Association of diabetes-related self-care activities with glycemic control of patients with type 2 diabetes in Pakistan

Associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with type 2 diabetes under the national essential public health services program

BACKGROUND

The rising prevalence of Type 2 diabetes (T2D) in China poses a critical health challenge, necessitating effective management strategies. The National Essential Public Health Services Program (NEPHSP), initiated in 2009, focuses on equitable access to health services, including T2D management. This study investigates the associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with T2D under NEPHSP, particularly examining the mediating role of self-care behaviors.

METHODS

Conducted from April to November 2020 in Huai'an City, Jiangsu Province, this study involved 1,577 T2D patients enrolled in NEPHSP. We assessed perceived care quality using the Patient Assessment of Chronic Illness Care (PACIC) scale and developed a comprehensive self-care behavior score, covering nine essential health practices. Glycemic control was evaluated using HbA1c levels. Linear regression models were used to explore these associations, adjusting for demographic and clinical factors, while causal mediation analyses examined the role of intermediate variables.

RESULTS

Higher PACIC scores significantly correlated with improved self-care behaviors (β = 0.294, 95% CI: 0.233 to 0.354) and were negatively associated with HbA1c levels (β=-0.109, 95% CI: -0.192 to -0.026). The self-care behavior score inversely related to HbA1c levels (β=-0.197, 95% CI: -0.263 to -0.132). Notably, self-care behaviors mediated 50.41% (P < 0.05) of the effect of perceived care quality on HbA1c levels.

CONCLUSIONS

This study demonstrates a substantial association between perceived care quality and better glycemic control in Chinese adults with T2D under NEPHSP, with self-care behaviors playing a crucial mediating role. These findings suggest that patient-centered care and comprehensive self-care practices are essential for effective T2D management within NEPHSP.

Validation of the Portuguese version of the diabetes self-management questionnaire-revised (DSMQ-R) in people with type 2 diabetes mellitus

BACKGROUND

Reflecting people with diabetes' self-management activities is often required in both research and clinical practice. This study evaluated the measurement properties of the Portuguese version of the Diabetes Self-Management Questionnaire-Revised (DSMQ-R) on a sample of people with type 2 diabetes mellitus (T2DM).

METHODS

Translation and cultural adaptation were conducted according to guidelines for cross-cultural adaptation and validation of healthcare measurement instruments. A cross-sectional study was performed including 365 people with T2DM in primary care. Reliability, construct validity, and criterion validity were analyzed.

RESULTS

The total scale of the translated DSMQ-R revealed sufficient internal consistency (alpha = 0.82), and most of the subscales performed adequately. The exploratory factor structure was robust, and confirmatory analysis showed a good model fit with the scale structure of the original scale. The scale scores correlated with the participants' last HbA1c estimates, supporting convergent validity, and convergence was confirmed by the adequate average variance extracted.

CONCLUSIONS

The Portuguese version of the DSMQ-R is a reliable and valid tool for gauging self-management behaviors in people with T2DM and their relationship with glycemic values.

Cultural Influences on Making Nutritional Adjustments in Type 2 Diabetes in Pakistan: The Perspectives of People Living With Diabetes and Their Family Members

In Pakistan, type 2 diabetes is widespread, and although dietary recommendations from healthcare professionals are critical to its treatment, cultural norms can have a great influence on the dietary habits of people living with diabetes (PLwD). Understanding the social aspects of the lives of PLwD is crucial when examining the effectiveness of nutritional recommendations and adjustments. This study investigated (1) how PLwD and their family members adjust their nutrition to the recommendations of healthcare professionals to manage type 2 diabetes mellitus (T2DM) and (2) what do PLwD and their family members perceive as enablers and barriers to the necessary nutritional adjustments for managing T2DM. Prime consideration was given to experiences of living in Pakistan as the cultural context. Semi-structured interviews were conducted with 30 PLwD and 17 family members; the data were analysed thematically. Three themes emerged: (i) 'Influence of family system, gender, and age on meals prepared at home': family hierarchy and opinions based on gender and age can enable or hinder nutritional adjustment in meals prepared at home; (ii) 'Temptations of "unhealthy" foods, festivals, cultural interactions, and social etiquette': family/social interactions at home, gatherings, or festivities can affect PLwD's ability to resist temptations to eat foods prohibited by healthcare professionals; and (iii) 'Folk knowledge, folk remedy, and the balance between culture and Western medicine': PLwD and their family members in Pakistan hold strong beliefs concerning foods' medicinal properties. Power dynamics within families need to be considered when making nutritional recommendations. Medical guidelines should acknowledge personal agency and cultural beliefs.

An Overview of Pharmaceutical Care in Type II Diabetes Mellitus Patients: Current Position and Prospects

Diabetes mellitus is an ongoing disease that is related to a high mortality rate due to severe complications. Diabetes mellitus type 2 (DMT2) is a persistent metabolic deficiency and its prevalence has been increasing consistently worldwide. As a result, it is rapidly turning into a plague in some parts of the world, and the number of people affected is expected to double in the following decade due to an increase in the maturing populace, adding to the overall existing importance for medical service providers, particularly in the underdeveloped nations. Extensive diabetes care is an intricate task that takes a whole group of medical care experts, including drug specialists, to provide multidisciplinary care for the patients. The duty of drug experts has changed significantly in recent years, changing from conventional drug dispensing in the drug store to patient- centered clinical support services. Upgrading the medication treatment to accomplish better remedial results without causing drug-related issues has been considered the essential objective of treatment for diabetic patients. This review discusses the healthcare needs of patients with T2DM, the current evidence for the role of pharmacists in diabetes care, and insight into the upcoming role of pharmacists in its management. The advanced role of clinical pharmacists in diabetes control through drug treatment, diabetes care centers, and diabetes health counselor schooling, is also discussed in this review.

