Assessing physical function after completing a supervised education and exercise program in adults with type 2 diabetes and exploring exercise motivation at one-year follow up: A case series study

BACKGROUND

Exercise programs for adults with type 2 diabetes (T2D) improve glycemic control and physical function. However, diabetes complications, disability, and motivation pose challenges for exercise participation.

OBJECTIVE

The purpose of the study was to: 1) measure change in fasting blood glucose, blood pressure, anthropometrics (i.e. BMI and waist circumference), and physical function (i.e. endurance, agility and balance, upper and lower-body strength and flexibility) after completing an eight-week education and exercise program for adults with T2D; and 2) explore the experience of exercise continuation in people living with T2D at one-year follow-up.

METHODS

A mixed methods case series design was conducted. Participants were ≥ 18 years and had a clinical diagnosis of T2D (glycated hemoglobin (A1C) ≥ 6.5%). Participants completed two one-hour exercise sessions and one one-hour education session per week for eight weeks. Blood glucose, blood pressure, body mass index (BMI), waist circumference, and physical function were measured at baseline and after completing the program. Follow-up telephone interviews were conducted at one, six, and 12-months and thematic analysis was employed to analyze interviews.

RESULTS

Twelve participants completed the program. Clinically significant improvements were observed for waist circumference, systolic blood pressure, six-minute walk test (6MWT), timed up-and-go test (TUG), 30-second chair stand test (CST) and arm curls. Three themes emerged from the interviews that described participant reflections and experiences with a supervised education and exercise program for management of their T2D: 1) medical management; 2) lifestyle management; and 3) finding what works. Conclusion: Supervised programming improves physical function and may mitigate disability. Physiotherapists are qualified to assess and treat physical function through education and exercise.

Research on the Construction of a Nursing Education Management Model Based on a Small Data-Driven Model and Its Application

Based on the concept of responsible holistic nursing care, a whole-process dual-tutor nursing practice model is established and its application effects are explored. This paper firstly reviews the research progress of nursing workload prediction methods at home and abroad, in order to provide a reference for clinical nursing workers in China to choose a scientific, reasonable, and easy-to-use nursing workload prediction method. It is proposed to construct a nursing education management model based on small data to provide ideas and references for nursing education management to effectively predict the evolutionary trend of students' behaviour and improve the level of accurate services. The experimental group adopted a dual-tutor responsibility system for the whole-process nursing practice model, including a complete three-level supervision system: a dual-tutor teaching system, a PDCA responsibility system for continuous improvement, and a multichannel teacher-student interaction platform; the control group adopted the traditional nursing practice model.

2022 National Standards for Diabetes Self-Management Education and Support

PURPOSE

The National Standards for Diabetes Self-Management Education and Support (DSMES) provide guidance and evidence-based, quality practice for all DSMES services. Due to the dynamic nature of health care and diabetes research, the National Standards are reviewed and revised approximately every 5 years by key stakeholders and experts within the diabetes care and education community. For each revision, the Task Force is charged with reviewing the current National Standards for appropriateness, relevance, and scientific basis and making updates based on current evidence and expert consensus. In 2021, the group was tasked with reducing administrative burden related to DSMES implementation across diverse care settings.

CONCLUSION

The evidence supporting the 2022 National Standards clearly identifies the need to provide person-centered services that embrace cultural differences, social determinants of health, and the ever-increasing technological engagement platforms and systems. Payers are invited to review the National Standards as a tool to inform and modernize DSMES reimbursement requirements and to align with the evolving needs of people with diabetes (PWD) and physicians/other qualified health care professionals. The American Diabetes Association and the Association of Diabetes Care & Education Specialists strongly advocate for health equity to ensure all PWD have access to this critical service proven to improve outcomes both related to and beyond diabetes. The 2022 National Standards update is meant to be a universal document that is easy to understand and can be implemented by the entire health care community. DSMES teams in collaboration with primary care have been shown to be the most effective approach to overcome therapeutic inertia.

