The effectiveness of stress management training on blood glucose control in patients with type 2 diabetes

A Synthesized Model for Applying Stress Management and Biofeedback Interventions in Research Utilization: A Systematic Review and Meta-analysis

Background

Stress management and biofeedback interventions have been shown to be effective in improving mental and physical health outcomes. However, previous research studies and synthesized models for applying these interventions in research utilization are insufficient.

Objective

This study aimed to synthesize a model for applying stress management and biofeedback interventions in research utilization.

Methods

A systematic review and meta-analysis were conducted according to the PRISMA guidelines.Multiple studies were used to assess the effectiveness of applying stress management and biofeedback interventions published from 2017 to 2023. The process included identifying the research questions, conducting a comprehensive literature search, assessing study quality, extracting data, synthesizing the data, analyzing and interpreting the findings, drawing conclusions, and making recommendations.

Results

The results indicated a significant mean effect size without evidence of publication bias. The effect sizes of the subgroups among the study variables were not significantly different [Q = 4.02, p = .26]. However, there were significant differences regarding the mean effect sizes among the studies [Q = 63.59, p < .001] and also in terms of the test of subgroups among the participants [Q = 8.49, p = .04].

Conclusion

The results emphasize the importance of evidence-based practice and highlight the need for ongoing evaluation and refinement of interventions. The proposed model was supported by related theories and research studies in order to ensure the robustness and reliability to guide practice and future research in the field of biofeedback interventions. By following this model, researchers and practitioners can ensure that stress management and biofeedback interventions are evidence-based and are effective in improving mental and physical health outcomes.

Behavioral and Psychological Factors in Buffering Diabetes-related Disability Development

BACKGROUND

Diabetes is associated with disability development. Healthy behaviors and psychosocial support can help patients manage their disease.

PURPOSE

To examine the role of various behavioral and psychological factors in buffering the effect of diabetes on disability development over time in Taiwanese adults.

METHODS

Data on 5,131 adults aged ≥50 years were obtained from the Taiwan Longitudinal Study on Aging. A cohort sequential multilevel design was employed to analyze the association between behavioral and psychosocial factors and the risk of disability over a 11-year period.

RESULTS

In patients with diabetes, having social support and exercising more than six times a week were associated with 4% and 49% reductions in the risk of disability, respectively (βdiabetes*socialsupport = -0.285, p = .006; βdiabetes*exercise3 = -2.612, p = .007). Exercising more than six times a week had an additional significant protective effect against disability development per year (βdiabetes*exercises3*age = -0.241, p = .038). Depression did not significantly interact with diabetes. However, a trajectory analysis revealed that individuals who had both diabetes and depression had the highest disability score from middle age among all participants.

CONCLUSIONS

Engaging in frequent exercise is the most influential factor for reducing the risk of disability in patients with diabetes. Social support provides an additional benefit for disability prevention in individuals with diabetes.

Coping and adaptation strategies among young persons living with type 1 diabetes and their caregivers: textual and photovoice analyses

BACKGROUND

Management of type 1 diabetes (T1D) is complex and demanding. It requires patients and their caregivers, particularly those in low-resource settings to adopt productive coping strategies to achieve ideal glycaemic control. Coping and adaptation strategies have far-reaching implications on their behavioural and health outcomes. Yet, it is uncertain how young people living with T1D and their caregivers in low-resource settings cope and adapt to the challenges of T1D management. This study analysed textual and photo evidence on the coping and adaptation strategies employed by young persons living with T1D (warriors) and their caregivers in Ghana.

METHODS

Qualitative data were collected from 28 warriors, 12 caregivers, 6 healthcare providers and other stakeholders in southern Ghana using semi-structured interview guides. Participants were identified at T1D support group centres, hospitals, and their places of residence, and recruited into the study using maximum variation and snowball sampling approaches. Data were collected via face-to-face interviews, photovoice, telephone interviews and videoconferencing and were thematically analysed using QSR NVivo 11.

RESULTS

Four superordinate themes which are productive coping, non-productive coping, keeping T1D a secret, and coping with costs of care were identified. Productive coping entailed condition acceptance, planning ahead, seeking social support, borrowing insulin, and overcoming the barriers of insulin storage. On the other hand, avoidance, disengagement, and re-use of syringes were the common non-productive coping approaches. Due to stigma and discrimination, the warriors shrouded their condition in secrecy. As a response to the financial burden of T1D care, caregivers/patients borrowed money, took loans, and sold household items.

CONCLUSION

Young persons living with T1D and their caregivers adopted coping strategies which both promoted and compromised their T1D management. There was an occasional co-existence of diverse coping strategies (productive and non-productive), and these reflects the personal and contextual stressors they faced. The results call for the need to eliminate barriers of T1D management and equip patients and their caregivers with ongoing T1D coping competencies.