Factors associated with glycaemic control among patients with type 2 diabetes mellitus in Ho, Ghana: A cross-sectional study

Background

The purpose of this study was to assess the status of glycaemic control and associated factors among patients with type 2 diabetes mellitus patients.

Methods

This was a hospital-based cross-sectional descriptive study of 326 patients with type 2 diabetes at the Ho Municipal and Teaching Hospitals. The adequate sample size was calculated using Yamane formula N/1 + Ne2, with 95 % confidence interval, 5 % margin of error and 10 % non-response rate and a sample size of 326 was determined. Using the sampling frame of patients chart, systematic random sampling technique was used to select the study participants. Glycaemic level was assessed using fasting blood glucose (FBG) readings. A poor glycaemic control was when an average of three months blood glucose level was above 130 mg/dl (7 mm/L). Data was analysed using STATA version 15.0.

Results

Out of 310 patients who participated in the study, more than two-thirds (76.1 %) had poor glycaemic control. Patients who use combination of oral medication and insulin (AOR = 3.67, 95 % CI: 1.34-8.74), patients with diabetes for 16 years or more (AOR = 4.67, 95 % CI: 2.44-9.29), patients who did not practised diabetes self-care activities (AOR = 4.32, 95 % CI: 2.82-9.31) and patients with complications were (AOR = 2.47, 95%CI: 1.45-8.66) more likely to have poor glycaemic control. Age, employment, diabetes education, comorbidities, diabetes self-care activities, treatment type, complications, resident and duration of diabetes were significantly associated with poor glycaemic control.

Conclusion

Based on this findings, teaching and counselling provided by nurses, physicians, dietitians and pharmacists should focus on improving adherence to diabetes self-care activities to attain good glycaemic control.

Application of Artificial Intelligence in Assessing the Self-Management Practices of Patients with Type 2 Diabetes

The use of Artificial intelligence in healthcare has evolved substantially in recent years. In medical diagnosis, Artificial intelligence algorithms are used to forecast or diagnose a variety of life-threatening illnesses, including breast cancer, diabetes, heart disease, etc. The main objective of this study is to assess self-management practices among patients with type 2 diabetes in rural areas of Pakistan using Artificial intelligence and machine learning algorithms. Of particular note is the assessment of the factors associated with poor self-management activities, such as non-adhering to medications, poor eating habits, lack of physical activities, and poor glycemic control (HbA1c %). The sample of 200 participants was purposefully recruited from the medical clinics in rural areas of Pakistan. The artificial neural network algorithm and logistic regression classification algorithms were used to assess diabetes self-management activities. The diabetes dataset was split 80:20 between training and testing; 80% (160) instances were used for training purposes and 20% (40) instances were used for testing purposes, while the algorithms' overall performance was measured using a confusion matrix. The current study found that self-management efforts and glycemic control were poor among diabetes patients in rural areas of Pakistan. The logistic regression model performance was evaluated based on the confusion matrix. The accuracy of the training set was 98%, while the test set's accuracy was 97.5%; each set had a recall rate of 79% and 75%, respectively. The output of the confusion matrix showed that only 11 out of 200 patients were correctly assessed/classified as meeting diabetes self-management targets based on the values of HbA1c < 7%. We added a wide range of neurons (32 to 128) in the hidden layers to train the artificial neural network models. The results showed that the model with three hidden layers and Adam's optimisation function achieved 98% accuracy on the validation set. This study has assessed the factors associated with poor self-management activities among patients with type 2 diabetes in rural areas of Pakistan. The use of a wide range of neurons in the hidden layers to train the artificial neural network models improved outcomes, confirming the model's effectiveness and efficiency in assessing diabetes self-management activities from the required data attributes.

Cognitive behavior therapy for diabetes distress, depression, health anxiety, quality of life and treatment adherence among patients with type-II diabetes mellitus: a randomized control trial

OBJECTIVE

Diabetes distress typically causes depressive symptoms; common comorbidity of diabetes unpleasantly affects patients' medical and psychological functions. Psychotherapeutic interventions are effective treatments to treat depressive symptoms and to improve the quality of life in many chronic diseases including diabetes. The present study investigated the efficacy of cognitive behavior therapy (CBT) to treat depressive symptoms in patients with type 2 diabetes mellitus (T2DM) using experimental and waitlist control conditions.

MATERIALS AND METHODS

A total of 130 diagnosed patients with T2DM were taken from outdoor patients services of different hospitals in Faisalabad. Ninety patients met the eligibility criteria and were randomly assigned to experimental (n = 45) and waitlist control (n = 45) conditions. All the patients completed clinical interviews and assessment measures at pre-and post-assessment stages (16 weeks intervals). Medical consultants at the respective hospitals diagnosed the patients on the base of their medical reports and then referred those patients to us. Then we used different scales to assess primary and secondary outcomes: Diabetes Distress Scale (DDS) and Patient Health Questionnaire (PHQ) to assess primary outcomes, and a Short Health Anxiety Inventory (SHAI), a Revised Version of the Diabetes Quality of Life Questionnaire (DQLQ), and a General Medication Adherence Scale (GMAS) were used to investigate secondary outcomes. Repeated measure ANOVA was used to analyze the results.

RESULTS

The findings indicated that patients who received CBT got a significant reduction in their diabetes distress F(1,60) = 222.710, P < 0.001, η² = .788), depressive symptoms F(1,60) = 94.436, P < 0.001, η² = .611), health anxiety F(1,60) = 201.915, P < .0.001, η² = 771), and a significant improvement in their quality of life F(1,60) = 83.352, P < 0.001, η² = .581), treatment adherence F(1,60) = 67.579, P < 0.001, η² = .566) and physical activity schedule F(1,60) = 164.245, P < .0.001, η² = .736 as compared to the patients in waitlist control condition.

