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Karter AJ, Parker MM, Huang ES, Seligman HK, Moffet HH, Ralston JD, Liu JY, Gilliam LK, Laiteerapong N, Grant RW, Lipska KJ. Food Insecurity and Hypoglycemia among Older Patients with Type 2 Diabetes Treated with Insulin or Sulfonylureas: The Diabetes & Aging Study. J Gen Intern Med 2024:10.1007/s11606-024-08801-y. [PMID: 38767746 DOI: 10.1007/s11606-024-08801-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Severe hypoglycemia is a serious adverse drug event associated with hypoglycemia-prone medications; older patients with diabetes are particularly at high risk. Economic food insecurity (food insecurity due to financial limitations) is a known risk factor for hypoglycemia; however, less is known about physical food insecurity (due to difficulty cooking or shopping for food), which may increase with age, and its association with hypoglycemia. OBJECTIVE Study associations between food insecurity and severe hypoglycemia. DESIGN Survey based cross-sectional study. PARTICIPANTS Survey responses were collected in 2019 from 1,164 older (≥ 65 years) patients with type 2 diabetes treated with insulin or sulfonylureas. MAIN MEASURES Risk ratios (RR) for economic and physical food insecurity associated with self-reported severe hypoglycemia (low blood glucose requiring assistance) adjusted for age, financial strain, HbA1c, Charlson comorbidity score and frailty. Self-reported reasons for hypoglycemia endorsed by respondents. KEY RESULTS Food insecurity was reported by 12.3% of the respondents; of whom 38.4% reported economic food insecurity only, 21.1% physical food insecurity only and 40.5% both. Economic food insecurity and physical food insecurity were strongly associated with severe hypoglycemia (RR = 4.3; p = 0.02 and RR = 4.4; p = 0.002, respectively). Missed meals ("skipped meals, not eating enough or waiting too long to eat") was the dominant reason (77.5%) given for hypoglycemia. CONCLUSIONS Hypoglycemia prevention efforts among older patients with diabetes using hypoglycemia-prone medications should address food insecurity. Standard food insecurity questions, which are used to identify economic food insecurity, will fail to identify patients who have physical food insecurity only.
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Affiliation(s)
- Andrew J Karter
- Kaiser Permanente Northern California Division of Research, Pleasanton, CA, USA.
| | - Melissa M Parker
- Kaiser Permanente Northern California Division of Research, Pleasanton, CA, USA
| | - Elbert S Huang
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Hilary K Seligman
- Division of General Internal Medicine at San Francisco General Hospital, University of California San Francisco Center for Vulnerable Populations, San Francisco, CA, USA
| | - Howard H Moffet
- Kaiser Permanente Northern California Division of Research, Pleasanton, CA, USA
| | - James D Ralston
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer Y Liu
- Kaiser Permanente Northern California Division of Research, Pleasanton, CA, USA
| | - Lisa K Gilliam
- Kaiser Northern California Diabetes Program, Endocrinology and Internal Medicine, Kaiser Permanente, South San Francisco Medical Center, South San Francisco, CA, USA
| | - Neda Laiteerapong
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Richard W Grant
- Kaiser Permanente Northern California Division of Research, Pleasanton, CA, USA
| | - Kasia J Lipska
- Section of Endocrinology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Diriba DC, Leung DYP, Suen LKP. Effects of family-based diabetes self-management education and support programme on support behaviour amongst adults with type 2 diabetes in Western Ethiopia. Sci Rep 2023; 13:20867. [PMID: 38012247 PMCID: PMC10682375 DOI: 10.1038/s41598-023-48049-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/21/2023] [Indexed: 11/29/2023] Open
Abstract
Support from family and peers may enhance the outcomes of diabetes management. This study reported the preliminary effect of a family-based diabetes self-management education and support (DSMES) programme on the perceived support status of people with diabetes and the family's caregiver support behaviour amongst dyads living in Western Ethiopia. A 1:1 two-armed pilot randomised controlled trial (RCT) was conducted. A total of 76 dyads were recruited using the convenience sampling method and randomly assigned to either intervention or control groups. The control group continued the usual care, whereas the intervention group continued the usual care and additionally received a 12-h social cognitive theory (SCT)-guided, family-supported DSMES programme in the community. Generalised estimating equations models were computed to test the preliminary effects of the DSMES programme on the outcomes. P-value < 0.05 was set as statistically significant. The pilot RCT shows a statistically significant between-group difference in the changes in support needed at T1 (d = 0.88) and T2 (d = 1.35) and support received at T1 (d = 0.88) and T2 (d = 1.44). The DSMES programme has outperformed usual care with a medium effect size at T1 (d = 0.54) and a large effect size at T2 (d = 0.97) on the family's supportive behaviour. Although the intervention group was not statistically significant at T1 (d = 0.43), a large effect size was obtained at T2 (d = 0.97) on the family's non-supportive behaviour. A SCT-guided, family-supported DSMES programme produced a promising positive effect on enhancing the support needed and support received from their family/friends, and it also improved the family's supportive behaviour. Thus, family support could be incorporated into DSMES programmes for diabetes management in Western Ethiopia. The trial was registered by the Chinese Clinical Trial Registry ( http://www.chictr.org.cn ); Registration number: ChiCTR2000040292.
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Affiliation(s)
- Dereje Chala Diriba
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Doris Y P Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Lorna K P Suen
- School of Nursing, Tung Wah College, Hong Kong, Hong Kong SAR, China.
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Diriba DC, Leung DYP, Suen LKP. Factors predicted quality of life of people with type 2 diabetes in western Ethiopia. PLoS One 2023; 18:e0281716. [PMID: 36791135 PMCID: PMC9931092 DOI: 10.1371/journal.pone.0281716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Multiple factors predict the quality of life of adults with diabetes. However, the relationships of demographics, self-management practice, and support status with the quality of life of people with diabetes are unknown. Therefore, the study aimed to assess factors related with the quality of life of adults with type 2 diabetes in western Ethiopia. METHODS A hospital-based cross-sectional study involving adults with type 2 diabetes was conducted in western Ethiopia from June 02, 2020, to August 31, 2020. Convenience sampling technique was used in selecting subjects. The translated and psychometrically tested summary of diabetes self-management activities (expanded), diabetes quality of life, and diabetes care profile support scales were used in measuring self-management practice, quality of life, and support status, respectively. Data were collected via face-to-face interviews. Factors related with quality of life were examined through bivariate analysis and multivariable linear regression. In all statistical tests, P value <0.05 and confidence level that excluded zero were considered statistically significant. RESULTS A total of 417 adults with type 2 diabetes participated in the study. In a multivariable linear regression, seven factors including age, male, homemakers, those separated/divorced, number of years since diabetes diagnosis, self-management practice and support needed were related with quality of life. Male patients (β = 2.786, 95% CI = 1.285 to 4.287, p < 0.001), homemakers (β = 0.366, 95% CI = 0.056; 0.677, p = 0.021), self-management practice (β = 4.528, 95% CI = 3.851 to 5.205, p < 0.001) and those who needed support from their families or peers (β = 1.623, 95% CI = 0.458; 2.788, p = 0.006) were related positively with quality of life whereas those who separated or divorced (β = -1.698, 95% CI = -3.371 to -0.025, p = 0.047), older age (β = -0.195, 95% CI = -0.269 to -0.121, p < 0.001) and those who lived with diabetes for a longer duration (β = -2.206, 95% CI = -4.151 to -0.261, p = 0.026) were related negatively with quality of life. CONCLUSION Quality of life of people with type 2 diabetes living in western Ethiopia was predicted positively by being male, homemakers, having self-management practice, and support needed, whereas negatively influenced by old age, separation or divorce, and long diabetes life. Thus, encouraging self-management practice, and continuous family or friend support are necessary to enhance quality of life of people with type 2 diabetes. Further study should employ random sampling techniques and involve participants from multiple study settings to increase representativeness of the samples.
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Affiliation(s)
- Dereje Chala Diriba
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Doris Y. P. Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Lorna K. P. Suen
- School of Nursing, Tung Wah College, Hong Kong, Hong Kong SAR, China
- * E-mail:
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Shiyanbola OO, Maurer M, Mott M, Schwerer L, Sarkarati N, Sharp LK, Ward E. A feasibility pilot trial of a peer-support educational behavioral intervention to improve diabetes medication adherence in African Americans. Pilot Feasibility Stud 2022; 8:240. [PMID: 36376960 PMCID: PMC9660113 DOI: 10.1186/s40814-022-01198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 10/31/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND African Americans are twice as likely to die from diabetes, compared to other racial and ethnic groups in the USA. Poor adherence to diabetes medications is common among African Americans and contributes to these disproportionally worse outcomes. A pilot study was conducted to determine the feasibility and acceptability of a peer-supported intervention targeting diabetes and medication beliefs, communication, and self-efficacy skills to enhance medication adherence among African Americans with type 2 diabetes. METHODS Based on the extended self-regulatory model and information-motivation-behavioral skills model, this intervention was piloted using a single group pre/post-intervention study design at two sites. Seventeen African Americans who self-reported as adherent to diabetes medicines (ambassadors) were paired with 22 African Americans with self-reported poor medication adherence (buddies). Feasibility outcomes evaluated recruitment, retention, and intervention adherence. Measures assessed at baseline and 1-month post-intervention included glycemic control (hemoglobin A1c), self-reported medication adherence, diabetes beliefs, concerns about diabetes medicines, and diabetes self-efficacy. Wilcoxon signed-rank tests assessed for differences in mean scores of outcome variables at baseline compared with a 3-month follow-up. Semi-structured 60-min interviews were conducted with each buddy to explore their acceptability of the intervention. To ensure the rigor of the qualitative data, we focused on analytic criteria such as credibility, confirmability, and transferability. RESULTS Most buddies and ambassadors were female and about 56 years old. Feasibility outcomes included recruitment success rates of 73% for buddies and 85% for ambassadors relative to our goals. Retention rate for hemoglobin A1c and medication adherence outcome assessment was 95% for buddies. Both buddies and ambassadors had excellent intervention adherence, with buddies having a mean attendance of 7.76 out of 8 sessions/phone calls and ambassadors completing > 99% of the 105 intervention calls with Buddies. Results showed a signal of change in hemoglobin A1c (effect size = 0.14) and medication adherence (effect size = 0.35) among buddies, reduction in buddies' negative beliefs about diabetes and an increase in necessity beliefs of diabetes medicines. Summative interviews with buddies showed they valued ambassador's encouragement of self-management behaviors. CONCLUSIONS Results support conduct of an efficacy trial to address medication adherence for African Americans with type 2 diabetes using a peer-supported tailored intervention. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04028076 .
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Affiliation(s)
- Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA.
| | - Martha Maurer
- Sonderegger Research Center, School of Pharmacy, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA
| | - Mattigan Mott
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Luke Schwerer
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Nassim Sarkarati
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Lisa K Sharp
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago, IL, USA
| | - Earlise Ward
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
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Hawkins J, Kieffer EC, Sinco B, Piatt G, Jones L, Mitchell J, Espitia N, LeBron A, Kloss KA, Kurnick K, Palmsiano G, Spencer MS. Using Path Analysis and Linear Regression to Test for Gender and Participation: Effects in a Culturally Tailored Diabetes Intervention for Latino Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11982. [PMID: 36231282 PMCID: PMC9565909 DOI: 10.3390/ijerph191911982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/17/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
While the incidence and prevalence of type 2 diabetes is higher among Latino/as, Latino men are disproportionately affected and have poorer outcomes. We aimed to determine whether gender impacted any outcomes in a culturally tailored type 2 diabetes (T2D) intervention and to evaluate the effects of gender and intervention participation intensity on outcomes at 6-month follow-up. Nested path and regression models were compared with the likelihood ratio test and information criteria in a sample of Latino/a adults with T2D (n = 222) participating in a T2D community health worker (CHW)-led intervention. Path analysis showed that the effect of the intervention did not vary by gender. The intervention was associated with significant improvements in knowledge of T2D management 0.24 (0.10); p = 0.014, diabetes distress, -0.26 (0.12); p = 0.023, and self-efficacy, 0.61 (0.21); p = 0.005. At 6-month follow-up, improved self-management was associated with greater self-efficacy and Hemoglobin A1c (HbA1c) was lower by -0.18 (0.08); p = 0.021 for each unit of self-management behavior. Linear regressions showed that class attendance and home visits contributed to positive intervention results, while gender was non-significant. Pathways of change in a CHW-led culturally tailored T2D intervention can have a significant effect on participant behaviors and health status outcomes, regardless of gender.