Association of stress management behavior and diabetic self-care practice among diabetes type II patients in North Shoa Zone: a cross-sectional study

BACKGROUND

The cornerstone of diabetes management is the self-care behavior of diabetics. However, many people with diabetes do not fully engage in these activities. Effective stress management behaviors have a positive impact on diabetes self-care. The purpose of this study was to investigate the relationship between self-care behaviors in people with diabetes and stress coping behaviors in people with type II diabetes.

METHOD

A facility-based cross-sectional study was undertaken in the North Shoa zone from March 2 to 29, 2022. The study involved 432 types II diabetic patients who were chosen at random from eight public hospitals. Eight item stress coping techniques tools was used to measure stress management behavior. Data were entered into Epi Data V.3.1 and analyzed using SPSS version 22. Data for continuous variables were reported as means and standard deviations and percentages for categorical variables. Descriptive statistic was used to summarize study variables. Binary logistic regression models were used to assess associations between sociodemographic variables, stress-coping behaviors, and self-care behaviors. Binary logistic regression model was used investigate the association between diabetic self-care behaviors and stress-coping behaviors. A p-value ≤ 0.05 and an OR with a 95% CI are considered statistically significant associations.

RESULT

the study showed that stress management behavior was observed in more than half of the patients (51.2; 95% CI; (46.5, 55.6). The study found that stress management behavior was associated with diabetic self-care practice (X2, 17.7; p < 0.0001). Patients with good stress management behavior (AOR = 2.0, 95% CI = (1.3, 3.0)), good perception (AOR = 2.3, 95% CI = (1.5, 3.4)), and family support (AOR = 2.3, 95% CI = (1.5, 3.6)) were more likely to conduct diabetes self-care.

CONCLUSION

This study shows that stress management behaviors and coping techniques are associated with self-care behavior and lead to significant improvements in diabetes self-care practices. Stress management and coping skills should be included in current systems as a common therapeutic service/treatment. Diabetes care practitioners should consider these factors when discussing diabetes self-management during consultations.

The impact of a telehealth intervention on the metabolic profile of diabetes mellitus patients during the COVID-19 pandemic - A randomized clinical trial

OBJECTIVES

The objective of this study was to evaluate the impact of a telehealth intervention on metabolic outcomes and self-perceptions of the patients regarding their management of diabetes during the COVID-19 pandemic.

METHODS

This is a non-blind randomized controlled clinical trial to assess a telehealth intervention. We included adults with diabetes mellitus. The outcomes assessed were the level of HbA1c, lipid profile, blood pressure levels, weight, body mass index and self-perceptions about diabetes management.

RESULTS

A total of 150 individuals with diabetes participated in the study and at the end of telehealth intervention there were no changes in the patient's HbA1c levels between intervention and control groups for neither type 1 (8.1% vs. 8.6%; p = 0.11) nor type 2 diabetes (8.6% vs. 9.0%; p = 0.09), respectively. From the rest of the metabolic profile, triglyceride levels from type 1 diabetes group was the only variable that demonstrated improvement with telehealth intervention (66.5% intervention group vs. 86.5% control group; p = 0.05).

CONCLUSIONS

After 4 months of telehealth intervention, no statistically significant results were observed in HbA1c nor in secondary outcomes (with the exception of triglycerides for the type 1 diabetes group).

An integrated intervention combining cognitive-behavioural stress management and progressive muscle relaxation improves immune biomarkers and reduces COVID-19 severity and progression in patients with COVID-19: A randomized control trial

COVID-19 is a world disaster. In response to COVID-19 quarantine, stress, anxiety, and depression may easily develop which negatively affect immunity and decrease the patient's response against the COVID-19 virus. This study investigated the effect of an integrated intervention combining cognitive-behavioural stress management (CBSM) and progressive muscle relaxation (PMRs) on immune biomarkers and disease severity and progression in patients with COVID-19 and the period to which these changes last. Thirty patients with mild or moderate COVID-19 were randomly distributed into intervention and control groups. The intervention group performed an integrated intervention combining CBSM and PMRs. There were three outcome measures including blood immune markers, salivary immunoglobulin A, and Wisconsin scale (WIS). Two-week post-intervention, there were significant differences between groups in the WIS total score, Leucocytes, Lymphocytes, Interleukin-6, and Immunoglobulin-A. While there were non-significant differences between both groups in Interleukin-10 and TNF-α. The significant differences between groups in the WIS total score, Leucocytes, Lymphocytes, Interleukin-6, and Immunoglobulin-A significantly continued 1 week as a follow-up. This study concluded that performing an integrated intervention combining CBSM and PMRs for 2 weeks significantly increases immune biomarkers mainly Leucocytes, Lymphocytes, Interleukin-10, and Interleukin-6 along with S-IgA. Also, this protocol significantly decreases disease severity and associated stress, anxiety, and depression; and enhances the quality of life in patients with COVID-19. The study was retrospectively registered with NCT04998708.

