Determinants of lifestyle behavior in type 2 diabetes: results of the 2011 cross-sectional survey on living with chronic diseases in Canada

Observance of hygiene and dietary rules and the associated factors among diabetic subjects in Essaouira Province, Morocco: a cross-sectional study

Introduction

hygiene and dietary recommendations are a fundamental pillar of diabetes management. The objective of this study is to measure the rate of observance of hygiene and dietary rules and the factors associated with these among a group of Moroccan diabetic subjects.

Methods

a cross-sectional questionnaire survey was conducted on 522 subjects with types 1 and 2 diabetes followed at different health centres in the province of Essaouira (Morocco).

Results

non-observance of hygiene and dietary rules rate was assessed at 41,4%, (66.5% for diet, 32.4% for lifestyle and 30.8% for physical activity). Rural area (p<0.001), poor glycaemic control (p<0.001), ignorance of hygiene and dietary rules (p<0.001) and long duration of diabetes (p<0.01) are associated with non-observance of diet. Good family support (p<0.01) is associated with good observance of lifestyle recommendations, short duration of diabetes progression (p<0.01) is associated with good observance of physical activity recommendations.

Conclusion

non-observance of hygiene and dietary rules is always a problem in the management of chronic diseases. Ignorance of hygiene and dietary measures, lassitude and difficulty in adapting to a new lifestyle are the main obstacles that diabetics must overcome in order to better manage their disease.

Eating behavior among persons with type 2 diabetes mellitus in North Ethiopia: a cross-sectional study

BACKGROUND

Diet is central to the management of type 2 diabetes mellitus (T2DM). Depending on the stage of the disease at which the recommended diet is initiated, optimal adherence can reduce HbA1c by about 1 to 2%. However, evidence on eating behavior is generally scarce including in Ethiopia. The present study aimed to assess the eating behavior of adults with T2DM in North Ethiopia.

METHODS

This cross-sectional study was conducted among 421 adults with T2DM from September to November 2019. Socio-demographic variables were collected using structured questionnaires; an asset-based wealth index was used to determine socioeconomic status. Three dimensions of eating behavior were assessed using Likert-type items: food selection, meal planning and calorie recognition. Raw Likert scores in each dimension were transformed to percent scales to maximum (%SM). Participants' behavior in each dimension was categorized into healthy and unhealthy taking 66.7% SM score as a cutoff. Overall eating behavior was determined by aggregating ranks scored in the three dimensions. Correlates of overall eating behavior were identified using Chi-square test and multinomial logistic regression with statistical significance set at P-value < 0.05.

RESULT

Only 1% of the participants had overall healthy eating behavior. Yet, overall unhealthy eating was apparent in 54.4%. By dimensions, healthy eating behaviors in food selection, meal planning and calorie recognition were seen in 43.5, 7.4 and 2.9% participants, respectively. Factors that were positively associated with having healthy eating behavior in one dimension relative to unhealthy in all were: receiving nutrition education [AOR 1.73; CI 1.09, 2.74], female gender [AOR 1.78; CI 1.03, 3.08] & being in 26-44 age category [AOR 3.7; CI 1.56, 8.85]. But, being in the poor [AOR 0.42; CI 0.16, 1.32] or average [AOR 0.54; CI 0.19, 1.55] socioeconomic strata were negatively associated. However, only receiving nutrition education [AOR 3.65; CI 1.31, 10.18] was significantly associated with having healthy behavior in two eating dimensions over unhealthy in all.

CONCLUSION

In North Ethiopia, the overall eating behavior of adults with T2DM is extremely poor. Diverse and integrated approaches including nutrition education during consultation should be implemented to address the gap.

