1
|
Majumder A, Mukherjee P, Chakraborty S, Chaudhuri SR, Chakraborty S. Improvement of knowledge following diabetes self-management education with respect to socioeconomic status: A retrospective cohort study among type 2 diabetes in Eastern India. J Family Med Prim Care 2024; 13:1747-1754. [PMID: 38948598 PMCID: PMC11213456 DOI: 10.4103/jfmpc.jfmpc_1597_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/19/2023] [Accepted: 12/30/2023] [Indexed: 07/02/2024] Open
Abstract
Introduction We assessed the baseline knowledge and the improvement and retention of knowledge after attending diabetes self-management education (DSME) programs with respect to different socioeconomic status (SES). We also looked into the change in body mass index (BMI), blood pressure, and glycemic parameters after attending the DSME sessions. Materials and Methods This was a retrospective, cohort study carried out via chart review based on data collected from manual or electronic medical records (EMR) and questionnaire responses of 160 adult patients with type 2 diabetes (T2D) who attended two DSME sessions with a gap of at least six months. Results Baseline knowledge on diabetes was uniform (P = 0.06), irrespective of differences in SES, and DSME sessions significantly improved the knowledge in all socioeconomic classes (P value < 0.05 in each SES group). However, SES did have a significant influence on the finally acquired knowledge of diabetes as was evident from the final score after attending two DSME sessions. A significant number of patients (48.1%) from our cohort either improved or retained their knowledge of diabetes over a mean follow-up of 15.5 months. The BMI of our cohort was significantly reduced from baseline to final follow-up (P = 0.016). Conclusion DSME sessions were effective in improving knowledge and awareness among T2D patients, irrespective of socioeconomic classes in Eastern India. The acquired knowledge from DSME sessions was retained over a long time.
Collapse
Affiliation(s)
- Anirban Majumder
- Department of Endocrinology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Poulomi Mukherjee
- Department of Community Medicine, Medical College and Hospital, Kolkata, West Bengal, India
| | - Soma Chakraborty
- Diabetes-Obesity-Thyroid and Hormone Clinic, Kolkata, West Bengal, India
| | | | - Sumanta Chakraborty
- Department of Community Medicine, Diamond Harbour Government Medical College, Harindanga, Diamond Harbour, West Bengal, India
| |
Collapse
|
2
|
Prayoonhong W, Sonsingh W, Permsuwan U. Clinical outcomes and economic evaluation of patient-centered care system versus routine-service system for patients with type 2 diabetes in Thailand. Heliyon 2024; 10:e25093. [PMID: 38333778 PMCID: PMC10850510 DOI: 10.1016/j.heliyon.2024.e25093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/08/2024] [Accepted: 01/19/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction Patient-centered care in diabetes is another approach for outcome improvement, yet the supporting economic and clinical evidence remains limited in Thailand. Objectives This study compared health outcomes and cost-utility of implementing Patient-Centered Care Systems (PCCS) in a primary care setting vs. the Routine Service System (RSS) in a hospital setting. Methods The economic evaluation was performed using a randomized controlled study design. The participants aged ≥18 were enrolled from Phimai City in Nakhon Ratchasima Province, Thailand from June 2022 to February 2023. Totally, 309 well-controlled patients with initial care in a hospital were referred to receive the PCCS at the primary care setting or remained receiving the RSS in the hospital. Outcomes of different approaches such as fasting blood sugar, Hemoglobin A1c (HbA1c), direct medical costs, direct nonmedical costs and utility were prospectively collected at months 0, 3 and 6. Fisher's exact test, t-test or Wilcoxon signed-rank test were used to analyze data, whichever was appropriate. An incremental cost-effectiveness ratio was calculated, and various sensitivity analyses were performed. Results The PCCS showed significantly reduced HbA1c (p < 0.001) and a greater number of patients with improved HbA1c (p < 0.001). The PCCS were a cost-saving strategy due to incurring lower total costs (60.15 vs. 73.42 USD) and gaining more quality-adjusted life-years (QALY)(0.340 vs. 0.330) compared with the RSS. With a ceiling ratio of 4,659 USD/QALY, the PCCS had a 94.6 % probability of being cost-effective. Conclusion This finding indicated that the PCCS in a primary care setting was a cost-saving strategy by lowering cost, providing a higher quality of life and improving glycemic control compared with the RSS in a hospital setting. However, generalizing the findings in a country as a whole, the economic evaluation of PCCS and RSS should be conducted among different levels of hospitals from all regions in Thailand.