Rationale, design, and recruitment outcomes for the Family/Friend Activation to Motivate Self-care (FAMS) 2.0 randomized controlled trial among adults with type 2 diabetes and their support persons

BACKGROUND

Self-care behaviors help reduce hemoglobin A1c (HbA1c) and prevent or delay type 2 diabetes (T2D) complications. Individualized interventions that support goal setting and self-monitoring improve self-care and HbA1c in the short-term; engaging family and friends may enhance and/or sustain effects. Family/Friend Activation to Motivate Self-care (FAMS) is a mobile phone-delivered intervention (i.e., phone coaching and text message support) based on Family Systems Theory which was successfully piloted among diverse adults with T2D.

METHODS

We made improvements to FAMS and conducted iterative usability testing to finalize FAMS 2.0 before evaluation in a randomized controlled trial (RCT). Adult persons with diabetes (PWDs) who enrolled were asked to invite a support person (friend or family member) to participate alongside them. For the RCT, dyads were randomly assigned to FAMS 2.0 or enhanced treatment as usual (control) for the first 9 months of the 15-month trial. Outcomes include PWDs' HbA1c and psychosocial well-being (including diabetes distress) and support persons' own diabetes distress and support burden.

RESULTS

We recruited RCT participants from April 2020 through October 2021 (N = 338 PWDs with T2D; 89% [n = 300] with a support person). PWDs were 52% male, 62% non-Hispanic White, aged 56.9 ± 11.0 years with HbA1c 8.7% ± 1.7% at enrollment; 73% cohabitated with their enrolled support person. Data collection is ongoing through January 2023.

CONCLUSION

Findings will inform the utility of engaging family/friends in self-care behaviors for both PWD and support person outcomes. Using widely available mobile phone technology, FAMS 2.0, if successful, has potential for scalability.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04347291 posted April 15, 2020.

Formative Qualitative Research: Design Considerations for a Self-Directed Lifestyle Intervention for Type-2 Diabetes Patients Using Human-Centered Design Principles in Benin

Given the burgeoning prevalence of Type-2 Diabetes (T2D) in Benin and other sub-Saharan countries, tailored diabetes self-management interventions are urgently needed. Human-centered designs can be useful for identifying beneficiaries' needs while keeping in mind feasibility and viability in a given context. Therefore, this study examined the acceptability and community perceptions of a self-directed lifestyle program for T2D patients in Cotonou, southern Benin. Data were collected using focus group discussions (FDGs) with T2D patients (n = 3; 32 participants), academic partners (n = 2; 16 participants), and community partners (n = 2; 12 participants). All FDG sessions were audio-recorded, transcribed from French into English verbatim, and analyzed using MAXQDA 2020. Most participants found the program to be useful and feasible. However, they preferred pictorial brochures as training materials and suggested community health workers as facilitators, assisted by clinicians or dietitians. They recommended community-based delivery mechanisms and mobile applications like WhatsApp to enhance patient adherence. Participants' characteristics, tangible health benefits, incentives, and simple curriculums were cited as critical to program feasibility, effectiveness, and acceptability. This study provides a deeper understanding of potential diabetes self-management participants' needs and concerns. Moreover, it highlights the need to consider key stakeholders' needs and voices for effective intervention.

Effectiveness of a mobile-based educational intervention on self-care activities and glycemic control among the elderly with type 2 diabetes in southwest of Iran in 2020

Background

The elderly constitute a large fraction of patients with type 2 diabetes worldwide. It has been well documented that the elderly’s adherence to disease control is not adequate. The present study aimed to evaluate the impact of a mobile-based educational intervention on self-care behaviors and glycemic control among elderly with type 2 diabetes.

Methods

The present study was conducted on 118 older people (59 in the intervention group and 59 in the control group) with type 2 diabetes who referred to Golestan Hospital in Ahvaz, southwest of Iran in 2020. Participants were randomly divided into experimental and control groups. Data were collected at baseline and after a 3-month follow-up. At baseline, the participants completed a valid and reliable multi-section questionnaire including items on attitude, the multidimensional scale of perceived social support (MSPSS), the Coping Self-Efficacy Scale (CSES), self-care constructs, and HBA1C. After analyzing the pre-test data, we designed a training program which was offered to the intervention group online via mobile phone in three online sessions. The control group, however, received no intervention except diabetes routine care. Data were analyzed using SPSS-15 at a significance level of 0.05.

Results

Before the intervention, the mean scores of CSES, attitudes towards self-care, MSPSS, and self-care were not statistically significant between study groups (P > 0.05), but after intervention, the study found significant differences between the groups in terms of CSES, attitude, MSPSS, and self-care (P = 0.001). Furthermore, after implementation of the intervention, the mean value of HbA1C in the intervention group was significantly less than that of the control group (7.00 vs. 7.32%) (P = 0.001).

Conclusion

The present results indicated that implementing an educational intervention via mobile phone can improve self-care practice and reduce HbA1C in the elderly with type 2 diabetes. The study also showed a moderate to large effect on the outcome variables. However, further studies with longer follow-up periods are recommended to confirm the results.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00957-5.

- The study provided a framework for developing a targeted mobile phone health education intervention.

