle modifications, monitoring of symptoms, medication use, and other forms of therapy. Treatment adherence is a crucial and complex concept in patient care provision, and it requires the voluntary active involvement of patients for the best possible outcome. Multiple factors, which may or may not be under the patient's control, can influence treatment adherence. However, adherence or non-adherence to a certain treatment is predominantly influenced by one's sense of agency, values, beliefs, attitudes, and willpower. It is evident that mental states appear to influence patients' decision-making, and the best treatment outcome occurs when a patient identifies their goals, needs, and desires and exercises their decision-making and free will during the course of receiving care. The role of healthcare providers is critical in promoting treatment adherence, thereby enhancing patient outcomes. Thus, this paper highlights the importance of promoting a sense of agency and integrating patients' values, beliefs, attitudes, and intentions during the provision of healthcare. It is indispensable to recognize the individual's ability and initiative to control and manage their illness in the face of challenging socioeconomic and cultural reality. On logical grounds, it is not enough to appreciate the value of free will and mental states, it is also essential to empower and cultivate an individual patient's willpower to make a well-informed, free decision based on their mental state for the most optimal treatment outcomes.
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Affiliation(s)
- Fisseha Zewdu Amdie
- School of Nursing, University of Gondar, Gondar, Ethiopia
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
- Correspondence: Fisseha Zewdu Amdie, Email
| | - Monakshi Sawhney
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
| | - Kevin Woo
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
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15
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Yoon S, Ng JH, Kwan YH, Low LL. Healthcare Professionals' Views of Factors Influencing Diabetes Self-Management and the Utility of a mHealth Application and Its Features to Support Self-Care. Front Endocrinol (Lausanne) 2022; 13:793473. [PMID: 35282452 PMCID: PMC8907617 DOI: 10.3389/fendo.2022.793473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The perspectives of healthcare professionals (HCPs) are pivotal to co-development of self-management strategies for patients with diabetes. However, literature has been largely limited to perspectives of patients within the context of a Western healthcare setting. This study aims to explore factors influencing diabetes self-management in adult patients with diabetes from the perspectives of HCPs and their views of the value of mHealth application for diabetes self-management. MATERIALS AND METHODS We conducted focus group discussions (FGD) with purposively selected HCPs in Singapore. All FGDs were audio-recorded and transcribed verbatim. Thematic analysis was conducted using NVivo 12. RESULTS A total of 56 HCPs participated in the study. Barriers to self-management included limited patient commitment to lifestyle changes, suboptimal adherence to medication and treatment, patient resistance to insulin initiation and insufficient rapport between patients and HCPs. Patients' perceived susceptibility to complications, social support from family and community, multidisciplinary team care and patient's understanding of the benefits of self-care were viewed as facilitating self-management. HCPs saw mHealth apps as a vital opportunity to engage patients in the self-management of conditions and empower them to foster behavior changes. Yet, there were concerns regarding patient's limited digital literacy, lack of integration into routine electronic system and reluctance. DISCUSSION We identified a set of factors influencing self-management in adult patients with diabetes and useful app features that can empower patients to manage their conditions. Findings will inform the development of a mHealth application, and its features designed to improve self-care.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Jun Hao Ng
- Duke-NUS Medical School, Singapore, Singapore
| | - Yu Heng Kwan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
- Internal Medicine Residency Programme, SingHealth Residency, Singapore, Singapore
| | - Lian Leng Low
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
- *Correspondence: Lian Leng Low,
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Pamungkas RA, Chamroonsawasdi K, Charupoonphol P, Vatanasomboon P. A health-based coaching program for diabetes self-management (DSM) practice: A sequential exploratory mixed-method approach. ENDOCRINOL DIAB NUTR 2021; 68:489-500. [PMID: 34863414 DOI: 10.1016/j.endien.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/22/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Diabetes self-management (DSM) is crucial for glycemic control among type-2 diabetic (T2D) people. METHOD This was a sequential exploratory mixed-method approach to assess whether a health-based coaching program designed to fit the unmet needs of T2D was the best intervention for improving DSM practice. Twenty-eight participants from different backgrounds were involved in phase 1 (Qualitative study) to explore DSM knowledge and practice, any difficulties obstructing such knowledge and practice, and the feasibility of implementing an intervention program nationwide. Sixty patients were recruited for phase 2 (Quasi-experimental study). A health-based coaching program, constructed to fit the unmet needs from phase 1 was implemented among thirty patients in an experimental group. By comparison, 30 patients in the control group received their usual care. Diabetes and DSM knowledge, DSM practice, and health outcomes were measured and compared between the two groups at baseline and after the 12th week of the intervention. RESULTS The following problems were found: (1) a low perception of susceptibility to and severity of illness, (2) inadequate DSM knowledge and skills, (3) a lack of motivation to perform DSM practice, and (4) social exclusion and feelings of embarrassment. After the implementation of the program among the experimental group, all the variables improved relative to baseline and to the control group. CONCLUSION A health-based coaching program can improve DSM knowledge and practice and health outcomes. A nationwide program is recommended to promote DSM practice among Indonesian communities.
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Affiliation(s)
- Rian Adi Pamungkas
- Department of Nursing, Faculty of Health Sciences, Esa Unggul University, Jakarta, Indonesia
| | - Kanittha Chamroonsawasdi
- Department of Family Health, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand.
| | - Phitaya Charupoonphol
- Department of Family Health, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand
| | - Paranee Vatanasomboon
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand
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Adhikari M, Devkota HR, Cesuroglu T. Barriers to and facilitators of diabetes self-management practices in Rupandehi, Nepal- multiple stakeholders' perspective. BMC Public Health 2021; 21:1269. [PMID: 34187461 PMCID: PMC8243465 DOI: 10.1186/s12889-021-11308-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/17/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Self-management of diabetes is associated with glycaemic control and adherence to medication and healthy lifestyle practices. There is lack of information on the barriers to and facilitators of diabetes self-management practices in low income country, Nepal. This study aimed to explore the barriers to and facilitators of Type 2 diabetes self-management practices taking multiple stakeholders' perspectives in Nepal. METHODS Four focus group discussions and 16 semi-structured interviews with people with Type 2 diabetes, caregivers, health care providers and health managers were conducted from April to May 2018 in Rupandehi district of Western Nepal. They were audio-recorded, transcribed, and analysed using a thematic approach. RESULTS Five main themes emerged that influenced diabetes self-management practices: individual factors, socio-cultural and economic factors, health system and policy factors, availability and accessibility of resources, and environmental factors. The important barriers were: lack of knowledge about diabetes self-management practices, cultural practices, insufficient counselling, lack of guidelines and protocols for counselling, and financial problems. The major facilitators were: motivation; support from family, peers, and doctors; and availability of resources in the community. CONCLUSION Based on our findings, a multilevel approach is needed to address these barriers and facilitators. These findings will help guide strategies to develop programs that impart knowledge and skills to improve the diabetes self-management practices of people with Type 2 diabetes.