Collapse
Affiliation(s)
- Watanyoo Prayoonhong
- Pharmacy Department, Phimai Hospital, Nakhon Ratchasima, Thailand
- Graduate Student in Pharmacy Management, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Wannakamol Sonsingh
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Unchalee Permsuwan
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
3
|
Karki A, Vandelanotte C, Khalesi S, Dahal P, Rawal LB. The effect of health behavior interventions to manage Type 2 diabetes on the quality of life in low-and middle-income countries: A systematic review and meta-analysis. PLoS One 2023; 18:e0293028. [PMID: 37844107 PMCID: PMC10578590 DOI: 10.1371/journal.pone.0293028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Behavioral interventions targeted at managing Type 2 diabetes mellitus (T2DM) may have a positive effect on quality of life (QOL). Limited reviews have synthesized this effect in low- and middle-income countries (LMICs). This review and meta-analysis synthesised available evidence on the effect of behavioral interventions to manage T2DM on the QOL of people with T2DM in LMICs. METHODS Electronic databases PUBMED/MEDLINE, SCOPUS, CINAHL, Embase, Web of Science and PsycINFO were searched from May to June 2022. Studies published between January 2000 and May 2022, conducted in LMICs using randomized controlled trial design, using a health behavior intervention for T2DM management, and reporting QOL outcomes were included. Difference in QOL change scores between the intervention and control group was calculated as the standardized mean difference (SMD) of QOL scores observed between the intervention and control groups. Random-effects model was used for meta-analysis. RESULTS Of 6122 studies identified initially, 45 studies met the inclusion criteria (n = 8336). Of them, 31 involved diabetes self-management education and 14 included dietary and/or physical activity intervention. There was moderate quality evidence from the meta-analysis of mean QOL (n = 25) that health behavior intervention improved the QOL of people with T2DM (SMD = 1.62, 95%CI = 0.65-2.60 I2 = 0.96, p = 0.001). However, no significant improvements were found for studies (n = 7) separately assessing the physical component summary (SMD = 0.76, 95%CI = -0.03-1.56 I2 = 0.94, p = 0.060) and mental component summary (SMD = 0.43, 95%CI = -0.30-1.16 I2 = 0.94, p = 0.249) scores. High heterogeneity and imprecise results across studies resulted in low to moderate quality of evidence. CONCLUSION The findings suggest that health behavior interventions to manage T2DM may substantially improve the QOL of individuals with T2DM over short term. However, due to low to moderate quality of evidence, further research is required to corroborate our findings. Results of this review may guide future research and have policy implications for T2DM management in LMICs.
Collapse
Affiliation(s)
- Ashmita Karki
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Corneel Vandelanotte
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Saman Khalesi
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Padam Dahal
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Lal B. Rawal
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney Australia
| |
Collapse
|
4
|
Alzahrani O, Fletcher JP, Hitos K. Quality of life and mental health measurements among patients with type 2 diabetes mellitus: a systematic review. Health Qual Life Outcomes 2023; 21:27. [PMID: 36949507 PMCID: PMC10031182 DOI: 10.1186/s12955-023-02111-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 03/14/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Over the past few decades the benefits of assessing Quality of Life (QoL) and mental health in patients with Type 2 Diabetes Mellitus (T2DM) have steadily increased with limited studies relating to the most useful method to assess these patients. This study aims to identify, review, summarise, and evaluate the methodological quality for the most validated commonly used health-related QoL and mental health assessment measurements in diabetic patients. METHODS All original articles published on PubMed, MedLine, OVID, The Cochrane Register, Web of Science Conference Proceedings and Scopus databases were systematically reviewed between 2011 and 2022. A search strategy was developed for each database using all possible combinations of the following keywords: "type 2 diabetes mellitus", "quality of life", mental health", and "questionnaires". Studies conducted on patients with T2DM of ≥ 18 years with or without other clinical illnesses were included. Articles designed as a literature or systematic review conducted on either children or adolescents, healthy adults and/or with a small sample size were excluded. RESULTS A total of 489 articles were identified in all of the electronic medical databases. Of these articles, 40 were shown to meet our eligibility criteria to be included in this systematic review. Approximately, 60% of these studies were cross-sectional, 22.5% were clinical trials, and 17.5% of cohort studies. The top commonly used QoL measurements are the SF-12 identified in 19 studies, the SF-36, included in 16 studies, and the EuroQoL EQ-5D, found in 8 studies. Fifteen (37.5%) studies used only one questionnaire, while the remaining reviewed (62.5%) used more than one questionnaire. Finally, the majority (90%) of studies reported using self-administered questionnaires and only 4 used interviewer mode of administration. CONCLUSION Our evidence highlights that the commonly used questionnaire to evaluate the QoL and mental health is the SF-12 followed by SF-36. Both of these questionnaires are validated, reliable and supported in different languages. Moreover, using single or combined questionnaires as well as the mode of administration depends on the clinical research question and aim of the study.
