Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association

Educational Needs and Priorities of People with Diabetes and Healthcare Providers in South Korea: A Mixed-Methods Study

Introduction: Effective self-care for managing diabetes requires culturally sensitive and patient-centered education. This study explored the educational needs and priorities of people with diabetes (PWD) and healthcare providers (HCPs). Method: A mixed-methods approach was employed with participants from a university-affiliated hospital in South Korea. Descriptive and content analyses were used for the questionnaire and interview data. Results: Both PWD (n=33) and HCPs (n=42) ranked diabetes-related side-effect management and medication purpose as the most important aspects of diabetes education. PWD had higher educational needs regarding diagnosed diseases and lifestyle modifications than HCPs. Three themes were revealed: incorporating lifestyle changes and medication taking, collaborating with HCPs and caregivers and providing care to meet person-centered mental health needs, and enhancing education on disease and complications. Discussion: Culturally sensitive and patient-centered education programs that recognize communal values, reflect individual preferences and needs, and promote lifestyle changes by leveraging technologies for Korean PWD are crucial.

Role of Psychological Distress in the Assessment of Chronic Illness Care and Self-Management Behaviors of Elderly Patients with T2DM Chronic Complications

Background

This study sought to explore the interrelationship between diabetes-related distress, patient evaluations of chronic illness management, and self-management practices among older adults diagnosed with T2DM and associated chronic complications.

Methods

This was a cross-sectional study including 264 older adults with T2DM in Shanghai, China. Chinese version of Problem Areas in Diabetes Scale (PAID-C), Patient Assessment of Chronic Illness Care (PACIC) and Diabetes Self-Management Behaviour for Older (DSMB-O) were employed. Student's t-test, one-way ANOVA or the nonparametric analysis (Mann-Whitney U-test), Pearson correlation coefficient and structural equation model (SEM) were used to analyse the data.

Results

A total of 264 participants (157 males [59.47%], with an average age of 71.07±6.47 years) were included in the study; their duration of T2DM ranged from 5 to 30 years, with a mean duration of 11.19±6.96 years. The DSMB-O scores exhibited a negative correlation with the PAID-C scores (r=-0.250, p<0.01), while showing a positive correlation with PACIC scores (r=0.348, p<0.01). Additionally, PAID-C scores demonstrated a negative correlation with PACIC scores (r=-0.182, p<0.01). The indirect effect of PAID-C on DSMB-O through PACIC was calculated as (-0.70*-0.39=0.27). Furthermore, the total effect of PAID-C on DSMB-O via PACIC was determined to be (0.27+0.22=0.49). Notably, the mediating effect accounted for 54.99%.

Conclusion

Psychological distress is intricately linked to self-management behaviour among elderly patients suffering from T2DM and chronic complications. Our findings carry significant implications for T2DM healthcare, indicating that addressing psychological distress may enhance the quality of chronic illnesses, ultimately fostering improved self-management practices and yielding better health outcomes.

The Role of Self-Efficacy Enhancement in Improving Self-Management Behavior for Type 2 Diabetes Mellitus Patients

Background

The effectiveness of a self-efficacy-focused structured education program for patients with diabetes mellitus has been verified. However, changes in self-efficacy for the behavior change mechanism in patients who participated in the program require clarification.

Aim

To analyze the mechanism of self-management behavioral variations in patients with type 2 diabetes mellitus who underwent a self-efficacy-focused structured education program.

Methods

A secondary analysis of patients who received a self-efficacy-focused structured education program was conducted using data from a multicenter randomized controlled trial. The relationships among the 3-, 6-, and 12-month changes in diabetes knowledge, self-efficacy, diabetes distress, and self-management behaviors in patients with type 2 diabetes mellitus were studied using a structural equation model.