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Affiliation(s)
| | | | - Tomris Cesuroglu
- Faculty of Science, Vrije University, Amsterdam, The Netherlands
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18
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Jayasvasti I, Jayasvasti M, Pengpid S, Peltzer K, Nanthananate P. Participants' Views on Lifestyle Intervention Program Enhancing Long-Term Health-Related Behaviors Improvement among Prehypertension and/or Prediabetes Mellitus Older Adults: A Qualitative Study Examined in Thailand at Health Promoting Hospitals. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211025209. [PMID: 34121492 PMCID: PMC8207270 DOI: 10.1177/00469580211025209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This study aimed to investigate the view of prediabetes and prehypertension elderly patients living around temple on long-term self-management in proficient way underneath the lifestyle intervention program based on both focus-group discussion and In-depth interview methods to fill the gap in partially successful intervention. 62 participants were selected from 220 participants of the quantitative published study by 2 researchers. The triangulation method was used to put great emphasis on the consistency and the credibility of the results. Almost all of the participants had benefited from the program regarding proper foods, suitable exercise and an inspiration of lifestyle modification. They made changes of eating behavior and exercise behavior during program attendance, however, after the program had finished, they had minimal concern to take care of themselves. Nonetheless, more than half of them demonstrated some health-related behaviors changes due to they gave the value of the suggestion in different aspects. Moreover, high-frequency program attendance was not related to blood results improvement. The knowledge obtained from program intervention together with adequate contact between the patient and the program staff, personal problems solving, personal attitude, practice and acceptable played a key role for long-term lifestyle modification and completely successful intervention.
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Affiliation(s)
| | | | - Supa Pengpid
- ASEAN Institute for Health Development Mahidol University, Nakhon Pathom, Thailand.,Department of Research Development and Innovation, University of Limpopo, Polokwane, South Africa
| | - Karl Peltzer
- Department of Psychology, University of the Free State, Bloemfontein, South Africa.,Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Watson A, McConnell D, Coates V. Reducing unscheduled hospital care for adults with diabetes following a hypoglycaemic event: which community-based interventions are most effective? A systematic review. J Diabetes Metab Disord 2021; 20:1033-1050. [PMID: 34131570 PMCID: PMC8192108 DOI: 10.1007/s40200-021-00817-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 05/09/2021] [Indexed: 01/09/2023]
Abstract
AIM To determine which community-based interventions are most effective at reducing unscheduled hospital care for hypoglycaemic events in adults with diabetes. METHODS Medline Ovid, CINAHL Plus and ProQuest Health and Medical Collection were searched using both key search terms and medical subject heading terms (MeSH) to identify potentially relevant studies. Eligible studies were those that involved a community-based intervention to reduce unscheduled admissions in adults with diabetes. Papers were initially screened by the primary researcher and then a secondary reviewer. Relevant data were then extracted from papers that met the inclusion criteria. RESULTS The search produced 2226 results, with 1360 duplicates. Of the remaining 866 papers, 198 were deemed appropriate based on titles, 90 were excluded following abstract review. A total of 108 full papers were screened with 19 full papers included in the review. The sample size of the 19 papers ranged from n = 25 to n = 104,000. The average ages within the studies ranged from 41 to 74 years with females comprising 57% of the participants. The following community-based interventions were identified that explored reducing unscheduled hospital care in people with diabetes; telemedicine, education, integrated care pathways, enhanced primary care and care management teams. CONCLUSIONS This systematic review shows that a range of community-based interventions, requiring different levels of infrastructure, are effective in reducing unscheduled hospital care for hypoglycaemia in people with diabetes. Investment in effective community-based interventions such as integrated care and patient education must be a priority to shift the balance of care from secondary to primary care, thereby reducing hospital admissions. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40200-021-00817-z.
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Affiliation(s)
- Aoife Watson
- Faculty of Life and Health Sciences, School of Nursing, Ulster University, Magee, Northland Road, Derry, BT48 7JL UK
| | - Donna McConnell
- Faculty of Life and Health Sciences, School of Nursing, Ulster University, Magee, Northland Road, Derry, BT48 7JL UK
| | - Vivien Coates
- Faculty of Life and Health Sciences, School of Nursing, Ulster University, Magee, Northland Road, Derry, BT48 7JL UK
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Chamroonsawasdi K, Chottanapund S, Pamungkas RA, Tunyasitthisundhorn P, Sornpaisarn B, Numpaisan O. Protection motivation theory to predict intention of healthy eating and sufficient physical activity to prevent Diabetes Mellitus in Thai population: A path analysis. Diabetes Metab Syndr 2021; 15:121-127. [PMID: 33340872 DOI: 10.1016/j.dsx.2020.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Diabetes mellitus is a global health problem causing premature death and economic burden. The study aimed to investigate an application of the protection motivation theory (PMT) model to explain the intention of healthy eating behaviors and physical activity among healthy Thais. METHODS This study was a part of a large case control focused only on the control group without noncommunicable diseases. Nine hundred ninety-seven subjects were drawn from eleven provinces of Thailand. A self-administered questionnaire was constructed based on the PMT model to gather information on predictive factors on eating behaviors and physical activity. Path analysis was used to determine whether the empirical data fit the PMT structure as well as to assess the strength of association among PMT constructed factors predicting behavioral intention. RESULTS The findings demonstrated that empirical data of eating behaviors (CMIN χ2 p-value = 0.462; CMIN/df = 0.901; NFI = 0.997; CFI = 1; RMSEA <0.001) and physical activity (CMIN χ2 p-value = 0.053; CMIN/df = 2.187; NFI = 0.987; CFI = 0.993; RMSEA = 0.035) fit the PMT. The strongest predictive factor of behavioral intention on eating behaviors was response efficacy (β = 0.146), while self-efficacy was found to be the strongest factor for physical activity (β = 0.11). Knowledge had the only indirect effect on behavior intention through perceived susceptibility and perceived severity. CONCLUSION In conclusion, information on susceptibility and severity should be incorporated in intervention strategies to enhance response efficacy and self-efficacy to prevent diabetes.
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Affiliation(s)
- Kanittha Chamroonsawasdi
- Department of Family Health, Faculty of Public Health, Mahidol University, Bangkok, 10400, Thailand.
| | - Suthat Chottanapund
- Bamrasnaradura Infectious Disease Institute, Ministry of Public Health, Nonthaburi, 11000, Thailand.
| | - Rian Adi Pamungkas
- Department of Nursing, Faculty of Health Sciences, Esa Unggul University, Jakarta, 11530, Indonesia.