- Mobile phone education can improve both behavioral and clinical indexes. This intervention increased the scores of perceived social support (MSPSS) and Coping Self-Efficacy Scale (CSES), and self-care practice and reduced HbA1C in the elderly with type 2 diabetes.

- Further studies with longer follow-up periods are warranted.

Meditative practices, stress and sleep among students studying complementary and integrative health: a cross-sectional analysis

Background

The International Cohort on Lifestyle Determinants of Health (INCLD Health) is an ongoing, prospective cohort study assessing the health behaviours and lifestyles of higher education students, including their use of specialty diets and complementary and integrative health (CIH) practices. Purpose: This cross-sectional analysis of the INCLD Health cohort aims to (1) evaluate the associations between perceived stress, sleep disturbance, and meditative practices with diurnal salivary free cortisol and (2) evaluate the associations of meditative practices as well as mind-body practices with perceived stress and sleep disturbance.

Methods

Serial multivariable linear regression models, adjusting for sociodemographic and lifestyle behaviours, were used to assess associations of (1) perceived stress, sleep disturbance, and meditative practices with salivary cortisol, and (2) meditative practices as well as mind-body practices with perceived stress and sleep disturbance. Meditative and mind-body practices were evaluated using a stress-management and self-care survey; perceived stress and sleep disturbance were evaluated using the 10-item Perceived Stress Scale (PSS), and the patient reported outcome measures information system-29 (PROMIS-29) sleep sub-score respectively. Salivary cortisol was collected at 4 time points over a 24-hour period and area under the curve (AUC) calculations conducted.

Results

82.5% (n = 80) of participants utilized at least monthly meditative practices. Greater disturbed sleep, but not perceived-stress, meditative, nor mind-body practices was independently associated with increased AUC cortisol (b = 0.02, 95% CI: 0.002–0.05, p = 0.03) after adjusting for age, sex, race, ethnicity, and BMI. Neither meditative nor mind-body practices were associated with perceived stress or disturbed sleep.

Conclusions

Among INCLD Health participants, greater sleep disturbance, but not perceived stress or meditative practices were associated with daytime cortisol.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-022-03582-5.

High blood pressure self-care among hypertensive patients in Iran: a theory-driven study

High blood pressure is becoming a universal epidemic for both developed and developing countries; it is one of the main public health problems all over the world. This research was conducted to assess blood pressure self-care among hypertensive patients in Iran. This cross-sectional analytic study was conducted on 527 patients with hypertension recruited from Zarandieh, Iran in 2018. Data were gathered using questionnaires assessing socio-demographic information, social support, health belief model (HBM) constructs (perceived benefits to healthy behavior, barriers to healthy behavior, perceived disease threat, self-efficacy to engage in healthy behavior, and cues to action), and self-care activities to address blood pressure. A stepwise multiple linear regression analysis was used to determine factors associated with self-care behaviors. Overall, 512 patients (215 men and 297 women) participated in this study. Participants who were married, and more educated engaged in more self-care behaviors. At least one-half of the patients (47.6%) demonstrated a moderate level of self-care behaviors with a mean score of self-care equal to 9.32 ± 3.6 (out of 18). All the elements of HBM and social support were significant predictors of self-care behaviors and self-efficacy was the strongest predictor, followed (in descending order) by perceived barriers, social support, perceived disease threat, and perceived benefits. Health education based on HBM, enhanced with attention to social support, may help patient enact healthier behaviors to reduce blood pressure.

Effect of College Students' Academic Stress on Anxiety Under the Background of the Normalization of COVID-19 Pandemic: The Mediating and Moderating Effects of Psychological Capital

Based on the background of the continuous development of COVID-19 pandemic, the effect of academic stress on anxiety of college students, as well as the mediating and moderating role of psychological capital are discussed, so as to provide intervention measures for reducing the academic stress and anxiety level of college students during the pandemic. The study used the Academic Stress Scale, the Psychological Capital Scale and the Anxiety Scale to conduct a questionnaire survey on 280 college students in five colleges and universities in Northern Hunan, and obtained 229 valid questionnaires. The data analysis results show that there are differences in academic stress between different genders, and differences in the variable of psychological capital among college students of different grades; Whether he is a student leader and whether he has won a scholarship, the difference of this factor in the three variables of academic stress, psychological capital and anxiety.is not statistically significant. The results of this study showed that psychological capital significantly negatively predicted anxiety (β = -0.602, t = -9.702, p < 0.001), academic stress significantly positively predicted anxiety (β = 0.247, t = 5.462, p < 0.001), psychological capital played a partial mediating role between academic stress and anxiety, and psychological capital also had a certain moderating role between academic stress and anxiety (β = -0.15, t = -4.51, p < 0.001). The conclusion of the study is that in the context of the continuous development of COVID-19 pandemic, positive psychological capital can effectively reduce the anxiety caused by academic stress. This result suggests that the positive psychological capital state of college students should be improved, which can effectively relieve pressure and reduce anxiety.