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Affiliation(s)
- Jaclynn Hawkins
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Edith C. Kieffer
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Brandy Sinco
- Center for Healthcare Outcomes & Policy, University of Michigan, 2800 Plymouth Road, North Campus Research Complex, Bldg. 16, Ann Arbor, MI 48109, USA
| | - Gretchen Piatt
- Department of Learning Health Sciences, School of Medicine, University of Michigan, 1111 E. Catherine Street, Ann Arbor, MI 48109, USA
| | - Lenette Jones
- School of Nursing, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI 48109, USA
| | - Jamie Mitchell
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Nicolaus Espitia
- Department of Sociology, Anthropology, Social Work and Criminal Justice Oakland University, 614 Pioneer Dr, Rochester, MI 48309, USA
| | - Alana LeBron
- School of Public Health, University of California, Irvine, 3151 Social Science Plaza, SST 369 (Chicano/Latino Studies) OR 653 E Peltason Drive, AIRB 2026 (Public Health), Irvine, CA 92697, USA
| | - Katherine A. Kloss
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Katie Kurnick
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Gloria Palmsiano
- Community Health and Social Services Center, 5635 West Fort Street, Detroit, MI 48209, USA
| | - Michael S. Spencer
- School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA 98105, USA
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Wainwright K, Romanowich P, Crabtree MA. Associations between impulsivity and self-care adherence in individuals diagnosed with Type 2 or prediabetes. PLoS One 2022; 17:e0263961. [PMID: 35271620 PMCID: PMC8912230 DOI: 10.1371/journal.pone.0263961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 02/02/2022] [Indexed: 01/28/2023] Open
Abstract
Diabetes is a chronic disease requiring extensive self-care. Different impulsivity constructs, including choice-based and self-report personality measures are associated with decreasing diabetes self-care adherence. However, both choice-based and self-report impulsivity have never been measured for individuals diagnosed with either Type 2 or prediabetes in the same study. The current study examined the relationship between impulsivity and diabetes self-care in 101 adults diagnosed with either Type 2 or prediabetes. Results indicated that increasing self-reported impulsiveness was significantly correlated with decreasing Type 2 diabetic self-care, whereas the choice-based measure was not associated with any self-care measure. No association between impulsivity and self-care was significant for individuals diagnosed with prediabetes. Path analyses showed that self-reported impulsiveness directly and positively predicted problems controlling blood sugar levels in individuals diagnosed with either prediabetes or Type 2 diabetes. However, self-reported impulsiveness only indirectly and negatively predicted exercise and diet adherence via diabetes management self-efficacy for individuals diagnosed with Type 2 diabetes. These results show what specific impulsivity constructs and diabetes management self-efficacy may be incorporated into interventions for increasing specific self-care behaviors.
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Affiliation(s)
- Katherine Wainwright
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, United States of America
| | - Paul Romanowich
- Department of Psychology, Gonzaga University, Spokane, Washington, United States of America
- * E-mail:
| | - Meghan A. Crabtree
- Department of Psychology, Colorado State University, Fort Collins, Colorado, United States of America
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C Diriba D, Leung DYP, Suen LKP. A nurse-led, community-based self management program for people living with type 2 diabetes in Western Ethiopia: A feasibility and pilot study protocol. Diabet Med 2021; 38:e14587. [PMID: 33884643 DOI: 10.1111/dme.14587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 12/23/2022]
Abstract
AIM To develop and examine the preliminary effects of a nurse-led, community-based diabetes self management education and support program on clinical outcomes, self care behaviours, quality of life and family support through a pilot randomized controlled trial among adults living with type 2 diabetes in Western Ethiopia. METHODS A two-arm parallel-group pilot randomized controlled trial involving participant-caregiver dyads will be conducted. A total of 76 dyads will be recruited, with 38 dyads randomly allocated to the intervention arm receiving six sessions of the diabetes self management education and support program supported by an educational handbook, flier and video on top of the usual care; the control arm will continue to receive the usual care. The intervention will be guided by social cognitive theory and related international guidelines for diabetes management, addressing misconceptions, using culturally tailored foods and involving family members in the intervention. Participants will be recruited at Nekemte Specialized Hospital over 2 months. Nurses will deliver the intervention in the community in Nekemte, western Ethiopia. Diabetes self care behaviour, quality of life, family support, glycosylated haemoglobin, body mass index, blood pressure and lipid profiles will be assessed. Descriptive statistics will summarize the sociodemographic variables of the dyads; people living with diabetes' clinical outcomes, self care behaviours, quality of life and the level of family support; family caregivers' behaviours; and the acceptability level. Cohen's d will be computed to estimate the effect size. TRIAL REGISTRATION The Chinese Clinical Trial Registry prospectively registered the trial, and the registration number was ChiCTR2000040292.
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Affiliation(s)
- Dereje C Diriba
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Doris Y P Leung
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Alshehri MM, Alothman SA, Alenazi AM, Rucker JL, Phadnis MA, Miles JM, Siengsukon CF, Kluding PM. The effects of cognitive behavioral therapy for insomnia in people with type 2 diabetes mellitus, pilot RCT part II: diabetes health outcomes. BMC Endocr Disord 2020; 20:136. [PMID: 32891140 PMCID: PMC7487570 DOI: 10.1186/s12902-020-00612-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Previous studies have shown the negative impact of sleep disturbances, specifically insomnia symptoms, on glucose metabolism for people with type 2 diabetes (T2D). People with insomnia symptoms are at risk of poor glycemic control and suboptimal diabetes self-care behavior (DSCB). Investigating the impact of a safe and effective intervention for individuals with T2D and insomnia symptoms on diabetes' health outcomes is needed. Therefore, the aim of this exploratory study is to examine the effects of Cognitive Behavioral Therapy for Insomnia (CBT-I) on glycemic control, DSCB, and fatigue. METHODS Twenty-eight participants with T2D and insomnia symptoms, after passing an eligibility criteria at a medical research center, were randomly assigned to CBT-I (n = 14) or Health Education (HE; n = 14). The CBT-I and HE groups received 6 weekly one-hour sessions. This Randomized Controlled Trial (RCT) used a non-inferiority framework to test the effectiveness of CBT-I. Validated assessments were administered at baseline and post-intervention to assess glycemic control, DSCB, and fatigue. A Wilcoxon signed-rank test was utilized to compare within-group changes from baseline to post-intervention. A Mann-Whitney test was utilized to measure the between-group differences. Linear regression was used to assess the association between the blood glucose level and the number of days in the CBT-I group. RESULTS The recruitment duration was from October 2018 to May 2019. A total of 13 participants completed the interventions in each group and are included in the final analysis. No adverse events, because of being a part of this RCT, were reported. CBT-I participants showed significantly greater improvement in glycemic control, DSCB, and fatigue. There was a significant association between the number of days in the CBT-I intervention with the blood glucose level before bedtime (B = -0.56, p = .009) and after awakening in the morning (B = -0.57, p = .007). CONCLUSIONS This study demonstrated a clinically meaningful effect of CBT-I on glycemic control in people with T2D and insomnia symptoms. Also, CBT-I positively impacted daytime functioning, including DSCB and fatigue. Future research is needed to investigate the long-term effects of CBT-I on laboratory tests of glycemic control and to understand the underlying mechanisms of any improvements. TRIAL REGISTRATION Clinical Trials Registry ( NCT03713996 ). Retrospectively registered on 22 October 2018.
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Affiliation(s)
- Mohammed M Alshehri
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd., Mail Stop 2002, Kansas City, Kansas, 66160, USA.
- Physical Therapy Department, Jazan University, Jazan, Southern Region, Saudi Arabia.
| | - Shaima A Alothman
- Lifestyle and Health Research Center, Princess Nora bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Aqeel M Alenazi
- Physical Therapy Department, Prince Sattam Bin Abdulaziz University, Alkharj, Central Region, Saudi Arabia.
| | - Jason L Rucker
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd., Mail Stop 2002, Kansas City, Kansas, 66160, USA
| | - Milind A Phadnis
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - John M Miles
- Endocrinology Department, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Catherine F Siengsukon
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd., Mail Stop 2002, Kansas City, Kansas, 66160, USA
| | - Patricia M Kluding
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd., Mail Stop 2002, Kansas City, Kansas, 66160, USA
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Alshehri MM, Alenazi AM, Hoover JC, Alothman SA, Phadnis MA, Miles JM, Kluding PM, Siengsukon CF. A comparison of diabetes self-care behavior in people with type 2 diabetes with and without insomnia symptoms. Acta Diabetol 2020; 57:651-659. [PMID: 31909434 DOI: 10.1007/s00592-019-01470-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/16/2019] [Indexed: 12/27/2022]
Abstract
AIMS Individuals with type 2 diabetes (T2DM) are advised to undertake diabetes self-care behavior (DSCB) in order to avoid complications of T2DM. However, comorbidities, such as insomnia symptoms which are commonly reported in people with T2DM, may limit the ability to engage in DSCB. Insomnia and the common sequelae accompanying insomnia such as pain, depression, and anxiety may negatively influence the performance of DSCB. Therefore, this study aimed to compare the DSCB of people with T2DM with and without insomnia symptoms. METHODS Sixty participants with T2DM were divided into two groups based on the presence of insomnia symptoms: T2DM-only group and T2DM+ insomnia group. Insomnia symptoms were identified using the Insomnia Severity Index (ISI). DSCB was assessed using the Diabetic Care Profile (DCP). A standardized composite score was established to account for all of the DCP domains. Chi-square and independent sample t tests were used to assess between-group differences in categorical and continuous variables, respectively. Stepwise linear regression analysis used the ISI score to predict standardized DCP composite score, while controlling for covariates. RESULTS Significant between-group differences were found in age, symptoms of pain, depression, and anxiety. The total DCP composite score was significantly lower in the T2DM+ insomnia group compared to the T2DM-only group (- 0.30 ± 0.46 vs. 0.36 ± 0.48, respectively, p < 0.001) with large effect size (g = 1.40). Stepwise linear regression results showed that a 1-point increase in ISI score significantly predicted a .03-point decrease in standardized DCP composite score, after controlling for age, symptoms of pain, depression, and anxiety (β = - 0.03, p = 0.04). CONCLUSIONS The data suggest that people with T2DM and insomnia symptoms had worse scores on the majority of the DSCB domains and a worse DCP composite score compared to people with T2DM only. The data suggest a negative association between insomnia severity and DSCB among people with T2DM. Further research using a larger sample size and more rigorous research design is required to examine the causal relationship between insomnia symptoms and DSCB.
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Affiliation(s)
- Mohammed M Alshehri
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd, Mail Stop 2002, Kansas City, KS, 66160, USA.