Results

Enhancement of self-efficacy among patients receiving a self-efficacy-focused structured education program directly influenced improvements in self-management behaviors at 3, 6 and 12 months. The increase in diabetes knowledge directly and indirectly improved self-management behaviors at 3 months, but the direct effect on behavior disappeared at 6 months and the indirect effect on behavior by enhancing self-efficacy only lasted until 6 months. The decrease in diabetes distress directly influenced improvement in self-management behaviors at 3 months. While it did not directly influence self-management behavior improvement at 6 and 12 months, it indirectly affected behavior improvement by enhancing self-efficacy.

Conclusion

The enhancement of self-efficacy plays a core role in improving and maintaining self-management behaviors in patients with type 2 diabetes mellitus who receive self-efficacy-focused structured education programs. Patients' behaviors can be improved by gaining more diabetes knowledge and mitigating diabetes distress at the 3- and 6-month follow-up. Improvements in behaviors at the 12-month follow-up could be achieved by mitigating diabetes distress.

WhatsApp-based intervention for people with type 2 diabetes: A randomized controlled trial

Diabetes mellitus is a metabolic disease characterized by prolonged elevated blood glucose levels. Diabetes self-management education and support programs are widely used in western countries. The impact of social media education and support interventions such as a WhatsApp-based program and the nurses' role in supporting and implementing this self-management program unclear. Using a WhatsApp-based program, we evaluated the effects of a 6-week program in improving self-efficacy and education among people with type 2 diabetes mellitus in Saudi Arabia. Eligible participants (n = 80) were recruited with the support of nurses into a randomized controlled trial and randomly assigned into self-management intervention and control groups. The intervention group (n = 40) received the self-management program support and the usual care. The control group (n = 40) received only the usual care with nurses' support. Results from generalized estimating equation analysis showed a significant increase in self-efficacy, self-management, and education in the WhatsApp-based intervention support group compared with the control group at 6 and 12 weeks (follow-up). Implementing the program via social media improves self-efficacy. The use of social media platforms should be promoted for global diabetes management.

Impact of Skills for Change Program on metabolic control, diet and physical activity levels in adults with type 2 diabetes: A cluster randomized trial

BACKGROUND

Type 2 diabetes mellitus is highly prevalent in the Arab Gulf countries. Despite this, limited culturally-adapted lifestyle intervention studies have been conducted in this region.

METHODS

In this culturally adapted 12-month cluster randomized trial, 382 patients with type 2 diabetes, aged 20-70 years were recruited from 6 public healthcare centers (3 interventions and 3 controls) in Al Ain, United Arab Emirates. The primary outcome of this study was a change in hemoglobin A1c (HbA1c). The secondary outcomes were Body Mass Index (BMI), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, total cholesterol, dietary intake, and physical activity levels. A diet and physical activity intervention, guided by the social cognitive theory, was delivered individually and in group format to the intervention group. The control group continued receiving only their usual diabetes management care. The data were collected at baseline and 1 year after participation.

RESULTS

The mean baseline HbA1c levels of the control and the intervention groups were 7.45 ± 0.11% and 7.81 ± 0.11%, respectively. At the end of the 12-month intervention, there was no significant difference in the changes of mean HbA1c between the intervention and the control groups. On the other hand, BMI and daily caloric intake were significantly decreased in the intervention compared to the control group by 1.18 kg/m2 (95% CI: -1.78 - -0.60) and 246 kcal (95% CI: -419.52 - -77.21), respectively, after controlling for age, gender, education, marital status, duration since diabetes diagnosis, diabetes treatment, treatment clinic, and baseline values. Sitting time during the week-end was significantly lower, difference 52.53 minutes (95% CI: 93.93 - -11.14).

CONCLUSIONS

This community-based lifestyle intervention for patients with baseline HbA1c <8% did not result in a significant decrease of HbA1c but reduced caloric intake, body weight, and weekend inactivity after controlling for the covariates.

TRIAL REGISTRATION

This trial was registered on February 11, 2020 with Clinicaltrials.gov (NCT04264793).