Collapse
Affiliation(s)
- Owiss Alzahrani
- Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, Westmead Hospital, Sydney, Australia.
- The University of Sydney, Faculty of Medicine and Health, Westmead Clinical School, Sydney, Australia.
- Department of Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - John P Fletcher
- Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, Westmead Hospital, Sydney, Australia
- The University of Sydney, Faculty of Medicine and Health, Westmead Clinical School, Sydney, Australia
| | - Kerry Hitos
- Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, Westmead Hospital, Sydney, Australia
- The University of Sydney, Faculty of Medicine and Health, Westmead Clinical School, Sydney, Australia
| |
Collapse
|
5
|
Asmat K, Dhamani K, Gul R, Froelicher ES. The effectiveness of patient-centered care vs. usual care in type 2 diabetes self-management: A systematic review and meta-analysis. Front Public Health 2022; 10:994766. [PMID: 36388341 PMCID: PMC9650641 DOI: 10.3389/fpubh.2022.994766] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/03/2022] [Indexed: 01/26/2023] Open
Abstract
Background Patient-centered care in diabetes self-management might be a significant factor in improving health outcomes of adults with type 2 diabetes, yet the supporting evidence is inadequate. This review aimed at assessing the effectiveness of patient-centered self-management care interventions on glycemic control (HbA1c) and self-care behaviors compared with usual care. Methods CINAHL, PubMed, Cochrane Library, Google Scholar, and the HEC Digital Library were searched for studies in English language that assessed patient-centered self-management educational and/or behavioral interventions in adults aged 18 years or older with type 2 diabetes from 2005 to 2020. Interventional studies with at least 3 months of follow-up and reporting on self-care outcomes such as glycemic control (HbA1c) and self-care behaviors including diet control, physical activity, foot care, and medication adherence were included. Results Of 168 identified records, 24 were found eligible comprising 20 RCTs and four QESs with total 4,083 participants. The meta-analysis involved 19 RCTs that provided enough information for a pooled estimate of HbA1c. Compared with the control group, patient-centered self-management interventions significantly lowered HbA1c, -0.56 (95% CI -0.79, -0.32). Stratified analysis for HbA1c with respect to various aspects of intervention showed larger effects in interventions employing both educational and behavioral components, -0.66 (95% CI -0.97, -0.34); spanned over shorter (<03 months) duration, -0.85 (95% CI -1.28, -0.43); administered by nurses, -0.80 (95% CI -1.44, -0.16); and delivered in community settings -0.70 (95% CI -1.14, -0.26). Conclusion This systematic review provided evidence supporting the effectiveness of patient-centered self-management care interventions in improving glycemic control and self-care behaviors in adults with type 2 diabetes and identified key features of intervention contributing toward success.
Collapse
Affiliation(s)
- Kainat Asmat
- Shifa College of Nursing, Shifa Tameer-e-Millat University, Islamabad, Pakistan,*Correspondence: Kainat Asmat
| | - Khairunnisa Dhamani
- Shifa College of Nursing, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Raisa Gul
- Shifa College of Nursing, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Erika Sivarajan Froelicher
- Department of Physiological Nursing, School of Nursing and Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
6
|
Wong VWH, Ho FYY, Shi NK, Sarris J, Ng CH, Tam OKY. Lifestyle medicine for anxiety symptoms: A meta-analysis of randomized controlled trials. J Affect Disord 2022; 310:354-368. [PMID: 35523299 DOI: 10.1016/j.jad.2022.04.151] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/31/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lifestyle medicine (LM) is gaining increasing attention as a treatment option for anxiety, but the current state of evidence has not yet been systematically examined. METHODS Six electronic databases were systematically searched from inception to February 2022. Randomized controlled trials (RCTs) comparing the effects of multicomponent LM interventions on anxiety symptoms with either care-as-usual, waitlist, no intervention, or attention control group on anxiety symptoms were identified. RESULTS A total of 53 RCTs with 18,894 participants were included for qualitative synthesis, in which 45 RCTs with data available were included for meta-analysis. Multicomponent LM intervention was significantly more effective than the control groups in reducing anxiety symptoms at immediate posttreatment (d = 0.19, p < .001) and at short-term follow-up (d = 0.29, p < .001). However, no significant difference at medium-term was found (p = .14), whereas more studies are needed to study the long-term effects. The subgroup analyses suggested that baseline anxiety symptoms was a significant moderator, suggesting that those with moderate level of baseline anxiety symptoms appeared to have greater improvements (d = 0.66, p < .05). LIMITATIONS Minimal anxiety symptoms at baseline contributed to the floor effect and influenced the degree of improvement. The included RCTs had a high risk of bias in general with potential publication bias detected. CONCLUSION The findings of this meta-analysis provided support for the positive effects of multicomponent LM interventions for anxiety symptoms. Future research is needed to determine the long-term effects of multicimponent LM and the optimal baseline anxiety severity.