Are Patients With Type 2 Diabetes Not Aware or Are They Unable to Practice Self-Care? A Qualitative Study in Rural South India

Background: Lack of awareness and poor adherence to dietary, lifestyle modifications, and medications among patients with diabetes result in poor health outcomes. Aim: This study aimed to understand patients’ perceptions about barriers to self-management of diabetes. Materials and Methods: This was a descriptive qualitative study among patients with diabetes attending a rural health center. Five focus group discussions were conducted with 8 to 11 participants using a topic guide. Results: Many were unaware of target levels and complications of diabetes. Some aspects of the dietary information were found to be quite confusing. Physical constraints prevented many from going for outdoor walking. They have not received any information on foot care. Conclusions: Understanding the barriers for self-care will help health care workers manage diabetes better.

[Dietary patterns of elderly Brazilians and associated determinants: a population-based study in the south of Brazil]

This cross-sectional study sought to assess the effect of demographic and socioeconomic factors, chronic diseases, and health counseling on dietary patterns of the elderly. Food consumption was assessed by means of a reduced eating frequency questionnaire distributed to 1,426 elderly residents in Pelotas, State of Rio Grande do Sul, Brazil, and dietary patterns were obtained using main component analysis. Two dietary patterns were identified: healthy diet (wholegrain food, fruits, vegetables, and milk) and Western diet (sweet snacks, fried foods, frozen foods, processed meats, and fast food). Females, non-smokers, and alcohol-free individuals tended more toward the healthy diet, whereas males, smokers, alcohol-dependent, and overweight individuals tended more toward the Western diet. Higher income and schooling were associated with a higher tendency toward both diets, and chronic diseases were not associated with either diet. Receiving counseling for adopting healthy habits was associated with a higher tendency toward a healthy diet and a lower tendency toward the Western diet. There is a need to increase effective guidance on healthy habits by health services to promote healthier eating practices, with special attention to elderly males, smokers, alcohol-dependent and overweight individuals.

The longitudinal association of psychological resources with chronic conditions and the mediating roles of health behaviours and allostatic load

Objective: To investigate the association of psychological resources with the prevalence of chronic conditions up to 10 years later, and the mediating roles of health behaviours and allostatic load. Design: Participants from the Midlife in the United States study (N = 850) completed surveys and biomarker assessments over the course of 10 years. Main Outcome Measures: Primary outcome was the prevalence of chronic conditions later in life, controlling for baseline chronic conditions. Secondary outcomes were health behaviours and allostatic load. Direct and indirect associations between psychological resources and chronic conditions were examined. Results: Psychological resources were negatively associated with chronic conditions directly (ƅ = -.177, p < .05) and indirectly through health behaviours (ƅ = -.026, p < .05), but not through allostatic load (ƅ = -.000, p > .05). Psychological resources were positively associated with health behaviours (ƅ = .130, p < .01), but no association was found between psychological resources and allostatic load (ƅ = -.002, p > .05). Health behaviours were negatively associated with chronic conditions (ƅ = -.201, p < .01), and allostatic load was positively associated with chronic conditions (ƅ = .197, p < .05). Conclusion: Findings highlight the beneficial influence of psychological resources on chronic conditions, and the mediating role of health behaviours.

The Play of Genes and Non-genetic Factors on Type 2 Diabetes

Diabetes has been a disease of public health concern for a number of decades. It was in the 1930s when scientists made an interesting discovery that the disease is actually divided into two types as some patients were insensitive to insulin treatment then. Type 2 Diabetes which happens to be the non-insulin dependent one is the most common form of the disease and is caused by the interaction between genetic and non-genetic factors. Despite conflicting results, numerous studies have identified genetic and non-genetic factors associated with this common type of diabetes. This review has summarized literature on some genes and non-genetic factors which have been identified to be associated with Type 2 diabetes. It has sourced literature from PubMed, Web of Science and Medline without any limitation to regions, publication types, or languages. The paper has started with the introduction, the play of non-genetic factors, the impact of genes in general, and ended with the interaction between some genes and environmental factors.

The global prevalence of tobacco use in type 2 diabetes mellitus patients: A systematic review and meta-analysis

BACKGROUND

A multi-layered association between tobacco use and type 2 diabetes mellitus (T2DM) is well established. However, global epidemiological patterns of tobacco use among T2DM patients are not well documented; this review thus aims to estimate the overall global burden of tobacco use in T2DM.