- Physical Therapy Department, Jazan University, Jazan, Southern Region, Saudi Arabia.
| | - Aqeel M Alenazi
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd, Mail Stop 2002, Kansas City, KS, 66160, USA
- Physical Therapy Department, Prince Sattam Bin Abdulaziz University, Alkharj, Central Region, Saudi Arabia
| | - Jeffrey C Hoover
- Psychology and Educational Research Department, University of Kansas, Lawrence, KS, USA
| | - Shaima A Alothman
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd, Mail Stop 2002, Kansas City, KS, 66160, USA
| | - Milind A Phadnis
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - John M Miles
- Endocrinology Department, University of Kansas Medical Center, Kansas City, KS, USA
| | - Patricia M Kluding
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd, Mail Stop 2002, Kansas City, KS, 66160, USA
| | - Catherine F Siengsukon
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd, Mail Stop 2002, Kansas City, KS, 66160, USA
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Alshehri MM, Alenazi AM, Hoover JC, Alothman SA, Phadnis MA, Rucker JL, Befort CA, Miles JM, Kluding PM, Siengsukon CF. Effect of Cognitive Behavioral Therapy for Insomnia on Insomnia Symptoms for Individuals With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e14647. [PMID: 31855189 PMCID: PMC6940863 DOI: 10.2196/14647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 12/17/2022] Open
Abstract
Background Insomnia symptoms are a common form of sleep difficulty among people with type 2 diabetes (T2D) affecting sleep quality and health outcomes. Several interventional approaches have been used to improve sleep outcomes in people with T2D. Nonpharmacological approaches, such as cognitive behavioral therapy for insomnia (CBT-I), show promising results regarding safety and sustainability of improvements, although CBT-I has not been examined in people with T2D. Promoting sleep for people with insomnia and T2D could improve insomnia severity and diabetes outcomes. Objective The objective of this study is to establish a protocol for a pilot randomized controlled trial (RCT) to examine the effect of 6 sessions of CBT-I on insomnia severity (primary outcome), sleep variability, and other health-related outcomes in individuals with T2D and insomnia symptoms. Methods This RCT will use random mixed block size randomization with stratification to assign 28 participants with T2D and insomnia symptoms to either a CBT-I group or a health education group. Outcomes including insomnia severity; sleep variability; diabetes self-care behavior (DSCB); glycemic control (A1c); glucose level; sleep quality; daytime sleepiness; and symptoms of depression, anxiety, and pain will be gathered before and after the 6-week intervention. Chi-square and independent t tests will be used to test for between-group differences at baseline. Independent t tests will be used to examine the effect of the CBT-I intervention on change score means for insomnia severity, sleep variability, DSCB, A1c, fatigue, sleep quality, daytime sleepiness, and severity of depression, anxiety, and pain. For all analyses, alpha level will be set at .05. Results This study recruitment began in February 2019 and was completed in September 2019. Conclusions The intervention, including 6 sessions of CBT-I, will provide insight about its effect in improving insomnia symptoms, sleep variability, fatigue, and diabetes-related health outcomes in people with T2D and those with insomnia symptoms when compared with control. Trial Registration ClinicalTrials.gov NCT03713996; https://clinicaltrials.gov/ct2/show/NCT03713996 International Registered Report Identifier (IRRID) DERR1-10.2196/14647
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Affiliation(s)
- Mohammed M Alshehri
- University of Kansas Medical Center, Lenexa, KS, United States.,Jazan University, Jazan, Saudi Arabia
| | - Aqeel M Alenazi
- University of Kansas Medical Center, Kansas City, KS, United States.,Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Jeffrey C Hoover
- University of Kansas Medical Center, Kansas City, KS, United States
| | | | - Milind A Phadnis
- University of Kansas Medical Center, Kansas City, KS, United States
| | - Jason L Rucker
- University of Kansas Medical Center, Kansas City, KS, United States
| | | | - John M Miles
- University of Kansas Medical Center, Kansas City, KS, United States
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Aronson R, Li A, Brown RE, Walker A, Lyons A, Orzech N. Optimizing Diabetes Self-management Using the Novel Skills, Confidence, and Preparedness Index (SCPI). Diabetes Care 2019; 42:1873-1878. [PMID: 31399439 DOI: 10.2337/dc19-0699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/23/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The Skills, Confidence, and Preparedness Index (SCPI) is an electronic tool designed to assess three dimensions (knowledge, confidence, and preparedness) in a clinically relevant measure with immediate feedback to guide the individualization of patient education. This study sought to assess the validity and reliability of the final SCPI generation, its relevance to glycemia, and its responsiveness to patient education. RESEARCH DESIGN AND METHODS In Part 1, patients with type 1 and type 2 diabetes were recruited from specialist clinics over a 6-month period and completed the 23-item SCPI using a tablet. In Part 2, participants also underwent a diabetes self-management education (DSME) program. Baseline SCPI score was used to guide the DSME, and SCPI and glycemia were assessed at completion. RESULTS In total, 423 patients met inclusion criteria and 405 had evaluable data. SCPI scores were found to have a high degree of validity, internal consistency, and test-retest reliability, with no floor or ceiling effects. Scoring was negatively correlated with HbA1c (type 1 diabetes: r = -0.26, P = 0.001; type 2 diabetes: r = -0.20, P = 0.004). In 51 participants who underwent a DSME intervention (6.4 ± 0.6 visits over a mean ± SD 3.4 ± 0.8 months), mean HbA1c improvement was 1.2 ± 0.2% (13.1 ± 2.2 mmol/mol, P < 0.0001). Total SCPI score and each subscore improved in parallel. CONCLUSIONS The SCPI tool is a quick and easy-to-use measurement of three domains: skills, confidence, and preparedness. The instant scoring and feedback and its relationship to glycemic control should improve the efficiency and quality of individualizing care in the diabetes clinic.
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Affiliation(s)
| | - Aihua Li
- LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
| | - Ruth E Brown
- LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
| | | | - Ashley Lyons
- LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
| | - Naomi Orzech
- LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
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12
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Randomized Trial of a Lifestyle Intervention for Urban Low-Income African Americans with Type 2 Diabetes. J Gen Intern Med 2019; 34:1174-1183. [PMID: 30963440 PMCID: PMC6614233 DOI: 10.1007/s11606-019-04894-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/12/2018] [Accepted: 01/22/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND African Americans suffer more than non-Hispanic whites from type 2 diabetes, but diabetes self-management education (DSME) has been less effective at improving glycemic control for African Americans. Our objective was to determine whether a novel, culturally tailored DSME intervention would result in sustained improvements in glycemic control in low-income African-American patients of public hospital clinics. RESEARCH DESIGN AND METHODS This randomized controlled trial (n = 211) compared changes in hemoglobin A1c (A1c) at 6, 12, and 18 months between two arms: (1) Lifestyle Improvement through Food and Exercise (LIFE), a culturally tailored, 28-session community-based intervention, focused on diet and physical activity, and (2) a standard of care comparison group receiving two group DSME classes. Cluster-adjusted ANCOVA modeling was used to assess A1c changes from baseline to 6, 12, and 18 months, respectively, between arms. RESULTS At 6 months, A1c decreased significantly more in the intervention group than the control group (- 0.76 vs - 0.21%, p = 0.03). However, by 12 and 18 months, the difference was no longer significant (12 months - 0.63 intervention vs - 0.45 control, p = 0.52). There was a decrease in A1c over 18 months in both the intervention (β = - 0.026, p = 0.003) and the comparison arm (β = - 0.018, p = 0.048) but no difference in trend (p = 0.472) between arms. The intervention group had greater improvements in nutrition knowledge (11.1 vs 6.0 point change, p = 0.002) and diet quality (4.0 vs - 0.5 point change, p = 0.018) while the comparison group had more participants with improved medication adherence (24% vs 10%, p < 0.05) at 12 months. CONCLUSIONS The LIFE intervention resulted in improved nutrition knowledge and diet quality and the comparison intervention resulted in improved medication adherence. LIFE participants showed greater A1c reduction than standard of care at 6 months but the difference between groups was no longer significant at 12 and 18 months. NIH TRIAL REGISTRY NUMBER NCT01901952.
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Mendez Campos B, Kieffer EC, Sinco B, Palmisano G, Spencer MS, Piatt GA. Effectiveness of a Community Health Worker-Led Diabetes Intervention among Older and Younger Latino Participants: Results from a Randomized Controlled Trial. Geriatrics (Basel) 2018; 3:47. [PMID: 30345345 PMCID: PMC6192048 DOI: 10.3390/geriatrics3030047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/01/2018] [Indexed: 12/16/2022] Open
Abstract
Diabetes management for older Latino adults is complex, given a higher incidence of multiple coexisting medical conditions and psychosocial barriers to self-management. Community health workers (CHWs) may be effective in reducing these barriers. The REACH Detroit CHW randomized controlled intervention studies with Latino/as with diabetes found improvements in self-management behaviors and glucose control after participating in a CHW-led intervention. Using data from the REACH Detroit Partnership's cohort 3, this study used descriptive statistics and multiple linear regression analyses to evaluate whether the six-month CHW intervention had a greater effect on older Latino/as (ages 55 and older) than younger participants between baseline and post-intervention follow-up at six months. There were significant intervention effects by age group that varied by outcome. Compared to a control group that received enhanced usual care, there were statistically significant intervention effects demonstrating greater self-efficacy scores 1.27 (0.23, 2.32); p < 0.05, and reductions in HbA1c 1.02 (-1.96,-0.07); p < 0.05, among older participants in the CHW intervention, and increases in diabetes support 0.74 (0.34, 1.13); p < 0.001; and understanding of diabetes management 0.39 (0.08, 0.70); p < 0.01 among younger participants.
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Affiliation(s)
- Barbara Mendez Campos
- University of Michigan School of Social Work, Ann Arbor, MI 48109, USA; (E.C.K.); (B.S.); (M.S.S.)
| | - Edith C. Kieffer
- University of Michigan School of Social Work, Ann Arbor, MI 48109, USA; (E.C.K.); (B.S.); (M.S.S.)
| | - Brandy Sinco
- University of Michigan School of Social Work, Ann Arbor, MI 48109, USA; (E.C.K.); (B.S.); (M.S.S.)
| | - Gloria Palmisano
- Community Health and Social Services (CHASS), Detroit, MI 48209, USA;
| | - Michael S. Spencer
- University of Michigan School of Social Work, Ann Arbor, MI 48109, USA; (E.C.K.); (B.S.); (M.S.S.)
| | - Gretchen A. Piatt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI 48109, USA;
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Spencer MS, Kieffer EC, Sinco B, Piatt G, Palmisano G, Hawkins J, Lebron A, Espitia N, Tang T, Funnell M, Heisler M. Outcomes at 18 Months From a Community Health Worker and Peer Leader Diabetes Self-Management Program for Latino Adults. Diabetes Care 2018; 41:1414-1422. [PMID: 29703724 PMCID: PMC6014532 DOI: 10.2337/dc17-0978] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 04/07/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study evaluated the effectiveness of a community health worker (CHW) diabetes self-management education (DSME) program, followed by two different approaches to maintain improvements in HbA1c and other clinical and patient-centered outcomes over 18 months. RESEARCH DESIGN AND METHODS The study randomized 222 Latino adults with type 2 diabetes and poor glycemic control from a federally qualified health center to 1) a CHW-led, 6-month DSME program or 2) enhanced usual care (EUC). After the 6-month program, participants randomized to the CHW-led DSME were further randomized to 1) 12 months of CHW-delivered monthly telephone outreach (CHW-only) or 2) 12 months of weekly group sessions delivered by peer leaders (PLs) with telephone outreach to those unable to attend (CHW+PL). The primary outcome was HbA1c. Secondary outcomes were blood pressure, lipid levels, diabetes distress, depressive symptoms, understanding of diabetes self-management, and diabetes social support. Assessments were conducted at baseline and at 6, 12, and 18 months. RESULTS Participants in the CHW intervention at the 6-month follow-up had greater decreases in HbA1c (-0.45% [95% CI -0.87, -0.03]; P < 0.05) and in diabetes distress (-0.3 points [95% CI -0.6, -0.03]; P < 0.05) compared with EUC. CHW+PL participants maintained HbA1c improvements at 12 and 18 months, and CHW-only participants maintained improvements in diabetes distress at 12 and 18 months. CHW+PL participants also had significantly fewer depressive symptoms at 18 months compared with EUC (-2.2 points [95% CI -4.1, -0.3]; P < 0.05). Participants in CHW-led DSME had significant improvements in diabetes social support and in understanding of diabetes self-management at 6 months relative to EUC, but these intervention effects were not sustained at 18 months. CONCLUSIONS This study demonstrates the effectiveness of a 6-month CHW intervention on key diabetes outcomes and of a volunteer PL program in sustaining key achieved gains. These are scalable models for health care centers in low-resource settings for achieving and maintaining improvements in key diabetes outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Tricia Tang
- University of British Columbia, Vancouver, British Columbia, Canada
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15
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Fincham FD, Seibert GS, May RW, Wilson CM, Lister ZD. Religious Coping and Glycemic Control in Couples with Type 2 Diabetes. JOURNAL OF MARITAL AND FAMILY THERAPY 2018; 44:138-149. [PMID: 28589560 DOI: 10.1111/jmft.12241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This study examines the role of religious coping in couples' diabetes management processes. Eighty-seven couples where one spouse had type 2 diabetes were surveyed. The relationships between religious coping (positive and negative), shared glycemic control activities (e.g., planning a healthy diet), and glycemic control were examined using repeated measures ANOVA and SEM. Findings show spousal engagement in shared activities is significantly associated with glycemic control. Furthermore, the use of negative religious coping by the diabetic spouse, and positive religious coping by the nondiabetic spouse, related to lower levels and higher levels of shared glycemic control activities, respectively. Religious coping and shared glycemic control activities appear integral to couples managing type 2 diabetes and, may serve as useful points of intervention.