Goal adjustment by people living with long-term conditions: A scoping review of literature published from January 2007 to June 2018

Long-term health conditions can limit achievement of personal goals. We aimed to map and synthesize definitions of goal adjustment, theoretical underpinnings, associations with recovery and supportive interventions for adults with long-term conditions. We searched multiple databases (January 2007-June 2018) and identified peer-reviewed research relating to goal adjustment. Data were charted, mapped and synthesized using content analysis and descriptive summaries. Two stakeholder consultations informed the review. Ninety-one articles were included. A range of long-term conditions were represented including cancer (22%), stroke (12%) and mixed neurological conditions (8%). Goal adjustment was one available option when faced with unattainable goals; other options were goal disengagement and goal re-engagement. Most studies were quantitative (58%), reporting mainly positive associations between goal adjustment, disengagement, reengagement and recovery. The Dual Process Model, Goal Adjustment Model and Self-Regulation Theory were most cited underpinning models/theory. Five interventions were identified; only one (self-system therapy) was evaluated in a randomized controlled trial. Our review provides original and significant insights into goal adjustment definitions, theoretical underpinnings and association with recovery. Effective interventions to support goal adjustment, disengagement and reengagement are lacking. This research-practice gap warrants attention to ensure people with long-term conditions are optimally supported when facing unattainable goals.

Thioredoxin reductase as a pharmacological target

Thioredoxin reductases (TrxRs) belong to the pyridine nucleotide disulfide oxidoreductase family enzymes that reduce thioredoxin (Trx). The couple TrxR and Trx is one of the major antioxidant systems that control the redox homeostasis in cells. The thioredoxin system, comprised of TrxR, Trx and NADPH, exerts its activities via a disulfide-dithiol exchange reaction. Inhibition of TrxR is an important clinical goal in all conditions in which the redox state is perturbed. The present review focuses on the most critical aspects of the cellular functions of TrxRs and their inhibition mechanisms by metal ions or chemicals, through direct targeting of TrxRs or their substrates or protein interactors. To update the involvement of overactivation/dysfunction of TrxRs in various pathological conditions, human diseases associated with TrxRs genes were critically summarized by publicly available genome-wide association study (GWAS) catalogs and literature. The pieces of evidence presented here justify why TrxR is recognized as one of the most critical clinical targets and the growing current interest in developing molecules capable of interfering with the functions of TrxR enzymes.

2017 National Standards for Diabetes Self-Management Education and Support

PURPOSE

The purpose of this study is to review the literature for Diabetes Self-Management Education and Support (DSMES) to ensure the National Standards for DSMES (Standards) align with current evidence-based practices and utilization trends.

METHODS

The 10 Standards were divided among 20 interdisciplinary workgroup members. Members searched the current research for diabetes education and support, behavioral health, clinical, health care environment, technical, reimbursement, and business practice for the strongest evidence that guided the Standards revision.

RESULTS

Diabetes Self-Management Education and Support facilitates the knowledge, skills, and ability necessary for diabetes self-care as well as activities that assist a person in implementing and sustaining the behaviors needed to manage their condition on an ongoing basis. The evidence indicates that health care providers and people affected by diabetes are embracing technology, and this is having a positive impact of DSMES access, utilization, and outcomes.

CONCLUSION

Quality DSMES continues to be a critical element of care for all people with diabetes. The DSMES services must be individualized and guided by the concerns, preferences, and needs of the person affected by diabetes. Even with the abundance of evidence supporting the benefits of DSMES, it continues to be underutilized, but as with other health care services, technology is changing the way DSMES is delivered and utilized with positive outcomes.