METHODS

A systematic review of studies published from Jan 1, 1990 to October 5, 2017 was undertaken, comprising: a comprehensive literature search on multiple electronic databases; quality assessment of studies; data extraction for the primary (prevalence of tobacco use in T2DM patients) and secondary outcomes (patterns of tobacco use in T2DM patients); and a meta-analysis. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. A protocol for this review is available on PROSPERO (CRD42016038793).

FINDINGS

74 studies were included in the review, reporting data from 3.2 million participants across 33 countries. Global mean prevalence of tobacco use in T2DM was 20·81% (95% CI 18·93-22·76), and was higher in the WHO East Asia and Pacific and South Asia regions, compared to the Americas, Middle East and North Africa, Europe and Central Asia. In studies which compared prevalence of tobacco use in patients to non-patients, patients with T2DM were 26% less likely to use tobacco (pooled OR = 0·74 (CI 0·61-0·88).

INTERPRETATION

Tobacco is used by one in five T2DM patients globally, but usage is less likely in patients than in non-patients. Global patterns of use demonstrated by this review have implications for both prevention and The understanding of diabetes burden, and the success of tobacco cessation strategies.

Determinants of coronary artery disease risk factor management across three world regions

Background

The SUrvey of Risk Factors (SURF) indicated poor control of risk factors in subjects with established coronary heart disease (CHD). The present study aimed to investigate determinants of risk factor management in patients with CHD.

Methods and results

SURF recruited 9987 consecutive patients with CHD from Europe, Asia and the Middle East between 2012 and 2013. Risk factor management was summarised as a Cardiovascular Health Index Score (CHIS) based on six risk factor targets (non-smoker/ex-smoker, body mass index <30, adequate exercise, controlled blood pressure, controlled low-density lipoprotein and controlled glucose). Logistic regression models assessed the associations between determinants (age, sex, family history, cardiac rehabilitation, previous hospital admission and diabetes) and achievement of moderate CHIS (≥3 risk factors controlled). The results are presented as OR with corresponding 95% CI. A moderate CHIS was less likely to be reached by women (OR 0.90, 95% CI 0.69 to 1.00), those aged <55 years old (OR 0.62, 95% CI 0.53 to 0.76) and those with diabetes (OR 0.41, 95% CI 0.37 to 0.46). Attendance in cardiac rehabilitation was associated with better CHIS achievements (OR 1.62, 95% CI 1.42 to 1.87). Younger Asian and European patients had poorer risk factor management, whereas for patients from the Middle East age was not significantly associated with risk factor management. The availability and applicability of cardiac rehabilitation varied by region.

Conclusions

Overall, risk factor management was poorer in women, those younger than 55 years old, those with diabetes and those who did not participate in a cardiac rehabilitation. Determinants of cardiovascular risk factor management differed by region.

How Does Diet Change with A Diagnosis of Diabetes? Protocol of the 3D Longitudinal Study

Diet quality influences glycemic control in people with type 2 diabetes (T2D), impacting their risk of complications. While there are many cross-sectional studies of diet and diabetes, there is little understanding of the extent to which people with T2D change their diet after diagnosis and of the factors that impact those changes. This paper describes the rationale for and design of the 3D longitudinal Study which aims to: (i) describe diet quality changes in the 12 months following T2D diagnosis, (ii) identify the demographic, physical and psychosocial predictors of sustained improvements in diet quality and glycemic control, and (iii) identify associations between glycemic control and diet quality in the 12 months following diagnosis. This cohort study will recruit adults registered with the Australian National Diabetes Services Scheme who have been recently diagnosed with T2D. Participants will be involved in five purposefully developed telephone surveys, conducted at 3 monthly intervals over a 12-month period. Diet quality will be determined using a 24-h dietary recall at each data collection point and the data will be scored using the Dietary Approaches to Stop Hypertension (DASH) diet-quality tool. This study is the first dedicated to observing how people newly diagnosed with T2D change their diet quality over time and the predictors of sustained improvements in diet and glycemic control.