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Affiliation(s)
| | | | - Ross W May
- Family Institute, The Florida State University, Florida
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16
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Ramkisson S, Pillay BJ, Sibanda W. Social support and coping in adults with type 2 diabetes. Afr J Prim Health Care Fam Med 2017; 9:e1-e8. [PMID: 28828879 PMCID: PMC5566130 DOI: 10.4102/phcfm.v9i1.1405] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/23/2017] [Accepted: 04/09/2017] [Indexed: 01/20/2023] Open
Abstract
Background The diagnosis of diabetes has been described as a lifelong psychological burden on the patient and his or her family. Social support plays a pivotal role in patients with diabetes and is important in enabling them to cope effectively with the disease. There is a dearth of research on social support and coping in patients with diabetes in South Africa. Objectives The aim of this study was to explore whether patients with poor perceived social support have lower levels of well-being and coping than patients with good social support. Method A cross-sectional study was conducted at both public and private facilities on the north coast of KwaZulu-Natal, South Africa. The Diabetes Care Profile (DCP), the General Health Questionnaire (GHQ), the Social Support Questionnaire (SSQ) and the WHO-5 Well-being Index (WHO-5) were administered to 401 participants. Results The findings indicate that there is an inverse relationship between social support and coping, which suggests that an increase in social support is associated with a decrease in emotional distress. There was a small positive correlation between the SSQ and the WHO-5, which suggests participants who had good support endorsed better levels of well-being. Although participants indicated that they were satisfied with their level of support, they had poor coping as indicated by the high mean score on the GHQ and the high HbA1c level. There was a small positive correlation between GHQ and HbA1c. There was no association between social support and HbA1c. Conclusion Social support is important in helping the patient with diabetes cope with the disease and to improve adherence to treatment. Health care providers should take cognisance of psychosocial factors in the treatment regime of the patient. Family members should be educated about diabetes, the importance of adherence and long-term complications of the disease.
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Affiliation(s)
- Samantha Ramkisson
- Department of Behavioural Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal.
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17
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Kim Yeary KHC, Long CR, Bursac Z, McElfish PA. Design of a randomized, controlled, comparative-effectiveness trial testing a Family Model of Diabetes Self-Management Education (DSME) vs. Standard DSME for Marshallese in the United States. Contemp Clin Trials Commun 2017; 6:97-104. [PMID: 29740640 PMCID: PMC5936863 DOI: 10.1016/j.conctc.2017.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/24/2017] [Accepted: 03/28/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is a significant public health problem, with U.S. Pacific Islander communities-such as the Marshallese-bearing a disproportionate burden. Using a community-based participatory approach (CBPR) that engages the strong family-based social infrastructure characteristic of Marshallese communities is a promising way to manage T2D. OBJECTIVES Led by a collaborative community-academic partnership, the Family Model of Diabetes Self-Management Education (DSME) aimed to change diabetes management behaviors to improve glycemic control in Marshallese adults with T2D by engaging the entire family. DESIGN To test the Family Model of DSME, a randomized, controlled, comparative effectiveness trial with 240 primary participants was implemented. Half of the primary participants were randomly assigned to the Standard DSME and half were randomly assigned to the Family Model DSME. Both arms received ten hours of content comprised of 6-8 sessions delivered over a 6-8 week period. METHODS The Family Model DSME was a cultural adaptation of DSME, whereby the intervention focused on engaging family support for the primary participant with T2D. The Standard DSME was delivered to the primary participant in a community-based group format. Primary participants and participating family members were assessed at baseline and immediate post-intervention, and will also be assessed at 6 and 12 months. SUMMARY The Family Model of DSME aimed to improve glycemic control in Marshallese with T2D. The utilization of a CBPR approach that involves the local stakeholders and the engagement of the family-based social infrastructure of Marshallese communities increase potential for the intervention's success and sustainability.
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Affiliation(s)
- Karen Hye-cheon Kim Yeary
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, USA
| | - Christopher R. Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Zoran Bursac
- College of Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38163, USA
| | - Pearl Anna McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
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18
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Heisler M, Mase R, Brown B, Wilson S, Reeves PJ. Study protocol: The Technology-Enhanced Coaching (TEC) program to improve diabetes outcomes - A randomized controlled trial. Contemp Clin Trials 2017; 55:24-33. [PMID: 28132876 PMCID: PMC5510884 DOI: 10.1016/j.cct.2017.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/19/2017] [Accepted: 01/21/2017] [Indexed: 10/20/2022]
Abstract
Background Racial and ethnic minority adults with diabetes living in under-resourced communities face multiple barriers to sustaining self-management behaviors necessary to improve diabetes outcomes. Peer support and decision support tools each have been associated with improved diabetes outcomes. Methods 290 primarily African American adults with poor glycemic control were recruited from the Detroit Veteran's Administration Hospital and randomized to Technology-Enhanced Coaching (TEC) or Peer Coaching alone. Participants in both arms were assigned a peer coach trained in autonomy-supportive approaches. Coaches are diabetes patients with prior poor glycemic control who now have good control. Participants met face-to-face initially with their coach to review diabetes education materials and develop an action plan. Educational materials in the TEC arm are delivered via a web-based, educational tool tailored with each participant's personalized health data (iDecide). Over six months, coaches call their assigned participants once a week to provide support for weekly action steps. Data are also collected on an Observational Control group with no contact with study staff. Changes in A1c, blood pressure, other patient-centered outcomes and mediators and moderators of intervention effects will be assessed. Results 290 participants were enrolled. Discussion Tailored e-Health tools with educational content may enhance the effectiveness of peer coaching programs to better prepare patients to set self-management goals, identify action plans, and discuss treatment options with their health care providers. The study will provide insights for scalable self-management support programs for diabetes and chronic illnesses that require high levels of sustained patient self-management.
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Affiliation(s)
- Michele Heisler
- Center for Clinical Management Research Ann Arbor VA, HSR&D, Ann Arbor, MI, United States; Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Rebecca Mase
- Center for Clinical Management Research Ann Arbor VA, HSR&D, Ann Arbor, MI, United States; Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, United States.
| | - Brianne Brown
- Center for Clinical Management Research Ann Arbor VA, HSR&D, Ann Arbor, MI, United States
| | - Shayla Wilson
- Center for Clinical Management Research Ann Arbor VA, HSR&D, Ann Arbor, MI, United States
| | - Pamela J Reeves
- John D. Dingell VA Medical Center, Detroit, MI, United States
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Lynch E, Mack LJ, Karavolos K, Avery E, Liebman R, Keim KS, Glover CM, Fogelfeld L. Recruitment and Baseline Characteristics of Participants in the Lifestyle Improvement Through Food and Exercise (LIFE) Study. J Health Care Poor Underserved 2017; 28:463-486. [PMID: 28239013 DOI: 10.1353/hpu.2017.0034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
African Americans experience poorer diabetes outcomes than non-Hispanic Whites. Few clinical trials of diabetes self-management interventions specifically target African Americans, perhaps due to well-documented barriers to recruitment in this population. This paper describes strategies used to successfully recruit 211 low-income African Americans from community clinics of a large, urban public hospital system to a randomized clinical trial of an 18-month diabetes self-management intervention. Diabetes-related physiological, psychosocial, and behavioral characteristics of the sample are reported. The sample was 77% female, mean age = 55, mean A1C = 8.5%, 39% low health literacy, 28.4% moderate/severe depression, and 48.3% low adherence. Participants ate a high-fat diet with low vegetable consumption. Relative to males, females had higher BMI, depression, and stress, and better glycemic control, less physical activity, and less alcohol consumption. Males consumed more daily calories, but females consumed a greater proportion of carbohydrates. Gender-specific diabetes self-management strategies may be warranted in this population.
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20
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Chyun D, Lacey KO, Katten DM, Talley S, Price WJ, Davey JA, Melkus GD. Glucose and Cardiac Risk Factor Control in Individuals With Type 2 Diabetes. DIABETES EDUCATOR 2016; 32:925-39. [PMID: 17102160 DOI: 10.1177/0145721706295016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this descriptive study was to describe attainment of glucose and coronary heart disease (CHD) risk factor goals and to identify factors that were associated with successful goal achievement. Methods A cross-sectional survey enrolled 110 subjects with type 2 diabetes undergoing screening for asymptomatic myocardial ischemia. Results Many participants had HbA1c levels ≥7% (45%), and 46% to 79% were not meeting goals for CHD risk reduction. Individual factors of age, gender, and anxiety; the illness-related factor of lipid-lowering therapy; and the family-related factor of living alone were independently associated with 1 of the 7 outcomes under study. Illness-related factors of a longer duration of diabetes were strongly associated with glucose and blood pressure control, insulin use with glucose control and waist circumference, and antihypertensive use with blood pressure, triglycerides, and body mass index. Family-related factors of higher income were significantly associated with poorer glucose control and higher body mass index, while higher levels of perceived support by family and friends were associated with a lower risk of not meeting lipid goals. However, individual factors, represented by several aspects of personal model beliefs (exercising regularly, testing glucose, and checking one’s feet) and physical activity, were consistently related to lipid and weight control. Conclusions A variety of factors were associated with control of blood glucose and CHD risk factors, suggesting that a one-size-fits-all approach to multiple risk factor reduction efforts may not result in goal attainment.
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Affiliation(s)
- Deborah Chyun
- The Yale University School of Nursing, New Haven, Connecticut (Dr Chyun, Ms Lacey, Dr Talley, Dr Melkus)
| | - Kimberly O Lacey
- The Yale University School of Nursing, New Haven, Connecticut (Dr Chyun, Ms Lacey, Dr Talley, Dr Melkus)
| | | | - Sandra Talley
- The Yale University School of Nursing, New Haven, Connecticut (Dr Chyun, Ms Lacey, Dr Talley, Dr Melkus)
| | - Wendie J Price
- University of Virginia Medical System, Charlottesville (Ms Price)
| | - Janice A Davey
- Yale University School of Medicine, New Haven, Connecticut (Ms Davey)
| | - Gail D Melkus
- The Yale University School of Nursing, New Haven, Connecticut (Dr Chyun, Ms Lacey, Dr Talley, Dr Melkus)
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McCaskill GM, Bolland KA, Burgio KL, Leeper J. Development and validation of a diabetes self-management instrument for older African-Americans. SOCIAL WORK IN HEALTH CARE 2016; 55:381-394. [PMID: 27045578 DOI: 10.1080/00981389.2015.1129012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of this study was to develop and validate a new diabetes self-management instrument for older African-Americans 65 years of age and older. The Self-Care Utility Geriatric African-American Rating (SUGAAR) was developed using the American Diabetes Association's standards for the management of type 2 diabetes in older adults and cognitive interviews with older African-Americans. The instrument underwent extensive review by a panel of experts, two rounds of cognitive interviews, and a pilot test before it was administered in an interview format to 125 community-dwelling older African-Americans. The instrument demonstrated content validity and significant, but modest, convergent validity with items from an established diabetes self-management instrument. Social workers and health care professionals can use the SUGARR to assess diabetes self-management and to identify areas for education and support for older African-Americans with type 2 diabetes.
