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Peres GB, Nucci LB, Andrade ALM, Enes CC. Lifestyle behaviors and associated factors among individuals with diabetes in Brazil: a latent class analysis approach. CIENCIA & SAUDE COLETIVA 2023; 28:1983-1992. [PMID: 37436312 DOI: 10.1590/1413-81232023287.05622022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 12/21/2022] [Indexed: 07/13/2023] Open
Abstract
The purpose of the cross-sectional study was to identify patterns of modifiable lifestyle behaviors and examine the relationship between sociodemographic characteristics and distinct lifestyle behaviors. The data were gathered from the National Health Survey 2019, a study that included adults with diabetes. Four domains of lifestyle behaviors were used to define these behaviors: smoking, alcohol consumption, physical activity, and diet. The association between patterns of lifestyle behaviors and variables of interest was assessed using multinomial regression analysis. The three lifestyle patterns identified were: Class 1, referred to as "unhealthy diet," comprised 17.0% of the sample and was characterized by unhealthy eating habits; Class 2 (less active and insufficient fruit and vegetable intake) represented 71.2% of the sample; Class 3 referred to as "low risk" (11.8%) is characterized by a lower probability of engaging in most risky behaviors. A person over 45 years of age with little or no education and no health care coverage was less likely to be a member of Class 1. Male individuals who do not attend a doctor regularly exhibited more chances of belonging to Class 2. Mixed-race individuals aged 45 years or more with a low level of education have a lower chance of belonging to this class.
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Affiliation(s)
- Gabriela Bertoldi Peres
- Programa de Pós-Graduação em Ciências da Saúde, Pontifícia Universidade Católica de Campinas. Av. John Boyd Dunlop s/n, Jardim Ipaussurama. 13034-685 Campinas SP Brasil.
| | - Luciana Bertoldi Nucci
- Programa de Pós-Graduação em Ciências da Saúde, Pontifícia Universidade Católica de Campinas. Av. John Boyd Dunlop s/n, Jardim Ipaussurama. 13034-685 Campinas SP Brasil.
| | - André Luiz Monezi Andrade
- Programa de Pós-Graduação em Psicologia, Pontifícia Universidade Católica de Campinas. Campinas SP Brasil
| | - Carla Cristina Enes
- Programa de Pós-Graduação em Ciências da Saúde, Pontifícia Universidade Católica de Campinas. Av. John Boyd Dunlop s/n, Jardim Ipaussurama. 13034-685 Campinas SP Brasil.
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Rønne ST, Joensen LE, Zabell V, Arnfred SM, Brown JVE, Jørgensen R. Schizophrenia and type 2 diabetes: Perceptions and understandings of illness management in everyday life. Int J Ment Health Nurs 2023; 32:893-903. [PMID: 36825444 DOI: 10.1111/inm.13135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/20/2023] [Accepted: 02/12/2023] [Indexed: 02/25/2023]
Abstract
People with schizophrenia and type 2 diabetes face complex challenges in daily life and the management of both illnesses is burdensome. This qualitative interview study aimed to explore perceptions and understandings of the day-to-day management of schizophrenia and type 2 diabetes. Fourteen semi-structured interviews were conducted between January 2020 and October 2021 in the participants' respective mental health clinics, in their homes or by phone. Thematic analysis led to four themes representing participants' self-management strategies and perceived challenges. The first theme showed that participants use self-learned strategies for managing schizophrenia. In contrast, they perceived type 2 diabetes self-management as governed by a set of rules and guidelines given by health professionals. The second theme showed that both psychotic and negative symptoms present challenges to diabetes management. Theme 3 illustrated that participants consider their type 2 diabetes to be a very serious illness. They worried about potential long-term consequences and expressed wishes and motivation to improve their lifestyle. The final theme showed that participants discuss challenges related to their schizophrenia with family and friends but not type 2 diabetes. In conclusion, this study highlights the importance of considering individual challenges and everyday routines when supporting this population. It underlines the need for future research to further explore the complexity of managing the illnesses and to understand the needs for treatment and support.