CONCLUSION

It is concluded that cognitive behavior therapy is an effective and promising intervention for depressive symptoms, diabetes distress, and health anxiety which also helps the person to promote quality of life, treatment adherence and physical activity.

Self-care behaviours among people with type 2 diabetes mellitus in South Asia: A systematic review and meta-analysis

Background

The burden of Type 2 Diabetes Mellitus (T2DM) in South Asian countries is increasing rapidly. Self-care behaviour plays a vital role in managing T2DM and preventing complications. Research on self-care behaviours among people with T2DM has been widely conducted in South Asian countries, but there are no systematic reviews that assess self-care behaviour among people with T2DM in South Asia. This study systematically assessed the studies reporting self-care behaviours among people with T2DM in South-Asia.

Methods

Adhering to the PRISMA guidelines, we searched six bibliographic databases (Scopus, PubMed, CINAHL, Embase, Web of Science, and PsychInfo) to identify the relevant articles published between January 2000 through March 2022. Eligibility criteria included all observational and cross-sectional studies reporting on the prevalence of self-care behaviours (ie, diet, physical activity, medication adherence, blood glucose monitoring, and foot care) conducted in South Asian countries among people with T2DM.

Results

The database search returned 1567 articles. After deduplication (n = 758) and review of full-text articles (n = 192), 92 studies met inclusion criteria and were included. Forward and backward reference checks were performed on included studies, which resulted in an additional 18 articles. The pooled prevalence of adherence to blood glucose monitoring was 65% (95% CI = 49-80); 64% for medication adherence (95% CI = 53-74); 53% for physical activity (95% CI = 39-66); 48% for diet (95% CI = 38-58); 42% for foot care (95% CI = 30-54). About a quarter of people with T2DM consumed alcohol (25.2%, IQR = 13.8%-38.1%) and were using tobacco products (18.6%, IQR = 10.6%-23.8%).

Conclusions

Our findings suggest that the prevalence of self-care behaviours among people with T2DM in South Asia is low. This shows an urgent need to thoroughly investigate the barriers to the practising of self-care and design and implement interventions to improve diabetes self-care behaviour among people with T2DM in South Asia.

The relationship between self-care activities, social support, and glycemic control in primary healthcare patients with type 2 diabetes

Objective

Egyptian studies in assessing the relationship between diabetes self-care, social support, and glycemic control in primary healthcare (PHC) are limited. Therefore, this study aimed to assess this relationship, and to evaluate the associated factors of diabetes self-care, social support, and glycemic control in Egyptian PHC patients with type 2 diabetes (T2DM).

Methods

A cross-sectional study was conducted on 320 T2DM patients at four PHC settings in Port Said city, affiliated with the General Authority of Healthcare. A semi-structured questionnaire was used to collect data, including demographic characteristics, socioeconomic status scale, disease profile, the Arabic versions of the Summary of Diabetes Self-Care Activities, and the received social support scales. Data were collected from January 2020 to June 2020.

Results

Diabetes self-care activities, and self-monitoring of blood glucose had a very weak negative correlations with glycated hemoglobin (HbA1c) levels (rho = - 0.125, p = 0.025, rho = - 0.112, p = 0.044, respectively). Receiving social support on following a meal correlated positively and very weakly with HbA1c levels (rho = 0.145, p = 0.010). Hardly positive correlation was found between receiving emotional support on feelings about diabetes, and following a specific diet (rho = 0.169, p = 0.002). Diabetes self-care activities were positively associated with higher education levels, and elevated BMI. Received social support was negatively associated with having coronary artery disease, and marital status e.g. divorced and widow. Increased age, and female gender were the predictors of good glycemic control.

Conclusion

Diabetes self-care activities were linked with reduced HBA1c levels. Further studies are needed to evaluate the buffering effect of social support on glycemic outcomes in PHC patients with T2DM.

Correlates of Glycemic Control Among Patients With Type 2 Diabetes in Eastern Ethiopia: A Hospital-Based Cross-Sectional Study

Introduction

Even though optimal blood glucose control reduces the risk of diabetes-related complications, many patients with type 2 diabetes (T2D) fail to achieve it for a variety of reasons. In the study area, there was a paucity of evidence regarding correlates of glycemic control. Therefore, this study aimed to find out the correlates of glycemic control among patients with T2D in Eastern Ethiopia.

Methods

A cross-sectional study was conducted among 879 adult patients with T2D on follow-up at two public hospitals in Harar. Data were collected through interviews, physical measurements, and record reviews. The level of glycemic control was determined from three consecutive fasting plasma glucose (FPG) measurements. A mean value of FPG measurements falling in the normal range (80-130 mg/dl) was considered as optimal glycemic control; otherwise, a mean FPG level that is below or above the normal range (<80 mg/dl or >130 mg/dl) was defined as suboptimal glycemic control. Descriptive statistics were used to summarize the data, while a linear regression model was used to find out the correlates of glycemic control. A beta coefficient and a 95% CI reported associations. The statistical significance was declared at a p-value ≤0.05.

Results

The mean age of the patients with T2D was 52.7 ( ± 13.3) years. The mean FPG level was 172 ± 56 mg/dl. Suboptimal glycemic control was found in 76% (95% CI: 73.41, 79.04) of patients with T2D. In a multivariable linear regression, khat chewing (β = 6.12; 95% CI: 1.55, 8.69), triglycerides (β = 0.56; 95% CI: 0.41.48, 0.65), comorbidity (β = 5.29; 95% CI: 1.39, 9.13), and poor level of self-care practices (β = 5.43; 95% CI: 1.41, 6.46) showed a significant correlation with glycemic control.

