Diabetes self-management education interventions and self-management in low-resource settings; a mixed methods study

Risk factors for cardiometabolic health in Ghana: Cardiometabolic Risks Study Protocol-APTI Project

Introduction

Cardiometabolic diseases are rapidly becoming primary causes of death in developing countries, including Ghana. However, risk factors for these diseases, including obesity phenotype, and availability of cost-effective diagnostic criteria are poorly documented in an African-ancestry populations in their native locations. The extent to which the environment, occupation, geography, stress, and sleep habits contribute to the development of Cardiometabolic disorders should be examined.

Purpose

The overall goal of this study is to determine the prevalence of undiagnosed diabetes, prediabetes, and associated cardiovascular risks using a multi-sampled oral glucose tolerance test. The study will also investigate the phenotype and ocular characteristics of diabetes and prediabetes subgroups, as well as determine if lifestyle changes over a one-year period will impact the progression of diabetes and prediabetes.

Methods and analysis

The study employs a community-based quasi-experimental design, making use of pre- and post-intervention data, as well as a questionnaire survey of 1200 individuals residing in the Cape Coast metropolis to ascertain the prevalence and risk factors for undiagnosed diabetes and prediabetes. Physical activity, dietary habits, stress levels, sleep patterns, body image perception, and demographic characteristics will be assessed. Glucose dysregulation will be detected using oral glucose tolerance test, fasting plasma glucose, and glycated hemoglobin. Liver and kidney function will also be assessed. Diabetes and prediabetes will be classified using the American Diabetes Association criteria. Descriptive statistics, including percentages, will be used to determine the prevalence of undiagnosed diabetes and cardiovascular risks. Inferential statistics, including ANOVA, t-tests, chi-square tests, ROC curves, logistic regression, and linear mixed model regression will be used to analyze the phenotypic variations in the population, ocular characteristics, glycemic levels, sensitivity levels of diagnostic tests, etiological cause of diabetes in the population, and effects of lifestyle modifications, respectively. Additionally, t-tests will be used to assess changes in glucose regulation biomarkers after lifestyle modifications.

Ethics and dissemination

Ethics approval was granted by the Institutional Review Board of the University of Cape Coast, Ghana (UCCIRB/EXT/2022/27). The findings will be disseminated in community workshops, online learning platforms, academic conferences and submitted to peer-reviewed journals for publication.

Prevalence of mild cognitive impairment and modifiable risk factors: A cross-sectional study in rural older adults with diabetes

To determine the prevalence and modifiable risk factors for MCI in older adults with T2DM in rural China. This cross-sectional study encompassed 96 villages, employing a cluster sampling approach to recruit eligible older adults with T2DM as study participants. Logistic regression analysis was utilized to identify modifiable risk factors associated with MCI. Average marginal effects were calculated. The discriminatory performance of these risk factors in identifying MCI was evaluated by plotting the receiver operating curve and calculating the value of the area under the curve. A total of 898 older adults with T2DM in our study. The overall prevalence of MCI was 50.22 %. Independent associations with MCI were found in poor self-management ability of diabetes (OR = 0.808, 95 % CI: 0.808, 0.766), depressive symptoms (OR = 3.500, 95 % CI: 1.933, 6.337), moderate (OR = 0.936, 95 % CI: 0.017, 0.075) and high (OR = 0.939, 95 % CI: 0.016, 0.100) levels of physical activity, poorer oral health (OR = 2.660, 95 % CI: 2.226, 3.179), and lower grip strength (OR = 0.913, 95 % CI: 0.870, 0.958). The AUC was 0.967 (95 % CI 0.508-0.470). The prevalence of MCI was high among older adults with T2DM in rural areas of China. The self-management ability of diabetes, depressive symptoms, physical activity, oral health and grip strength were modifiable risk factors of MCI. Targeted interventions should be developed and implemented to address these modifiable risk factors, aiming to enhance cognitive function and mitigate the incidence of MCI in older adults with T2DM.

The Role of Self-Efficacy Enhancement in Improving Self-Management Behavior for Type 2 Diabetes Mellitus Patients

Background

The effectiveness of a self-efficacy-focused structured education program for patients with diabetes mellitus has been verified. However, changes in self-efficacy for the behavior change mechanism in patients who participated in the program require clarification.

Aim

To analyze the mechanism of self-management behavioral variations in patients with type 2 diabetes mellitus who underwent a self-efficacy-focused structured education program.

Methods

A secondary analysis of patients who received a self-efficacy-focused structured education program was conducted using data from a multicenter randomized controlled trial. The relationships among the 3-, 6-, and 12-month changes in diabetes knowledge, self-efficacy, diabetes distress, and self-management behaviors in patients with type 2 diabetes mellitus were studied using a structural equation model.

Results

Enhancement of self-efficacy among patients receiving a self-efficacy-focused structured education program directly influenced improvements in self-management behaviors at 3, 6 and 12 months. The increase in diabetes knowledge directly and indirectly improved self-management behaviors at 3 months, but the direct effect on behavior disappeared at 6 months and the indirect effect on behavior by enhancing self-efficacy only lasted until 6 months. The decrease in diabetes distress directly influenced improvement in self-management behaviors at 3 months. While it did not directly influence self-management behavior improvement at 6 and 12 months, it indirectly affected behavior improvement by enhancing self-efficacy.

Conclusion

The enhancement of self-efficacy plays a core role in improving and maintaining self-management behaviors in patients with type 2 diabetes mellitus who receive self-efficacy-focused structured education programs. Patients' behaviors can be improved by gaining more diabetes knowledge and mitigating diabetes distress at the 3- and 6-month follow-up. Improvements in behaviors at the 12-month follow-up could be achieved by mitigating diabetes distress.

The effectiveness of diabetes self-management education intervention on glycaemic control and cardiometabolic risk in adults with type 2 diabetes in low- and middle-income countries: A systematic review and meta-analysis

Diabetes mellitus (DM) poses a significant challenge to public health. Effective diabetes self-management education (DSME) interventions may play a pivotal role in the care of people with type 2 diabetes mellitus (T2DM) in low- and middle-income countries (LMICs). A specific up-to-date systematic review is needed to assess the effect of DSME interventions on glycaemic control, cardiometabolic risk, self-management behaviours, and psychosocial well-being among T2DM across LMICs. The MEDLINE, Embase, CINAHL, Global Health, and Cochrane databases were searched on 02 August 2022 and then updated on 10 November 2023 for published randomised controlled trials (RCTs) and quasi-experimental studies. The quality of the studies was assessed, and a random-effect model was used to estimate the pooled effect of diabetes DSME intervention. Heterogeneity (I2) was tested, and subgroup analyses were performed. Egger's regression test and funnel plots were used to examine publication bias. The risk of bias of the included studies was assessed using the Cochrane risk-of-bias tool for randomized trial (RoB 2). The overall assessment of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. A total of 5893 articles were retrieved, and 44 studies (n = 11838) from 21 LMICs met the inclusion criteria. Compared with standard care, pooled analysis showed that DSME effectively reduced the HbA1c level by 0.64% (95% CI: 0.45% to 0.83%) and 1.27% (95% CI: -0.63% to 3.17%) for RCTs and quasi-experimental design studies, respectively. Further, the findings showed an improvement in cardiometabolic risk reduction, diabetes self-management behaviours, and psychosocial well-being. This review suggests that ongoing support alongside individualised face-to-face intervention delivery is favourable for improving overall T2DM management in LMICs, with a special emphasis on countries in the lowest income group.