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Affiliation(s)
- Sabrina Trappaud Rønne
- Research Unit of Psychotherapy and Psychopathology, Region Sjaelland, Slagelse, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Eide Joensen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Vicki Zabell
- Research Unit of Psychotherapy and Psychopathology, Region Sjaelland, Slagelse, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sidse Marie Arnfred
- Research Unit of Psychotherapy and Psychopathology, Region Sjaelland, Slagelse, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Rikke Jørgensen
- Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Healy KV, Weise S, Fink A, Frese T, Richter M, Knöchelmann A. Learning Approaches as a Means to Understand Difficulties and Opportunities in Type 2 Diabetes Self-Management Training: A Qualitative Content Analysis of Two German Educational Curricula. AMERICAN JOURNAL OF HEALTH EDUCATION 2022. [DOI: 10.1080/19325037.2022.2120580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | | | - Astrid Fink
- Martin Luther University Halle-Wittenberg
- District Administration Groß-Gerau
| | | | - Matthias Richter
- Martin Luther University Halle-Wittenberg
- Technical University of Munich
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Carmienke S, Fink A, Baumert J, Heidemann C, Du Y, Frese T, Heise M. Participation in structured diabetes self-management education programs and its associations with self-management behaviour - a nationwide population-based study. PATIENT EDUCATION AND COUNSELING 2022; 105:843-850. [PMID: 34272129 DOI: 10.1016/j.pec.2021.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the relationship between participation in structured diabetes self-management education programs (DSME) and self-management behaviour (SMB) in routine care. METHODS The study included 864 ever- and 515 never-DSME participants from the population-based survey German Health Update (GEDA) 2014/2015. SMB and clinical care variables were: Following a diet plan, keeping a diabetes diary, holding a diabetes pass, self-monitoring of blood glucose (SMBG), foot self-examination (FSE), retinopathy screening, haemoglobin A1c (HbA1c) measurement and examination of the feet by clinicians (FEC). We conducted logistic regression analyses for association of DSME-participation with SMB, adjusting for various variables. RESULTS DSME-participation was significantly associated with SMB including following a diet plan (OR 1.88 [95% CI 1.21-2.92]), keeping a diabetes journal (OR 3.83 [2.74-5.36]), holding a diabetes health passport (OR 6.11 [4.40-8.48]), SMBG (OR 2.96 [2.20-3.98]) and FSE (OR 2.64 [2.01-3.47]) as well as retinopathy screening (OR 3.30 [2.31-4.70]), HbA1c measurement (OR 2.58 [1.88-3.52]), and FEC (OR 3.68 [2.76-4.89]) after adjusting for confounders. CONCLUSION DSME-participation is associated with higher frequencies of various SMB and clinical care variables in routine care. Never-DSME attenders are more likely not to receive retinopathy screening, FEC and HbA1c measurements as recommended. PRACTICE IMPLICATIONS Clinicians should refer diabetes patients to a DSME and ensure a regular follow up for never-DSME attenders.
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Affiliation(s)
- Solveig Carmienke
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle, Saale, Germany
| | - Astrid Fink
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Saale, Germany
| | - Jens Baumert
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, Berlin, Germany
| | - Christin Heidemann
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, Berlin, Germany
| | - Yong Du
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, Berlin, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle, Saale, Germany
| | - Marcus Heise
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle, Saale, Germany.