Social inequalities in care for the elderly with diabetes in Brazil

Objective.

To measure the prevalence of various care services offered to the elderly with diabetes mellitus in Brazil, and to assess the social inequalities in these services.

Methods.

This cross-sectional, population-based study was carried out in 2013. The care services offered were evaluated in terms of the following eight indicators: recommendations to lower carbohydrates, to measure blood glucose, and to examine the feet; requests made for blood tests, for glycated hemoglobin tests, and for glycemic curve tests; and whether service users had had their eyes or feet examined in the previous year. We used the slope index of inequality and the concentration index to assess the inequalities among wealth quintiles.

Results.

A total of 1 685 elderly persons with diabetes were evaluated. Overall, 41.7% of them had had their eyes examined in the preceding year, 35.4% had had their feet examined in the preceding year, and 10.9% had been offered all eight of the care services. The largest absolute differences (in percentage points) between the first (poorest) and fifth (richest) wealth quintiles in terms of the care services that were offered to the users were for: a recommendation to measure blood glucose (25.8), a glycated hemoglobin test request (27.4), a glycemic curve test request (31.9), having the eyes examined in the preceding year (29.3), and having the feet examined in the preceding year (27.0).

Conclusion.

There were notable inequalities in the prevalences of the care services. In the future, measurement of blood glucose and examination of the feet should be emphasized, especially for elderly persons in a lower socioeconomic level.

The Effect of Group Discussion-based Education on Self-management of Adults with Type 2 Diabetes Mellitus Compared with Usual Care: A Randomized Control Trial

Objectives

We sought to determine the effect of group discussion-based education on the self-management capability of patients with type 2 diabetes in Iran.

Methods

This randomized control trial was conducted on 90 patients with type 2 diabetes. Participants were allocated randomly into one of two groups; intervention and control. The intervention group received the group discussion-based education while the control group received routine care only. The Lin's self-management questionnaire was completed at baseline and three months post-intervention.

Results

Statistical analysis, including the use of independent t-test, identified that in comparison to the control group, significant increases were observed in the scores of self-organization (t =11.24, p < 0.001), self-adjustment (t = 7.53, p < 0.001), interaction with health experts (t = 7.31, p < 0.001), blood sugar self-monitoring (t = 6.42, p < 0.001), adherence to the proposed diet (t = 5.22, p < 0.001), and total self-management (t = 10.82, p < 0.001) in the intervention group.

Conclusions

Sharing experiences through group discussions and receiving instructive feedback can improve the ability to self-manage diabetes.

Community Pharmacy-Based Inducement Programs Associated With Better Medication Adherence: A Cohort Study

BACKGROUND

Inducement programs can promote customer loyalty; however, the clinical effects of these programs are unknown.

OBJECTIVE

To examine relationships among inducement program use, medication adherence, and health outcomes.

METHODS

Alberta residents with ≥ 1 physician visit for diabetes or hypertension between April 2008 and March 2014 were eligible for this study and included if they were new statin users and alive at least 455 days after the first statin dispensation. Group assignment was based on whether all statin dispensations in the first year were obtained from pharmacies with or without inducement programs. Discontinuation was defined as no statin dispensations between 275 and 455 days after the first statin dispensation. Acute coronary syndrome (ACS) hospitalizations or deaths were identified between 456 days and 3 years after the first statin dispensation. Multivariable regression analyses were conducted to examine relationships among inducement program use, discontinuation, and ACS events.

RESULTS

Among the 159 998 new statin users, mean age was 60.2 (±13.7) years and 67 534 (42%) were women. Statin discontinuation occurred in 22 455 (28.9%) of 77 803 inducement group participants and 25 816 (31.4%) of 82 195 noninducement group participants (adjusted odds ratio = 0.88; 95% CI = 0.86-0.90). Risk of an ACS event was similar between groups (adjusted hazard ratio = 1.00; 95% CI 0.92-1.08); however, discontinuing statin therapy was associated with a higher risk of an ACS event (adjusted hazard ratio = 1.27; 95% CI = 1.16-1.39).