Development of Quality Measures for Inpatient Diabetes Care and Education Specialists: A Call to Action

ABSTRACT

Diabetes and hyperglycemia are associated with an increased risk of in-hospital complications that lead to longer lengths of stay, increased morbidity, higher mortality, and risk of readmission. Diabetes care and education specialists (DCESs) working in hospital settings are uniquely prepared and credentialed to serve as content experts to facilitate change and implement processes and programs to improve glycemic-related outcomes. A recent survey of DCESs explored the topic of productivity and clinical metrics. Outcomes highlighted the need to better evaluate the impact and value of inpatient DCESs, advocate for the role, and to expand diabetes care and education teams to optimize outcomes. The purpose of this article was to recommend strategies and metrics that can be used to quantify the work of inpatient DCESs and describe how such metrics can help to show the value of the inpatient DCES and assist in making a business case for the role.

Feasibility of Cooking Matters for Diabetes: A 6-week Randomized, Controlled Cooking and Diabetes Self-Management Education Intervention

BACKGROUND

Diabetes self-management education and support is the cornerstone of diabetes care, yet <10% of adults with diabetes manage their condition successfully. Feasible interventions are needed urgently.

OBJECTIVE

Our aim was to assess the feasibility of a cooking intervention with food provision and diabetes self-management education and support.

DESIGN

This was a waitlist-controlled, randomized trial.

PARTICIPANTS/SETTING

Thirteen adults with type 1 or type 2 diabetes who participated in Cooking Matters for Diabetes (CMFD) participated in 2 focus groups.

INTERVENTION

CMFD was adapted from Cooking Matters and the American Diabetes Association's diabetes self-management education and support intervention into a 6-week program with weekly lesson-aligned food provisions.

MAIN OUTCOME MEASURES

Feasibility was evaluated quantitatively and qualitatively along the following 5 dimensions: demand, acceptability, implementation, practicality, and limited efficacy.

STATISTICAL ANALYSIS

Two coders extracted focus group themes with 100% agreement after iterative analysis, resulting in consensus. Administrative data were analyzed via descriptive statistics.

RESULTS

Mean (SD) age of focus group participants was 57 (14) years; 85% identified as female; 39% identified as White; 46% identified as Black; and income ranged from <$5,000 per year (15%) to $100,000 or more per year (15%). Mean (SD) baseline hemoglobin A1c was 8.6% (1.2%). Mean attendance in CMFD was 5 of 6 classes (83%) among all participants. Demand was high based on attendance and reported intervention utilization and was highest among food insecure participants, who were more likely to report using the food provisions and recipes. Acceptability was also high; focus groups revealed the quality of instructors and interaction with peers as key intervention strengths. Participant ideas for implementation refinement included simplifying recipes, lengthening class sessions, and offering more food provision choices. Perceived effects of the intervention included lower hemoglobin A1c and body weight and improvements to health-related quality of life.

CONCLUSIONS

The CMFD intervention was feasible according to the measured principles of demand, acceptability, implementation, practicality, and limited efficacy.

The current diabetes education experience: Findings of a cross-sectional survey of adults with type 2 diabetes

OBJECTIVE

To survey persons with type 2 diabetes (PWD) on their experiences with diabetes education to better understand what it means when a PWD says they have "had diabetes education."

METHODS

We conducted a cross-sectional descriptive study among a convenience sample of adult PWD receiving primary care and/or diabetes self-management education and support in a mid-Atlantic regional US healthcare system. Descriptive, bivariate, and regression analyses were used to describe and explore the diabetes education experience.

RESULTS

Participants (n = 498) were majority female, African American, and non-Hispanic. Half reported having "had diabetes education." Of those, 44% had only one session. Education was most often provided in clinical settings by a dietitian (68%) or doctor (51%), in one-on-one (70%) sessions. While most participants reported receiving core diabetes knowledge, fewer reported education on topics that are not related to their daily routine, such as what to do about diabetes medications when sick.