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Affiliation(s)
- Gina M McCaskill
- a Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC) , Department of Veterans Affairs , Birmingham , Alabama , USA
- b Comprehensive Center for Healthy Aging, School of Medicine , The University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Kathleen A Bolland
- c School of Social Work , The University of Alabama , Tuscaloosa , Alabama , USA
| | - Kathryn L Burgio
- a Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC) , Department of Veterans Affairs , Birmingham , Alabama , USA
- b Comprehensive Center for Healthy Aging, School of Medicine , The University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - James Leeper
- d Department of Community and Rural Medicine , The University of Alabama , Tuscaloosa , Alabama , USA
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Rosland AM, Kieffer E, Spencer M, Sinco B, Palmisano G, Valerio M, Nicklett E, Heisler M. Do pre-existing diabetes social support or depressive symptoms influence the effectiveness of a diabetes management intervention? PATIENT EDUCATION AND COUNSELING 2015; 98:1402-1409. [PMID: 26234800 PMCID: PMC4609239 DOI: 10.1016/j.pec.2015.05.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 03/27/2015] [Accepted: 05/28/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Examine influences of diabetes-specific social support (D-SS) and depressive symptoms on glycemic control over time, among adults randomized to a diabetes self-management education and support (DSME/S) intervention or usual care. METHODS Data were from 108 African-American and Latino participants in a 6-month intervention trial. Multivariable linear regression models assessed associations between baseline D-SS from family and friends and depressive symptoms with changes in HbA1c. We then examined whether baseline D-SS or depression moderated intervention-associated effects on HbA1c. RESULTS Higher baseline D-SS was associated with larger improvements in HbA1c (adjusted ΔHbA1c -0.39% for each +1-point D-SS, p=0.02), independent of intervention-associated HbA1c decreases. Baseline depressive symptoms had no significant association with subsequent HbA1c change. Neither D-SS nor depression moderated intervention-associated effects on HbA1c. CONCLUSIONS AND PRACTICE IMPLICATIONS Diabetes self-management education and support programs have potential to improve glycemic control for participants starting with varying levels of social support and depressive symptoms. Participants starting with more support for diabetes management from family and friends improved HbA1c significantly more over 6 months than those with less support, independent of additional significant DSME/S intervention-associated HbA1c improvements. Social support from family and friends may improve glycemic control in ways additive to DSME/S.
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Affiliation(s)
- Ann-Marie Rosland
- University of Michigan Medical School, Department of Internal Medicine, USA; VA Ann Arbor Center for Clinical Management Research, USA.
| | | | | | - Brandy Sinco
- University of Michigan School of Social Work, USA
| | | | - Melissa Valerio
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, USA
| | | | - Michele Heisler
- University of Michigan Medical School, Department of Internal Medicine, USA; VA Ann Arbor Center for Clinical Management Research, USA; University of Michigan School of Public Health, Department of Health Behavior and Health Education, USA
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Lu Y, Xu J, Zhao W, Han HR. Measuring Self-Care in Persons With Type 2 Diabetes: A Systematic Review. Eval Health Prof 2015; 39:131-84. [PMID: 26130465 DOI: 10.1177/0163278715588927] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This systematic review examines the characteristics and psychometric properties of the instruments used to assess self-care behaviors among persons with type 2 diabetes. Electronic databases were searched for relevant studies published in English within the past 20 years. Thirty different instruments were identified in 75 articles: 18 original instruments on type 2 diabetes mellitus self-care, 8 translated or revised version, and 4 not specific but relevant to diabetes. Twenty-one instruments were multidimensional and addressed multiple dimensions of self-care behavior. Nine were unidimensional: three focusing exclusively on medication taking, three on diet, one on physical activity, one on self-monitoring of blood glucose, and one on oral care. Most instruments (22 of 30) were developed during the last decade. Only 10 were repeated more than once. Nineteen of the 30 instruments reported both reliability and validity information but with varying degrees of rigor. In conclusion, most instruments used to measure self-care were relatively new and had been applied to only a limited number of studies with incomplete psychometric profiles. Rigorous psychometric testing, operational definition of self-care, and sufficient explanation of scoring need to be considered for further instrument development.
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Affiliation(s)
- Yan Lu
- School of Nursing, China Medical University, Shenyang City, Liaoning Province, People's Republic of China
| | - Jiayun Xu
- Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Weigang Zhao
- Endocrinology Department, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Hae-Ra Han
- Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, MD, USA
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Compeán Ortiz LG, Del Ángel Pérez B, Reséndiz González E, Piñones Martínez S, González Quirarte NH, Berry DC. Self-Care Behaviors and Glycemic Control in Low-Income Adults in México With Type 2 Diabetes Mellitus May Have Implications for Patients of Mexican Heritage Living in the United States. Clin Nurs Res 2015; 25:120-38. [PMID: 26040723 DOI: 10.1177/1054773815586542] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This study examined self-care behaviors and their relationship to glycemic control in low-income Mexican adults with type 2 diabetes in Southeastern Tamaulipas, México. A total of 135 patients were enrolled from 17 community health centers. The most frequent self-care behavior was medication management (80%), and the least frequent self-care behavior was self blood glucose monitoring (7%). All the patients demonstrated poor glycemic control, with glycated hemoglobin > 7%. Self-care behaviors were associated with fasting blood glucose (rs = .223, p = .005). Medication management was influenced by cognitive performance, F(1, 130) = 4.49, p = .036, and depression, F(1, 130) = 8.22, p = .005. Dietary behaviors were influenced by previous diabetes education, F(1, 130) = 6.73, p = .011. These findings indicate that education and cognitive behavioral interventions in Spanish for Mexican adults with type 2 diabetes are urgently needed.
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Affiliation(s)
| | | | | | | | | | - Diane C Berry
- The University of North Carolina at Chapel Hill, USA
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25
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Strom Williams J, Walker RJ, Lynch CP, Voronca D, Egede LE. Meaning of Illness and Self-Care in Patients With Type 2 Diabetes. DIABETES EDUCATOR 2015; 41:301-8. [DOI: 10.1177/0145721715572445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose The purpose of this study was to assess the relationship between meaning of illness, diabetes knowledge, self-care understanding, and behaviors in a group of individuals with type 2 diabetes. Methods Patients diagnosed with type 2 diabetes completed questionnaires with measures for diabetes knowledge, self-care understanding, diet adherence, and control problems based on the validated Diabetes Care Profile, as well as a 5-factor Meaning of Illness Questionnaire (MIQ) measure. Linear regression investigated the associations between self-care outcomes and the 5 MIQ factors. Results After adjustment for possible confounders, both diabetes self-care understanding and diet adherence were negatively and significantly associated with little effect of illness. Control problems were negatively associated with degree of stress/change in commitments. Diabetes knowledge was not significantly associated with meaning of illness. Conclusion Aspects of the meaning attributed to illness were significantly associated with self-care in patients with type 2 diabetes. Therefore, cognitive appraisals may explain variances observed in self-care understanding and behaviors. Based on these results, it is important to understand the negative effect that diabetes could have when promoting self-care understanding and diet adherence. In addition, it shows that helping patients address the stress and changing commitments that result from diabetes may help decrease the amount of diabetes control problems, even if there is little effect on diabetes understanding. Taking these differences into account may help in creating more personalized and effective self-care education plans.
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Affiliation(s)
- Joni Strom Williams
- Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr Strom Williams, Dr Walker, Dr Lynch, Ms Voronca, Dr Egede)
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina (Dr Strom Williams, Dr Lynch, Dr Egede)
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Dr Walker, Dr Lynch, Dr Egede)
| | - Rebekah J. Walker
- Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr Strom Williams, Dr Walker, Dr Lynch, Ms Voronca, Dr Egede)
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina (Dr Strom Williams, Dr Lynch, Dr Egede)
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Dr Walker, Dr Lynch, Dr Egede)
| | - Cheryl P. Lynch
- Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr Strom Williams, Dr Walker, Dr Lynch, Ms Voronca, Dr Egede)
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina (Dr Strom Williams, Dr Lynch, Dr Egede)
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Dr Walker, Dr Lynch, Dr Egede)
| | - Delia Voronca
- Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr Strom Williams, Dr Walker, Dr Lynch, Ms Voronca, Dr Egede)
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina (Dr Strom Williams, Dr Lynch, Dr Egede)
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Dr Walker, Dr Lynch, Dr Egede)
| | - Leonard E. Egede
- Center for Health Disparities Research, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr Strom Williams, Dr Walker, Dr Lynch, Ms Voronca, Dr Egede)
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina (Dr Strom Williams, Dr Lynch, Dr Egede)
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina (Dr Walker, Dr Lynch, Dr Egede)
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Abstract
Type 2 diabetes mellitus (T2DM) is associated with poorer performance on certain measures of cognitive function. However, little is known about the associations among working memory (WM), executive function (EF), and self-care in those with severe T2DM. This investigation explored these relationships among 67 middle-aged and older individuals with T2DM (mean age of 62.9 years). Severity of T2DM was measured with a health status composite (HSC) score from the Diabetes Care Profile, the number of prescribed medications, and the number of comorbid conditions. Cognitive assessments included the Working Memory Index and the Executive Interview 25 (EXIT 25). Self-care was measured using the Self-Care Inventory-Revised (SCI-R) and hemoglobin A1c (HgbA1c). WM was significantly correlated with all measures of severity of T2DM (HSC, r = .542, p < . 01; number of comorbidities, r = -.476, p < .01; and number of prescription medications, r = -.344, p < .01). EF was significantly correlated with all measures of severity of T2DM (HSC, r = -.504, p < .01; number of comorbidities, r = .492, p < .01; and number of prescription medications, r = .326, p < .01). The self-care measure HgbA1c was significantly correlated with WM (r = -.352, p < .01) and EF (r = .510, p < .01). The EXIT 25 score fully mediated the relationship between severity of T2DM and self-care as measured by HgbA1c (β = .431, p < .001). These findings provide preliminary evidence for the associations among severity of T2DM, WM, EF, and self-care.
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Affiliation(s)
| | - K C Insel
- University of Arizona, Tucson, AZ, USA
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27
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Outcomes from a diabetes self-management intervention for Native Hawaiians and Pacific People: Partners in Care. Ann Behav Med 2014; 45:24-32. [PMID: 23086589 DOI: 10.1007/s12160-012-9422-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Culturally adapted interventions are needed to reduce diabetes-related morbidity and mortality among Native Hawaiian and Pacific People. PURPOSE The purpose of this study is to pilot test the effectiveness of a culturally adapted diabetes self-management intervention. METHODS Participants were randomly assigned in an unbalanced design to the Partners in Care intervention (n = 48) or wait list control group (n = 34). Assessments of hemoglobin A1c, understanding of diabetes self-management, performance of self-care activities, and diabetes-related distress were measured at baseline and 3 months (post intervention). Analysis of covariance was used to test between-group differences. The community steering committee and focus group data informed the cultural adaptation of the intervention. RESULTS There were significant baseline adjusted differences at 3 months between the Partners in Care and wait list control group in intent-to-treat (p < 0.001) and complete case analyses (p < 0.0001) for A1c, understanding (p < 0.0001), and performing diabetes self-management (p < 0.0001). CONCLUSIONS A culturally adapted diabetes self-management intervention of short duration was an effective approach to improving glycemic control among Native Hawaiian and Pacific Islanders.
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Li J, Li Z, Zhao W, Pan H, Halloran EJ. The reliability and validity of the diabetes care profile for Chinese populations. Eval Health Prof 2014; 38:200-18. [PMID: 24586109 DOI: 10.1177/0163278714525628] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to translate into Chinese the Diabetes Care Profile (DCP), a measure of psychosocial factors and diabetes treatment, and to test the reliability and validity of the instrument within a Chinese population. The English version of the DCP was translated into Chinese following the standard translation methodology with consideration to cultural adaptation. The questionnaire was administered to 313 people with type 2 diabetes in an urban community in Beijing, China. Cronbach's α coefficient was used to calculate reliabilities, which ranged from .55 to .86 on DCP subscales. Mean values on the DCP differed by diabetes treatment as expected and supports the construct validity of the DCP. The overall score on the DCP correlated well both with blood glucose levels and with a validated measure of a Chinese version of the Diabetes Specific Quality of Life scale, thus supporting the DCP's criterion validity. The DCP is an acceptable measure of the psychosocial factors related to diabetes and its treatment in a Chinese population with type 2 diabetes.