Conclusions

This study found that about three-fourths of patients with T2D had suboptimal glycemic control. Khat chewing, comorbidity, and poor level of self-care practices were independently correlated with glycemic control. Thus, suppressing glycemic levels through appropriate treatment and strict diabetes self-care practices including avoidance of Khat chewing is a useful approach to attaining glycemic target that subsequently reduces cardiovascular risks.

Self-care practices and correlates among patients with type 2 diabetes in Eastern Ethiopia: A hospital-based cross-sectional study

Objective:

This study investigated the level and correlates of self-care practices among patients with type 2 diabetes on follow-up in two public hospitals in Harar, Eastern Ethiopia.

Methods:

We conducted a hospital-based cross-sectional study on adult patients with type 2 diabetes, surveying diabetes self-care practices using a 15-item Summary of Diabetes Self-Care Activities. Responses ranged from 0 to 7 days, and a composite score was computed representing the mean days of diabetes self-care practices. A generalized Poisson regression model with robust variance was used. The association between the diabetes self-care practices and correlates was examined using the incidence rate ratio with a 95% confidence level. The statistical significance was set at a p value of ⩽0.05.

Results:

This study included 879 patients with type 2 diabetes. The overall mean (standard deviation) diabetes self-care practices were 3.7 ± 1.1 days out of the recommended 7 days, indicating low self-care practices. After controlling for other variables, tertiary educational level (incidence rate ratio = 1.06; 95% confidence interval: 1.01, 1.12), adequate diabetes knowledge (incidence rate ratio = 1.04; 95% confidence interval: 1.00, 1.08), moderate (incidence rate ratio = 1.07; 95% confidence interval: 1.02, 1.11) and high perceived self-efficacy (incidence rate ratio = 1.14; 95% confidence interval: 1.09, 1.13) (incidence rate ratio = 1.07; 95% confidence interval: 1.02, 1.11), high to marginal food security (incidence rate ratio = 1.13; 95% confidence interval: 1.03, 1.24), and receiving dietary advice (incidence rate ratio = 1.11; 95% confidence interval: 0.06, 1.15) were positively correlated with diabetes self-care practices. A history of hospitalization, on the other hand, was found to be inversely correlated with diabetes self-care practices (incidence rate ratio = 0.94; 95% confidence interval: 0.88, 0.99).

Conclusion:

The study indicated that adherence of patients with type 2 diabetes to the recommended self-care practices was considerably low. Therefore, tailored diabetes self-management education to enhance self-efficacy and diabetes self-care practices must be in place. This can be achieved through the system or individual-based integrated intervention efforts.

Impact of Pharmacist-Led Diabetes Self-Care Education on Patients With Type 2 Diabetes in Pakistan: A Randomized Controlled Trial

Introduction: There is a little evidence on efficacy of pharmacy-based interventions on clinical outcomes of type 2 diabetes mellitus (T2DM) patients in Pakistan.

Objective: To appraise the impact of pharmacist-led self-care education on glycemic control, self-care practices and disease knowledge of T2DM patients with poor glycemic control (HbA1c ≥ 7%).

Methods: In this 6-months, randomized controlled trial (RCT), n = 75, T2DM patients seeking care at a diabetes clinic were randomized in to two groups. Intervention group (n = 38) received two face-to-face educational sessions (at enrollment and on week 12), whereas control group (n = 37) received usual care. Outcome measures such as glycemic control, self-care practices and disease knowledge were assessed at the time of enrollment and after 6-months in both groups.

Results: Thirty-three intervention and thirty-three participants from the control group completed the study. Mean glycated hemoglobin (% HbA1c) significantly reduced in the intervention group from 9.00 ± 1.43 to 8.09 ± 1.16 (p < .01). However, no significant change was observed in the control group (9.20 ± 1.24 to 8.93 ± .97; p = .06). Cohen’s d effect size of the intervention on HbA1c was .78. Percentage of participants achieving glycemic control (HbA1c < 7%) were significantly higher (p < .05) in the intervention group as compared to the control group (twenty-four vs. six), after 6 months of the trial. A significant (p < .01) improvement in mean scores for disease knowledge and self-care activities was also observed in the intervention group participants, whereas no significant improvements (p > .05) were observed in the control group.

Conclusion: The study demonstrated an improvement in glycemic control, disease knowledge and self-care activities of T2DM patients who received pharmacist-led educational intervention. The study findings support clinical significance of integrating pharmacy-based interventions in diabetes management.

A Self-Report Measure of Diabetes Self-Management for Type 1 and Type 2 Diabetes: The Diabetes Self-Management Questionnaire-Revised (DSMQ-R) – Clinimetric Evidence From Five Studies

Aims

Measurement tools to evaluate self-management behavior are useful for diabetes research and clinical practice. The Diabetes Self-Management Questionnaire (DSMQ) was introduced in 2013 and has become a widely used tool. This article presents a revised and updated version, DSMQ-R, and evaluates its properties in assessing self-management practices in type 1 diabetes (T1D) and type 2 diabetes (T2D).

Methods

The DSMQ-R is a multidimensional questionnaire with 27 items regarding essential self-management practices for T1D and T2D (including diabetes-adjusted eating, glucose testing/monitoring, medication taking, physical activity and cooperation with the diabetes team). For the revised form, the original items were partially amended and the wording was updated; eleven items were newly added. The tool was applied as part of health-related surveys in five clinical studies (two cross-sectional, three prospective) including a total of 1,447 people with T1D and T2D. Using this data base, clinimetric properties were rigorously tested.

Results

The analyses showed high internal and retest reliability coefficients for the total scale and moderate to high coefficients for the subscales. Reliability coefficients for scales including the new items were consistently higher. Correlations with convergent criteria and related variables supported validity. Responsiveness was supported by significant short to medium term changes in prospective studies. Significant associations with glycemic outcomes were observed for DSMQ-R-assessed medication taking, glucose monitoring and eating behaviors.