CONCLUSION

The self-reported diabetes education experience varies in content, modality, setting, and education provider. Education receipt is low, and for those who receive education, the amount is low.

PRACTICAL IMPLICATIONS

The diabetes education experience may fall short of the comprehensive US National Standards-recommended process. Innovative strategies are needed to address these gaps.

Gender differences in social support for diabetes self-management: A qualitative study among veterans

OBJECTIVE

Describe the role of social support in veterans' diabetes self-management and examine gender differences.

METHODS

We conducted semi-structured interviews among veterans with diabetes from one Veterans Health Administration Health Care System. Participants described how support persons influenced their diabetes self-management and perspectives on a proposed self-management program incorporating a support person. We used thematic analysis to identify salient themes and examine gender differences.

RESULTS

Among 18 women and 18 men, we identified four themes: 1) women felt responsible for their health and the care of others; 2) men shared responsibility for managing their diabetes, with support persons often attempting to correct behaviors (social control); 3) whereas both men and women described receiving instrumental and informational social support, primarily women described emotional support; and 4) some women's self-management efforts were hindered by support persons. Regarding programs incorporating a support person, some participants endorsed including family/friends and some preferred programs including other individuals with diabetes.

CONCLUSIONS

Notable gender differences in social support for self-management were observed, with women assuming responsibility for their diabetes and their family's needs and experiencing interpersonal barriers.

PRACTICE IMPLICATIONS

Gender differences in the role of support persons in diabetes self-management should inform support-based self-management programs.

Lower education and immigrant background are associated with lower participation in a diabetes education program - Insights from adult patients in the Outcomes & Multi-morbidity In Type 2 diabetes cohort (OMIT)

OBJECTIVES

Diabetes educational programmes should be offered to patients with type 2 diabetes mellitus (T2DM). We assessed the proportion of diabetes educational program participation among adults with T2DM, and its associations with place of residence in Norway, education, and immigrant background.

METHODS

We identified 28,128 diagnosed with T2DM (2008-2019) in the Outcomes & Multi-morbidity In Type 2 diabetes cohort. To examine associations between sociodemographic factors and participation in diabetes start courses (yes/no), we computed adjusted risk ratios (95% CI) using log-binomial regression.

RESULTS

Overall, 18% participated on the diabetes start course, but partaking differed by Norwegian counties (range:12-34%). Individuals with an immigrant background were 29% less likely to participate (RR 0.71, CI 0.65-0.79). Similarly, those with a lower educational level were 23% less likely to participate (RR 0.77, CI 0.72-0.83) than those with the highest education. The association between education and start course participation was not significant in the subgroup of immigrant individuals (RR 0.88 CI 0.70-1.12).

CONCLUSIONS

We found that diabetes start course participation was overall low, especially in individuals with low education and immigrant background.

PRACTICE IMPLICATIONS

More efforts are needed to promote diabetes start courses in patients with T2DM.

Interprofessional care of patients with type 2 diabetes mellitus in primary care: family physicians’ perspectives

Background

There is a lack of understanding of the team processes and factors that influence teamwork and medication management practices in the care of patients with type 2 diabetes mellitus (T2DM). The purpose of the study was to explore physicians’ perspectives of barriers and facilitators to interprofessional care of patients with T2DM within team-based family practice settings.

Methods

This was a qualitative, descriptive study. Participants included physicians affiliated with a primary care network providing care to patients with T2DM in an interprofessional team-based primary care setting in Edmonton, Alberta, Canada. Participants’ contact information was obtained from the publicly available College of Physicians and Surgeons of Alberta and respective primary care network websites. Interview questions addressed physicians’ perspectives on factors or processes that facilitated and hindered the care and medication management of adult patients with T2DM in primary care team-based clinical practice. Interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis and a constant comparative approach.

