Associations of different adherences in patients with type 2 diabetes mellitus

Dietary practices and associated factors among adult diabetic patients at academic tertiary-level hospitals in central Ethiopia: convergent mixed study

BACKGROUND

Diabetes mellitus (DM) is one of the most prevalent chronic diseases worldwide. Despite the existence of national strategies to prevent potential complications, DM-related morbidities and mortality continue to rise in Ethiopia. Although studies have been conducted regarding dietary practices among DM patients in the country, there is a lack of in-depth understanding of the situation.

OBJECTIVE

To assess dietary practices and associated factors among adult DM patients at academic tertiary-level hospitals in central Ethiopia in 2024.

METHODS

A concurrent mixed-methods study was conducted from January 01 to 30, 2024, involving 420 adult DM patients. Participants were selected using a simple random sampling technique for the quantitative study. A purposive sampling technique was used to select sixteen participants for qualitative analysis. For the quantitative study, a self-administered structured questionnaire was used to collect data, and in-depth interviews were conducted for the qualitative part. Multivariate binary logistic regressions were used to assess the explanatory variables associated with dietary practice. A thematic analysis was performed for qualitative data.

RESULT

Of 420 eligible participants, 406 (96.7%) participated in the study. The overall proportion of good dietary practices among participants was 172 (42.4%). Being female, residing in urban areas, having a family history of DM, and having good dietary knowledge were significantly associated with better dietary practices. From the qualitative analysis, two themes emerged "Living as before and not adhering to diabetic dietary recommendations" and "Barriers to adherence to effective eating practices."

CONCLUSIONS AND RECOMMENDATIONS

Less than half of adult DM patients had good dietary practices. Sex, geographic location, family history of DM, and level of knowledge of diabetic diet were associated with dietary practice. Intervention programs on awareness creation and training to improve the dietary practice by stakeholders were recommended.

Impact of a Cooking Intervention on the Cooking Skills of Adult Individuals with Type 2 Diabetes Mellitus: A Pilot Study

OBJECTIVE

To investigate the impact of the Nutrition and Culinary in the Kitchen (NCK) Program on the cooking skills of Brazilian individuals with type 2 diabetes mellitus (T2DM).

METHODS

A randomized controlled intervention study was performed, with intervention and control groups. The intervention group participated in weekly sessions of the NCK Program for six weeks (including two in-person practical cooking and three online cooking workshops). The cooking recipes were adapted by replacing high glycemic index ingredients with low and medium glycemic index alternatives. Of note, the recipes did not contain added sugars or sweeteners, were based on the use of fresh or minimally processed foods, herbs, and spices, and were sensorially tested by individuals with T2DM before use in the intervention. The study outcomes were participant score changes on the seven scales. A validated online instrument was administered to the control and intervention groups at baseline (T1) and post-intervention (T2). Parametric and non-parametric tests were used to assess the differences between the T1 and T2 parameters.

RESULTS

Of the 60 individuals enrolled, 44 answered the questionnaire at both times. The findings revealed a 45.37% ± 93.57% increase in Knowledge of Cooking Terms in the intervention group, whereas the control group showed a 3.82% ± 16.17% reduction (p = 0.008). There was an increase in all the other cooking skills and healthy eating scales from T1 to T2 in the intervention group, but the differences were not significant.

CONCLUSIONS

The development of cooking skills can contribute to increasing culinary knowledge and the availability of time to cook at home. The results contribute to the planning of health actions aimed at individuals with DM2 through culinary interventions and public food and nutrition policies.

Factors Related to Treatment Non-Adherence Among Caregivers of Pediatric and Adolescent Growth Hormone Deficiency Patients in Japan

Background

About one-third of caregivers of pediatric or adolescent growth hormone deficiency (pGHD) patients in Japan have reported poor treatment adherence. However, few studies have examined factors related to adherence for that group.

Objective

The aim of this study is to consider factors related to poor adherence to daily treatment among caregivers of pGHD patients in Japan.