Spline Longitudinal Multi-response Model for the Detection of Lifestyle- Based Changes in Blood Glucose of Diabetic Patients

BACKGROUND

Blood sugar and lifestyle problems have long been problems in diabetes. There has also been a lot of research on that. However, we see that diabetic patients are still increasing even though many patients are not aware of the start of the disease occurrence. Therefore, we consider it very important to examine these two main problems of diabetes by using a more flexible statistical approach to obtain more specific results regarding the patient's condition.

OBJECTIVE

The form of data for type 2 diabetes patients is repeated measurements so that it is approached through longitudinal studies. We investigated various intervals of pattern change that can occur in blood glucose, namely fasting, random, and 2 hours after meals based on blood pressure and carbohydrate diets in diabetic patients in South Sulawesi Province, Indonesia.

METHODS

This research is a longitudinal study proposing a flexible and accurate statistical approach. It is a weighted spline multi-response nonparametric regression model. This model is able to detect any pattern of changes in irregular data in large dimensions. The data were obtained from Hasanuddin University Teaching Hospital in South Sulawesi Province, Indonesia. The number of samples analyzed was 418 from 50 patients with different measurements.

RESULTS

The optimal spline model was obtained at 2 knots for blood pressure and 3 knots for carbohydrate diets. There are three blood pressure intervals that give different patterns of increase in patient blood glucose levels, namely below 126.6 mmHg, 126.6-163.3 mmHg, and above 163.3 mmHg. It was found that blood sugar rose sharply at blood pressure above 163.3 mmHg. Furthermore, there are four carbohydrate diet intervals that are formed, which are below 118.6 g, 118.6-161.8 g, 161.8-205 g, and above 205 g. The result is that blood sugar decreased significantly at intervals of carbohydrate diet 161.8-205 g.

CONCLUSION

Blood glucose increases with a very high increase in blood pressure, whereas for a carbohydrate diet, there is no guarantee that a high diet will be able to reduce blood glucose significantly. This may be affected by the patient's saturation of a very high carbohydrate diet.

Examination of Health Care Providers' Use of Language in Diabetes Care: A Secondary Qualitative Data Analysis

The purpose of this secondary qualitative data analysis was to assess the frequency and context of stigmatizing language used by health care providers (HCPs). The authors conducted content and thematic analysis of in-depth face-to-face and telephone interviews with HCPs in southeastern Ohio. Participants frequently used labeling language, such as "diabetic" and "noncompliant," as well as language with negative connotations, such as "control," "testing," and "regimen." These findings offer a real-world glimpse of how HCPs communicate about people with diabetes in this region of the country.

Effects of diabetes self-management education program on lowering blood glucose level, stress, and quality of life among females with type 2 diabetes mellitus in Thailand

Aim:

The aim of this study is to assess the effect of diabetes self-management education (DSME) on lowering blood glucose level, stress, and quality of life (QoL) among female patients with type 2 diabetes mellitus (T2DM) in Thailand.

Background:

The burden of noncommunicable diseases has increased globally, and it has negatively affected the QoL of diabetic patients.

Methods:

A quasi-experimental study was conducted by including 77 T2DM patients selected from 2 public health centers in Thailand. The respondents were randomly selected 38 in control group and 39 in intervention group. Pretested, piloted, and validated tool were used during this study. Knowledge on blood glucose level, stress, and QoL was measured at baseline and then compared to end line after 3 months of the intervention. The effects of intervention were estimated by regression coefficient of intervention on blood glucose level and QoL. The study was ethically approved by the Chulalongkorn University, Thailand.

Findings:

Baseline characteristics of both the groups were similar before the start of the intervention and there were no significant differences observed in age, education, blood sugar monitoring behavior, medical checkup, knowledge, self-care, stress, and hemoglobin HbA1c (>0.05). However, blood HbA1c, stress level, and QoL among the T2DM patients had significant changes (<0.05) after the intervention. The control group was remained same and there was no statistically significant difference reported (>0.05).

Conclusions:

The study concluded that the designed intervention of DSME has proved effective in lowering the blood sugar level, HbA1c level, stress level, and improved QoL among T2DM patients during this limited period of time. Hence, policy-makers can replicate this intervention for diabetic patients in a similar context.

Cultural Considerations for the Adaptation of a Diabetes Self-Management Education Program in Cotonou, Benin: Lessons Learned from a Qualitative Study

Background: Type 2 diabetes (T2D) poses a disproportionate burden on Benin, West Africa. However, no diabetes intervention has yet been developed for Benin’s contexts. This study aimed to explore specific cultural beliefs, attitudes, behaviors, and environmental factors to help adapt a diabetes self-management program to patients with T2D from Cotonou, in southern Benin. Methods: Qualitative data were collected through focus group discussions (FDGs) involving 32 patients with T2D, 16 academic partners, and 12 community partners. The FDGs were audio-recorded, transcribed verbatim from French to English, and then analyzed thematically with MAXQDA 2020. Results: Healthy food was challenging to obtain due to costs, seasonality, and distance from markets. Other issues discussed were fruits and vegetables as commodities for the poor, perceptions and stigmas surrounding the disease, and the financial burden of medical equipment and treatment. Information about local food selections and recipes as well as social support, particularly for physical activity, were identified, among other needs. When adapting the curriculum, gender dynamics and spirituality were suggested. Conclusions: The study demonstrates the need for culturally sensitive interventions and a motivation-based approach to health (spiritual and emotional support). It also lays the groundwork for addressing T2D contextually in Benin and similar sub-Saharan African countries.