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Sallay V, Klinovszky A, Csuka SI, Buzás N, Papp-Zipernovszky O. Striving for autonomy in everyday diabetes self-management-qualitative exploration via grounded theory approach. BMJ Open 2021; 11:e058885. [PMID: 34952888 PMCID: PMC9066350 DOI: 10.1136/bmjopen-2021-058885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The rapid worldwide increase in the incidence of diabetes significantly influences the lives of individuals, families and communities. Diabetes self-management requires personal autonomy and the presence of a supportive social environment. These attributes can considerably ameliorate the outcomes of the chronic condition. However, little is known about individual variations in overcoming the illness-related challenges and in the achievement of autonomy in daily activities. This paper seeks to bridge this knowledge gap. DESIGN This qualitative study used the grounded theory approach. Semi-structured interviews were conducted, and the data collection and data analysis probed participant experiences of autonomy through the self-management of their daily socio-physical environments. SETTING Participants were recruited from the outpatient ward of a university clinic in Hungary. PARTICIPANTS The study was conducted with 26 adult patients with type 2 diabetes mellitus (15 females and 11 males aged between 26 and 80 years; M=62.6 years; SD=13.1). The inclusion criteria were: T2D diagnosis at least 1 year before the beginning of the study; prescribed insulin injection therapy; aged over 18 years; native Hungarian speaker and not diagnosed with dementia or any form of cognitive impairment. RESULTS The study established three principal aspects of the active construction of personal autonomy in diabetes self-management: coping strategies vis-à-vis threats posed by the symptoms and the treatment of the disease; autonomous ways of creating protective space and time and relationship processes that support everyday experiences of self-directedness. CONCLUSIONS The results of this study confirm the validity of the self-determination theory in diabetes self-management. They also imply that pathways towards constructing everyday experiences of self-directedness in participants lead through self-acceptance, supporting family relationships and a doctor-patient relationship characterised by partnership. The tentative empirical model of pathways towards patients' experience of self-directedness can serve as a framework for future research, patient-centred clinical practice, and education.
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Affiliation(s)
- Viola Sallay
- Institute of Psychology, University of Szeged, Szeged, Hungary
| | - Andrea Klinovszky
- Department of Health Economics, University of Szeged, Szeged, Hungary
| | - Sára Imola Csuka
- Károly Rácz Doctoral School, Semmelweis University, Budapest, Hungary
- Institute for the Psychology of Special Needs, Eötvös Loránd University, Budapest, Hungary
| | - Norbert Buzás
- Department of Health Economics, University of Szeged, Szeged, Hungary
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Habebo TT, Pooyan EJ, Mosadeghrad AM, Babore GO, Dessu BK. Prevalence of Poor Diabetes Self-Management Behaviors among Ethiopian Diabetes Mellitus Patients: A Systematic Review and Meta-Analysis. Ethiop J Health Sci 2021; 30:623-638. [PMID: 33897223 PMCID: PMC8054449 DOI: 10.4314/ejhs.v30i4.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Diabetes has no cure so far, but appropriate self-management contributes to delay or control its progression. However, poor self-management by diabetic patients adds to disease burden. The pooled prevalence of overall, and its main components of poor self-management among Ethiopian diabetic patients remain elusive. Hence, this study aimed to determine the prevalence of poor diabetes self-management behaviors among diabetic patients in Ethiopia. Method by using different combinations of search terms, we accessed articles done until February 15, 2020 through Pubmed, Scopus, Web of Science and Embase databases. Newcastle-Ottawa quality assessment scale was used for quality assessment, and STATA version 14 software along with the random-effects model was employed for statistical analyses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA.) guideline was followed to report the results. Result Twenty-one studies with 7,168 participants were included in this meta-analysis. The overall pooled prevalence of poor self-management behavior among diabetic patients in Ethiopia was 49.79% (95% CI: 43.58%, 56.01%). Based on subgroup analysis, the estimated magnitudes of poor self-management by regions were 68.58% in Tigray, 55.46% in Harari, 54.74%, in Amhara, 40.90%, in SNNPRS and 37.06% in Addis Ababa. The worst (80.91%) and relatively better (24.65%) self-management components were observed on self-blood glucose monitoring and medication adherence, respectively. Conclusion One in two diabetic patients in Ethiopia had poor self-management. Thus, we strongly recommend to the ministry of health and universities to train diabetes health educators, and the health facilities to deliver tailored diabetes health education.