Results

A total of 15 family physicians participated in individual interviews. Family physicians identified facilitators of interprofessional team-based care and medication management of patients with T2DM in three theme areas—access to team members and programs, knowledgeable and skilled health professionals, and provision of patient education by other health professionals. Two themes emerged as barriers to interprofessional care – lack of provider continuity and the loss of skills from delegation of tasks.

Conclusion

Family physicians perceive both benefits and risks to interprofessional team-based care in caring for patients with T2DM. Successful functioning of team-based care in family practice will require overcoming traditional professional roles.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01688-w.

Cognitive Behavioral Therapy (CBT) Telehealth Augmented With a CBT Smartphone Application to Address Type 2 Diabetes Self-Management: A Randomized Pilot Trial

Purpose:

The purpose of the study was to investigate the feasibility and acceptability of phone-delivered cognitive behavioral therapy (CBT) combined with an adjunctive smartphone application CBT MobileWork-DM© to improve self-management of type 2 diabetes mellitus (T2DM).

Methods:

Participants were 12 patients with T2DM on antihyperglycemic medication and had an A1C level of 8 or greater. A randomized controlled pilot study assessed treatment as usual (TAU) T2DM care versus a phone-delivered CBT (6, 8, or 12 weekly sessions) augmented with a CBT skills practice smartphone application. The CBT telehealth intervention addressed T2DM self-management and diabetes distress. Electronic and self-report medication taking, diabetes-related distress, and A1C were assessed at baseline and post-intervention.

Results:

After 16 weeks, a decrease in A1C and distress levels was observed in all 3 CBT phone groups and TAU group. The group with the most improvement was the 12-week CBT group, which had the greatest mean decrease in A1C (−2.33) and diabetes distress (−31.67). The TAU group exhibited a mean decrease of −2.15 and −21 for A1C and diabetes distress, respectively. The overall rate of completion for phone CBT sessions across the 3 CBT groups was 83%.

Conclusion:

This study demonstrates that telehealth CBT augmented with a smartphone application is feasible and acceptable. Patients demonstrated improvements in both T2DM management and distress.

Effectiveness of a Health Coaching Intervention for Patient-Family Dyads to Improve Outcomes Among Adults With Diabetes: A Randomized Clinical Trial

IMPORTANCE

More than 75% of US adults with diabetes do not meet treatment goals. More effective support from family and friends ("supporters") may improve diabetes management and outcomes.

OBJECTIVE

To determine if the Caring Others Increasing Engagement in Patient Aligned Care Teams (CO-IMPACT) intervention improves patient activation, diabetes management, and outcomes compared with standard care.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial was conducted from November 2016 to August 2019 among participants recruited from 2 Veterans Health Administration primary care sites. All patient participants were adults aged 30 to 70 years with diabetes who had hemoglobin A1c (HbA1c) levels greater than 8% of total hemoglobin (to convert to proportion of total hemoglobin, multiply by 0.01) or systolic blood pressure (SBP) higher than 150 mm Hg; each participating patient had an adult supporter. Of 1119 recruited, 239 patient-supporter dyads were enrolled between November 2016 and May 2018, randomized 1:1 to receive the CO-IMPACT intervention or standard care, and followed up for 12 to 15 months. Investigators and analysts were blinded to group assignment.

INTERVENTIONS

Patient-supporter dyads received a health coaching session focused on dyadic information sharing and positive support techniques, then 12 months of biweekly automated monitoring telephone calls to prompt dyadic actions to meet diabetes goals, coaching calls to help dyads prepare for primary care visits, and after-visit summaries. Standard-care dyads received general diabetes education materials only.

MAIN OUTCOMES AND MEASURES

Intent-to-treat analyses were conducted according to baseline dyad assignment. Primary prespecified outcomes were 12-month changes in Patient Activation Measure-13 (PAM-13) and UK Prospective Diabetes Study (UKPDS) 5-year diabetes-specific cardiac event risk scores. Secondary outcomes included 12-month changes in HbA1c levels, SBP, diabetes self-management behaviors, diabetes distress, diabetes management self-efficacy, and satisfaction with health system support for the involvement of family supporters. Changes in outcome measures between baseline and 12 months were analyzed using linear regression models.