Conclusions

The results support good clinimetric properties of the DSMQ-R. The tool can be useful for research and clinical practice and may facilitate the identification of improvable self-management practices in individuals.

Assessment of the psychometric properties of the Persian version of the diabetes self-management questionnaire (DSMQ) in patients with type 2 diabetes

Background

Performing self-care behaviors by diabetic patients is essential to achieve optimal glycemic control, reduction of complications, and improvement in the quality of life. The Diabetes Self-care Questionnaire (DSMQ) is designed to assess self-care behaviors that can predict glycemic control. The present study aimed to evaluate the psychometric properties of the Persian version of the DSMQ in patients with type 2 diabetes.

Methods

The present methodological cross-sectional study investigated 460 patients with T2DM referred to the Isfahan Endocrine and Metabolism Research Center, Isfahan, Iran through the convenience sampling procedure. The translation process of the DSMQ was carried out based on the guidelines suggested by Beaton et al. We assessed the reliability (internal consistency), content validity, convergent validity and construct validity. Construct validity was evaluated using exploratory factor analysis (calibration sample = 230) and confirmatory factor analysis (validation sample = 230). Furthermore, a linear regression analysis was used to determine the prediction power of self-care behaviors in explaining the variance of the HbA1c level.

Results

In the EFA with Varimax rotation, we extracted four factors that could explain 67.46% of the total variance of the DSMQ scale. The CFA exhibited a satisfactory fit level for the four-factor structure extracted from EFA with the following measures. CFI: 0.980, IFI: 0.980, NFI: 0.956, TLI: 0.974, RMSEA: 0.042). Internal consistency was good (Cronbach's alpha coefficient for the whole scale: 0.84; the subscales: 0.75-0.91). The convergent validity showed significant negative correlations (GM: -0.53; DC: -0.22; PA: -0.16; HU: -0.17; SS: -0.45; p < 0.01) between DSMQ subscales and HbA1c. However, only two factors of glucose management and diet control in the statistical model obtained from regression analysis (stepwise) were able to explain 30% of the HbA1c level (P < 0.001).

Conclusion

The Persian version of the DSMQ is a valid and reliable instrument to assess self-care behaviors associated with glycemic control in Iranian patients with T2DM. Therefore, this instrument can be used in both future research and clinical practices.

Glycemic Control and Its Relationship with Diabetes Self-Care Behaviors Among Patients with Type 2 Diabetes in Northern Jordan: A Cross-Sectional Study

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a chronic progressive disease that significantly impacts morbidity and mortality worldwide. Glycemic control is central in diabetes management, yet complex and challenging to achieve; it can be affected by various factors. Diabetes self-care behaviors are vital strategies for effective T2DM management.

PURPOSE

To evaluate the levels of glycemic control and diabetes self-care behaviors, and the significance of each behavior on glycemic control among patients with T2DM in Jordan.

PATIENTS AND METHODS

This cross-sectional study was conducted in medical and endocrinology outpatient clinics of three hospitals in northern Jordan. A convenience sample of 520 patients with T2DM participated in the study. Diabetes self-care behaviors, including diet, exercise, blood glucose testing, taking medication, and foot care behaviors, were measured using the Arabic version of the Summary of Diabetes Self-Care Activities (SDSCA-Arabic) questionnaire. Psychological distress was measured using the Arabic version of the 4-items Patient Health Questionnaire (PHQ-4). Glycated hemoglobin (HbA1c) levels were used to assess glycemic control.

RESULTS

Out of 520 participants, 92.7% (n= 482) had poor glycemic control (HbA1c ≥7%), with a mean of 9.29% (SD=2.06) for HbA1c. The SDSCA overall mean score was 3.25 days (SD=0.88), indicating an unsatisfactory level, with 79.2% of participants having performed self-care activities 4-days/week. Greater adherence to diabetes self-care behaviors was associated with better glycemic control. Exercise was the most important predictor of HbA1c (p<0.001), followed by general diet (p<0.001), specific diet (p<0.001), and blood sugar testing (p<0.001). Moreover, the Body Mass Index (p<0.001), treatment type (p<0.001), and income (p=0.03) were significant predictors.

CONCLUSION

The proportions of poor glycemic control and unsatisfactory self-care behaviors were high among T2DM patients. To enhance patients' self-care behaviors and lifestyles changes, the patients need tailored diabetes self-care management educational and supportive programs, conducted by qualified diabetes educators using culturally sensitive strategies.

Glycemic control outcome in patients with type 2 diabetes mellitus: chronic care management support of family care team in Thailand

Purpose

We aimed to ascertain diabetic self-management predictors in the family care team chronic care model, and to analyze the factors associated with glycemic control.

Methods

A cross-sectional study was conducted with type 2 diabetes mellitus (T2DM) patients at Pak Phun Municipality Hospital, Thailand, from 2019 to 2020. The 282 participants' compraised 16 health care providers, 128 healthy volunteers, and 138 T2DM patients. Data were collected using a questionnaire. The statistics were descriptive, association and multiple regression were tested.

Results

Of the T2DM patients, 68.1% were female, overweight (body mass index 25.8 ± 3.99 kg/m²), had diabetic periods of 8.2 ± 4.65 y, high fasting plasma glucose (FPG) (139.3 ± 44.59 mg/dL), uncontrolled A1C (7.8 ± 1.57%), and presented with diabetic nephropathy (61.6%). Diabetic self-management was at a high level (76.8%). The factors significantly associated with A1C were income (p < 0.001), low-density lipoprotein (p < 0.05) estimated glomerular filtration rate, and FPG (p < 0.001). A1C was predicted by self-efficacy (SE) (38.0%; p < 0.001), social support (SO) (40.8%; p < 0.001), health providers evaluated by the Assessment of Chronic Illness Care (ACIC) (22.8%; p < 0.001), and patients' perception by Patient Assessment of Care for Chronic Conditions (PACIC) (17%; p < 0.01).