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Chepulis L, Morison B, Cassim S, Norman K, Keenan R, Paul R, Lawrenson R. Barriers to Diabetes Self-Management in a Subset of New Zealand Adults with Type 2 Diabetes and Poor Glycaemic Control. J Diabetes Res 2021; 2021:5531146. [PMID: 34136579 PMCID: PMC8177985 DOI: 10.1155/2021/5531146] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/02/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite the fact that there is an increasingly effective armoury of medications to treat diabetes, many people continue to have substantially elevated blood glucose levels. The purpose of this study was to explore what the barriers to diabetes management are in a cohort of people with diabetes and poor glycaemic control. METHODS Qualitative semistructured interviews were carried out with 10 people with diabetes who had known diabetes and a recent HbA1c of >11.3% (100 mmol/mol) to explore their experiences of barriers to diabetes self-management and glycaemic control. RESULTS Barriers to diabetes management were based around two key themes: biopsychosocial factors and knowledge about diabetes. Specifically, financial concerns, social stigma, medication side effects, and cognitive impairment due to hyperglycaemia were commonly reported as barriers to medication use. Other barriers included a lack of knowledge about their own condition, poor relationships with healthcare professionals, and a lack of relevant resources to support diet and weight loss. CONCLUSION People with diabetes with poor glycaemic control experience many of the same barriers as those reported elsewhere, but also experience issues specifically related to their severe hyperglycaemia. Management of diabetes could be improved via the increased use of patient education and availability of locally relevant resources.
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Affiliation(s)
- Lynne Chepulis
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Brittany Morison
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Shemana Cassim
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Kimberley Norman
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Rawiri Keenan
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Ryan Paul
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
- Waikato District Health Board, Waikato, Hamilton, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
- Waikato District Health Board, Waikato, Hamilton, New Zealand
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Alomran AM, Almubarak DA, Alrashed BA, Khan AS. Psychological insulin resistance among type 2 diabetic patients attending primary healthcare centers, Al-Ahsa, Saudi Arabia. J Family Community Med 2020; 27:192-199. [PMID: 33354150 PMCID: PMC7745782 DOI: 10.4103/jfcm.jfcm_226_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/25/2020] [Accepted: 08/15/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Patients' adherence to insulin therapy is crucial to achieve good glycemic control. The present study was conducted to determine psychological insulin resistance (PIR) and the effect of doctor-patient relationship on PIR among type 2 diabetes patients attending primary health-care centers of Al-Ahsa region in Saudi Arabia. MATERIALS AND METHODS This was a cross-sectional survey of all type 2 diabetic patients attending the primary healthcare centers of Al-Ahsa. A multistage sampling technique was used. The calculated sample size was 396. Two validated structured questionnaires were used to collect information. The degree of agreement to insulin therapy was done on the Likert 5° scale. SPSS was used for data entry and analysis. Chi-square test was used to test for stistical significane at P=0.05. RESULTS Out of 396 patients who were given the questionnaires, 366 filled the questionnaires yielding 92% response rate. Fifty-one percent were male and about 85% were older than 35 years. Willingness to use insulin was significantly associated with age (P = 0.013) and duration of diabetes (P=0.0001). The strongest negative attitudes toward insulin therapy arose from participants having heard about a bad experience with insulin (59.34%, P < 0.05) and the fear of possible dependence (54.20%, P < 0.05). Participants who responded of "mostly appropriate" and "very appropriate" to questions on patient-doctor relationship were significantly more willing to take insulin (64.9% vs 24.5%, and 70.3% vs 22.9%, P = 0.0001). CONCLUSION The study showed that one-third of the patients with type 2 diabetes had PIR. Since the behavior of doctor plays an important role in reducing PIR, there is a need for greater emphasis on the importance of good doctor-patient relationship and the establishment of a therapeutic education program.
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Affiliation(s)
- Asmaa M. Alomran
- Postgraduate Center for Studies of Family and Community Medicine, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Duaa A. Almubarak
- Postgraduate Center for Studies of Family and Community Medicine, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Batool A. Alrashed
- Postgraduate Center for Studies of Family and Community Medicine, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Abdul S. Khan
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
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Abstract
Background Insulin-naive patients are often reluctant to receive insulin treatment, and even insulin-treated patients frequently have poor rates of adherence to their prescribed insulin injection regimes. Assessing attitudes toward insulin injection may help in the design of interventions that improve the insulin injection behaviors of patients with type 2 diabetes (T2DM). The concept of decisional balance has been associated with behavior in many studies and may be useful in assessing the attitude of patients with T2DM toward insulin injection. Decisional balance for insulin injection (DBII) has not been widely assessed in patients with T2DM. Purpose The aim of this study was to develop an insulin injection (DBII) scale that is valid for insulin-naive and insulin-treated patients and to test the psychometric characteristics of this scale based on the concept of decisional balance. Methods This cross-sectional study administered an 18-item DBII scale, including pro and con subscales, to 95 insulin-naive and 237 insulin-treated patients in Taiwan. The decisional balance score was calculated as the mean score of the pro subscale minus the mean score of the con subscale. Construct validity was examined using exploratory factor analysis and confirmatory factor analysis; concurrent validity was assessed by examining the association between the score of the DBII scale and the stages of behavioral change and of hemoglobin A1c for, respectively, insulin-naive patients and insulin-treated patients; and reliability was assessed using internal consistency and test–retest reliability. Results A 13-item DBII scale supported by exploratory factor analysis and confirmatory factor analysis was developed. The stages of behavioral change and hemoglobin A1c levels were found to be significantly associated with the scores of decisional balance of the 13-item DBII scale for both insulin-naive and insulin-treated patients. The Cronbach's α ranged between .78 and .92. Conclusions The 13-item DBII scale is appropriately short and possesses satisfactory validity and reliability for both insulin-naive and insulin-treated patients with T2DM. Healthcare providers may use this scale as a checklist to guide clinical discussions related to insulin therapy with both insulin-naive and insulin-treated patients with T2DM across time.
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Pamungkas RA, Chamroonsawasdi K, Vatanasomboon P, Charupoonphol P. Barriers to Effective Diabetes Mellitus Self-Management (DMSM) Practice for Glycemic Uncontrolled Type 2 Diabetes Mellitus (T2DM): A Socio Cultural Context of Indonesian Communities in West Sulawesi. Eur J Investig Health Psychol Educ 2019; 10:250-261. [PMID: 34542483 PMCID: PMC8314228 DOI: 10.3390/ejihpe10010020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 12/24/2022] Open
Abstract
Diabetes mellitus self-management (DMSM) is an essential strategy used to maintain blood glucose levels and to prevent severe complications. Several barriers have been documented while implementing DMSM practices. A qualitative study aimed to explore barriers to effective DMSM practice among uncontrolled glycemic type 2 diabetes mellitus (T2DM) patients in Indonesia. We conducted in-depth interviews and focus group discussions (FGDs) among 28 key informants, including patients, family members, healthcare providers (HCPs), and village health volunteers (VHVs). The interviews and FGDs were audiotaped and transcribed verbatim. The results revealed six core themes with sub-categories of themes used by all participants to describe the barriers to effective DMSM practice among uncontrolled T2DM patients. The critical barriers of DMSM practice included low perception of susceptibility to and severity of the illness; inadequate knowledge and skill of diabetes mellitus self-management; lack of motivation to perform diabetes mellitus self-management; insufficient human resources; lack of social engagement; and social exclusion and feelings of embarrassment. Our findings provide valuable information regarding the barriers while implementing the DMSM practice. Healthcare providers should negotiate with both T2DM patients and caretakers to participate in a DMSM program at a community health care level.