Collapse
Affiliation(s)
| | - Fiona Yan-Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong.
| | - Nga-Kwan Shi
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong
| | - Jerome Sarris
- Western Sydney University, NICM Heath Research Institute, Westmead, NSW, Australia; Professorial Unit, The Melbourne Clinic, Department of Psychiatry, The University of Melbourne, VIC, Australia
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, The University of Melbourne, Richmond, VIC, Australia
| | | |
Collapse
|
7
|
Shrimant Kumar S, Santhi Sree M, Manjusha M, Reddy MM, B R, Kishore B, G RS, Mohapatra JJ. Efficacy of Residential, Group-Based, Intensive Holistic Lifestyle Intervention Among Type-2 Diabetes Patients - A Single Group Pre- And Post-intervention Study. Cureus 2022; 14:e22253. [PMID: 35350487 PMCID: PMC8933147 DOI: 10.7759/cureus.22253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/11/2022] Open
Abstract
Background The present study assessed the efficacy of the residential, group-based, intensive holistic lifestyle intervention on glycaemic control. Materials and methods A one-group pre and post-intervention study was conducted among 145 people with diabetes for a period of one year from February 2019 to January 2020. The study population underwent "Brahma Kumaris Raja Yoga lifestyle" intervention. Outcome variables were changes in HbA1c levels and anthropometric parameters (like weight, BMI, etc.). Paired t-test was used to compare normally distributed numeric variables. Results The mean age was 52.39±5.79 years, with a male-female ratio close to 1:1. Mean HbA1c at baseline was 9.06±2.1%. The mean weight and BMI were 71.03±12.84 kg and 28.28±4.83kg/m2, respectively. Mean HbA1c value had shown a reduction of 1.60% (95%CI 1.17 to 1.90, p <0.001) at three months and 1.58% (95% CI 1.13-1.87, p<0.001) reduction at a six-month follow-up. Between the third and sixth months, there was no significant change in the HbA1c value. Mean weight reduced by 0.79 kg (95% CI 0.08-1.08, p=0.023) at six-month follow-up and mean BMI decreased by 0.31 units from baseline to three months (95% CI 0.05-0.56, p=0.017). A statistically significant reduction was observed in waist circumference at the third month (MD=1.61 95% CI =0.95 to 2.28, P<0.001) and sixth month (MD=1.53, 95% CI 0.82-2.25, p<0.001) follow-up. Conclusion This residential, group-based, intensive holistic lifestyle intervention showed a significant decrease in HbA1c levels and anthropometric parameters at three- and six-months follow-up, thereby improving the overall health and wellbeing of people with diabetes.
Collapse
|
8
|
Gupta SK, Lakshmi PVM, Rastogi A, Kaur M. Development and evaluation of self-care intervention to improve self-care practices among people living with type 2 diabetes mellitus: a mixed-methods study protocol. BMJ Open 2021; 11:e046825. [PMID: 34210727 PMCID: PMC8252870 DOI: 10.1136/bmjopen-2020-046825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/02/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The management of diabetes mellitus (DM) depends on medication adherence, self-care and regular follow-up to prevent complications and premature mortality. This study aims to develop and implement the behavioural change theory and model based diabetes self-care intervention package to improve self-care practices among people living with type 2 DM. METHODS AND ANALYSIS An exploratory sequential mixed-method study design wherein, quantitative follows qualitative will be used to develop, implement and evaluate the effect of diabetes self-care intervention package among people living with type 2 diabetes. The qualitative research method will be used to identify barriers and facilitators for self-care practices among people living with type 2 DM and will also provide the basis for the development of the diabetes self-care intervention package. The quasi-experimental with control study design will be used to evaluate the developed intervention package among 220 randomly selected people living with type 2 diabetes in both intervention and control arms. Baseline, follow-ups and endline data will be collected using same prevalidated and structured questionnaire for each self-care activity. Difference-in-difference analysis will be used to measure for changes in the proportion of people living with type 2 DM doing different component of self-care practices, preintervention and postintervention in both arms. ETHICS AND DISSEMINATION Permission for conducting the study has been taken from Institutional Ethical Committee of PGIMER, Chandigarh (Ref no. NK/4538/PhD/226, Dated 18.08.18). The findings of the trial will be disseminated through publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER CTRI/2018/10/016108; Pre-results.
Collapse
Affiliation(s)
- Saurabh Kumar Gupta
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, Chandigarh, India
| | - Ashu Rastogi
- Department of Endocrinology, PGIMER, Chandigarh, Chandigarh, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, Chandigarh, India
| |
Collapse
|