Conclusion

In order to reduce diabetes complications, the family care team played a critical role. Self-efficacy and social support were important factors in managing diabetes. The chronic care model begins with a procedure of self-management support and intervention by stakeholders such as caregivers in the community.

Healthcare Professionals' Perspectives of Patients' Experiences of the Self-Management of Type 2 Diabetes in the Rural Areas of Pakistan: A Qualitative Analysis

The main objective of this research work was to explore the healthcare professionals’ perspectives of type 2 diabetes patients’ experiences of self-management of diabetes in the rural area of Pakistan. In this study, we have carried out a methodological approach to use a self-management framework to direct the interview guide for healthcare professionals to examine their perceptions and expectations of their diabetes patients’ adherence to the medications prescribed. Twenty healthcare professionals were recruited in this study consisting of ten general practitioners and ten nurses from various clinics (medical centres) of Al-Rehman Hospital at Abbottabad, Pakistan. This qualitative study explored the feelings and opinions of general practitioners on patients’ compliance and adherence by using the semi-structured interview guide using a methodological framework. All interviews of participants were audiotaped and transcribed for content analysis. Six major themes were identified: patient–doctor relationship; patient’s non-adherence to diet and exercise; conflicts with the patients; low self-efficacy and feeling of “resignation with poor care”; the influence of culture on patients’ self-management activities and lack of support for patients by health care providers, patients, and their families. We have derived relevant solutions from qualitative studies and considered that communication, tailored, and shared care is the best approach for patient adherence to treatment. GPs felt that a structured consultation and follow-up in a multidisciplinary team might help to increase adherence. The results of this qualitative health research highlighted the challenges healthcare professionals are facing in rural Pakistan in managing patients with type 2 diabetes and supporting their management activities. Healthcare professionals and patients may benefit by adopting a methodological framework approach to ensure meaningful participation and adjusting the patient–doctor relationship, and setting up achievable management and self-management goals.

Nutritional status and quality of life in diabetic patients on hemodialysis: a cross-sectional study from Palestine

BACKGROUND

End-stage renal disease (ESRD) is a leading cause of death and morbidity worldwide. Malnutrition is a common problem among hemodialysis (HD) patients that negatively impacts their prognosis and is linked to an increase in morbidity and mortality in these patients, as well as a decrease in their quality of life (QOL). In this study, we aimed to evaluate the QOL and to investigate factors that can influence it, including nutritional status, as well as socio-demographic factors, among Palestinian diabetic patients on HD therapy.

METHODS

This was a cross-sectional study that occurred at a large hemodialysis center in Palestine. Malnutrition was assessed by the malnutrition-inflammation scale (MIS), and the quality of life was evaluated by using the EuroQoL five-dimensional instrument (EQ-5D). Multivariable linear regression analysis was carried out to look at the effect of multiple variables on QOL.

RESULTS

A total of 118 diabetic patients on HD were included. Of these, 66.9% were male, and 60.2% were aged 60 years or higher. Having multiple comorbid diseases (p=0.004) and having been on HD for >4 years (p=0.003) were significantly associated with a higher MIS score, whereas living alone (p=0.037) and having been on HD for >4 years (p=0.002) was significantly associated with lower EQ-5D score. We also observed a significant association between the MIS score and the EQ-5D score(r=-0.616, p<0.001). Multiple linear regression analysis demonstrated that diabetic hemodialysis patients who lived within a family household were positively correlated with the QOL score (standardized coefficient, 0.178; 95% confidence interval (CI), 0.042 to 0.372; p = 0.015), and MIS score was significantly and negatively correlated with QOL scores (standardized coefficient, -0.587; 95% CI, -0.047 to -0.028; p < 0.001).

CONCLUSIONS

We found that malnutrition was associated with a lower QOL score among diabetic patients on HD. We recommend general practitioners, dietitians, nephrologists, and nurses to make plans that pay more attention to this group of patients who show evidence of malnutrition. Patients on dialysis for ≥ 4 years, patients who live alone, and those suffering from multiple co-morbid diseases should receive special care due to their higher risk of being impacted by this problem.

Diabetes self-care practice and associated factors among type 2 diabetic patients in public hospitals of Tigray regional state, Ethiopia: A multicenter study

Background

The prevalence of type 2 diabetes is increasing steadily at an alarming rate. Ethiopia is placed fourth among the top five countries of the African region members of the international diabetes federation. This study aimed to determine the level of diabetes self-care practice and associated factors among patients with type 2 diabetes mellitus attending public hospitals of the Tigray region.

Methods

An institution-based, cross-sectional study was conducted in six selected hospitals of Tigray region from January to February 2020. Study participants were recruited using a systematic random sampling method. Diabetes self-care practice was assessed using Summary Diabetes Self-Care Activities (SDSCA) assessment tool. The data were collected by trained nurses via face-to-face interview. Binary and multivariable logistic regression analyses were used to identify factors associated with self-care practices. Statistical significance was declared at p-value < 0.05.

Results

A total of 570 patients with type 2 diabetes were included in this study. The mean (SD) age of the participant was 46 (±14.6) years. Less than half (46.7%) of the participants had good diabetes self-care practices. Surprisingly, only 68 (11.9%) of the participants had access to a personal glucometer. Urban residency (AOR = 1.9, 95% CI = 1.20–2.94), age group 48–63 years (AOR = 2.1, 95% CI = 1.19–3.98), not having a formal education (AOR = 2.6, 95% CI = 1.32–5.25), having family support (AOR = 1.9, 95% CI = 1.24–2.85), and having a personal glucometer at home (AOR = 6.1, 95% CI = 2.83–13.0) were the factors associated with good diabetes self-care practices.