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Affiliation(s)
- Teshome Tesfaye Habebo
- Tehran University of Medical Sciences, international campus (TUMS-IC), Tehran, Iran.,School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Kembata Tembaro zone Health department, SNNPRS, Ethiopia
| | | | | | - Getachew Ossabo Babore
- Department of nursing, college of medicine and health sciences, Wachemo University, Hosanna, Ethiopia
| | - Blen Kassahun Dessu
- Department of anesthesia, college of health sciences and medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Lee LY, Hsieh CJ, Lin YT. Life satisfaction and emotional distress in people living with type 2 diabetes mellitus: The mediating effect of cognitive function. J Clin Nurs 2021; 30:2673-2682. [PMID: 33655571 DOI: 10.1111/jocn.15740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 01/24/2021] [Accepted: 02/25/2021] [Indexed: 10/22/2022]
Abstract
AIMS AND OBJECTIVES To explore the relationships among emotional distress, cognitive function and life satisfaction in people living with type 2 diabetes mellitus (T2DM), and to verify the mediating role of cognitive function. BACKGROUND People with T2DM face cognitive decline caused by age and disease complications. Emotional distress will reduce their life satisfaction, and cognitive function will also affect the life satisfaction, but whether cognitive function mediates the effect of emotional distress on life satisfaction has not been verified. DESIGN A cross-sectional study. METHODS A total of 200 people living with T2DM in the community by convenience sampling were enrolled from November-December 2018. Data collection involved a demographic and disease characteristic questionnaire, Problem Areas in Diabetes Scale, Subjective and Objective Cognitive Function Evaluation and Life Satisfaction Questionnaire. Data analysis included descriptive statistics and structural equation modelling. This report followed the STROBE guideline. RESULTS The emotional distress and subjective memory complaints of cognitive function had a significant positive correlation, while both emotional distress and cognitive function showed significant negative correlations with life satisfaction. In addition, cognitive function completely mediated the relationship between emotional distress and life satisfaction. CONCLUSION The cognitive function played a mediating role in life satisfaction and explains how emotional distress affects life satisfaction of people with T2DM. Therefore, it is suggested that diabetes nurses should early identify the decline of cognitive function, and to intervene at an early stage. RELEVANCE TO CLINICAL PRACTICE This study provides opinions on the mediating factors of cognitive function. Coping strategies and supporting resources to help the T2DM people to improve their life satisfaction are suggested.
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Affiliation(s)
- Li-Yen Lee
- School of nursing, College of Nursing, Lecturer of Cardinal Tien Junior of Healthcare and Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chia-Jung Hsieh
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Ya-Ting Lin
- School of nursing, College of Nursing, Lecturer of St. Mary's Junior College of Medicine, Nursing and Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Heise M, Fink A, Baumert J, Heidemann C, Du Y, Frese T, Carmienke S. Patterns and associated factors of diabetes self-management: Results of a latent class analysis in a German population-based study. PLoS One 2021; 16:e0248992. [PMID: 33740024 PMCID: PMC7978380 DOI: 10.1371/journal.pone.0248992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/10/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Few studies on diabetes self-management considered the patterns and relationships of different self-management behaviours (SMB). The aims of the present study are 1) to identify patterns of SMB among persons with diabetes, 2) to identify sociodemographic and disease-related predictors of SMB among persons with diabetes. RESEARCH DESIGN AND METHODS The present analysis includes data of 1,466 persons (age 18 to 99 years; 44.0% female; 56.0% male) with diabetes (type I and II) from the population-based study German Health Update 2014/2015 (GEDA 2014/2015-EHIS). We used latent class analysis in order to distinguish different patterns of self-management behaviours among persons with diabetes. The assessment of SMB was based on seven self-reported activities by respondents (dietary plan, diabetes-diary, diabetes health pass, self-assessment of blood glucose, self-examination of feet, retinopathy-screenings and assessment of HbA1c). Subsequent multinomial latent variable regressions identified factors that were associated with self-management behaviour. RESULTS Latent class analysis suggested a distinction between three patterns of SMB. Based on modal posterior probabilities 42.8% of respondents showed an adherent pattern of diabetes self-management with above-average frequency in all seven indicators of SMB. 32.1% showed a nonadherent pattern with a below-average commitment in all seven forms of SMB. Another 25.1% were assigned to an ambivalent type, which showed to be adherent with regard to retinopathy screenings, foot examinations, and the assessment of HbA1c, yet nonadherent with regard to all other forms of SMB. In multivariable regression analyses, participation in Diabetes Self-Management Education programs (DSME) was the most important predictor of good self-management behaviour (marginal effect = 51.7 percentage points), followed by attentiveness towards one's personal health (31.0 percentage points). Respondents with a duration of illness of less than 10 years (19.5 percentage points), employed respondents (7.5 percentage points), as well as respondents with a high socioeconomic status (24.7 percentage points) were more likely to show suboptimal forms of diabetes self-management. DISCUSSION In the present nationwide population-based study, a large proportion of persons with diabetes showed suboptimal self-management behaviour. Participation in a DSME program was the strongest predictor of good self-management. Results underline the need for continual and consistent health education for patients with diabetes.