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Affiliation(s)
- Jing Li
- School of Nursing, Peking Union Medical College, Beijing, P.R. China
| | - Zheng Li
- School of Nursing, Peking Union Medical College, Beijing, P.R. China
| | - Weigang Zhao
- Department of endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Hui Pan
- Department of endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Edward J Halloran
- School of Nursing, University of North Carolina at Chapel Hill, NC, USA
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Nicklett EJ, Heisler MEM, Spencer MS, Rosland AM. Direct social support and long-term health among middle-aged and older adults with type 2 diabetes mellitus. J Gerontol B Psychol Sci Soc Sci 2013; 68:933-43. [PMID: 24150176 PMCID: PMC3805290 DOI: 10.1093/geronb/gbt100] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 08/19/2013] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES This study examined whether or not direct social support is associated with long-term health among middle-aged and older adults with diabetes mellitus. METHOD Direct social support was assessed at baseline (2003) for 1,099 adults with type 2 diabetes mellitus from the Health and Retirement Study. Self-reported health status was examined at baseline and in 4 biennial survey waves (2003-2010). A series of ordinal logistic regression models examined whether or not the 7-item Diabetes Care Profile scale was associated with a subsequent change in health status over time. Additional analyses examined whether or not individual components of direct social support were associated with health status change. RESULTS After adjusting for baseline covariates, greater direct social support as measured by the Diabetes Care Profile was associated with improved health outcomes over time; however, this trend was not significant (p = .06). The direct social support measures that were associated with improved health over follow-up were support for taking medicines (odds ratio [OR] = 1.22), physical activity (OR = 1.26), and going to health care providers (OR = 1.22; all p < .05). DISCUSSION Interventions that specifically target improving specific aspects of diabetes social support may be more effective in improving long-term health than less targeted efforts.
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Affiliation(s)
- Emily J Nicklett
- Correspondence should be addressed to Emily J. Nicklett, MSW, School of Social Work, University of Michigan, 1080 S University Avenue, Ann Arbor, MI 48109. E-mail:
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Dyke ML, Cuffee YL, Halanych JH, McManus RH, Curtin C, Allison JJ. The relationship between coping styles in response to unfair treatment and understanding of diabetes self-care. DIABETES EDUCATOR 2013; 39:848-55. [PMID: 24096805 DOI: 10.1177/0145721713507112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study examined the relationship between coping style and understanding of diabetes self-care among African American and white elders in a southern Medicare-managed care plan. METHODS Participants were identified through a diabetes-related pharmacy claim or ICD-9 code and completed a computer-assisted telephone survey in 2006-2007. Understanding of diabetes self-care was assessed using the Diabetes Care Profile Understanding (DCP-U) scale. Coping styles were classified as active (talk about it/take action) or passive (keep it to yourself). Linear regression was used to estimate the associations between coping style with the DCP-U, adjusting for age, sex, education, and comorbidities. Based on the conceptual model, 4 separate categories were established for African American and white participants who displayed active and passive coping styles. RESULTS Of 1420 participants, the mean age was 73 years, 46% were African American, and 63% were female. Most respondents (77%) exhibited active coping in response to unfair treatment. For African American participants in the study, active coping was associated with higher adjusted mean DCP-U scores when compared to participants with a passive coping style. No difference in DCP-U score was noted among white participants on the basis of coping style. CONCLUSIONS Active coping was more strongly associated with understanding of diabetes self-care among older African Americans than whites. Future research on coping styles may give new insights into reducing diabetes disparities among racial/ethnic minorities.
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Affiliation(s)
- Michelle L Dyke
- Massachusetts General Hospital, Boston, Massachusetts (Dr Dyke)
| | | | - Jewell H Halanych
- University of Alabama at Birmingham,Birmingham, Alabama (Dr Halanych)
| | - Richard H McManus
- University of Massachusetts Medical School, Worcester, Massachusetts (Mr McManus, and Dr Allison)
| | - Carol Curtin
- Eunice Kennedy Shriver Center, Waltham, Massachusetts (Ms Curtin)
| | - Jeroan J Allison
- University of Massachusetts Medical School, Worcester, Massachusetts (Mr McManus, and Dr Allison)
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van Olmen J, Ku GM, van Pelt M, Kalobu JC, Hen H, Darras C, Van Acker K, Villaraza B, Schellevis F, Kegels G. The effectiveness of text messages support for diabetes self-management: protocol of the TEXT4DSM study in the democratic Republic of Congo, Cambodia and the Philippines. BMC Public Health 2013; 13:423. [PMID: 23635331 PMCID: PMC3658970 DOI: 10.1186/1471-2458-13-423] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 03/19/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND People with diabetes find it difficult to sustain adequate self-management behaviour. Self-Management Support strategies, including the use of mobile technology, have shown potential benefit. This study evaluates the effectiveness of a mobile phone support intervention on top of an existing strategy in three countries, DR Congo, Cambodia and the Philippines to improve health outcomes, access to care and enablement of people with diabetes, with 480 people with diabetes in each country who are randomised to either standard support or to the intervention. DESIGN/METHODS The study consists of three sub-studies with a similar design in three countries to be independently implemented and analysed. The design is a two-arm Randomised Controlled Trial, in which a total of 480 adults with diabetes participating in an existing DSME programme will be randomly allocated to either usual care in the existing programme or to usual care plus a mobile phone self-management support intervention. Participants in both arms complete assessments at baseline, one year and two years after inclusion.Glycosylated haemoglobin blood pressure, height, weight, waist circumference will be measured. Individual interviews will be conducted to determine the patients' assessment of chronic illness care, degree of self-enablement, and access to care before implementation of the intervention, at intermediate moments and at the end of the study.Analyses of quantitative data including assessment of differences in changes in outcomes between the intervention and usual care group will be done. A probability of <0.05 is considered statistically significant. Outcome indicators will be plotted over time. All data are analysed for confounding and interaction in multivariate regression analyses taking potential clustering effects into account.Differences in outcome measures will be analysed per country and realistic evaluation to assess processes and context factors that influence implementation in order to understand why it works, for whom, under which circumstances. A costing study will be performed. DISCUSSION The intervention addresses the problem that the greater part of diabetes management takes place without external support and that many challenges, unforeseen problems and questions occur at moments in between scheduled contacts with the support system, by exploiting communication technology. TRIAL REGISTRATION ISRCTN86247213.
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Affiliation(s)
- Josefien van Olmen
- Department of Public Health, Institute of Tropical Medicine, Brussels, Antwerp, Belgium
- Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The netherlands
| | - Grace Marie Ku
- Department of Public Health, Institute of Tropical Medicine, Brussels, Antwerp, Belgium
- Veterans Memorial Medical Center, Quezon, Philippines
| | | | | | | | | | - Kristien Van Acker
- Diabetologist, working at Algemeen ziekenhuis Heilige Familie, Reet & Centre de Santé des Fagnes, Chimay, Belgium
| | | | - Francois Schellevis
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, Netherlands & Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research VU University Medical Center, Amsterdam, The Netherlands
| | - Guy Kegels
- Department of Public Health, Institute of Tropical Medicine, Brussels, Antwerp, Belgium
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Ryan JG, Jennings T, Vittoria I, Fedders M. Short and Long-Term Outcomes from a Multisession Diabetes Education Program Targeting Low-Income Minority Patients: A Six-Month Follow Up. Clin Ther 2013; 35:A43-53. [DOI: 10.1016/j.clinthera.2012.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/10/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
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Chasens ER, Korytkowski M, Sereika SM, Burke LE. Effect of poor sleep quality and excessive daytime sleepiness on factors associated with diabetes self-management. DIABETES EDUCATOR 2012. [PMID: 23192600 DOI: 10.1177/0145721712467683] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of this study is to investigate the association of impaired sleep quality and daytime sleepiness on self-reported diabetes control and psychological and social factors that affect diabetes self-management. METHODS Participants were 107 adults with type 2 diabetes (T2DM) with self-reported daytime sleepiness. Subjective sleepiness was assessed using the Epworth Sleepiness Scale (ESS); sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) Global score and its 3 factors of Perceived Sleep Quality, Sleep Efficiency, and Daily Disturbances. The Diabetes Care Profile (DCP) scales (Control Problems, Social and Personal Factors, Positive Attitude, Negative Attitude, Self-Care Adherence, and Diet Adherence) were used to measure difficulty in maintaining glycemic control and factors important for diabetes control. RESULTS Poor sleep quality was associated with significantly worse scores on the DCP scales, with lower diabetes control, negative attitude, decreased positive attitude, lower self-care adherence, and decreased adherence to dietary adherence. Hierarchal linear regression modeling revealed no significant associations between diabetes control problems and age, education, gender, and daytime sleepiness. Being married or partnered significantly decreased glycemic control problems, whereas poor sleep quality increased diabetes control problems. Further examination of PSQI factors (perceived sleep quality, sleep efficiency, and daily disturbances) found that being married or partnered significantly decreased diabetes control problems, whereas of the 3 factors of the PSQI, only the Daily Disturbances factor was significantly associated with increased diabetes control problems. CONCLUSIONS Impaired sleep quality and daytime sleepiness are associated with decreased diabetes self-management in adults with T2DM.
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Affiliation(s)
- Eileen R Chasens
- University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania (Dr Chasens)
| | - Mary Korytkowski
- University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania (Dr Korytkowski)
| | - Susan M Sereika
- University of Pittsburgh, School of Nursing and the Graduate School of Public Health, Pittsburgh, Pennsylvania (Dr Burke, Dr Sereika)
| | - Lora E Burke
- University of Pittsburgh, School of Nursing and the Graduate School of Public Health, Pittsburgh, Pennsylvania (Dr Burke, Dr Sereika)
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Chen A, Huang Z, Wan X, Deng W, Wu J, Li L, Cai Q, Xiao H, Li Y. Attitudes toward diabetes affect maintenance of drug-free remission in patients with newly diagnosed type 2 diabetes after short-term continuous subcutaneous insulin infusion treatment. Diabetes Care 2012; 35:474-81. [PMID: 22228747 PMCID: PMC3322723 DOI: 10.2337/dc11-1638] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Short-term intensive insulin treatment in patients with newly diagnosed type 2 diabetes can improve β-cell function and insulin sensitivity, which results in long-term remission without need for further antidiabetes medication. Patient attitudes toward their disease were assessed using the Diabetes Care Profile (DCP) tool to evaluate the potential impact on maintaining long-term remission. RESEARCH DESIGN AND METHODS Newly diagnosed patients with type 2 diabetes were recruited and treated with continuous subcutaneous insulin infusion (CSII) for 2-3 weeks. They were also invited to participate in diabetes self-management intervention during hospitalization and complete a DCP questionnaire on attitudes toward diabetes at baseline and 3, 6, and 12 months after suspension of CSII. RESULTS Near normoglycemia was achieved by 118 patients after short-term CSII, with 65 remaining in drug-free remission for >1 year. They had significantly better glycemic control and greater restoration of acute insulin response after CSII as well as higher educational attainment compared with patients experiencing relapse. They also achieved higher scores in positive attitude, (belief in) importance of care, care ability, self-care adherence, and less negative attitude. Differences between the two groups became greater over time. Cox proportional hazards model analysis indicated that greater self-care adherence (hazard ratio 0.184, P < 0.001) and homeostasis model assessment of insulin resistance before treatment (0.854, P = 0.053) were independent predictors for long-term remission, whereas elevated 2-h postprandial plasma glucose after CSII (1.156, P = 0.015) was a risk factor for relapse. CONCLUSIONS Attitudes toward diabetes affect long-term drug-free remission in newly diagnosed patients with type 2 diabetes after short-term CSII.
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Affiliation(s)
- Ailing Chen
- Department of Endocrinology and Diabetes Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Vieta A, Badia X, Sacristán JA. A systematic review of patient-reported and economic outcomes: value to stakeholders in the decision-making process in patients with type 2 diabetes mellitus. Clin Ther 2012; 33:1225-45. [PMID: 21856000 DOI: 10.1016/j.clinthera.2011.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2011] [Indexed: 12/26/2022]
Abstract
BACKGROUND The need for an approach to measuring health results that incorporates patients' and payers' perspectives has generated a wide range of health care outcomes (HCOs), but it is yet unknown whether these HCOs are appropriate or valid for the health care decision-making process. OBJECTIVE The goal of this study was to assess HCOs, patient-reported outcomes (PROs), and economic outcomes in terms of validity and appropriateness to health care decision making in type 2 diabetes mellitus (T2DM). METHODS This systematic review of studies published between January 1, 1996, and November 1, 2010, comprised an electronic literature search of MEDLINE and Centre for Reviews and Dissemination databases. Studies included were clinical trials, observational studies, economic analyses, and studies on the development and validation of HCOs in T2DM in the adult population. HCOs were assessed and classified according to their relevance for decision makers in terms of feasibility for routine use, validity, sensitivity, reliability, understanding, and scope. RESULTS Two independent reviewers screened 4497 citations. Of these, 281 potentially eligible full articles were retrieved, and 185 met the inclusion criteria. A total of 121 HCOs in T2DM were identified: 80 (66.1%) PROs and 41 (33.9%) economic outcomes. Only 44.6% of the outcomes assessed were appropriate and valid for health care decision making. Greater deficiencies in evidence were found for PROs (61.3%), followed by economic outcomes (43.9%). CONCLUSIONS A large number of HCOs are being used in the health care decision-making process, but a significant proportion of these new outcomes have not been properly validated. Despite the fact that appropriate measures will depend on the specific needs of the decision makers, researchers need to use HCOs for which evidence of quality and appropriateness is available.