RESULTS

A total of 239 dyads enrolled; among patient participants, the mean (SD) age was 60 (8.9) years, and 231 (96.7%) were male. The mean (SD) baseline HbA1c level was 8.5% (1.6%) and SBP was 140.2 mm Hg (18.4 mm Hg). A total of 168 patients (70.3%) lived with their enrolled supporter; 229 patients (95.8%) had complete 12-month outcome data. In intention-to-treat analyses vs standard care, CO-IMPACT patients had greater 12-month improvements in PAM-13 scores (intervention effect, 2.60 points; 95% CI, 0.02-5.18 points; P = .048) but nonsignificant differences in UKPDS 5-year cardiac risk (intervention effect, 1.01 points; 95% CI, -0.74 to 2.77 points; P = .26). Patients in the CO-IMPACT arm also had greater 12-month improvements in healthy eating (intervention effect, 0.71 d/wk; 95% CI, 0.20-1.22 d/wk; P = .007), diabetes self-efficacy (intervention effect, 0.40 points; 95% CI, 0.09-0.71 points; P = .01), and satisfaction with health system support for the family supporter participants' involvement (intervention effect, 0.28 points; 95% CI, 0.07-0.49 points; P = .009); however, the 2 arms had similar improvements in HbA1c levels and in other measures.

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, the CO-IMPACT intervention successfully engaged patient-supporter dyads and led to improved patient activation and self-efficacy. Physiological outcomes improved similarly in both arms. More intensive direct coaching of supporters, or targeting patients with less preexisting support or fewer diabetes management resources, may have greater impact.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02328326.

Diabetes self-management and its associated factors among patients with diabetes in central Vietnam: A cross-sectional study

Objective

Diabetes self-management (DSM) enables maintenance of optimal individualized glycemic control for patients with diabetes through comprehensive lifestyle, medication adherence, and self-monitoring glucose level. This study aimed to evaluate DSM and to find associated factors among Vietnamese diabetes patients by using the Vietnamese version of Diabetes Self-Management Instrument (DSMI).

Methods

A cross-sectional study was conducted at a single hospital in the central Vietnam. DSM was assessed using the DSMI. The participant’s socio-demographic and clinical features were obtained through face-to-face interviews and medical records. Multivariate linear regression was used to determine independent factors associated with total DSMI.

Results

The mean total DSM score based on DSMI self-administered questionnaire scores was 88.4 ± 22.1, with a range of 47 to 140. The mean self-integration, self-regulation, interaction with health professionals, self-monitoring blood glucose, and adherence to the prescribed regime were 24.8, 22.3, 21.6, 10.2, and 9.5, respectively. 48.1% of DM patients had good HbA1c control. Sex, educational status, BMI, waist circumference, medical nutrition therapy, and sufficient physical activities were factors independently predictive of DSMI total score.

Conclusion

This study emphasizes that the DSM situation is seen to be average among DM patients with mean DSMI score 88.4 ± 22.1 and sex, educational status, BMI, waist circumference, medical nutrition therapy, and sufficient physical activities were independently predictive factors of DSMI total score. This evidence suggests that there is a need to enhance the effectiveness of DSM education programs among diabetic patients.

The Role of the Diabetes Care and Education Specialist in the Hospital Setting

It is the position of Association of Diabetes Care & Education Specialists that all inpatient interdisciplinary teams include a diabetes care and education specialist to lead or support quality improvement initiatives that affect persons hospitalized with diabetes and/or hyperglycemia. This encompasses not only patient, family, and caregiver education but also education of interdisciplinary team members and achievement of diabetes-related organizational quality metrics and performance outcomes.