CONCLUSIONS

Inducement programs are associated with better adherence and not directly associated with risk of health outcomes.

Self-reported receipt of healthcare professional's weight management counselling is associated with self-reported weight management behaviours of type 2 diabetes mellitus patients

BACKGROUND

Weight loss has been shown to influence the health outcomes of type 2 diabetes patients. Providing weight management counselling to diabetes patients may help them adopt appropriate weight management behaviours to lose weight. This study determined the association between self-reported receipt of healthcare professional's weight management counselling and the weight management behaviours of type 2 diabetes patients.

METHODS

This cross-sectional study was conducted among 378 type 2 diabetes mellitus patients seeking care from two hospitals. Using a questionnaire, participants' weight management behaviours were assessed as well as receipt of healthcare professional's weight management counselling.

RESULTS

Half (51.3 %) of the participants reported receipt of healthcare professional's weight management counselling in the last 12 months. Half of the participants ever tried to lose weight. Fewer than half of the participants reported modifying their dietary habits (45.5 %) or engaging in exercise (48.7 %) to lose weight. Those who reported receipt of weight management counselling were more likely to report ever trying to lose weight (AOR 43.0, 95 % CI 23.0-81.6; p < 0.001), modifying their dietary habits (AOR 22.5, 95 % CI 13.0-39.19; p < 0.001), and engaging in exercise (AOR 13.0, 95 % CI 7.8-21.7; p < 0.001) to lose weight.

CONCLUSION

Participants engaged in varied weight management behaviours. Receipt of health care professionals' weight management counselling was associated to participants' reported participation in weight management behaviours. Weight management counselling from health care professionals may support the adoption of weight management behaviours in type 2 diabetes mellitus patients.

Hábitos saudáveis: que tipo de orientação a população idosa está recebendo dos profissionais de saúde?

RESUMO: Objetivo: Descrever a prevalência de orientações sobre hábitos saudáveis recebidas de profissionais de saúde entre idosos e sua relação com indicadores socioeconômicos, demográficos, comportamentais, de saúde e do tipo de serviços. Métodos: Estudo transversal, de base populacional, com indivíduos de 60 anos ou mais da zona urbana de Pelotas, Rio Grande do Sul. Foram avaliadas sete orientações sobre hábitos saudáveis: controlar o peso, reduzir o sal, açúcar e gordura, praticar atividade física, não fumar e não ingerir bebidas alcoólicas. Resultados: Entre os 1.451 idosos entrevistados, 1.281 (88,3%) consultaram no último ano. As orientações mais referidas foram para redução do consumo de gordura (61,7%), de sal (61,5%) e prática de atividade física (58,2%). Idosos que consultaram três vezes ou mais e em serviços financiados pelo Sistema Único de Saúde receberam mais orientações. Aqueles idosos de classificação econômica A/B tiveram maior probabilidade de receber orientação para controle de peso (RP = 1,27; IC95% 1,06 - 1,70) e para prática de atividade física (RP = 1,34; IC95% 1,06 - 1,69). Conclusão: As orientações, por profissionais de saúde, foram pouco frequentes e, em alguns casos, desfocalizadas.

Effects of the behavior of elderly type 2 diabetic patients and their relatives as caregivers on diabetes follow-up parameters in Bolu, Turkey

AIM

In the present study, patients with type 2 diabetes mellitus and their relatives as caregivers during the treatment period, and the effects on treatment success were evaluated.

METHODS

A cross-sectional study of type 2 diabetes mellitus patients aged 65 years and older and their relatives as caregivers was carried out. The questionnaire given to the participants consisted of three sections: the first section included questions regarding sociodemographic characteristics; the second section included questions on patient treatment, habits of drug use, lifestyle changes such as dietary habits; and the third section included anthropometric measurements and laboratory evaluations. The questionnaire given to the patients' relatives as caregivers consisted of questions regarding their sociodemographic characteristics and information regarding the patient.