Methods

A cross-sectional survey was conducted among caregivers of pGHD patients in Japan. Caregivers were asked about demographic and treatment characteristics, health literacy, treatment satisfaction, opinions about treatment, and treatment adherence. Health literacy was assessed using the 14-item health literacy scale (HLS-14). Adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8). Statistical association with adherence was considered using Chi-square and Student's t-testing. An exploratory factor analysis (EFA) and K-means cluster analysis was conducted to consider the influence of treatment satisfaction and opinions concerning treatment on adherence.

Results

Responses were collected from 112 caregivers. The caregiver's age being 30-39 years old, the primary caregiver being male, the primary caregiver being employed, and low functional health literacy for the caregiver were associated with poor adherence. Patients being pre-elementary school age was also associated with poor adherence. Low satisfaction with drug treatment and/or their device and communication with healthcare professionals (HCPs), and lack of agreement with the importance of treatment management (eg, keeping injection records, getting informed about the disease/therapy, reporting non-adherence, and sticking to an administration schedule), were also associated with poor adherence.

Conclusion

Strategies to improve treatment adherence among caregivers of pGHD patients in Japan should consider the age, gender, and employment status of the caregiver - as well as their functional literacy. Improvement in satisfaction with the drug or device used, better communication with HCPs, and greater awareness of the importance of treatment management, may also lead to better adherence.

Dietary Practices and Associated Factors Among Adult Diabetic Patients at Academic Tertiary-Level Hospitals in Central Ethiopia: Convergent Mixed Study

Background

Diabetes mellitus (DM) is one of the most common chronic diseases globally. Despite the presence of national strategies to prevent potential sequelae DM has been associated with increased morbidities and mortality in Ethiopia, and the prevalence appears to be on the rise. Although studies have been conducted among DM patients in the country, there is a lack of information that could allow an in-depth understanding of the situation.

Objective

To assess dietary practices and associated factors among adult DM patients at academic tertiary-level hospitals in central Ethiopia.

Methods

The institution-based concurrent mixed-methods study was conducted from January 01 to 30 2024 involving 420 adult DM patients. Participants were selected using a simple random sampling technique for quantitative study. A purposive sampling technique was used to select 16 participants for qualitative analysis. For the quantitative study, a self-administered structured questionnaire was used to collect data, and an in-depth interview for the qualitative part. Multivariate binary logistic regressions were used to assess the explanatory variables associated with dietary practice. A thematic analysis was performed for qualitative data.

Result

Of 420 eligible participants, 406 (96.7%) participated in the study. The overall proportion of good dietary practices among participants was 172 (44.2%). The being female, urban residence a family history of DM, and good dietary were significantly associated with the dietary practice. From qualitative analysis, two themes have emerged; Living as before and not adhering to diabetic dietary recommendations and barriers to adherence to effective eating practice.

Conclusions and recommendations

Less than half of adult DM patients had good dietary practices. Sex, geographic location, family history of DM, and level of knowledge of diabetic diet were associated with dietary practice. Intervention programs on awareness creation and training to improve the dietary practice by stakeholders were recommended.

Dietary practice and associated factors among type 2 diabetic patients attending chronic follow-up in public hospitals, central Ethiopia, 2022

BACKGROUND

Diabetes Mellitus (DM) is affecting numerous Ethiopian populations regardless of environmental and social status. Diabetic people all over the world are commonly urged to acquire a healthy eating habit, which necessitates lifelong changes in food habits, beliefs, and meal patterns. Dietary management is considered one of the cornerstones of diabetes care, as it is an important component of the overall treatment plan. Choosing and following a healthy diet is important for everyone, especially people with diabetes.

OBJECTIVE

This study aims to assess dietary practices and associated factors among type 2 diabetes patients in the west Shewa Zone, Oromia Regional State, Ethiopia, in 2022.