New Horizons: Next-Generation Insulin Analogues: Structural Principles and Clinical Goals

Design of "first-generation" insulin analogues over the past 3 decades has provided pharmaceutical formulations with tailored pharmacokinetic (PK) and pharmacodynamic (PD) properties. Application of a molecular tool kit-integrating protein sequence, chemical modification, and formulation-has thus led to improved prandial and basal formulations for the treatment of diabetes mellitus. Although PK/PD changes were modest in relation to prior formulations of human and animal insulins, significant clinical advantages in efficacy (mean glycemia) and safety (rates of hypoglycemia) were obtained. Continuing innovation is providing further improvements to achieve ultrarapid and ultrabasal analogue formulations in an effort to reduce glycemic variability and optimize time in range. Beyond such PK/PD metrics, next-generation insulin analogues seek to exploit therapeutic mechanisms: glucose-responsive ("smart") analogues, pathway-specific ("biased") analogues, and organ-targeted analogues. Smart insulin analogues and delivery systems promise to mitigate hypoglycemic risk, a critical barrier to glycemic control, whereas biased and organ-targeted insulin analogues may better recapitulate physiologic hormonal regulation. In each therapeutic class considerations of cost and stability will affect use and global distribution. This review highlights structural principles underlying next-generation design efforts, their respective biological rationale, and potential clinical applications.

Impact of a Dyadic Intervention on Family Supporter Involvement in Helping Adults Manage Type 2 Diabetes

BACKGROUND

Family support for adults' diabetes care is associated with improved self-management and outcomes, but healthcare providers lack structured ways to engage those supporters.

OBJECTIVE

Assess the impact of a patient-supporter diabetes management intervention on supporters' engagement in patients' diabetes care, support techniques, and caregiving experience.

DESIGN

Multivariate regression models examined between-group differences in support-related measures observed as part of a larger trial randomizing participants to a dyadic intervention versus usual care.

PARTICIPANTS

A total of 239 adults with type 2 diabetes and either A1c >8% or systolic blood pressure >160mmHg enrolled with a family supporter.

INTERVENTION

Health coaches provided training on positive support techniques and facilitated self-management information sharing and goal-setting.

MAIN MEASURES

Patient and supporter reports at baseline and 12 months of supporter roles in diabetes care and caregiving experience.

RESULTS

At 12 months, intervention-assigned patients had higher odds of reporting increased supporter involvement in remembering medical appointments (AOR 2.74, 95% CI 1.44, 5.21), performing home testing (AOR 2.40, 95% CI 1.29, 4.46), accessing online portals (AOR 2.34, 95% CI 1.29, 4.30), deciding when to contact healthcare providers (AOR 2.12, 95% CI 1.15, 3.91), and refilling medications (AOR 2.10, 95% CI 1.14, 3.89), but not with attending medical appointments or with healthy eating and exercise. Intervention-assigned patients reported increased supporter use of autonomy supportive communication (+0.27 points on a 7-point scale, p=0.02) and goal-setting techniques (+0.30 points on a 5-point scale, p=0.01). There were no differences at 12 months in change scores measuring supporter distress about patients' diabetes or caregiving burden. Intervention-assigned supporters had significantly larger increases in satisfaction with health system support for their role (+0.88 points on a 10-point scale, p=0.01).

CONCLUSIONS

A dyadic patient-supporter intervention led to increased family supporter involvement in diabetes self-management and increased use of positive support techniques, without increasing caregiver stress.

The effect of health literacy-based, health belief-constructed education on glycated hemoglobin (HbA1c) in people with type 2 diabetes: A randomized controlled study

AIMS

Adopting effective self-care behaviors is essential in maintaining optimal glycated hemoglobin (HbA1c) levels. The study aimed to evaluate the effect of health literacy-based, health belief-constructed education and counseling on glycated hemoglobin (HbA1c) in people with type 2 diabetes.