Engineering digital biomarkers of interstitial glucose from noninvasive smartwatches

Prediabetes affects one in three people and has a 10% annual conversion rate to type 2 diabetes without lifestyle or medical interventions. Management of glycemic health is essential to prevent progression to type 2 diabetes. However, there is currently no commercially-available and noninvasive method for monitoring glycemic health to aid in self-management of prediabetes. There is a critical need for innovative, practical strategies to improve monitoring and management of glycemic health. In this study, using a dataset of 25,000 simultaneous interstitial glucose and noninvasive wearable smartwatch measurements, we demonstrated the feasibility of using noninvasive and widely accessible methods, including smartwatches and food logs recorded over 10 days, to continuously detect personalized glucose deviations and to predict the exact interstitial glucose value in real time with up to 84% and 87% accuracy, respectively. We also establish methods for designing variables using data-driven and domain-driven methods from noninvasive wearables toward interstitial glucose prediction.

The effect of educational program based on theory of planned behavior on promoting retinopathy preventive behaviors in patients with type 2 diabetes: RCT

BACKGROUND

Diabetic retinopathy is the most common microvascular complication of diabetes and it is a leading cause of visual impairment and blindness among patients with diabetes. This study aimed to investigate the effect of educational program based on Theory of Planned Behavior (TPB) on promoting retinopathy preventive behaviors in patients with type 2 diabetes.

METHODS

The present study is an educational randomized controlled trial research that was conducted on 94 patients with type 2 diabetes who had gone to diabetes clinic. The samples were randomly assigned to the intervention (N = 47) and control groups (N = 47). Data collection instrument was a researcher-made questionnaire based on TPB and FBS and HbA1C tests. Then, educational program was performed for the intervention group through four educational sessions. After 3 months, data collection was repeated for the two groups and FBS, HbA1C testes were done again and data were analyzed.

RESULTS

The performance of the intervention group on preventive behaviors of retinopathy increased from 2.48 ± 1.42 to 4.48 45 1.45 after the education (p < 0.001). The mean of FBS and HbA1c in the intervention group also decreased after the intervention (P < 0.05).

CONCLUSION

Applying the TPB model proved is very effective in developing an educational program for patients with diabetes, to control their blood sugar and enhance preventive behaviors of retinopathy. Besides such programs, follow-up education for controlling and monitoring are highly recommended. This theory serves as a helpful theoretical framework for health-related behaviors and can be an appropriate pattern to plan for educational interventions.

TRIAL REGISTRATION

This trial has been registered at Iranian Registry of Clinical Trials, IRCT20180819040834N1 . Prospectively registered 8 Apr 2019, https://en.irct.ir/trial/38401.

The Relationship Between Autonomic Dysfunction of the Gastrointestinal Tract and Emotional Distress in Patients With Systemic Sclerosis

BACKGROUND/OBJECTIVES

We hypothesized that emotional distress in systemic sclerosis (SSc) patients with moderate to severe gastrointestinal (GI) dysfunction is associated with dysautonomia. We sought to determine (1) the clinical characteristics associated with emotional distress in SSc, (2) the odds of having dysautonomia in those with emotional distress, and (3) whether GI dysautonomia, as measured by the Survey of Autonomic Symptoms (SAS), correlates with GI dysautonomia on the Composite Autonomic Symptom Score-31 (COMPASS-31).

METHODS

Clinical and demographic features from our prospective cohort study were compared among SSc patients with and without GI-associated emotional distress (University of California at Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 well-being subscale >0.5 or ≤0.5) in cross-sectional analysis. Covariates/confounders independently associated with emotional distress were used to construct multivariable logistic regression models. The COMPASS-31 and SAS GI subdomains were compared with Spearman correlation.

RESULTS

Forty-six patients with SSc were enrolled in the study. In univariate analyses, age (odds ratio [OR], 1.06; p = 0.026), severity of GI dysautonomia (COMPASS-31: OR, 1.41; p = 0.003), anti-centromere (A/B) antibodies (OR, 3.60; p = 0.044), and anti-PM-Scl (75/100) antibodies (OR, 0.15; p = 0.035) were associated with emotional distress. In the adjusted model, those with more severe GI dysautonomia remained more likely to have emotional distress (OR, 1.85; p = 0.026); those with anti-PM-Scl (75/100) antibodies were less likely to have emotional distress (OR, 0.03; p = 0.031). The SAS and COMPASS-31 GI subdomains moderately correlated (ρ = 0.68, p < 0.001).