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Affiliation(s)
- Ana Vieta
- IMS, Health Economics and Outcomes Research, Barcelona, Spain.
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Tang TS, Funnell MM, Gillard M, Nwankwo R, Heisler M. Training peers to provide ongoing diabetes self-management support (DSMS): results from a pilot study. PATIENT EDUCATION AND COUNSELING 2011; 85:160-8. [PMID: 21292425 PMCID: PMC3783215 DOI: 10.1016/j.pec.2010.12.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 10/22/2010] [Accepted: 12/14/2010] [Indexed: 05/23/2023]
Abstract
OBJECTIVE This study determined the feasibility of training adults with diabetes to lead diabetes self-management support (DSMS) interventions, examined whether participants can achieve the criteria required for successful graduation, and assessed perceived efficacy of and satisfaction with the peer leader training (PLT) program. METHODS We recruited nine African-American adults with diabetes for a 46-h PLT pilot program conducted over 12 weeks. The program utilized multiple instructional methods, reviewed key diabetes education content areas, and provided communication, facilitation, and behavior change skills training. Participants were given three attempts to achieve the pre-established competency criteria for diabetes knowledge, empowerment-based facilitation, active listening, and self-efficacy. RESULTS On the first attempt 75%, 75%, 63%, and 75% passed diabetes knowledge, empowerment-based facilitation, active listening, and self-efficacy, respectively. Those participants who did not pass on first attempt passed on the second attempt. Participants were highly satisfied with the program length, balance between content and skills development, and preparation for leading support activities. CONCLUSION Findings suggest that it is feasible to train and graduate peer leaders with the necessary knowledge and skills to facilitate DSMS interventions. PRACTICAL IMPLICATIONS With proper training, peer support may be a viable model for translating and sustaining DSMS interventions into community-based settings.
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Affiliation(s)
- Tricia S Tang
- Department of Medical Education and the Michigan Diabetes Research and Training Center, University of Michigan Medical School, Ann Arbor, USA.
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Tang TS, Funnell MM, Gillard M, Nwankwo R, Heisler M. The development of a pilot training program for peer leaders in diabetes: process and content. THE DIABETES EDUCATOR 2011; 37:67-77. [PMID: 21220362 PMCID: PMC4117387 DOI: 10.1177/0145721710387308] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The goal of this study is to describe the process of developing a program that trains peers to facilitate an empowerment-based diabetes self-management support intervention. METHODS To guide and advise the development process, the authors formed a peer leader training action committee. The committee was an interdisciplinary group (principal investigator, nurse-certified diabetes educators, dietitian-certified diabetes educators, nutritionist, physician, and 3 community members) that met every 3 months over a 1-year period for continuous quality improvement meetings. During meetings, the committee reviewed and supervised the curriculum development, provided feedback, and informed modifications and improvements. RESULTS The resulting peer leader training program is a 46-hour program with 2 training sessions conducted per week over a 12-week period. The competency-based training program is based on the theory of experiential learning, and it consists of 3 major components--namely, building a diabetes-related knowledge base, developing skills (communication, facilitation, and behavior change), and applying skills in experiential settings. All components are integrated within each training session using a range of instructional methods, including group brainstorming, group sharing, role-play, peer leader simulations, and group facilitation simulations. CONCLUSION Through the process described above, the authors developed a training program that equips peer leaders with the knowledge and skills to facilitate empowerment-based diabetes self-management support interventions. Future directions include conducting and evaluating the peer training program.
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Affiliation(s)
- Tricia S Tang
- The University of Michigan Department of Medical Education, University of Michigan Medical School and Michigan Diabetes Research and Training Center; Department of Internal Medicine, University of Michigan Medical School and Health Behavior and Health Education, School of Public Health, Ann Arbor, Michigan
| | - Martha M Funnell
- The University of Michigan Department of Medical Education, University of Michigan Medical School and Michigan Diabetes Research and Training Center; Department of Internal Medicine, University of Michigan Medical School and Health Behavior and Health Education, School of Public Health, Ann Arbor, Michigan
| | - Marylou Gillard
- The University of Michigan Department of Medical Education, University of Michigan Medical School and Michigan Diabetes Research and Training Center; Department of Internal Medicine, University of Michigan Medical School and Health Behavior and Health Education, School of Public Health, Ann Arbor, Michigan
| | - Robin Nwankwo
- The University of Michigan Department of Medical Education, University of Michigan Medical School and Michigan Diabetes Research and Training Center; Department of Internal Medicine, University of Michigan Medical School and Health Behavior and Health Education, School of Public Health, Ann Arbor, Michigan
| | - Michele Heisler
- The University of Michigan Department of Medical Education, University of Michigan Medical School and Michigan Diabetes Research and Training Center; Department of Internal Medicine, University of Michigan Medical School and Health Behavior and Health Education, School of Public Health, Ann Arbor, Michigan
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Sarkar U, Karter AJ, Liu JY, Moffet HH, Adler NE, Schillinger D. Hypoglycemia is more common among type 2 diabetes patients with limited health literacy: the Diabetes Study of Northern California (DISTANCE). J Gen Intern Med 2010; 25:962-8. [PMID: 20480249 PMCID: PMC2917655 DOI: 10.1007/s11606-010-1389-7] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 03/13/2010] [Accepted: 04/20/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Little is known about the frequency of significant hypoglycemic events in actual practice. Limited health literacy (HL) is common among patients with type 2 diabetes, may impede diabetes self-management, and thus HL could increase the risk of hypoglycemia. OBJECTIVE To determine the proportion of ambulatory, pharmacologically-treated patients with type 2 diabetes reporting > or =1 significant hypoglycemic events in the prior 12 months, and evaluate whether HL is associated with hypoglycemia. RESEARCH DESIGN Cross-sectional analysis in an observational cohort, the Diabetes Study of Northern California (DISTANCE). SUBJECTS The subjects comprised 14,357 adults with pharmacologically-treated, type 2 diabetes who are seen at Kaiser Permanente Northern California (KPNC), a non-profit, integrated health care delivery system. MEASURES Patient-reported frequency of significant hypoglycemia (losing consciousness or requiring outside assistance); patient-reported health literacy. RESULTS At least one significant hypoglycemic episode in the prior 12 months was reported by 11% of patients, with the highest risk for those on insulin (59%). Patients commonly reported limited health literacy: 53% reported problems learning about health, 40% needed help reading health materials, and 32% were not confident filling out medical forms by themselves. After adjustment, problems learning (OR 1.4, CI 1.1-1.7), needing help reading (OR 1.3, CI 1.1-1.6), and lack of confidence with forms (OR 1.3, CI 1.1-1.6) were independently associated with significant hypoglycemia. CONCLUSIONS Significant hypoglycemia was a frequent complication in this cohort of type 2 diabetes patients using anti-hyperglycemic therapies; those reporting limited HL were especially vulnerable. Efforts to reduce hypoglycemia and promote patient safety may require self-management support that is appropriate for those with limited HL, and consider more vigilant surveillance, conservative glycemic targets or avoidance of the most hypoglycemia-inducing medications.
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Affiliation(s)
- Urmimala Sarkar
- UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA, USA.
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Deltsidou A. Age at menarche and menstrual irregularities of adolescents with type 1 diabetes. J Pediatr Adolesc Gynecol 2010; 23:162-7. [PMID: 19679499 DOI: 10.1016/j.jpag.2009.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 06/26/2009] [Accepted: 06/29/2009] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVE The aim of the study was to investigate the age at menarche and menstrual irregularities in adolescents with type 1 diabetes. DESIGN This was an aged-matched, controlled study. SETTING The study was done in the diabetes center of a children's hospital in Athens and in high schools in major regions of central Greece. PARTICIPANTS The study involved two groups: a group of 100 female adolescents, 12 to 18 years of age, with type 1 diabetes; and a control group of 225 healthy adolescents, matched for age. MAIN OUTCOME MEASURES The relationship between age at menarche and menstrual irregularities was studied. RESULTS The mean age at menarche differed significantly in the two groups (P=0.000). In particular, the mean age at menarche in the study group was 12.2 years (+/- 1.4) and in the control group it was 11.7 years old (+/- 1.2). The mean age of menarche was older in the subgroup of adolescents who had received a diagnosis of diabetes before the age of 10 than it was in those diagnosed after the age of 10. CONCLUSIONS Menarche was observed to be delayed in adolescents with type 1 diabetes who had been diagnosed before the age of 10 in comparison with those diagnosed after the age of 10. Menstrual irregularities were found to be more common in adolescents with type 1 diabetes than in healthy ones.
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Affiliation(s)
- Anna Deltsidou
- School of Nursing Studies, Technological Educational Institute, Lamia 35100, Greece.
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D'Eramo Melkus G, Chyun D, Vorderstrasse A, Newlin K, Jefferson V, Langerman S. The Effect of a Diabetes Education, Coping Skills Training, and Care Intervention on Physiological and Psychosocial Outcomes in Black Women With Type 2 Diabetes. Biol Res Nurs 2010; 12:7-19. [DOI: 10.1177/1099800410369825] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An 11-week culturally relevant group diabetes self-management training (DSMT), coping skills training (CST), and diabetes care intervention was compared to a 10-week usual diabetes education and diabetes care intervention on physiological and psychosocial outcomes in 109 Black women (aged 48 ± 10 years) with type 2 diabetes in primary care (PC). Strong time effects for hemoglobin A1c improvement were seen in both groups from baseline to 3 months and remained similar at 12 and 24 months (p < .0001). Systolic blood pressure (p =.01) and low-density lipoprotein cholesterol levels (p = .05) improved in both groups from baseline to 24 months. Baseline quality of life ([QOL]; Medical Outcome Study Short Form-36) was low. Social function, role-emotional, and mental health domains increased initially in both groups then declined slightly, with less decline for the experimental group at 12 months. At 24 months, experimental group scores increased. General health (p = .002), vitality (p = .01), role-physical, and bodily pain (p = .02) domains increased in both groups over time. Perceived provider support for diet (p = .0001) and exercise (p = .0001) increased in both groups over time. Diabetes-related emotional distress decreased in the experimental compared to the control group (group x time, p = .01). Findings suggest that both methods of diabetes education combined with care can improve metabolic control, QOL, and perceptions of provider care. CST may further assist in long-term improvements in health outcomes. Behavioral interventions are needed in addition to routine diabetes care, particularly in PC.
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When is social support important? The association of family support and professional support with specific diabetes self-management behaviors. J Gen Intern Med 2008; 23:1992-9. [PMID: 18855075 PMCID: PMC2596525 DOI: 10.1007/s11606-008-0814-7] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 06/25/2008] [Accepted: 09/10/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Social support is associated with better diabetes self-management behavior (SMB), yet interventions to increase family and friend support (FF support) have had inconsistent effects on SMB. OBJECTIVE To test whether FF support differentially affects specific SMBs and compare the influence of support from health professionals and psychological factors on specific SMBs to that of FF support. DESIGN Cross-sectional survey of people with diabetes recruited for a self-management intervention PARTICIPANTS AND SETTING One hundred sixty-four African-American and Latino adults with diabetes living in inner-city Detroit MEASUREMENTS AND MAIN RESULTS For every unit increase in FF support for glucose monitoring, the adjusted odds ratio (AOR) of completing testing as recommended was 1.77 (95% CI 1.21-2.58). FF support was not associated with four other SMBs (taking medicines, following a meal plan, physical activity, checking feet). Support from non-physician health professionals was associated with checking feet [AOR 1.72 (1.07-2.78)] and meal plan adherence [AOR = 1.61 (1.11-2.34)]. Diabetes self-efficacy was associated with testing sugar, meal plan adherence, and checking feet. Additional analyses suggested that self-efficacy was mediating the effect of FF support on diet and checking feet, but not the FF support effect on glucose monitoring. CONCLUSIONS The association between FF support and SMB performance was stronger for glucose monitoring than for other SMBs. Professional support and diabetes self-efficacy were each independently associated with performance of different SMBs. SMB interventions may need to differentially emphasize FF support, self-efficacy, or professional support depending on the SMB targeted for improvement.