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Affiliation(s)
- Rian Adi Pamungkas
- Doctor of Public Health Program, Department of Family Health, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
| | - Kanittha Chamroonsawasdi
- Department of Family Health, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
| | - Paranee Vatanasomboon
- Department of Health Promotion and Behavioral Science, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
| | - Phitaya Charupoonphol
- Department of Family Health, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
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Comellas M, Marrero Y, George F, Matthews L. Age and glycemic control among adults with type 2 diabetes in the United States: An assessment from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. Diabetes Metab Syndr 2019; 13:3069-3073. [PMID: 31765980 DOI: 10.1016/j.dsx.2019.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022]
Abstract
AIM To assess the age and its association with glycemic control (GC) among adults with type 2-diabetes in the United States. MATERIALS AND MATERIALS Data were collected from the National Nutrition Examination Survey (NHANES) 2013-2014 (n = 697), cross-sectional national survey adults with Type2 diabetes. Characteristics included retinopathy diagnosis, blood pressure, albumin-creatinine ratio, hemoglobin A1c (HbA1c), BMI, cholesterol, smoking status, pills/insulin, exercise, age, age at diagnosis, education, sex, race, and marital status. Diabetes preventive behaviors were included. Predictors of GC were assessed using logistic regression. RESULTS The mean age was 61 (SD ±13); the average age at diagnosis 50 (SD ±12.9) and women (51%). Age ≥60, diabetes length >10yrs, taking pills/on insulin, albumin-creatinine ratio ≤30mg/g, optimal BP, no retinopathy diagnosis, optimal cholesterol, seeing a doctor for diabetes, doctors checkup ≥2 times and checking HbA1c annually were significant predictors of GC. The association between GC and age (OR=.97, p<.001; CI: .96-.98) diabetes length >10yrs (OR=1.55, p<.05; CI: 1.02-2.34), creatinine-albumin ratio ≤30mg/g (OR=1.97, p<.001; CI: 1.32-2.94) and checking HbA1c annually (OR=1.86, p<.01; CI: 1.16-3.00) remained significant after adjustment for the effects of all other statistically significant covariates. CONCLUSIONS GC was prevalent among older individuals; suggestive of intervention programs for young adults with diabetes and continuous HbA1c assessment at least annually.
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Affiliation(s)
- Mariceli Comellas
- Health Services Administration, Florida International University, United States, Florida International University, 3000 N.E. 151 Street, Miami, FL, United States.
| | - Yamile Marrero
- Health Services Administration, Florida International University, United States, Florida International University, 3000 N.E. 151 Street, Miami, FL, United States
| | - Florence George
- Health Services Administration, Florida International University, United States, Florida International University, 3000 N.E. 151 Street, Miami, FL, United States
| | - Lisa Matthews
- Health Services Administration, Florida International University, United States, Florida International University, 3000 N.E. 151 Street, Miami, FL, United States
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Hasan UA, Mohd Hairon S, Yaacob NM, Daud A, Abdul Hamid A, Hassan N, Ariffin MF, Yi Vun L. Effectiveness of Diabetes Community Sharp Disposal Education Module in Primary Care: An Experimental Study in North-East Peninsular Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183356. [PMID: 31514391 PMCID: PMC6765895 DOI: 10.3390/ijerph16183356] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/04/2019] [Accepted: 09/07/2019] [Indexed: 01/23/2023]
Abstract
Background: Structured education is needed to cultivate safe sharp disposal behavior among diabetic patients. Thus, this study aimed to assess the effectiveness of the Diabetes Community Sharp Disposal Education Module in improving knowledge and sharp disposal practice among Malaysian Type 2 diabetic patients. Methods: This quasi-experimental study was conducted at primary health clinics in two districts in Kelantan, a state in the North-East Region of Peninsular Malaysia. A total of 132 Type 2 diabetic patients on insulin therapy were involved, with 68 participants in each control and intervention group. The health education intervention was based on the validated Diabetes Community Sharp Disposal Education Module. The knowledge and practices were measured using a validated questionnaire at baseline, one month, and three months after the intervention. Results: There was a significant increment in the mean knowledge score for intervention group; from baseline to one month follow up and from baseline to three months follow up [Greenhouse-Geisser; F(1.5, 199.7) = 62.38, p < 0.001; effect size (η2) = 0.318]. Intervention group had significantly higher mean knowledge score as compared to control group; at one month and three months follow up [F(1, 134) = 17.38, p < 0.001; effect size (η2) = 0.115]. There was a statistically significant increment in the proportion of participants in the intervention group who practiced the proper community sharp disposal method over time, X2(2) = 52.061, p < 0.001. Conclusions: The Diabetes Community Sharp Disposal Education Module was an effective health education tool to improve knowledge and encourage Malaysian diabetic patients to engage with proper sharp disposal practices.
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Affiliation(s)
- Ummu Atiyyah Hasan
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, 16150 Kelantan, Malaysia
| | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, 16150 Kelantan, Malaysia
| | - Najib Majdi Yaacob
- Unit of Biostatistics & Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, 16150 Kelantan, Malaysia.
| | - Aziah Daud
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, 16150 Kelantan, Malaysia
| | - Anees Abdul Hamid
- Primer Unit, Kelantan State Health Department, Kota Bharu, 15200 Kelantan, Malaysia
| | - Norzaihan Hassan
- Kota Bharu District Health Office, Kelantan State Health Department, Kota Bharu, 15200 Kelantan, Malaysia
| | - Mohd Faiz Ariffin
- Non-Communicable Disease Control Unit, Kelantan State Health Department, Kota Bharu, 15200 Kelantan, Malaysia
| | - Lau Yi Vun
- Kota Bharu District Health Office, Kelantan State Health Department, Kota Bharu, 15200 Kelantan, Malaysia
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Hasan UA, Mohd Hairon S, Yaacob NM, Daud A, Abdul Hamid A, Hassan N, Ariffin MF, Yi Vun L. Factors Contributing to Sharp Waste Disposal at Health Care Facility Among Diabetic Patients in North-East Peninsular Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132251. [PMID: 31247892 PMCID: PMC6651231 DOI: 10.3390/ijerph16132251] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Type 2 diabetic patients are major users of medical sharps in the community. Proper sharp disposal practice among them, however, was reported to be low. The current study was aimed to determine the factors contributing to sharp waste disposal at a health care facility among Type 2 diabetic patients. METHODS In this cross-sectional study, Type 2 diabetic patients who were on insulin therapy attending health clinics were randomly selected and interviewed using a validated questionnaire. Binary logistic regression analysis was applied. RESULTS Out of 304 respondents, only 11.5% of them brought their used sharps to be disposed at health care facilities. Previous advice on sharp disposal from health care providers, knowledge score, and duration of diabetes were significant contributing factors for sharp waste disposal at health care facilities: (Adj. OR 6.31; 95% CI: 2.63, 15.12; p < 0.001), (Adj. OR 1.05; 95% CI: 1.03, 1.08; p < 0.001), and (Adj. OR 2.51; 95% CI: 1.06, 5.93; p = 0.036), respectively. CONCLUSION Continuous education and a locally adapted safe sharp disposal option must be available to increase awareness and facilitate diabetic patients adopting proper sharp disposal behavior.