Conclusion

The diabetes self-care practice in the region was found to be poor. Where factors like, being an urban resident, age group between 49–63 years, not having a formal education, and having a personal glucometer at home were associated with good self-care practices. Health care providers might have to consider actions to act on the identified factors and improve the level of self-care practices of the patients.

Type 2 Diabetes Patients' Perspectives, Experiences, and Barriers Toward Diabetes-Related Self-Care: A Qualitative Study From Pakistan

Objective: This study aimed to qualitatively explore perspectives, practices, and barriers to self-care practices (eating habits, physical activity, self-monitoring of blood glucose, and medicine intake behavior) in urban Pakistani adults with type 2 diabetes mellitus (T2DM). Methods: Pakistani adults with T2DM were recruited from the outpatient departments of two hospitals in Lahore. Semistructured interviews were conducted and audiorecorded until thematic saturation was reached. Two researchers thematically analyzed the data independently using NVivo® software with differences resolved by a third researcher. Results: Thirty-two Pakistani adults (aged 35-75 years, 62% female) participated in the study. Six themes were identified from qualitative analysis: role of family and friends, role of doctors and healthcare, patients' understanding about diabetes, complication of diabetes and other comorbidities, burden of self care, and life circumstances. A variable experience was observed with education and healthcare. Counseling by healthcare providers, family support, and fear of diabetes-associated complications are the key enablers that encourage study participants to adhere to diabetes-related self-care practices. Major barriers to self care are financial constraints, physical limitations, extreme weather conditions, social gatherings, loving food, forgetfulness, needle phobia, and a hectic job. Conclusion: Respondents identified many barriers to diabetes self care, particularly related to life situations and diabetes knowledge. Family support and education by healthcare providers were key influencers to self-care practices among Pakistani people with diabetes.

Application of structural equation modeling in assessing the self-management activities of patients with type 2 diabetes

OBJECTIVE

This study aimed at assessing the self-management activities of type 2 diabetes patients using Structural Equation Modeling (SEM) which measures and analyzes the correlations between observed and latent variables. This statistical modeling technique explored the linear causal relationships among the variables and accounted for the measurement errors.

METHODS

A sample of 200 patients was recruited from the middle-aged population of rural areas of Pakistan to explore the self-management activities of type 2 diabetes patients using the validated version of the Urdu Summary of Diabetes Self-care Activities (U-SDSCA) instrument. The structural modeling equations of self-management of diabetes were developed and used to analyze the variation in glycemic control (HbA1c).

RESULTS

The validated version of U-SDSCA instrument showed acceptable psychometric properties throughout a consecutive reliability and validity evaluation including: split-half reliability coefficient 0.90, test-retest reliability (r = 0.918, P ≤ .001), intra-class coefficient (0.912) and Cronbach's alpha (0.79). The results of the analysis were statistically significant (α = 0.05, P-value < .001), and showed that the model was very well fitted with the data, satisfying all the parameters of the model related to confirmatory factor analysis with chi-squared = 48.9, CFI = 0.94, TLI = 0.95, RMSEA = 0.065, SPMR = 0.068. The model was further improved once the items related to special diet were removed from the analysis, chi-squared value (30.895), model fit indices (CFI = 0.98, TLI = 0.989, RMSEA = 0.045, SPMR = 0.048). A negative correlation was observed between diabetes self-management and the variable HbA1c (r = -0.47; P < .001).

CONCLUSIONS

The Urdu Summary of Diabetes Self-Care Activities (U-SDSCA) instrument was used for the patients of type 2 diabetes to assess their diabetes self-management activities. The structural equation models of self-management showed a very good fit to the data and provided excellent results which may be used in future for clinical assessments of patients with suboptimal diabetes outcomes or research on factors affecting the associations between self-management activities and glycemic control.

Frequency and factors associated with inadequate self-care behaviors in patients with type 2 diabetes mellitus in Najran, Saudi Arabia. Based on diabetes self-management questionnaire

OBJECTIVES

To investigate the frequency and factors associated with inadequate self-care behaviors in patients with type 2 diabetes mellitus (T2DM).

METHODS

A cross-sectional study was conducted on a sample of 355 patients with T2DM, using multistage cluster sampling, attending the Najran University Hospital and Primary health care centres in Najran, Saudi Arabia, from January to May 2019. The assessment of self-care behaviors was conducted using the 16-item diabetes self-management questionnaire (DSMQ). Results: The majority (85.1%) of the patients with T2DM were uncontrolled, 42% were obese, and 5.9% were morbidly obese. Based on DSMQ criteria, the majority of patients (90.1%) had poor self-care behaviors. The mean sum of DSMQ was 5.04 out of 10. Among the DSMQ subscales, health care use had the highest mean score of 5.63, followed by glucose management with a score of 5.12, while dietary control had lower mean scores of 4.96 and physical activity had 4.46, all were inadequate. Being married (OR=2.178, p=0.035) and having DM for more than 5 years (OR=2.711, p less than 0.006) were the significant independent factors associated with poor self-care behavior.

CONCLUSION

Inadequate self-care behavior is widely prevalent in Najran city, Saudi Arabia. All the DSMQ subscales were poorly managed by most of the diabetic patients. Furthermore, being married and having a longer DM duration are the significant independent factors associated with poor self-care behaviors.

Impact of Diabetes-related Self-management on Glycemic Control in Type II Diabetes Mellitus

INTRODUCTION

 Self-care activities are behaviors adopted in order to enhance one's health. Self-care behaviors and activities are studied in their role to enhance glycemic control, reduce diabetes-related complications, and contribute to enhancing overall quality of life in people with diabetes. The aim of this observational study was to evaluate the impact of diabetes self-care activities and behaviors on glycemic control in people with diabetes.