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Relationships of Religion and Spirituality to Glycemic Control in Black Women With Type 2 Diabetes. Nurs Res 2008; 57:331-9. [DOI: 10.1097/01.nnr.0000313497.10154.66] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Egede LE, Ellis C. The effects of depression on diabetes knowledge, diabetes self-management, and perceived control in indigent patients with type 2 diabetes. Diabetes Technol Ther 2008; 10:213-9. [PMID: 18473696 DOI: 10.1089/dia.2007.0278] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study was designed to assess differences in diabetes knowledge, diabetes self-management, and perceived control among depressed and nondepressed individuals in an indigent population with type 2 diabetes. RESEARCH DESIGN AND METHODS Depressed and nondepressed patients with the clinical diagnosis of type 2 diabetes were recruited from an indigent care clinic. Subjects completed validated surveys to assess diabetes knowledge, diabetes self-management, and perceived control of diabetes. We compared demographic characteristics and diabetes knowledge, diabetes self-management, and perceived control of diabetes by depression status. Statistical analysis was performed with SPSS version 14.0 (SPSS, Inc., Chicago, IL). RESULTS Of the 201 subjects with diagnosed type 2 diabetes enrolled in the study, approximately 20% n = 40) of the sample was depressed. Subjects with depression were more likely to report self-care control problems (mean = 2.2 +/- 1.0 vs. 1.5 +/- 0.6, P < 0.001) and less likely to report positive attitude (mean = 2.9 +/- 0.7 vs. 3.7 +/- 0.5, P < 0.001), self-care ability (mean = 3.2 +/- 3.6 vs. 3.7 +/- 0.5, P < 0.001), and self-care adherence (mean = 3.3 +/- 0.9 vs. 4.1 +/- 0.6, P < 0.001). Depressed patients were less likely to report perceived control of diabetes (mean = 47.7 +/- 8.5 vs. 57.8 +/- 7.4, P < 0.001). There were no significant differences in diabetes knowledge, self-care understanding, and perceived importance of self-care between depressed and nondepressed patients. CONCLUSIONS In this indigent population with type 2 diabetes, diabetes knowledge did not differ significantly by depression status, but diabetes self-management practices and perceived control of diabetes differed significantly by depression status. Patients who were depressed had poorer diabetes self-care and felt they had less control over their disease.
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Affiliation(s)
- Leonard E Egede
- Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC 29425, USA.
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Hiss RG, Armbruster BA, Gillard ML, McClure LA. Nurse care manager collaboration with community-based physicians providing diabetes care: a randomized controlled trial. DIABETES EDUCATOR 2007; 33:493-502. [PMID: 17570880 DOI: 10.1177/0145721707301349] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to demonstrate the potential value of close collaboration at the office level of a nurse care manager with community-based primary care physicians in the care of adult patients with type 2 diabetes, particularly those physicians not affiliated with an integrated care system that some managed care organizations provide. METHODS Patients with type 2 diabetes were recruited from the general population of a large metropolitan area. Each received a comprehensive evaluation of his or her diabetes with results reported to patients and their physicians (basic intervention). A random one-half of patients were additionally assigned to individual counseling, problem identification, care planning, and management recommendations by a nurse care manager (individualized intervention). The patients receiving only the basic intervention served as the control group to those receiving the individualized intervention. Re-evaluation of all patients at 6 months after their entry into the study determined the effectiveness of the nurse-directed individualized intervention using A1C, blood pressure, and cholesterol as outcome measures. RESULTS Of 220 patients recruited, 197 had type 2 diabetes, randomly assigned only the basic intervention (102 patients) or individualized intervention (95 patients). Postintervention data were obtained on 164 patients (83%). Significant improvement occurred in mean systolic blood pressure and A1C of all patients in the individualized but not the basic intervention only group. Patients with a systolic blood pressure>or=130 mm Hg at baseline showed improvement if they had more than 2 contacts with the study nurse but not if they had less than 2 contacts. CONCLUSIONS A nurse care manager collaborating at the office level with community-based primary care physicians can enhance the care provided to adult patients with type 2 diabetes. For those many physicians not affiliated with an integrated care system featured by some managed care organizations, this collaboration could underlie a team approach (nurse/patient/physician) for the ambulatory patient with diabetes that would be an essential element in a chronic disease model of care for diabetes at the community level.
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Affiliation(s)
- Roland G Hiss
- The University of Michigan Medical School, Department of Medical Education, Ann Arbor, Michigan (Dr Hiss, Ms Armbruster, Ms Gillard)
| | - Betty A Armbruster
- The University of Michigan Medical School, Department of Medical Education, Ann Arbor, Michigan (Dr Hiss, Ms Armbruster, Ms Gillard)
| | - Mary Lou Gillard
- The University of Michigan Medical School, Department of Medical Education, Ann Arbor, Michigan (Dr Hiss, Ms Armbruster, Ms Gillard)
| | - Leslie A McClure
- University of Michigan School of Public Health, Department of Biostatistics, Ann Arbor, Michigan (Dr. McClure's current address is Department of Biostatistics, University of Alabama at Birmingham.)
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Cunningham V, Mohler MJ, Wendel CS, Hoffman RM, Murata GH, Shah JH, Duckworth WC. Reliability and validity of the DCP among hispanic veterans. Eval Health Prof 2005; 28:447-63. [PMID: 16272425 DOI: 10.1177/0163278705281077] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Diabetes Care Profile (DCP) was designed to measure psychosocial factors related to diabetes and its treatment. This study sought to determine the reliability and validity of the DCP in Hispanic veterans with Type 2 diabetes. Hispanic (n=81) and non-Hispanic White (n=238) patients were recruited at three southwestern VA hospitals. Scale reliabilities calculated by Cronbach's coefficient alpha revealed reliabilities ranging from .54 to .97 in Hispanics and .63 to .95 in non-Hispanic Whites. Only one scale, Monitoring Barriers, differed significantly between the two patient groups. Mean values on the DCP scales were consistent within and across ethnicities lending support for construct validity of the DCP in Hispanics. Convergent validity was also supported for DCP scales within the Hispanic patients as evidenced by correlations in expected directions with external measures.
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Heisler M, Piette JD, Spencer M, Kieffer E, Vijan S. The relationship between knowledge of recent HbA1c values and diabetes care understanding and self-management. Diabetes Care 2005; 28:816-22. [PMID: 15793179 DOI: 10.2337/diacare.28.4.816] [Citation(s) in RCA: 201] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Knowledge of one's actual and target health outcomes (such as HbA(1c) values) is hypothesized to be a prerequisite for effective patient involvement in managing chronic diseases such as diabetes. We examined 1) the frequency and correlates of knowing one's most recent HbA(1c) test result and 2) whether knowing one's HbA(1c) value is associated with a more accurate assessment of diabetes control and better diabetes self-care understanding, self-efficacy, and behaviors related to glycemic control. RESEARCH DESIGN AND METHODS We conducted a cross-sectional survey of a sample of 686 U.S. adults with type 2 diabetes in five health systems who had HbA(1c) checked in the previous 6 months. Independent variables included patient characteristics, health care provider communication, and health system type. We examined bivariate and multivariate associations between each variable and the respondents' knowledge of their last HbA(1c) values and assessed whether knowledge of HbA(1c) was associated with key diabetes care attitudes and behaviors. RESULTS Of the respondents, 66% reported that they did not know their last HbA(1c) value and only 25% accurately reported that value. In multivariate analyses, more years of formal education and high evaluations of provider thoroughness of communication were independently associated with HbA(1c) knowledge. Respondents who knew their last HbA(1c) value had higher odds of accurately assessing their diabetes control (adjusted odds ratio 1.59, 95% CI 1.05-2.42) and better reported understanding of their diabetes care (P < 0.001). HbA(1c) knowledge was not associated with respondents' diabetes care self-efficacy or reported self-management behaviors. CONCLUSIONS Respondents who knew their HbA(1c) values reported better diabetes care understanding and assessment of their glycemic control than those who did not. Knowledge of one's HbA(1c) level alone, however, was not sufficient to translate increased understanding of diabetes care into the increased confidence and motivation necessary to improve patients' diabetes self-management. Strategies to provide information to patients must be combined with other behavioral strategies to motivate and help patients effectively manage their diabetes.
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Affiliation(s)
- Michele Heisler
- HSR&D Field Program, Veterans Affairs Center for Practice Management, VA Ann Arbor Healthcare System, P.O. Box 130170, 11H, Ann Arbor, MI 48113, USA.
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de Leon EM, Jacober SJ, Sobel JD, Foxman B. Prevalence and risk factors for vaginal Candida colonization in women with type 1 and type 2 diabetes. BMC Infect Dis 2002; 2:1. [PMID: 11835694 PMCID: PMC65518 DOI: 10.1186/1471-2334-2-1] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2001] [Accepted: 01/30/2002] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Diabetes mellitus increases the rate of vaginal colonization and infection with Candida species METHODS We surveyed women with diabetes receiving care at either an urban or suburban diabetes clinic to examine the relationship between vaginal Candida colonization, diabetes type and duration, and HbA1c level. 101 participants completed the self-administered questionnaire and self-collected a vaginal swab for Candida culture. Candida colonization was similar by age and race. RESULTS Type 1 diabetics were three times as likely as type 2 diabetics to be colonized with any Candida species (OR = 3.4; 95% CI: 1.03, 11.41; p = 0.04); even after adjusting for abnormal HbA1c, which had an independent effect (OR = 1.4; 95% CI: 1.04, 1.76; p = 0.02). Recent antibiotic use (OR = 4.5; 95% CI: 1.18, 16.79; p = 0.03), lifetime history of chlamydia (OR = 5.8; 95% CI: 1.09, 30.54; p = 0.04), and performing oral sex during the past 2 weeks (OR = 4.9; 95% CI:0.84, 28.27; p = 0.08) were also associated with Candida carriage after adjusting for diabetic type and abnormal HbA1c. C. albicans was isolated from the majority of colonized type 1 participants (56%), while C. glabrata was the most common isolate among colonized type 2 participants (54%). CONCLUSIONS Improving glucose control and possibly modifying sexual behavior may reduce risk of Candida colonization, and potentially symptomatic infection, among women with diabetes.
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Affiliation(s)
- Ella M de Leon
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Scott J Jacober
- Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jack D Sobel
- Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Betsy Foxman
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Luscombe FA. Health-related quality of life measurement in type 2 diabetes. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2000; 3 Suppl 1:15-28. [PMID: 16464206 DOI: 10.1046/j.1524-4733.2000.36032.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Type 2 diabetes has significant adverse effects on health-related quality of life (HRQoL). A vast array of questionnaires has been used to measure HRQoL in diabetes patients, contributing to the difficulty of selecting instruments for future research. To systematically evaluate these measures, a literature search was undertaken to identify relevant publications. This paper summarizes the generic, diabetes-specific, and psychological measures utilized to evaluate persons with type 2 diabetes, and highlights related findings. Generic instruments demonstrate significant reductions in health status compared with other chronic disease populations and healthy controls. Multiple diabetes-specific measures are available to assess domains affected by the disease, including symptoms, worries, self-care, locus of control, functional ability, social support, and sexual functioning. Psychological measures show that type 2 diabetes is frequently associated with adverse psychological effects, particularly depression. Since much of this research has been cross-sectional in nature, little is known about responsiveness of many of the HRQoL measures to clinical change and treatment effects. It is clear that HRQoL results are influenced by multiple patient and disease factors, particularly age, gender, and the presence and severity of disease complications and comorbid conditions. These factors should be considered in the design and analysis of HRQoL evaluations in type 2 diabetes patients. Selection of instruments for future research will therefore require careful evaluation of study design and objectives, population characteristics, the presence of disease-related factors, and outcomes of interest.
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