Patients' empowerment, physicians' perceptions, and achievement of therapeutic goals in patients with type 1 and type 2 diabetes mellitus in Mexico

Diabetes Self-Management Among Healthcare Providers in King Abdulaziz Medical City, Riyadh: A Cross-Sectional Pilot Study

Background Diabetes mellitus (DM), a chronic metabolic disease, is a rising global concern with significant social, economic, and health implications. Proper glycemic control is crucial to guarantee protection against these implications such as micro and macrovascular complications. To achieve proper glycemic control, patients' self-management is probably the most essential component, and the development of appropriate self-management behaviors which include medication adherence and lifestyle modifications improves the prognosis and the incidence of DM complications. Objective The aim of the study is to examine diabetes self-management and control of diabetic healthcare providers from different specialties working at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. Design and setting This is a cross-sectional pilot study carried out in King Abdulaziz Medical City, Riyadh, Saudi Arabia, using a pre-validated self-administered questionnaire that was "Diabetes Self-Management Questionnaire" (DSMQ), which examined diabetes management and control within the last two months. The questionnaire was distributed to the healthcare providers of all specialties at the site of the study. Correlations and descriptive analyses were carried out using the Statistical Package for Social Science (SPSS) software version 23 (IBM Corp, Armonk, USA). Results The total number of participants was 370 healthcare providers (100% response rate). It was found that 26 (7%) of them had diabetes (92.3% of them with type 2 diabetes). The diabetic participants' mean age was 48.58±7.3 years old. 42.3% were applied medical sciences specialists, with 38.5% having years of experience between 16 to 20 years old. 26.3% were Saudi nationals. The mean HbA1c levels among diabetic patients were 6±1.03%, ranging between (5.1%-9%). There was a significant inverse relationship between each section's scores and total scores with the HbA1c levels (p-value<0.05). Total scores for adherence were significantly higher among the age group (51 to 60) (p-value=0.03) and physicians (p-value=0.035). Dietary control was significantly better among age group (51 to 60) (p-value=0.015), and type 2 diabetes (p-value=0.022). Physician contact was significantly higher in the age group (51 to 60) (p-value=0.027). Physical activity was significantly higher among physicians (p-value=0.030). Blood glucose monitoring was significantly better among the age group (above 60) (p-value=0.026), males (p-value=0.03), and physicians (p-value=0.039). Conclusion The findings suggest the glycemic control and adherence to treatment among diabetic healthcare providers in KAMC-Riyadh are adequate the findings suggest the glycemic control and adherence to treatment among diabetic healthcare providers in KAMC-Riyadh are adequate. Future studies with an adequate sample size are essential to assess diabetes self-management and identify if there is any obstacle toward better compliance in healthcare providers.

Patient Commitment and Its Relationship to A1C

IN BRIEF This study examined the relationship between patient commitment and A1C. Patients completed the Altarum Consumer Engagement (ACE) measure. Multiple A1C values were extracted from medical records for 273 military beneficiaries. Effects were analyzed with generalized linear models. The ACE Commitment subscale was significantly inversely related to A1C trends. Low-commitment patients were more likely to have a high A1C. High-commitment patients were 16% more likely to have an A1C <7.0%; this likelihood increased to 65% over time. The ACE Commitment domain may be a useful clinical tool. Increasing patients' commitment to managing diabetes may improve their A1C over time.

Does knowledge on diabetes management influence glycemic control? A nationwide study in patients with type 1 diabetes in Brazil

OBJECTIVE

The purpose of this study is to establish demographic and clinical data associated with the knowledge on diabetes management and its influence on glycemic control in patients with type 1 diabetes.

METHODS

This was a retrospective, observational, multicenter study conducted with 1,760 patients between August 2011 and August 2014 in 10 cities of Brazil.

RESULTS

Overall, 1,190 (67.6%) patients knew what glycated hemoglobin (HbA1c) means. These patients were older, had longer disease duration, longer follow-up in each center, reported lower frequency of self-reported hypoglycemia, and were more frequently Caucasians and at glycemic goal. Multivariate analysis showed that knowledge on what HbA1c means was related to more years of school attendance, self-reported ethnicity (Caucasians), severe hypoglycemia, economic status, follow-up time in each center, and participation on diabetes educational programs. Good glycemic control was related to older age, more years of school attendance, higher frequency of daily self-monitoring of blood glucose, higher adherence to diet, and knowledge on what HbA1c means.

CONCLUSION

Patients with a knowledge on what HbA1c means had a better chance of reaching an adequate glycemic control that was not found in the majority of our patients. Diabetes care teams should rethink the approaches to patients and change them to more proactive schedules, reinforcing education, patients' skills, and empowerment to have positive attitudes toward reaching and maintaining a better glycemic control. Finally, the glucocentric approach to diabetes management should be changed to actions that include patients' psychosocial aspects aiming to reduce the stress of living with diabetes, improving glycemic control, and avoiding adverse outcomes.