METHODS

A hospital-based cross-sectional study design was conducted in West Shewa Zone public hospitals among 421 randomly selected type 2 diabetic patients from February 1 to March 30, 2022. Data were collected using a structured and pre-tested interviewer-administered questionnaire. Descriptive, bivariate, and multivariate binary logistic regression analyses were done using SPSS.

RESULTS

In this study, about 35.6% (95% CI: 30.9-39.9) of type 2 diabetes patients had good dietary practices. Diabetes knowledge (AOR 9 2; 95% CI 4.4-19.4), food-secured households (AOR 3.3; 95% CI 1.6-6.9), high self-efficacy (AOR 6.6; 95% CI 3.2-13.9), diabetes diet information from healthcare professionals (AOR 2.9; 95% CI 1.3-6.4), complete dietary change (AOR = 2.3; 95% CI 1.1-4.8), and female gender (AOR 3.6; 95% CI 1.6-8.1) were independent predictors of good dietary practice.

CONCLUSION

The proportion of patients with type 2 diabetes, who attended follow-up at West Shawa Public Hospitals and practiced good dietary habits, was low. Patients' household food insecurity, diabetes knowledge, self-efficacy, source of information on the diabetic diet, complete dietary change after diabetes diagnosis, and gender were all significantly associated with type 2 diabetic patients' dietary practices. Thus, promoting the provision of continuous, modified, and comprehensive education and advice on the importance of diabetes self-management, particularly adherence to dietary recommendations, is fundamental to decreasing the burden of diabetes complications and massive health expenses among diabetic patients.

The evaluation of the role of diabetes health literacy and health locus of control on quality of life among type 2 diabetes using the Path analysis

Quality of life (QOL) in patients with diabetes is affected by multiple factors, and this study aimed to determine the effect of health locus of control points (HLOC) and diabetes health literacy (DHL) on QOL in Iranian patients with type 2 diabetes. This cross-sectional study was conducted between October 2021 and February 2022 among 564 people with type 2 diabetes. Patients were selected using proportional stratified sampling and simple random sampling methods. Data were collected using three questionnaires: (1) Multidimensional Health Locus of Control scale (form C), (2) World Health Organization Quality of Life Scale, and (3) Diabetes Health Literacy Scale. Data were analyzed by software's of SPSS _V22 and AMOS _V24. There was a positive and significant correlation between DHL and QOL. There was a positive and significant correlation between the subscales of internal HLOC, and doctors HLOC with QOL. According to the Path analysis results, all variables showed 58.93% of the direct effects and 41.07% of indirect effects of the final model. Numerate health literacy, informational health literacy, communicative health literacy, internal HLOC, other powerful people HLOC, chance HLOC, and doctors HLOC were able to predicted 49% variance of diabetes QOL (R2 = 0.49). The subscales of communicative health literacy, informational health literacy, internal HLOC, doctors HLOC, and chance HLOC had the greatest impact on QOL of people with diabetes. Based on the results of Path analysis, diabetes health literacy and HLOC play an effective role in QOL of diabetic. Therefore, there is a need to design and implement programs to improve the health literacy of patients as well as HLOC to improve QOL of patients.

Factors Associated with Adherence to Treatment in Patients with HIV and Diabetes Mellitus

We aim to identify the factors that influence the therapeutic adherence of subjects with chronic disease. The design followed in this work was empirical, not experimental, and cross-sectional with a correlational objective. The sample consisted of a total of 400 subjects (199 patients with HIV and 201 patients with diabetes mellitus). The instruments applied for data collection were a sociodemographic data questionnaire, the 4-item Morisky Medication Adherence Scale (MMAS-4) and the Coping Strategies Questionnaire. In the group of subjects with HIV, that the use of emotional coping strategies was related to lower adherence to treatment. On the other hand, in the group of subjects with diabetes mellitus, the variable related to compliance with treatment was the duration of illness. Therefore, the predictive factors of adherence to treatment were different in each chronic pathology. In the group of subjects with diabetes mellitus, this variable was related to the duration of the disease. In the group of subjects with HIV, the type of coping strategy used predicted adherence to treatment. As a result of these results, it is possible to develop health programmes to promote, from nursing consultations to adherence to treatment of patients with HIV and diabetes mellitus.