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Affiliation(s)
- Marcus Heise
- Institute of General Practice and Family Medicine, Medical Faculty of Martin Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Astrid Fink
- Institute of Medical Sociology, Medical Faculty of Martin Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Jens Baumert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Yong Du
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Medical Faculty of Martin Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Solveig Carmienke
- Institute of General Practice and Family Medicine, Medical Faculty of Martin Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Pal R, Yadav U, Verma A, Bhadada SK. Awareness regarding COVID-19 and problems being faced by young adults with type 1 diabetes mellitus amid nationwide lockdown in India: A qualitative interview study. Prim Care Diabetes 2021; 15:10-15. [PMID: 32660907 PMCID: PMC7351665 DOI: 10.1016/j.pcd.2020.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 02/06/2023]
Abstract
AIMS To assess the awareness about COVID-19 and the problems being faced by young adults with T1DM amid nationwide lockdown in India. METHODS A cross-sectional telephone-based qualitative interview study was conducted in young adults (aged 18-30 years) with T1DM amid lockdown. Following verbal consent, participants were asked 8 open-ended questions, 5 on awareness about COVID-19 and 3 catering to problems being faced concerning diet, physical activity and treatment amid lockdown. On average, 3 interviews were conducted per day with each lasting for 15-20 min. Interviews were recorded, transcribed and analyzed by qualitative content analysis. RESULTS Thirty-two participants were interviewed; after exclusion of two poorly recorded interviews, 30 were finally analyzed. Mean age of participants was 22.4 ± 4.0 years (M:F = 8:7). Only 30%, 40% and 53% of participants were aware of modes of transmission (respiratory droplets and fomites), cardinal symptoms (fever, cough and breathing difficulty) and means of prevention (staying indoors, social distancing and regular hand washing), respectively. Majority of participants were unaware of additional risks associated with COVID-19 in diabetes mellitus. Most participants could continue with their routine diet and prescribed treatment regime, however, 90% reported a reduction in physical activity and 72% experienced worsening of glycemic control amid lockdown. CONCLUSIONS Young adults with T1DM lack adequate awareness about COVID-19. Increasing awareness and imparting diabetes self-management education via digital/print media is needed.
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Affiliation(s)
- Rimesh Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Urmila Yadav
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Anmol Verma
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Sanjay K Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India.