METHODS

 This observational, cross-sectional study was conducted at the outpatient department of a secondary care hospital in Karachi, Pakistan from 1st September 2019 till 30th November 2019. Patients with known type II diabetes of age ≥45 years visiting the hospital for routine follow-up visit were included. Diabetes Self-Management Questionnaire (DSMQ) in Urdu version was used to assess their status of self-management. For data entry and statistical analysis SPSS for Windows version 21.0 was used.

RESULTS

 There were 174 (54.9%) males and 152 (47.9%) were of age 45-60 years. Glycemic control was good (HbA1c <7%) in 125 (39.4%) and poor (HbA1c ≥7%) in 192 (60.6%) patients. Patients with good glycemic control scored significantly better on DSMQ overall (5.53 ± 0.35 vs. 4.32 ± 0.61; p<0.0001), and on three sub-scales - dietary control (4.24 ± 1.04 vs. 3.63 ± 0.98; p<0.0001), physical activity (4.16 ± 0.56 vs. 3.47 ± 1.17; p<0.0001), and healthcare use (4.22 ± 0.78 vs. 3.98 ± 0.65; p=0.003).  Conclusions: The self-care activities that impact glycemic control in patients with diabetes include dietary control, physical activity, and healthcare use.

Knowledge about Diabetes and Glycemic Control among Diabetic Patients in Saudi Arabia

The prevalence of diabetes in various regions has attracted significant attention of the medical experts. The prevalence of diabetes is expected to increase in the future due to changes in lifestyle and unhealthy diets of individuals. The objective of the study is to identify the extent of knowledge related to diabetes and glycemic controls in various diabetic patients living in Saudi Arabia. A total of 435 patients were recruited using a random sampling technique, while following a cross-sectional design. Patients' knowledge was tested using the Michigan Diabetes Knowledge Test. Findings of the study illustrated that the problem was common among middle-aged male patients. A significant amount of knowledge related to the consumption of medicines, insulin, healthy diet, etc. was found among diabetic patients. Despite the fact that people have adequate knowledge, valuable attention is yet required to provide necessary counselling to people living in Saudi Arabia that may help them to control health risks and mortality.

Diabetes Self-care Activities and Their Relation with Glycemic Control in Patients Presenting to The Indus Hospital, Karachi

Introduction Nowadays, chronic conditions are increasing globally, stressing on self-management and patients' responsibility toward recognizing and resolving issues related to their illness. Diabetes is also a chronic illness, and diabetes-related self-care activities have been shown to be promising towards preventing its complications and achieving optimal glycemic control. Objective 1) To assess the association between glycemic control and diabetes-related self-care activities 2) To evaluate the association of patients' sociodemographic characteristics with diabetes-related self-care activities 3) To examine the impact of patients' sociodemographic characteristics on glycemic control Materials and methods This cross-sectional study was conducted at The Indus Hospital Karachi from February 2019 to July 2019. A total of 288 patients of both genders, age ≥18 years, having type 2 diabetes mellitus with glycated hemoglobin (HbA1c) done within the last three months from the interview date were enrolled in the study using a non-probability consecutive sampling technique. Whereas patients not giving consent for participation in the study, ICU admitted patients, critically ill patients, pregnant women, comatose, patients with type 1 diabetes mellitus, Alzheimer's disease, dementia, coexisting and chronic liver disease were excluded from the study. Results Majority of the patients were female (n=209; 72.6%) and had uncontrolled glycemic control (n=235; 81.6%). Furthermore, less than half of the patients had inadequate diabetes-related self-care activities (n=140; 48.6%). The Mean ± SD of age was 51.9±10.2 years. The significantly higher proportion of patients who have had a duration of illness and treatment ≥3 years had uncontrolled diabetes but adequate diabetes-related self-care activities. Moreover, there was no association between diabetes-related self-care activities and glycemic control. Conclusion There was no significant relationship between diabetes-related self-care activities and glycemic control. Moreover, a higher proportion of patients with a longer duration of diabetes (≥3 years) had poor glycemic control but adequate diabetes-related self-care activities.

Association of diabetes knowledge with glycemic control and self-care practices among Pakistani people with type 2 diabetes mellitus

OBJECTIVE

This study explored the relationship of disease knowledge with glycemic control and self-care practices in adult Pakistani people diabetes (PWD).

METHODS

People diagnosed with type 2 diabetes (n=218) were selected from three health care centers, located in different cities of Pakistan. Disease knowledge and self-care practices were assessed by Urdu versions of Diabetes Knowledge Questionnaire (DKQ) and Diabetes Self-Management Questionnaire (DSMQ), using a cross-sectional design. Chi-square and correlation analysis were applied to explore the relationship of disease knowledge with glycemic control and self-care practices. Linear regression was used to explore the predictors for disease knowledge.

RESULTS

Majority of the sample was >45-60 years old (48.8%), suffering from type 2 diabetes mellitus for <5 years (49.5%) and had poor glycemic control (HbA1C≥7%; n=181 participants). Disease knowledge was significantly associated (p<0.05) with patient's gender, level of education, family history of diabetes, nature of euglycemic therapy, and glycemic control. Correlation matrix showed strongly inverse correlations of DKQ with glycated hemoglobin levels (r=-0.62; p<0.001) and strongly positive with DSMQ sum scale (r=0.63; p<0.001). PWD having university-level education (β=0.22; 95% Confidence Interval (CI) 0.189, 0.872; p<0.01), doing job (β=0.22; 95% CI 0.009, 0.908]; p=0.046), and use of oral hypoglycemic agents in combination with insulin (β=-0.16; 95% CI [-1.224, -0.071]; p=0.028) were the significant predictors for disease knowledge.

CONCLUSION

Disease knowledge significantly correlated with glycated hemoglobin levels and self-care activities of PWD. These findings will help in designing patient-tailored diabetes educational interventions for yielding a higher probability of achieving target glycemic control.