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Affiliation(s)
- Ummu Atiyyah Hasan
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan 16150, Malaysia.
| | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan 16150, Malaysia.
| | - Najib Majdi Yaacob
- Unit of Biostatistics & Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan 16150, Malaysia.
| | - Aziah Daud
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan 16150, Malaysia.
| | - Anees Abdul Hamid
- Primer Unit, Kelantan State Health Department, Kota Bharu, Kelantan 15200, Malaysia.
| | - Norzaihan Hassan
- Kota Bharu District Health Office, Kelantan State Health Department, Kota Bharu, Kelantan 15200, Malaysia.
| | - Mohd Faiz Ariffin
- Non-Communicable Disease Control Unit, Kelantan State Health Department, Kota Bharu, Kelantan 15200, Malaysia.
| | - Lau Yi Vun
- Kota Bharu District Health Office, Kelantan State Health Department, Kota Bharu, Kelantan 15200, Malaysia.
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Kebede MM, Schuett C, Pischke CR. The Role of Continuous Glucose Monitoring, Diabetes Smartphone Applications, and Self-Care Behavior in Glycemic Control: Results of a Multi-National Online Survey. J Clin Med 2019; 8:jcm8010109. [PMID: 30658463 PMCID: PMC6352012 DOI: 10.3390/jcm8010109] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 01/01/2023] Open
Abstract
Background: This study investigated the determinants (with a special emphasis on the role of diabetes app use, use of continuous glucose monitoring (CGM) device, and self-care behavior) of glycemic control of type 1 and type 2 diabetes mellitus (DM). Methods: A web-based survey was conducted using diabetes Facebook groups, online patient-forums, and targeted Facebook advertisements (ads). Demographic, CGM, diabetes app use, and self-care behavior data were collected. Glycemic level data were categorized into hyperglycemia, hypoglycemia, and good control. Multinomial logistic regression stratified by diabetes type was performed. Results: The survey URL was posted in 78 Facebook groups and eight online forums, and ten targeted Facebook ads were conducted yielding 1854 responses. Of those owning smartphones (n = 1753, 95%), 1052 (62.6%) had type 1 and 630 (37.4%) had type 2 DM. More than half of the type 1 respondents (n = 549, 52.2%) and one third the respondents with type 2 DM (n = 210, 33.3%) reported using diabetes apps. Increased odds of experiencing hyperglycemia were noted in persons with type 1 DM with lower educational status (Adjusted Odds Ratio (AOR) = 1.7; 95% Confidence Interval (CI): 1.21–2.39); smokers (1.63, 95% CI: 1.15–2.32), and high diabetes self-management concern (AOR = 2.09, 95% CI: 1.15–2.32). CGM use (AOR = 0.66, 95% CI: 0.44–1.00); “general diet” (AOR = 0.86, 95% CI: 0.79–0.94); and “blood glucose monitoring” (AOR = 0.88, 95%CI: 0.80–0.97) self-care behavior reduced the odds of experiencing hyperglycemia. Hypoglycemia in type 1 DM was reduced by using CGM (AOR = 0.24, 95% CI: 0.09–0.60), while it was increased by experiencing a high diabetes self-management concern (AOR = 1.94, 95% CI: 1.04–3.61). Hyperglycemia in type 2 DM was increased by age (OR = 1.02, 95% CI: 1.00–1.04); high self-management concern (AOR = 2.59, 95% CI: 1.74–3.84); and poor confidence in self-management capacity (AOR = 3.22, 2.07–5.00). Conversely, diabetes app use (AOR = 0.63, 95% CI: 0.41–0.96) and “general diet” self-care (AOR = 0.84, 95% CI: 0.75–0.94), were significantly associated with the reduced odds of hyperglycemia. Conclusion: Diabetes apps, CGM, and educational interventions aimed at reducing self-management concerns and enhancing dietary self-care behavior and self-management confidence may help patients with diabetes to improve glycemic control.
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Affiliation(s)
- Mihiretu M Kebede
- Health Sciences, University of Bremen, Grazerstrasse 2, D-28359 Bremen, Germany.
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, D-28359 Bremen, Germany.
- Institute of Public Health, College of Medicine and Health Science, University of Gondar, Po.box-196 Gondar, Ethiopia.
| | - Cora Schuett
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, D-28359 Bremen, Germany.
| | - Claudia R Pischke
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, D-28359 Bremen, Germany.
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Universitätsstrasse 1, D-40225 Duesseldorf, Germany.
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Chen SY, Hsu HC, Wang RH, Lee YJ, Hsieh CH. Glycemic Control in Insulin-Treated Patients With Type 2 Diabetes: Empowerment Perceptions and Diabetes Distress as Important Determinants. Biol Res Nurs 2018; 21:182-189. [PMID: 30585081 DOI: 10.1177/1099800418820170] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this cross-sectional study was to explore the determinants of hemoglobin A1c (HbA1c) levels in insulin-treated patients with Type 2 diabetes mellitus (T2DM) based on demographic and disease characteristics, self-reported regimen adherence factors (adherence in insulin regimen and self-monitoring of blood glucose), and psychosocial factors (decisional balance for insulin injection, health literacy, self-efficacy for insulin injection, diabetes distress, and empowerment perceptions). Via convenience sampling, 255 insulin-treated patients with T2DM were recruited from two endocrinology clinics in Taiwan. A self-report questionnaire was used to collect demographic and disease characteristics, regimen adherence factors, and psychosocial factors. The first HbA1c level measured after completion of the questionnaire was the dependent variable. The last HbA1c level measured before patients started insulin therapy as well as body mass index (BMI) was collected from medical records. Results indicated that adherence in insulin regimen was relatively good. Regimen adherence factors did not significantly correlate with HbA1c levels, but empowerment perception, decisional balance for insulin injection, health literacy, and diabetes distress did. The hierarchical multiple regression models indicated that BMI, the last HbA1c levels before starting insulin therapy, empowerment perception, and diabetes distress were important determinants of HbA1c levels. Nurses could periodically assess the diabetes distress of insulin-treated patients with T2DM and refer to mental health professionals when needed. Furthermore, applying empowerment approaches such as enhancing self-awareness of improved glycemic control and sharing more decision-making power with insulin-treated patients with T2DM might have benefits for their glycemic control.