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Trento M, Fornengo P, Amione C, Salassa M, Barutta F, Gruden G, Mazzeo A, Merlo S, Chiesa M, Cavallo F, Charrier L, Porta M. Self-management education may improve blood pressure in people with type 2 diabetes. A randomized controlled clinical trial. Nutr Metab Cardiovasc Dis 2020; 30:1973-1979. [PMID: 32811740 DOI: 10.1016/j.numecd.2020.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/12/2020] [Accepted: 06/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Diabetes is a suitable model to evaluate intervention programmes aimed at chronic diseases, because of its well-defined and measurable process and outcome indicators. In this study, we aimed at investigating the effects of group based self-management education on clinical and psychological variables in type 2 diabetes. METHODS AND RESULTS Four-year randomized controlled clinical trial (ISRCTN14558376) comparing Group Care and traditional one-to-one care. Clinical and psychological variables were monitored at baseline, 2 and 4 years. Although differences between groups appear to be non-significant at univariate analysis, body weight, BMI and HbA1c, systolic and diastolic blood pressure improved in the patients followed by Group Care but not among Controls. Prescription of lipid-lowering and anti-hypertensive agents did not change among the patients on Group Care, whereas anti-hypertensives were stepped up among Controls without improving their blood pressure. Multivariable analysis suggests that blood pressure improvement among patients on Group Care was independent of BMI, duration of diabetes and antihypertensive medication, suggesting a direct effect of education, presumably by increasing adherence. The "Powerful Others" dimension of the Locus of Control worsened and fear of complications decreased among Controls. CONCLUSIONS The results confirm that a multidisciplinary structured group educational approach improves blood pressure, presumably through better adherence to healthy lifestyle and medication, in people with type 2 diabetes. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN14558376.
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Affiliation(s)
- Marina Trento
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy.
| | - Paolo Fornengo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy
| | - Cristina Amione
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy
| | - Martina Salassa
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy
| | - Federica Barutta
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy
| | - Gabriella Gruden
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy
| | - Aurora Mazzeo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy
| | - Stefano Merlo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy
| | - Mario Chiesa
- Links Foundation, Polytechnic University of Turin, Italy
| | - Franco Cavallo
- Department of Public Health and Paediatric Sciences, University of Turin, Italy
| | - Lorena Charrier
- Department of Public Health and Paediatric Sciences, University of Turin, Italy
| | - Massimo Porta
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy
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O'Donnell S. 'Your wealth is your health': the fundamental causes of inequalities in diabetes management outcomes: a qualitative analysis. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1626-1641. [PMID: 33460137 DOI: 10.1111/1467-9566.13156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Fundamental Cause Theory (FCT) is among the most influential explanations for health inequalities. The theory posits that the social gradient in health persists because higher-socioeconomic status (SES) groups are systematically more able to take advantage of new medical innovations and health-enhancing knowledge due to their greater access to resources. Taking the life histories of people with diabetes (PwD) (N = 17) in the Republic of Ireland as a case study, this paper aims to elucidate the behaviours and agencies underlying 'fundamental causality' through examining how PwD of contrasting SES respond to disease management information. Findings highlight how the most common barriers to effective diabetes control were chronic psychological distress, combined with the cultural significance of alcohol consumption, which was central to both the social and economic subsistence of male participants in particular. However, higher-SES groups were more likely to experience a 'turnabout' in their life, whereby they could remove themselves from the conditions giving rise to their distress and move into a social space where more health-enhancing behaviours were possible. It concludes with a discussion of potential mechanisms that may explain why such turnabouts were more likely to occur in the case of higher-SES groups and the implications for FCT.
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Affiliation(s)
- Shane O'Donnell
- School of Sociology, University College Dublin, Dublin, Ireland
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12
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Baptista S, Wadley G, Bird D, Oldenburg B, Speight J. User Experiences With a Type 2 Diabetes Coaching App: Qualitative Study. JMIR Diabetes 2020; 5:e16692. [PMID: 32706649 PMCID: PMC7395244 DOI: 10.2196/16692] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/08/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Diabetes self-management apps have the potential to improve self-management in people with type 2 diabetes (T2D). Although efficacy trials provide evidence of health benefits, premature disengagement from apps is common. Therefore, it is important to understand the factors that influence engagement in real-world settings. OBJECTIVE This study aims to explore users' real-world experiences with the My Diabetes Coach (MDC) self-management app. METHODS We conducted telephone-based interviews with participants who had accessed the MDC self-management app via their smartphone for up to 12 months. Interviews focused on user characteristics; the context within which the app was used; barriers and facilitators of app use; and the design, content, and delivery of support within the app. RESULTS A total of 19 adults with T2D (8/19, 42% women; mean age 60, SD 14 years) were interviewed. Of the 19 interviewees, 8 (42%) had T2D for <5 years, 42% (n=8) had T2D for 5-10 years, and 16% (n=3) had T2D for >10 years. In total, 2 themes were constructed from interview data: (1) the moderating effect of diabetes self-management styles on needs, preferences, and expectations and (2) factors influencing users' engagement with the app: one size does not fit all. CONCLUSIONS User characteristics, the context of use, and features of the app interact and influence engagement. Promoting engagement is vital if diabetes self-management apps are to become a useful complement to clinical care in supporting optimal self-management. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry CTRN126140012296; URL https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366925&isReview=true.