Prognostic factors of adherence to home-based exercise therapy in patients with chronic diseases: A systematic review and meta-analysis

Background

Patients with a chronic disease may have an increased risk of non-adherence to prescribed home-based exercise therapy. We performed a systematic review with the aim to identify variables associated with adherence to home-based exercise therapy in patients with chronic diseases and to grade the quality of evidence for the association between these prognostic factors and adherence.

Methods

Cohort studies, cross-sectional studies and the experimental arm of randomized trials were identified using a search strategy applied to PubMed, Embase, PsychINFO and CINAHL from inception until August 1, 2022. We included studies with participants ≥18 years with a chronic disease as an indication for home-based exercise therapy and providing data on prognostic factors of adherence to home-based exercise. To structure the data, we categorized the identified prognostic factors into the five WHO-domains; (1) Patient-related, (2) Social/economic, (3) Therapy-related, (4) Condition-related, and (5) Health system factors. Risk of bias was assessed using the Quality in Prognostic Studies (QUIPS) tool. Prognostic factors of adherence were identified and the quality of the evidence between the prognostic factors and adherence were graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework for predictor studies. We performed a meta-analysis of the obtained information.

Results

A total of 57 studies were included. Within patient-related factors moderate- and high-quality evidence suggested that more self-efficacy, exercise history, motivation and perceived behavioral control predicted higher adherence. Within social-economic factors moderate-quality evidence suggested more education and physical health to be predictive of higher adherence and within condition-related factors moderate- and low-quality evidence suggested that less comorbidities, depression and fatigue predicted higher adherence. For the domains therapy-related and health-system factors there was not enough information to determine the quality evidence of the prognostic factors.

Conclusion

These findings might aid the development of future home-based exercise programs as well as the identification of individuals who may require extra support to benefit from prescribed home-based exercise therapy.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=277003, identifier PROSPERO CRD42021277003.

Adherence to Dietary Recommendation and Its Associated Factors among People with Type 2 Diabetes: A Cross-Sectional Study in Nepal

Introduction

Intensive lifestyle modification including a healthy diet changes the diagnostic status of patient from prediabetes to nondiabetes. In type 2 diabetes, improper eating habits increase insulin resistance. This study is aimed at assessing adherence to the dietary recommendation and its associated factors among people with type 2 diabetes.

Methods

A cross-sectional descriptive study was conducted among systematically sampled type 2 diabetic patients using interview on Gandaki Medical College Teaching Hospital and Diabetes, Thyroid, and Endocrinology Care Center, Pokhara. The Perceived Dietary Adherence Questionnaire was used to assess dietary adherence. Data was entered in EpiData version 3.1 and analyzed on SPSS version 20. Logistic regression with adjusted odds ratio and the corresponding 95% confidence intervals were used to find out significance of association.

Results

Among 204 participants, only 15.7% of the participants had good dietary adherence. The mean age and standard deviation were 53.03 ± 11.90 years. Factors such as participants living in single family (AOR 2.7, 95% CI 1.0-7.4), participants who could afford recommended diet (AOR 2.9, 95% CI 1.0-8.3), participants having self-control on food (AOR 4.1, 95% CI 1.2-14.1), participants who were engaged in moderate to heavy physical activities (AOR 3.3, 95% CI 1.2-9.2), and participants who had adherence to medication (AOR 3.5, 95% CI 1.2-10.1) were significantly associated with adherence to dietary recommendation.

Conclusions

Adherence to dietary recommendation among people with type 2 diabetes was low. Factors such as family type, affordability of recommended diet, self-control on food, physical activity, and medication adherence were significantly associated with adherence to dietary recommendations among people with type 2 diabetes. These factors should be considered by nutrition counselors and clinical decision-makers in patient counseling regarding dietary adherence.