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Affiliation(s)
- Shi-Yu Chen
- 1 Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Hui-Chun Hsu
- 2 Lee's Endocrinology Clinic, Pingtung City, Taiwan
| | - Ruey-Hsia Wang
- 3 College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,4 Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | - Chang-Hsun Hsieh
- 1 Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
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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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Perceptions of insulin use in type 2 diabetes in primary care: a thematic synthesis. BMC FAMILY PRACTICE 2018; 19:70. [PMID: 29788908 PMCID: PMC5964885 DOI: 10.1186/s12875-018-0753-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 05/01/2018] [Indexed: 01/29/2023]
Abstract
Background Increasing numbers of patients with type 2 diabetes mellitus are progressing to insulin therapy, and despite its potency many such individuals still have suboptimal glycaemic control. Insulin initiation and intensification is now often conducted by Practice Nurses and General Practitioners in many parts of the UK. Therefore, gaining insight into perspectives of patients and primary care clinicians is important in determining self-management and engagement with insulin. A thematic synthesis of studies was conducted exploring the views and experiences of people with type 2 diabetes and of healthcare professionals on insulin use and management in the context of primary care. Methods Protocol based systematic searches of electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, and Web of Science) were performed on 1 October 2014 and updated on 31 March 2015, to identify studies that identified the views and experiences of adults with type 2 diabetes or primary care clinicians on the use of insulin in the management of type 2 diabetes. Studies meeting the review inclusion criteria were critically appraised using the CASP qualitative research checklist or Barley’s checklist for survey designs. A thematic synthesis was then conducted of the collected studies. Results Thirty-four studies were selected. Of these, 12 used qualitative interviews (nine with patients and three with healthcare professionals) and 22 were survey based (14 with patients, three with healthcare professionals, and five with both). Twelve key themes were identified and formed three domains, patient perceptions, healthcare professional perceptions, and health professional-patient relationships. The patient-centred themes were: insulin-related beliefs, social influences, psychological factors, hypoglycaemia, and therapy barriers. The clinician-related themes were: insulin skills of general practitioners, healthcare integration, healthcare professional-perceived barriers, hypoglycaemia, and explanations for adherence. Healthcare professional-patient relationship themes were drawn from the perspectives of patients and from clinicians. Conclusions This review reveals multiple barriers to optimal insulin use in primary care at both the patient and healthcare professional levels. These barriers indicate the need for multimodal interventions to: improve the knowledge and competencies of primary care professionals in insulin use; provide more effective patient education and self-management support; and introduce integrated insulin support systems. Electronic supplementary material The online version of this article (10.1186/s12875-018-0753-2) contains supplementary material, which is available to authorized users.
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Aghili R, Ridderstråle M, Farshchi A, Valojerdi AE, Banazadeh Z, Malek M, Kia M, Khamseh ME. Psychosocial factors and glycemic control in insulin-naïve and insulin-experienced people with type 2 diabetes: a path analysis model. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-017-0581-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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[Family, socioeconomic status and health services: Clues to health care in diabetic patients with lower limb amputations in Andalusia. A qualitative study]. Aten Primaria 2017; 50:611-620. [PMID: 29150148 PMCID: PMC6837089 DOI: 10.1016/j.aprim.2017.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/18/2017] [Accepted: 06/23/2017] [Indexed: 11/27/2022] Open
Abstract
Objetivo Explorar la vivencia de los cuidados diabéticos en pacientes sometidos a amputación de miembros inferiores por pie diabético. Diseño Estudio cualitativo con perspectiva fenomenológica. Emplazamiento Área hospitalaria de Cádiz. Participantes Dieciséis participantes (11 hombres y 5 mujeres) con diabetes tipo 2 y amputación no traumática de miembros inferiores. Métodos Entrevistas semiestructuradas individuales y análisis de contenido de la información usando el método propuesto por Graneheim y Lundman. Resultados Se identificaron 4 categorías: 1. La familia es la piedra angular de los cuidados; 2. Los aspectos socioeconómicos y laborales determinan la calidad de los autocuidados; 3. La interacción paciente-personal de salud dinamiza los cuidados; y 4. Las limitaciones en la provisión de servicios sanitarios. Conclusión La familia, la situación económica y laboral y los factores del sistema sanitario constituyen los elementos más relevantes en los cuidados de pacientes con diabetes y amputación de miembros inferiores. Los determinantes sociales, económicos y laborales deben ser tomados en especial consideración y de manera más personalizada desde los servicios sanitarios para aumentar el impacto de los cuidados proporcionados en la prevención de las complicaciones de la diabetes mellitus.
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Pamungkas RA, Chamroonsawasdi K, Vatanasomboon P. A Systematic Review: Family Support Integrated with Diabetes Self-Management among Uncontrolled Type II Diabetes Mellitus Patients. Behav Sci (Basel) 2017; 7:E62. [PMID: 28914815 PMCID: PMC5618070 DOI: 10.3390/bs7030062] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 01/03/2023] Open
Abstract
The rate of type-2 diabetes mellitus (T2D) is dramatically increasing worldwide. Continuing diabetes mellitus (DM) care needs effective self-management education and support for both patients and family members. This study aimed to review and describe the impacts of diabetes mellitus self-management education (DSME) that involve family members on patient outcomes related to patient health behaviors and perceived self-efficacy on self-management such as medication adherence, blood glucose monitoring, diet and exercise changes, health outcomes including psychological well-being and self-efficacy, and physiological markers including body mass index, level of blood pressure, cholesterol level and glycemic control. Three databases, PubMed, CINAHL, and Scopus were reviewed for relevant articles. The search terms were "type 2 diabetes," "self-management," "diabetes self-management education (DSME)," "family support," "social support," and "uncontrolled glycaemia." Joanna Briggs Institute (JBI) guidelines were used to determine which studies to include in the review. Details of the family support components of DSME intervention and the impacts of these interventions had on improving the health outcomes patients with uncontrolled glycaemia patients. A total of 22 intervention studies were identified. These studies involved different DSME strategies, different components of family support provided, and different health outcomes to be measured among T2D patients. Overall, family support had a positive impact on healthy diet, increased perceived support, higher self-efficacy, improved psychological well-being and better glycemic control. This systematic review found evidence that DSME with family support improved self-management behaviors and health outcomes among uncontrolled glycaemia T2D patients. The findings suggest DSME models that include family engagement can be a useful direction for improving diabetes care.
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Affiliation(s)
- Rian Adi Pamungkas
- Department of Family Health, Mahidol University, Bangkok 10400, Thailand.
- Department of Nursing, College of Health, Mega Rezky Makassar, Makassar 90245, Indonesia.
| | | | - Paranee Vatanasomboon
- Department of Health Education and Behavioral Science, Mahidol University, Bangkok 10400, Thailand.
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Soufi S, Chabrier S, Bertoletti L, Laporte S, Darteyre S. Lived experience of having a child with stroke: A qualitative study. Eur J Paediatr Neurol 2017; 21:542-548. [PMID: 28185801 DOI: 10.1016/j.ejpn.2017.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/01/2016] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the lived experience of parents whose child has suffered a stroke. METHODS A qualitative study model was chosen, comprising in-depth interviews with parents separately or altogether. A semi-structured interview guide was used. Interviews were audio-recorded, transcribed verbatim and analysed using constant comparison and content analysis. Participant checking was performed. Thirteen families of children aged 1 month to 17 years, having suffered ischaemic or haemorrhagic arterial stroke within one to five years, were recruited. Interviews were conducted within home setting. RESULTS After fourteen interviews, data saturation was met and six main narrative themes were identified, underlining a common path of stroke lived experience: brutality of diagnosis, lack of information regarding disease condition, feeling of abandonment after discharge from hospital, focus on functional recovery, late awareness of cognitive disorders, and need for psychological support and family adaptation. CONCLUSION This is the first qualitative study reporting lived experience of childhood stroke caregivers. In line with other qualitative studies exploring the feelings of parents coping with severe neurological conditions of childhood, our results advocate the need for evaluation of family centred health interventions.