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Affiliation(s)
- Shaira Baptista
- Melbourne School of Population and Global Health, Melbourne, Australia.,Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
| | - Greg Wadley
- School of Computing and Information Systems, The University of Melbourne, Melbourne, Australia
| | - Dominique Bird
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, Melbourne, Australia
| | - Jane Speight
- Melbourne School of Population and Global Health, Melbourne, Australia.,Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
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- See Authors' Contributions section,
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13
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Hashim SM, Idris IB, Sharip S, Bahari R, Jahan N. Understanding the Turning Point of Patients with Diabetes. Korean J Fam Med 2020; 42:123-131. [PMID: 32418396 PMCID: PMC8010448 DOI: 10.4082/kjfm.19.0177] [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: 12/30/2019] [Accepted: 03/26/2020] [Indexed: 11/21/2022] Open
Abstract
Background The patient’s intention to engage in diabetes care is the hallmark of role acceptance as a health manager and implies one’s readiness to change. The study aimed to understand the process of having the intention to engage in diabetes care. Methods A qualitative study using narrative inquiry was conducted at a public primary care clinic. Ten participants with type 2 diabetes of more than a 1-year duration were selected through purposive sampling. In-depth interviews were conducted using a semi-structured protocol guide and were audio-taped. The interviews were transcribed and the texts were analyzed using a thematic approach with the Atlas.ti ver. 8.0 software (Scientific Software Development GmbH, Berlin, Germany). Results Three themes emerged from the analysis. The first theme, “Initial reactions toward diabetes,” described the early impression of diabetes encompassing negative emotions, feeling of acceptance, a lack of concern, and low level of perceived efficacy. “Process of discovery” was the second overarching theme marking the journey of participants in finding the exact truth about diabetes and learning the consequences of ignoring their responsibility in diabetes care. The third theme, “Making the right decision,” highlighted that fear initiated a decision-making process and together with goal-setting paved the way for participants to reach a turning point, moving toward engagement in their care. Conclusion Our findings indicated that fear could be a motivator for change, but a correct cognitive appraisal of diabetes and perceived efficacy of the treatment as well as one’s ability are essentially the pre-requisites for patients to reach the stage of having the intention to engage.
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Affiliation(s)
- Syahnaz Mohd Hashim
- Department of Family Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.,Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Idayu Badilla Idris
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Shalisah Sharip
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Rafidah Bahari
- Department of Psychiatry, University of Cyberjaya, Selangor, Malaysia
| | - Nasrin Jahan
- Freelance Public Health Physician, Dhaka, Bangladesh
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14
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Carmienke S, Baumert J, Gabrys L, Heise M, Frese T, Heidemann C, Fink A. Participation in structured diabetes mellitus self-management education program and association with lifestyle behavior: results from a population-based study. BMJ Open Diabetes Res Care 2020; 8:e001066. [PMID: 32205327 PMCID: PMC7206925 DOI: 10.1136/bmjdrc-2019-001066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/12/2020] [Accepted: 02/26/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Whether participation in structured diabetes self-management education programs (DSME) for participants with diabetes mellitus is associated with a healthy lifestyle in routine care apart from randomized-controlled studies remains unclear and is this studies' research question. RESEARCH DESIGN AND METHODS We identified 1300 persons with diabetes mellitus drawn from the cross-sectional population-based analysis German Health Update 2014/2015 (GEDA 2014/2015), which integrated the modules of the European Health Interview Survey (EHIS) wave 2. Of those, 816 were ever-DSME participants and 484 never-participants. We conducted multivariable weighted logistic regression analyses for lifestyle differences comparing ever-DSME and never-DSME participants. Lifestyle was defined by physical activity (PA), current smoking, fruit/vegetable consumption and body mass index (BMI). Age, sex, socioeconomic status, living together, limitation due to health problems for at least for 6 months, self-efficacy