RESULTS

The present study consisted of 115 patients diagnosed with type 2 diabetes mellitus and their relatives as caregivers. The average duration of diabetes was 12.14 ± 6.74 years. Body mass index was 30.2 ± 4.2 kg/m(2) , average hemoglobin A1c level was 7.09 ± 0.64%, and 40.1% of the patients lived with their partners only. As the frequency of physical exercise increased, hemoglobin A1c levels decreased to <7.5% (P < 0.05).The patients whose caregivers were college-educated or equivalent had a significantly low body mass index (P < 0.05). Patients who lived with their partners showed a significant correlation with lower hemoglobin A1c levels (<7.5%; P = 0.002).

CONCLUSION

In order to improve diabetic conditions in the elderly and to overcome obstacles to disease management, maximizing the cooperative efforts between the patients and their caregivers is necessary.

A pilot study examining patient attitudes and intentions to adopt assistive technologies into type 2 diabetes self-management

Approximately half of individuals living with type 2 diabetes mellitus (T2DM) have suboptimal self-management, which could be improved by using assistive technologies in self-management regimes. This study examines patient attitudes and intentions to adopt assistive technologies into T2DM self-management. Forty-four participants (M = 58.7 years) with T2DM were recruited from diabetes education classes in the southwestern Ontario, Canada, between February and April 2014. Participants completed a self-reported in-person survey assessing demographic characteristics, current diabetes management, and attitudes toward using assistive technologies in their diabetes self-management. Demographics, disease characteristics, and current technology use and preferences of the cohort were examined, followed by a correlational analysis of descriptive characteristics and attitudes and intentions to use technology in self-management. The majority of (but not all) participants felt that using Internet applications (65%) and smartphone (53.5%) applications for self-management was a good idea. The majority of participants did not currently use an Internet (92.5%) or mobile (96%) application for self-management. Of participants, 77% intended to use an Internet application to manage their diabetes in the future and 58% intended to use mobile applications. Younger age was associated with more positive attitudes (r = -.432, P = .003) and intentions (r = -.425, P = .005) to use assistive technologies in diabetes self-management. Findings suggest that patients, especially those younger in age, are favorable toward adopting assistive technologies into management practice. However, attitudes among older adults are less positive, and few currently make use of such technologies in any age group.

Profile of adults with type 2 diabetes and uptake of clinical care best practices: results from the 2011 Survey on Living with Chronic Diseases in Canada - Diabetes component

AIMS

This study aimed to (1) describe the profile of adults with type 2 diabetes (T2D) in Canada and (2) assess the uptake of clinical care best practices, as defined by the Canadian Diabetes Association (CDA) Clinical Practice Guidelines (CPGs).

METHODS

We used data from the 2011 Survey on Living with Chronic Diseases in Canada - Diabetes component. Participants were aged 20 years and older, living in the 10 Canadian provinces, with self-reported T2D. Descriptive analyses present the prevalence of complications and comorbidities, as well as the level of clinical monitoring and self-monitoring/lifestyle management recommendations participants received.

RESULTS

We included 2335 participants with T2D, a mean age of 62.9 years, and high prevalence of complications/comorbidities and prescription medication use. Most participants reported being monitored as recommended for eye disease (73.9%), weight (81.0%), blood pressure (89.0%) and blood cholesterol levels (94.3%), but only 65.5% reported having at least two HbA1c tests during the last year and 46.5% reported an annual foot examination by a health professional. About two-thirds of the participants reported having received recommendations on weight management (59.9%) and physical activity (64.7%) from a health professional in the previous year; only 47.8% of the participants reported having received diet counseling to improve diabetes control.

CONCLUSION

Although the uptake of CDA CPGs for clinical and self-monitoring was high, with the majority of the participants reporting meeting most indicators, it was lower for HbA1c measurement and foot examination. Uptake of lifestyle management recommendations provided by health professionals was also significantly lower.