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Affiliation(s)
- Syrine Soufi
- Université Claude Bernard, Institut des Sciences et Techniques de la Réadaptation, F-69677 Lyon, France
| | - Stéphane Chabrier
- INSERM, SAINBIOSE, U1059, unité dysfonction vasculaire et hémostase, université Jean-Monnet, CIC 1408, F-42055 Saint-Etienne, France; CHU Saint-Étienne, Centre national de référence de l'AVC de l'enfant - Service de médecine physique et réadaptation pédiatrique, F-42055 Saint-Etienne, France
| | - Laurent Bertoletti
- INSERM, SAINBIOSE, U1059, unité dysfonction vasculaire et hémostase, université Jean-Monnet, CIC 1408, F-42055 Saint-Etienne, France
| | - Silvy Laporte
- INSERM, SAINBIOSE, U1059, unité dysfonction vasculaire et hémostase, université Jean-Monnet, CIC 1408, F-42055 Saint-Etienne, France
| | - Stéphane Darteyre
- INSERM, SAINBIOSE, U1059, unité dysfonction vasculaire et hémostase, université Jean-Monnet, CIC 1408, F-42055 Saint-Etienne, France.
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Duan F, Liu Y, Chen X, Congdon N, Zhang J, Chen Q, Chen L, Chen X, Zhang X, Yu C, Liu Y. Influencing factors on compliance of timely visits among patients with proliferative diabetic retinopathy in southern China: a qualitative study. BMJ Open 2017; 7:e013578. [PMID: 28348188 PMCID: PMC5372015 DOI: 10.1136/bmjopen-2016-013578] [Citation(s) in RCA: 7] [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] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To identify the reasons for low adherence among patients with diabetic retinopathy (DR) in southern China using a qualitative method. METHODS Exploratory indepth interviews were conducted in 27 diabetic patients with proliferative diabetic retinopathy who required vitrectomy surgery at Zhongshan Ophthalmic Centre, Sun Yat-sen University, from March to August 2015. Qualitative data analysis and research software (ATLAS.ti7) was used for data processing and analysis. RESULTS Factors influencing the occurrence of timely visits included lack of DR related knowledge, fear and worries about insulin, interactions between patients and society combined with the complexity of emotions and social culture, and the economic burden of treatment. CONCLUSIONS Although the reasons for low adherence involved social, emotional, cultural and economic factors, the key issue was the lack of awareness and knowledge of DR. Our findings have several practical implications for health policymakers and programme planners in China.
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Affiliation(s)
- Fang Duan
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
| | - Yuhong Liu
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
| | - Xiang Chen
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
| | - Nathan Congdon
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
| | - Jian Zhang
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
| | - Qianyun Chen
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
| | - Lingling Chen
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
| | - Xi Chen
- Centre of Medical Anthropology and Behavioural Health, School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, China
| | - Xiulan Zhang
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
| | - Chengpu Yu
- Centre of Medical Anthropology and Behavioural Health, School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, China
| | - Yizhi Liu
- Zhongshan Ophthalmic Centre, State Key Laboratory of Ophthalmology, SunYat-sen University, Guangzhou, China
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Abstract
INTRODUCTION Despite type 2 diabetes (T2D) management offers a variety of pharmacological interventions targeting different defects, numerous patients remain with persistent hyperglycaemia responsible for severe complications. Unlike resistant hypertension, treatment resistant T2D is not a classical concept although it is a rather common observation in clinical practice. Areas covered: This article proposes a definition for 'treatment resistant diabetes', analyses the causes of poor glucose control despite standard therapy, briefly considers the alternative approaches to glucose-lowering pharmacotherapy and finally describes how to overcome poor glycaemic control, using innovative oral or injectable combination therapies. Expert opinion: Before considering intensifying the pharmacotherapy of a patient with poorly controlled T2D, it is important to verify treatment adherence, target obesity and consider various non pharmacological improvement quality interventions. If treatment resistant diabetes is defined as not achieving glycated haemoglobin target despite oral triple therapy with a third glucose-lowering agent added to metformin-sulfonylurea dual treatment, the combination of a dipeptidyl peptidase-4 (DPP-4) inhibitor and a sodium glucose cotransporter type 2 (SGLT2) inhibitor may offer new opportunities before considering injectable therapies. Insulin basal therapy (± metformin) may be optimized by the addition of a SGLT2 inhibitor or a glucagon-like peptide-1 (GLP-1) receptor agonist.
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Affiliation(s)
- André J Scheen
- a Division of Clinical Pharmacology, Centre for Interdisciplinary Research on Medicines (CIRM) , University of Liège , Liège , Belgium.,b Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine , CHU Liège , Liège , Belgium
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McBain H, Begum S, Rahman S, Mulligan K. Barriers to and enablers of insulin self-titration in adults with Type 2 diabetes: a qualitative study. Diabet Med 2017; 34:253-261. [PMID: 27505306 DOI: 10.1111/dme.13196] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2016] [Indexed: 12/20/2022]
Abstract
AIMS To identify the barriers to and enablers of effective insulin self-titration in people with Type 2 diabetes. METHODS A qualitative semi-structured interview approach was used. Questions were structured according to the Theoretical Domains Framework, which outlines 14 domains that can act as barriers to and enablers of changing behaviour. Interviews were audio-recorded and transcribed verbatim. The data were coded according to the 14 domains, belief statements were created within each domain, and a frequency count of the most reported barriers and enablers was then carried out. Analyses were conducted by two researchers, and discrepancies agreed with a third researcher. RESULTS A total of 18 adults with Type 2 diabetes took part in an interview. The majority were of South-Asian ethnicity (n = 8) and were men (n = 12). Their mean age was 61 years old. The mean duration of diabetes was 16 years and time on insulin 9 years. Inter-rater reliability for each of the domains varied (29-100%). The most frequently reported domains were Social Influence and Beliefs about Consequences; the least frequently reported were Optimism and Reinforcement. Interviewees reported receiving support to self-titrate from a range of sources. Self-titrating was perceived to have a range of both positive and negative consequences, as was not titrating. CONCLUSIONS The findings highlight that those interviewed experienced a range of barriers and enablers when attempting to self-titrate. Improved education and training when initiating insulin treatment among adults with Type 2 diabetes, and throughout their journey on insulin therapy could help identify and address these barriers in order to optimize self-titration.