and attention to one's health were included as confounders in the regression models. RESULTS Ever-DSME participants engaged significantly more often in cycling at least 1 day per week (OR 1.62, 95% CI: 1.15-2.30) and performed significantly more often aerobic endurance training of 150 min per week (including walking: OR 1.42, 95% CI: 1.03-1.94, without walking: OR 1.48, 95% CI: 1.08-2.03) compared with never-DSME participants. Ever-DSME participants were significantly more often ex-smoker compared with never-DSME participants (OR 1.39, 95% CI: 1.03-1.88). DSME attendance was not significantly associated with current smoking, BMI and fruit or vegetable consumption. CONCLUSION DSME participation is associated with a moderately healthier lifestyle particularly for PA even in routine healthcare. Study results emphasize the importance of a broadly dissemination of DSME access for nationwide diabetes healthcare. Future studies should adjust for DSME participation when investigating lifestyle in persons with diabetes.
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Affiliation(s)
- Solveig Carmienke
- Institute for General Practice and Family Medicine, Medical Faculty of Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Jens Baumert
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
| | - Lars Gabrys
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
- Fachhochschule für Sport und Management Potsdam, Potsdam, Germany
| | - Marcus Heise
- Institute for General Practice and Family Medicine, Medical Faculty of Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Thomas Frese
- Institute for General Practice and Family Medicine, Medical Faculty of Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
| | - Astrid Fink
- Institute of Medical Sociology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
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15
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Morro T, Fink A, Carmienke S, Frese T, Guenther S. Learning types and learning success in a structured diabetes education programme for patients with type 2 diabetes: study protocol of a prospective, longitudinal study. BMJ Open 2019; 9:e030611. [PMID: 31444191 PMCID: PMC6707680 DOI: 10.1136/bmjopen-2019-030611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Diabetes mellitus (DM) has had a wide-ranging impact on healthcare politics. Secondary diseases and complications caused by diabetes are relevant cost and utilisation factors in the healthcare system. For decades, diabetes self-management education (DSME) has played a major role in the treatment of patients with type 2 DM (T2DM). The aim of this training is to empower patients to actively influence their diabetes process by gaining knowledge about health-related behaviours, such as healthy nutrition and exercise, and cardiovascular risks. The aim of the project is to analyse the practice of structured diabetes education and the effects of different learning types of participants. This project focuses on the needs of socioeconomically deprived patients and aims to improve DSME for this group. This patient group has a higher prevalence of T2DM, more complications and worse therapy-relevant parameters. METHODS AND ANALYSIS The study will be conducted as a prospective longitudinal study. Patients will be recruited in outpatient physician offices over a period of 12 months. Patients will be included if they are 18 years and older, have T2DM and are scheduled to participate in DSME for the first time. A pseudonymised, written survey with standardised questionnaires will be administered. The data will be analysed using inferential statistical methods, such as correlation analysis, regression models and variance analytical designs. ETHICS AND DISSEMINATION The study will be carried out following the principles of the Declaration of Helsinki and good scientific standards. Ethical approval of the Ethics Review Committee of the Medical Faculty at Martin-Luther-University, Halle-Wittenberg, was obtained. All participants in the study will receive comprehensive information and will be included after written informed consent is obtained. The results will be published in international peer-reviewed journals and presented at several congresses. TRIAL REGISTRATION NUMBER DRKS00016630.
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Affiliation(s)
- Thimo Morro
- Institute of Medical Sociology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Astrid Fink
- Institute of Medical Sociology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Solveig Carmienke
- Institute of General Practice and Family Medicine of the Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine of the Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Sebastian Guenther
- Institute of Medical Sociology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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