Levels and Correlates of Numeracy Skills in Lebanese Adults with Diabetes: A Cross-Sectional Study

Diabetes numeracy skills are required in the interpretation of food labels, insulin pump dosage, the interpretation of blood glucose meter data, and the determination of carbohydrate intake. This study assessed the levels and correlates of numeracy skills in Lebanese adults with diabetes to identify those most at risk of uncontrolled diabetes. In total, 299 adults with diabetes, mean age 47.4 ± 19.8 years, took the questionnaire. It consisted of self-developed items on sociodemographic and health-related factors, in addition to the Diabetes Numeracy Test-15 (DNT-15) and the Single Item Literacy Screener. Many participants (62%) scored < 10 on the DNT-15 indicating insufficient numeracy skills. DNT-15 scores were positively associated with literacy, exercise, healthy diet, perceived diabetes control, frequency of glycaemia measurement, ability to afford treatment, and ease of understanding information related to diabetes. Age, BMI, and complications were negatively correlated with DNT-15 score. Numeracy skills were higher in males, single individuals, and in people with type 1 diabetes, fewer complications, controlled HbA1c, higher income, higher education, a prior visit to a dietician, and ability to maintain personal care despite COVID-19. Interventions to strengthen numeracy skills would empower individuals with diabetes, lead to appropriate self-management behaviors, and prevent health complications in at-risk individuals.

Food security status of patients with type 2 diabetes and their adherence to dietary counselling from selected hospitals in Addis Ababa, Ethiopia: A cross-sectional study

Background

Even though adherence to dietary counselling for patients with diabetes is essential for improving health and preventing complications, access to an adequate and quality diet is challenging for patients living in a food-insecure household. The availability of data in this regard is limited in Ethiopia. Thus, this study assessed the food security status of patients with type 2 diabetes, their adherence to dietary counselling, and contributing factors at public hospitals in Addis Ababa, Ethiopia.

Methods

This was a facility-based cross-sectional study among 602 patients with Type 2 diabetes in Addis Ababa, Ethiopia, from July to August 2019. Patients were selected randomly after the total number of samples was proportionally allocated to four public hospitals. Relevant information was collected by trained data collectors using a pre-tested questionnaire. Data were entered into Epi-info version 7 and exported to SPSS version 24 for data analysis. Logistic regression analysis was employed to identify factors associated with adherence to dietary counselling.

Result

The proportion of nonadherence to dietary counselling among patients with type 2 diabetes was 67.3% (95%CI: 63.5%-71.1%). Nearly half (50.7%) of the respondents were food insecure. Of these, mildly food insecure, moderately food insecure, and severely food insecure were 8.5%, 29.2%, and 13%, respectively. Physical activity (AOR = 1.7; 95%CI: 1.1–2.9); diabetes knowledge (AOR = 1.8; 95%CI: 1.2–2.6); lack of access to information (AOR = 1.6; 95%CI: 1.1–2.6); moderately food insecure (AOR = 2.2; 95%CI: 1.3–3.7); and severely food insecure (AOR = 5.6; 95%CI: 2.1–15.0) were the major significant factors associated with nonadherence to dietary counselling.

Conclusion

Over two-thirds of patients with diabetes did not adhere to dietary counselling, which appears high. As a result, improving diabetes education, information access, and food security status should be considered to ensure dietary counselling adherence among type 2 diabetes patients.

Dietary Practice among Type 2 Diabetic Ppatients in Southern Ethiopia

BACKGROUND

Diabetic patients' dietary practice is critical to improve glycemic, lipid, and blood pressure control. However, a significant number of patients had poor dietary practice. In Ethiopia, more than half of diabetic patients were not practicing a healthy dietary approach. Therefore, this study assessed variables that were hardly addressed in previous studies. The aim of this study was to assess dietary practice and associated factors among patients with type 2 diabetes.