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Affiliation(s)
- H McBain
- School of Health Sciences, City University London, London, UK
- East London Foundation NHS Foundation Trust, London, UK
| | - S Begum
- School of Social Sciences, City University, London, UK
| | - S Rahman
- East London Foundation NHS Foundation Trust, London, UK
| | - K Mulligan
- School of Health Sciences, City University London, London, UK
- East London Foundation NHS Foundation Trust, London, UK
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Vahedparast H, Mohammadi E, Ahmadi F. From threat to gradual lifestyle changes: Iranians' experiences with chronic illnesses. Int Nurs Rev 2016; 64:405-412. [PMID: 27896801 DOI: 10.1111/inr.12319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to explore and describe the experience of making a healthy lifestyle change among the patients with chronic illness. BACKGROUND Despite the existence of different evidence on the critical role of lifestyle in the prevention and management of chronic diseases, many people face challenges in terms of starting and maintaining a healthy lifestyle. METHODS A descriptive qualitative study with in-depth semi-structured interviews was carried out in 2015 in Iran. Thirty-four patients with common chronic illnesses were invited to the study using purposive sampling. The collected data were analysed by content analysis. FINDINGS The main themes were: trying to remove the perceived threat, considering and trying to do physical activities, considering and planning for a healthy diet, striving to manage stress and having gradual acceptance of new habits and coping with them. LIMITATIONS The participants were selected from among those with chronic illness. However, there is also a need to assess the family and healthcare providers' perspectives. CONCLUSION AND IMPLICATIONS FOR NURSING The perceived threat of the disease plays an important role in the process of changing to a healthy lifestyle in Iranian with chronic illnesses. It is necessary for healthcare providers, especially nurses, to use this threat as a golden opportunity to accelerate changes in patients' behaviours. IMPLICATIONS FOR NURSING POLICY Findings may help policy makers become aware of the need for nurses to create community-based nursing in Iran. Community nurses can remind patients of perceived threats to their health to motivate them for continued healthy behaviours. Therefore, nursing curricula should be revised and educational programs utilise a community-based health approach.
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Affiliation(s)
- H Vahedparast
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - E Mohammadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - F Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Goh SY, Ang E, Bajpai S, Deerochanawong C, Hong EG, Hussein Z, Joshi S, Kamaruddin NA, Kho S, Kong APS, Pan CY, Perfetti R, Vichayanrat A, Vlajnic A, Chan JCN. A patient-centric approach to optimise insulin therapy in Asia. J Diabetes Complications 2016; 30:973-80. [PMID: 27288201 DOI: 10.1016/j.jdiacomp.2016.05.019] [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] [Received: 03/24/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 11/16/2022]
Affiliation(s)
| | - Ernesto Ang
- Cardinal Santos Medical Center, San Juan, Philippines; The Institute for Studies on Diabetes Foundation Inc., Metro Manila, Philippines
| | | | | | - Eun-Gyoung Hong
- Hallym University School of Medicine, Dongtan Sacred Heart Hospital, Gyeonggi-do, South Korea
| | | | | | | | - Sjoberg Kho
- University of Santo Tomas, Manila, Philippines
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Aghili R, Polonsky WH, Valojerdi AE, Malek M, Keshtkar AA, Esteghamati A, Heyman M, Khamseh ME. Type 2 Diabetes: Model of Factors Associated with Glycemic Control. Can J Diabetes 2016; 40:424-430. [PMID: 27291886 DOI: 10.1016/j.jcjd.2016.02.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the related factors and their intercorrelated impacts on glycemic control in people with type 2 diabetes mellitus. METHODS Patients with type 2 diabetes were recruited for this study during their regular clinic visits at a major medical centre in Iran. Glycated hemoglobin (A1C) levels were used as the indicator of glycemic control. Regression analysis was used to determine the relationships between glycemic control and demographics, self-care behaviours, resources and affective variables. Moreover, the associations between diabetes-related distress and measured variables were tested. RESULTS Three hundred eighty people with type 2 diabetes completed the study. The mean duration of diabetes was 8.94±6.57 years, and the mean A1C levels were 7.78%±1.7%. Diabetes-related distress was significantly associated with A1C levels, controlling for all other variables (p=0.01). On the other hand, depression (p<0.001), self-management (p<0.001), anxiety (p<0.001) and patient-physician relationship (p=0.023) were significantly associated with diabetes-related distress. CONCLUSIONS Diabetes-related distress was found to be associated with glycemic control in people with type 2 diabetes, whereas age, depression, anxiety, self-management and family and social support may affect glycemic control indirectly through diabetes-related distress. Thus, it is important to assess and, if appropriate, treat people with diabetes for diabetes-related distress in order to identify and help them overcome barriers to optimal glycemic control.
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Affiliation(s)
- Rokhsareh Aghili
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ameneh Ebrahim Valojerdi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Malek
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Ali Keshtkar
- Osteoporosis Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mark Heyman
- Department of Psychiatry, UCSD School of Medicine, San Diego, California, United States
| | - Mohammad Ebrahim Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
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Gharaibeh B, Gajewski BJ, Al-smadi A, Boyle DK. The relationships among depression, self-care agency, self-efficacy and diabetes self-care management. J Res Nurs 2016. [DOI: 10.1177/1744987115621782] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
At the time the study was conducted, Besher Gharaibeh, Byron Gajewski, and Diane Boyle were affiliated with School of Nursing University of Kansas, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; Ahmed Al-smadi was affiliated with University of Ulster, Belfast, Newtownabbey Co. Antrim BT37 0QB, Jordandtown road, UK. The coexistence of diabetes and depression is associated with negative outcomes such as poor diabetes self-care management (DSCM). Complex relationships exist among diabetes knowledge, self-efficacy, self-care agency, depression and DSCM. No study has examined the relationships among all these factors at the same time. We aimed to examine relationships among depression, diabetes knowledge, self-care agency, self-efficacy and DSCM in insulin- treated people based on a modification of the DSCM model. A cross-sectional, correlational model testing design was used. Participants with type 1 ( n = 35) and type 2 ( n = 43) diabetes were recruited from both outpatient and community sites. Participants mean age was 46.6 years (standard deviation 13.7) and the majority were men (56.4%). Multiple regression analyses tested the hypothesised relationships. Depression was found to have a direct negative relationship with self-care agency and self-efficacy. The relationship between depression and DSCM was not direct. Self-care agency and self-efficacy completely mediated the effect of depression on DSCM. Self-efficacy completely mediated the effect of self-care agency on DSCM. We conclude that effective treatment programmes for persons managed with insulin should probably include not only screening and treatment of depression, but also skills training to enhance patient self-care agency and self-efficacy alongside DSCM.
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Affiliation(s)
- Besher Gharaibeh
- Assistant Professor, Faculty of Nursing, Jordan University of Science and Technology, Jordan
| | - Byron J Gajewski
- Professor, Department of Biostatistics, University of Kansas Medical Center, USA
| | - Ahmed Al-smadi
- Assistant Professor, Department of Basic Sciences and Humanities, American University of Madaba, Jordan
| | - Diane K Boyle
- Professor, Fay W. Whitney School of Nursing, University of Wyoming, USA
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