CONCLUSIONS

In SSc, increased symptom burden related to GI dysautonomia is associated with emotional distress. Multidisciplinary approaches addressing both the physical and emotional needs of the SSc patient may be warranted to optimize patient care.

Serum osteocalcin is associated with subjective stress in people with depression and type 2 diabetes

BACKGROUND

Low serum osteocalcin is a risk factor for type 2 diabetes mellitus (T2DM), and osteocalcin release from bone is associated with an acute stress response in mice. Both diabetes and stress are associated with depression. Here, we assess relationships between serum osteocalcin, depression and subjective stress in people with T2DM.

METHODS

Participants with T2DM (HbA1c above 6.4 %, impaired fasting glucose or impaired glucose tolerance) were assessed for a major depressive episode using the research version of the Structured Clinical Interview for DSM-5 depression criteria (SCID-5RV). Subjective stress over the past month was assessed using the Perceived Stress Scale (PSS). Serum carboxylated (cOCN) and fully decarboxylated (dcOCN) osteocalcin were assayed from fasting morning blood by commercial enzyme-linked immunosorbent assay.

RESULTS

Among 95 participants (mean age 62.4 ± 9.9, 51 % women), 22 % were experiencing a depressive episode (9 men, 12 women). The presence of a depressive episode was not associated with dcOCN or cOCN concentrations; however, higher concentrations of cOCN were associated with higher PSS scores in participants with depression (r = 0.585, p = 0.005). In an analysis of covariance model controlling for age, sex, body mass index, glycemic control (glycosylated hemoglobin), insulin resistance (homeostatic model), depression, and antidepressant use, cOCN was associated with PSS scores (F=10.302, p = 0.002), and this relationship was stronger in those with depression (depression × cOCN interaction F=4.978, p = 0.028). Although associations between dcOCN concentrations and PSS scores did not reach significance, the same trend seen with cOCN concentrations was observed in participants with depression for dcOCN (r=0.365, p=0.10), and for a depression × dcOCN interaction associated with PSS scores in the whole group (F=2.165, p = 0.15).

CONCLUSIONS

Osteocalcin is a neuroendocrine marker associated with perceived chronic stress among people with T2DM experiencing a depressive episode.

Type D Personality Is Associated with Glycemic Control and Socio-Psychological Factors on Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

Purpose

Type D personality (TDP) has been recognized as a risk factor for many diseases. The aims of our study were to estimate the prevalence of TDP and glycemic control on the patients with type 2 diabetes mellitus (T2DM) and to assess their relationship between TDP and socio-psychological factors, such as perceived stress, self-efficacy, self-care behaviors, and psychological distress.

Patients and Methods

A total of 198 T2DM patients (male 62.6%, mean age 51.2±11.0, mean HbA1c 7.3±1.8%) were recruited consecutively from the Department of Endocrinology of a regional hospital in Taipei, Taiwan, from December 2017 to April 2018. They completed questionnaires that contain questions about sociodemographic characteristics, TDP, illness-related stress, self-efficacy, execution of diabetes management and emotional distress. Their medical records were reviewed for biomedical data.

Results

Of the 198 patients, 82 (41.4%) had TDP. Controlling for sociodemographic factors, patients with TDP were reported significantly poorer on glycemic control than those without TDP (mean HbA1c (%) 7.6±1.9 vs 7.1±1.8, P<0.05). Compared to those without TDP, the results showed significantly higher levels of perceived stress (P<0.001) and psychological distress (anxiety and depression) (P<0.001), as well as significantly lower levels of self-efficacy (P<0.001) and self-care behaviors (P<0.001) on patients with TDP. TDP was positively correlated with perceived stress and psychological distress and negatively correlated with self-efficacy and self-care behaviors scores.

Discussion

This study provides the evidence linking TDP with poor glycemic control, low levels of self-efficacy and self-care behaviors, as well as high levels of perceived stress and psychological distress, which highlights the screening of TDP and the tailored needs for the care among T2DM patients with TDP.

Stress as a challenge in promoting mental health among dementia caregivers

BACKGROUND

Caregiver stress is harmful to the health of both caregivers and people living with Alzheimer's disease or other dementias. The present study was conducted to assess stress and its predictors of people living with Alzheimer's disease or other dementias' caregivers.

METHODS

The present descriptive, analytical, cross-sectional study was conducted in December 2017-June 2018 in Isfahan, Iran. Data were collected by interviewing 99 caregivers had at least 6 months of experience caring for a patient diagnosed with Alzheimer's disease, through questionnaires developed by the researcher. A convenience sample (easy access) of caregivers was recruited from calling the home of formally diagnosed with Alzheimer's patient, that have registered in educational hospitals affiliated to Isfahan University of Medical Sciences and psychiatrists' office both paid caregivers (formal) and unpaid caregivers (family). All caregivers provided informed consent. The type and severity of the relationship between the dependent (stress) and independent variable were assessed using Pearson's and Spearman's correlation coefficients, the independent t-test, and the multivariate regression analysis.