Coconstruction d’une intervention infirmière centrée sur la personne pour soutenir l’autogestion des individus vivant avec le diabète de type 2

Introduction : People living with type 2 diabetes are brought to make demanding behavioral changes that can lead to self-management difficulties.Background : The guidelines recommend that healthcare professionals follow a person-centered approach (PCA) when caring. However, this approach seems difficult to adopt in practice.Objective : Coconstruct an intervention inspired by the concept map (CM) to promote the adoption of PCA by nurses during self-management support encounters.Method : This study is based on a model for developing evidence-based nursing interventions. Five experts (2 patients, 2 nurses, 1 educational specialist) collaborated in the coconstruction of the intervention.Results : The Person-Centered Approach Diabetes Self-Management Support (PCA-DSMS) intervention has been developed in accordance with the foundations of a PCA and the CM. It includes four steps : 1) Introduce the intervention ; 2) Develop the Needs Map ; 3) Intervene according to priority needs ; 4) Conclude and plan a follow-up.Discussion : More studies are needed to explore whether the intervention is acceptable and feasible as well as its ability to lead nurses to adopt PCA.Conclusion : The PCA-DSMS could bring nurses to adopt a PCA.

Perception of diabetes management and cardiovascular disease risk among men with type 2 diabetes: A qualitative study

Aim

The aim of this study was to explore the perception and understanding of men with type 2 diabetes about their illness control, risk for CVD and their adherence to healthcare management plans in Jordan.

Design

A qualitative descriptive design was used, recruiting a purposive sample of 13 men diagnosed with type 2 diabetes.

Methods

Data were collected between February and April 2019 through in-depth semi-structured interviews and analysed using content analysis.

Results

Data analysis revealed four themes: (a) Perception of diabetes control; (b) Perception of cardiovascular disease risk; (c) Coping with disease-imposed limitations; and (d) Information validation.

Conclusion

The study concludes that the perception of disease control does not necessarily coincide with actual disease control. Examining patients with diabetes perception and knowledge of their healthcare management and increased CVD risks is essential. An individualized culture and gender-sensitive health education and counselling involving spouses are recommended. Social media to disseminate scientific valid health instructions can enhance adherence.

2017 National Standards for Diabetes Self-Management Education and Support

PURPOSE

The purpose of this study is to review the literature for Diabetes Self-Management Education and Support (DSMES) to ensure the National Standards for DSMES (Standards) align with current evidence-based practices and utilization trends.

METHODS

The 10 Standards were divided among 20 interdisciplinary workgroup members. Members searched the current research for diabetes education and support, behavioral health, clinical, health care environment, technical, reimbursement, and business practice for the strongest evidence that guided the Standards revision.

RESULTS

Diabetes Self-Management Education and Support facilitates the knowledge, skills, and ability necessary for diabetes self-care as well as activities that assist a person in implementing and sustaining the behaviors needed to manage their condition on an ongoing basis. The evidence indicates that health care providers and people affected by diabetes are embracing technology, and this is having a positive impact of DSMES access, utilization, and outcomes.

CONCLUSION

Quality DSMES continues to be a critical element of care for all people with diabetes. The DSMES services must be individualized and guided by the concerns, preferences, and needs of the person affected by diabetes. Even with the abundance of evidence supporting the benefits of DSMES, it continues to be underutilized, but as with other health care services, technology is changing the way DSMES is delivered and utilized with positive outcomes.

2017 National Standards for Diabetes Self-Management Education and Support

PURPOSE

The purpose of this study is to review the literature for Diabetes Self-Management Education and Support (DSMES) to ensure the National Standards for DSMES (Standards) align with current evidence-based practices and utilization trends.

METHODS

The 10 Standards were divided among 20 interdisciplinary workgroup members. Members searched the current research for diabetes education and support, behavioral health, clinical, health care environment, technical, reimbursement, and business practice for the strongest evidence that guided the Standards revision.

RESULTS

Diabetes Self-Management Education and Support facilitates the knowledge, skills, and ability necessary for diabetes self-care as well as activities that assist a person in implementing and sustaining the behaviors needed to manage their condition on an ongoing basis. The evidence indicates that health care providers and people affected by diabetes are embracing technology, and this is having a positive impact of DSMES access, utilization, and outcomes.