METHODS

The parallel-group, randomized controlled study was conducted between June 2019 and March 2020. One hundred and twenty patients were randomized to receive either 12-week health literacy-based group education and phone counseling (intervention, 60 patients) or routine diabetic care (control, 60 patients). The study was completed with 107 patients (54 intervention, 53 control). HbA1c (primary outcome), self-efficacy, perceived susceptibility, severity, barriers, and benefits (secondary outcomes) were evaluated at baseline and six months.

RESULTS

Both groups had decreases in HbA1c. There was no significant decrease in HbA1c between the intervention and control groups. However, there was a significant improvement in self-efficacy, change in perceived susceptibility, perceived barriers, and perceived benefits in the intervention group. This effect was the same for all patients in the high and low health literacy intervention groups.

CONCLUSIONS

Education and counseling based on health literacy levels and framed with health belief constructs change health beliefs, predicting higher engagement and efficacy in disease management activities.

CLINICAL TRIAL NUMBER

NCT04677127.

Effect of educational interventions on knowledge of the disease and glycaemic control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Globally, type 2 diabetes has continued to increase, now accounting for over 90% of all diabetes cases. Though the magnitude of uncontrolled glycaemic levels in patients with type 2 diabetes is steadily rising, evidence showed that effectively controlled glycaemic levels can prevent complications and improve the quality of life of these patients. As little is known about the effect of educational interventions on this population, this systematic review and meta-analysis evaluated the effectiveness of educational interventions versus standard care on glycaemic control and disease knowledge among patients with type 2 diabetes.

METHODS

PubMed, Google Scholar, Cochrane Library, Scopus, African Journals Online and Wiley Online Library were searched. Two authors independently assessed within-trial risk of bias in each included study using revised Cochrane risk-of-bias tool for randomised trials. A random-effects model was employed to estimate combined effect sizes. Subgroup analyses were employed to investigate possible sources of heterogeneity between studies. The overall certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

A total of 19 trials with 2708 study participants were included in the review. Primary outcomes (glycaemic control) were reported in 18 trials. The pooled estimated impact of educational intervention on glycaemic levels using the random-effects model was -0.83 (95% CI: -1.17 to -0.49, p<0.001). Subgroup analyses revealed greater A1c reductions in those studies with intervention duration of up to 3 months and with empirical intervention designs. Educational interventions led to significant increases in participants' knowledge of type 2 diabetes (standardised mean difference: 1.16; 95% CI: 0.71 to 1.60; I2=93%).

CONCLUSION

In the current review overall, educational interventions can potentially lead to improved glycaemic control levels in patients with type 2 diabetes despite heterogeneity across the studies. Besides, the findings showed that educational interventions could increase disease knowledge among patients with type 2 diabetes.

PROSPERO REGISTRATION NUMBER

CRD42020205838.

Visual Impairment and Self-Efficacy in Diabetes Management

PURPOSE

The purpose of this study is to examine the relationship between visual impairment and diabetes management self-efficacy.

METHODS

The present study utilized pooled cross-sectional data (2008-2018) from the Medical Expenditure Panel Survey Household Component and Diabetes Care Survey. Binary and generalized ordinal logit regression models were used to compare diabetes management self-efficacy between patients with and without visual impairments.

RESULTS

Compared to their non-visually impaired counterparts, visually impaired persons had a lower odds of reporting high diabetes management self-efficacy. Similarly, visually impaired adults with diabetes have a significantly lower odds of being very confident in their ability to manage their conditions compared with adults who reported being not confident, somewhat confident, or confident. Several control factors, including self-behaviors and receipt of diabetes self-management education (DSME), were also associated with diabetes management self-efficacy.

CONCLUSIONS

Visually impaired persons experience significant disparities in diabetes management self-efficacy. Given the relationship between self-efficacy and diabetes-related outcomes, it is crucial that DSME be tailored to effectively meet the individual needs of this population. Future research should explore the relationship between DSME and self-care behaviors, self-efficacy, and diabetes-related outcomes in visually impaired persons.