RESULTS

The caregivers' mean stress score was 25.4 ± 10.9 (range: 4-54). About 80% of the caregivers were female. Age and stress score was correlated (P = 0.004), the mean stress score was significantly higher in female caregivers (P = 0.04), informal caregivers (P < 0.001), and significantly lower in the caregivers with previous experience of caring for Alzheimer's patients (P = 0.02) or those introduced by service companies (P = 0.005). Variables including the family relationship with the patient (P = 0.01), kind of caregiving (P = 0.03), and previous experience of caring for Alzheimer's patients (P = 0.04) were stronger predictors of the stress score.

CONCLUSION

Stress is a challenge in promoting mental health among dementia caregivers. Providing social support with an emphasis on physical, mental, and social health is mandatory, especially for female and family caregivers, to promote stress management, mental health in this group, and enable optimal and purposeful care.

Meditative Movements for Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

OBJECTIVE

Physical activity plays a specific role in the fundamental aspect of diabetes care. It is necessary to develop exercise programs for these patients. The aim of this systematic review is to summarize current evidence regarding the effectiveness of meditative movement in patients with type 2 diabetes.

METHODS

The following databases were searched: PubMed, CENTRAL, Web of Science, Ovid LWW, and EMBASE. Two independent investigators searched and screened the studies by finding duplications, excluding irrelevant titles and abstracts, and then selecting eligible studies by reviewing full texts. 21 studies fulfilled the inclusion criteria. Meta-analyses were performed on glycated hemoglobin (HbA1c), fasting blood glucose (FBG) and postprandial blood glucose (PPBG), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and body mass index (BMI).

RESULTS

Meta-analyses showed that meditative movements significantly improved FBG, HbA1c, PPBG, TC, LDL-C, and HDL-C. No improvement was found in BMI.

CONCLUSIONS

The results demonstrated a favorable effect or tendency of meditative movements to improve blood glucose and blood lipid levels in patients with type 2 diabetes mellitus. The special effects of meditative movements in type 2 diabetes mellitus patients need further research.

Prevalence of the Effects of Anxiety and Depression on People with Type 2 Diabetes Mellitus: An Analysis of Health Policy Studies in Improving the Quality of Life of Poor Families in the Urban Areas of West Lombok, Indonesia

BACKGROUND

To explore the tendency of the effects of anxiety and depression that occur in type 2 diabetes patients, especially poor patients who live in the urban areas with poor economic conditions, who do not have health access from the government, and live away from the hospitals.

METHODS

It is a cross-sectional study which aimed to determine the number of patients who experienced anxiety and depression problems due to the declining health conditions caused by diabetes. A sample size of 98 diabetics experiencing anxiety and depression when the treatment was carried out was included. The study design included a qualitative study with in-depth interviews with respondents who were at risk of diabetes, as well as to determine the level of anxiety and depression that occurred when medical care was provided and the feelings experienced by the respondents after the completion of treatment.

RESULTS

Diabetic patients are generally unaware that their illness is a chronic disease that takes a long time to treat. When the patients are sick, most of them do not immediately go to the hospital or a specialist to get their health examination and treatment, because the hospital is far from the patients' residence. Furthermore, some patients still use traditional medicine and non-medical treatment, so when the patients with critical conditions are taken to the hospital, they already have chronic diabetes.

CONCLUSION

The lack of access to health for chronic patients with poor economic conditions who live far from the hospitals and the scarcity of medical staff to carry out treatment of chronic diseases such as diabetes for poor patients in urban areas certainly have an impact on increasing the number of patients with chronic diseases. Therefore, the government is expected to be able to provide easy health policies to remote rural communities in order to achieve optimal community welfare and health.

The association between attitude, self-efficacy, and social support and adherence to diabetes self-care behavior

OBJECTIVES

Diabetes is a chronic illness which requires lifelong self-care behaviors. The objective of the present research was to investigate the association of self-efficacy, attitude and social support with adherence to diabetes self-care behavior.

MATERIALS AND METHODS

In this cross-sectional study conducted in 2017, 403 diabetic patients of Zarandieh, Iran participated. They were evaluated by valid and reliable questionnaires comprised of items on diabetes self-care, self-efficacy in dealing with problems, social support and attitude towards self-care. Data were analyzed using SPSS 18 applying t test, ANOVA, and multiple regression analysis.

RESULTS

The results indicated that patients with higher self-care scores had better self-efficacy, social support, and attitude towards self-care. Moreover, self-efficacy, social support, and attitude towards self-care variables accounted for 39.5% of the total variance of self-care behavior. Furthermore, social support (β = 0.87), self-efficacy (β = 0.52), and attitude towards self-care (β = 0.42) were respectively the most important predictors of self-care behaviors.

CONCLUSION

Social support, self-efficacy and attitude towards self-care behaviors were associated with self-care behaviors in patient with diabetes. They might suggest that educational programs specifically target these factors.