CONCLUSION

Quality DSMES continues to be a critical element of care for all people with diabetes. The DSMES services must be individualized and guided by the concerns, preferences, and needs of the person affected by diabetes. Even with the abundance of evidence supporting the benefits of DSMES, it continues to be underutilized, but as with other health care services, technology is changing the way DSMES is delivered and utilized with positive outcomes.

Family-Driven Goals to Improve Care for Children With Autism Spectrum Disorder

OBJECTIVES

Constipation and insomnia are not consistently identified and treated in children with autism spectrum disorder (ASD) despite their high prevalence and deleterious impact in this population. To standardize care, a constipation practice pathway and an insomnia practice pathway were previously developed by Autism Treatment Network clinicians. Our objective was to implement and refine these practice pathways in clinical settings.

METHODS

Eleven Autism Treatment Network sites participated in a Learning Collaborative (ie, multidisciplinary quality improvement team) and chose to implement either the constipation or insomnia practice pathway in the clinical setting. Families set intervention goals (eg, increase stool frequency, decrease nighttime awakenings) before treatment. Each site began implementation with 1 patient and then increased implementation by factors of 5. Before each increase, the Learning Collaborative evaluated progress and refined the practice pathways. Process improvement was measured primarily by duration until goal attainment and by percentage of families who meet their goals.

RESULTS

Across sites, 82 children with ASD and constipation and 101 children with ASD and insomnia were managed. Difficulties with intervention adherence and communication between providers and families were reported and were subsequently improved with parallel refinements to both practice pathways. The most notable modification was incorporating a goal-setting session in which families generated their own intervention goals (ie, family-driven goals). In this quality improvement initiative, 75% of families met at least 1 constipation or insomnia goal, with the median time to improvement being 6 weeks.

CONCLUSIONS

By integrating a family-centered approach into the standardization of care, constipation and insomnia practice pathways may improve engagement, adherence, and management of medical conditions in children with ASD.

Patients' and healthcare professionals' perceptions of self-management support interactions: Systematic review and qualitative synthesis

Objective To review studies examining the experience of self-management support in patient-provider interactions and the shaping of goals through interactions. Methods We undertook a systematic review and thematic synthesis of the qualitative literature. We searched six databases (2004-2015) for published studies on the provision of self-management support in one-to-one, face-to-face, patient-provider interactions for obesity, type 2 diabetes mellitus and chronic obstructive pulmonary disease, with 14 articles meeting inclusion criteria. Results Themes identified from studies were (1) dominance of a traditional model of care, encompassing the provision of generic information, exclusion of the psychosocial and temporal nature of interactions and (2) a context of individual responsibility and accountability, encompassing self-management as patients' responsibility and adherence, accountability and the attribution of blame. Interactions were constrained by consultation times, patient self-blame and guilt, desire for autonomy and beliefs about what constitutes 'effective' self-management. Discussion Encounters were oriented towards a traditional model of care delivery and this limited opportunity for collaboration. These findings suggest that healthcare professionals remain in a position of authority, limiting opportunities for control to be shared with patients and shared understandings of social context to be developed.

2017 National Standards for Diabetes Self-Management Education and Support

Purpose

The purpose of this study is to review the literature for Diabetes Self-Management Education and Support (DSMES) to ensure the National Standards for DSMES (Standards) align with current evidence-based practices and utilization trends.

Methods

The 10 Standards were divided among 20 interdisciplinary workgroup members. Members searched the current research for diabetes education and support, behavioral health, clinical, health care environment, technical, reimbursement, and business practice for the strongest evidence that guided the Standards revision.

Results

Diabetes Self-Management Education and Support facilitates the knowledge, skills, and ability necessary for diabetes self-care as well as activities that assist a person in implementing and sustaining the behaviors needed to manage their condition on an ongoing basis. The evidence indicates that health care providers and people affected by diabetes are embracing technology, and this is having a positive impact of DSMES access, utilization, and outcomes.

Conclusion

Quality DSMES continues to be a critical element of care for all people with diabetes. The DSMES services must be individualized and guided by the concerns, preferences, and needs of the person affected by diabetes. Even with the abundance of evidence supporting the benefits of DSMES, it continues to be underutilized, but as with other health care services, technology is changing the way DSMES is delivered and utilized with positive outcomes.

2017 National Standards for Diabetes Self-Management Education and Support

This article was copublished in Diabetes Care 2017;40:1409-1419 and The Diabetes Educator 2017;43:449-464 and is reprinted with permission. The previous version of this article, also copublished in Diabetes Care and The Diabetes Educator, can be found at Diabetes Care 2012;35:2393-2401 (https://doi.org/10.2337/dc12-1707).

2017 National Standards for Diabetes Self-Management Education and Support

Purpose The purpose of this study is to review the literature for Diabetes Self-Management Education and Support (DSMES) to ensure the National Standards for DSMES (Standards) align with current evidence-based practices and utilization trends. Methods The 10 Standards were divided among 20 interdisciplinary workgroup members. Members searched the current research for diabetes education and support, behavioral health, clinical, health care environment, technical, reimbursement, and business practice for the strongest evidence that guided the Standards revision. Results Diabetes Self-Management Education and Support facilitates the knowledge, skills, and ability necessary for diabetes self-care as well as activities that assist a person in implementing and sustaining the behaviors needed to manage their condition on an ongoing basis. The evidence indicates that health care providers and people affected by diabetes are embracing technology, and this is having a positive impact of DSMES access, utilization, and outcomes. Conclusion Quality DSMES continues to be a critical element of care for all people with diabetes. The DSMES services must be individualized and guided by the concerns, preferences, and needs of the person affected by diabetes. Even with the abundance of evidence supporting the benefits of DSMES, it continues to be underutilized, but as with other health care services, technology is changing the way DSMES is delivered and utilized with positive outcomes.

Goal setting: an integral component of effective diabetes care

Goal setting is a widely used behavior change tool in diabetes education and training. Prior research found specific relatively difficult but attainable goals set within a specific timeframe improved performance in sports and at the workplace. However, the impact of goal setting in diabetes self-care has not received extensive attention. This review examined the mechanisms underlying behavioral change according to goal setting theory and evaluated the impact of goal setting in diabetes intervention studies. Eight studies were identified, which incorporated goal setting as the primary strategy to promote behavioral change in individual, group-based, and primary care settings among patients with type 2 diabetes. Improvements in diabetes-related self-efficacy, dietary intake, physical activity, and A1c were observed in some but not all studies. More systematic research is needed to determine the conditions and behaviors for which goal setting is most effective. Initial recommendations for using goal setting in diabetes patient encounters are offered.

Effective interventions to improve medication adherence in Type 2 diabetes: a systematic review

AIM

Medication adherence is associated with improved outcomes in diabetes. Interventions have been established to help improve medication adherence; however, the most effective interventions in patients with Type 2 diabetes remain unclear. The goal of this study was to distinguish whether interventions were effective and identify areas for future research.

METHODS

Medline was searched for articles published between January 2000 and May 2013, and a reproducible strategy was used. Study eligibility criteria included interventions measuring medication adherence in adults with Type 2 diabetes.

RESULTS

Twenty seven studies met the inclusion criteria and 13 showed a statistically significant change in medication adherence.

CONCLUSION

Heterogeneity of the study designs and measures of adherence made it difficult to identify effective interventions that improved medication adherence. Additionally, medication adherence may not be solely responsible for achieving glycemic control. Researchers must emphasize tailored interventions that optimize management and improve outcomes, and examine the need for clear indicators of medication adherence.