METHODS

A facility-based cross-sectional study was performed among patients with type 2 diabetes in Arba Minch General Hospital from April 21 to May 20, 2020. A systematic sampling technique was used to select 352 patients. The data were entered into EpiData version 3.1 and exported to SPSS version 21 for cleaning and analysis. Descriptive statistics were performed. All variables in bivariate analysis with p-value <0.25 were entered into a multivariable logistic regression model, and statistical significance was declared at a p-value of less than 0.05.

RESULTS

The prevalence of poor dietary practice was found to be 40.6% (95%CI (35.7-46.0)). After adjusting for other variables in multivariable analysis, not attending formal education (AOR = 3.0; 95%CI (1.6-5.5)), being at primary education level (AOR = 2.2; 95%CI (1.1-4.4)), being moderately food insecure (AOR = 5.3; 95%CI (2.8-9.9)), having depression (AOR = 5.9; 95%CI (3.0-11.4)), and not having nutrition education (AOR = 2.2; 95% (1.1-4.6)) were factors associated with poor dietary practice.

CONCLUSIONS

A significant proportion of patients had poor dietary practice. The poor dietary practice was significantly higher among those with no formal education, at the primary education level, from the moderately food-insecure household, having depression, and not having nutrition education. The results imply the need for strengthening health information dissemination concerning healthy dietary practice in the form of a package.

Striving for autonomy in everyday diabetes self-management-qualitative exploration via grounded theory approach

OBJECTIVES

The rapid worldwide increase in the incidence of diabetes significantly influences the lives of individuals, families and communities. Diabetes self-management requires personal autonomy and the presence of a supportive social environment. These attributes can considerably ameliorate the outcomes of the chronic condition. However, little is known about individual variations in overcoming the illness-related challenges and in the achievement of autonomy in daily activities. This paper seeks to bridge this knowledge gap.

DESIGN

This qualitative study used the grounded theory approach. Semi-structured interviews were conducted, and the data collection and data analysis probed participant experiences of autonomy through the self-management of their daily socio-physical environments.

SETTING

Participants were recruited from the outpatient ward of a university clinic in Hungary.

PARTICIPANTS

The study was conducted with 26 adult patients with type 2 diabetes mellitus (15 females and 11 males aged between 26 and 80 years; M=62.6 years; SD=13.1). The inclusion criteria were: T2D diagnosis at least 1 year before the beginning of the study; prescribed insulin injection therapy; aged over 18 years; native Hungarian speaker and not diagnosed with dementia or any form of cognitive impairment.

RESULTS

The study established three principal aspects of the active construction of personal autonomy in diabetes self-management: coping strategies vis-à-vis threats posed by the symptoms and the treatment of the disease; autonomous ways of creating protective space and time and relationship processes that support everyday experiences of self-directedness.

CONCLUSIONS

The results of this study confirm the validity of the self-determination theory in diabetes self-management. They also imply that pathways towards constructing everyday experiences of self-directedness in participants lead through self-acceptance, supporting family relationships and a doctor-patient relationship characterised by partnership. The tentative empirical model of pathways towards patients' experience of self-directedness can serve as a framework for future research, patient-centred clinical practice, and education.

Use of health locus of control on self-management and HbA1c in patients with type 2 diabetes

Aim

To assess the effects of health locus of control‐based education programme (HLCEP) on self‐management, health locus of control and glycated haemoglobin (HbA1c) among type 2 diabetes mellitus (T2DM).

Design

Quasi‐experimental study.

Methods

The study recruited 120 T2DM participants from May–September 2020. The control group received one‐week in‐hospital care and 12‐week follow‐up. The intervention group received additional HLCEP. The self‐management and the health locus of control were measured by using the Summary of Diabetes Self‐care Activities and the Multidimensional Health Locus of Control at baseline and the 4th and 12th week after discharge. The HbA1c was collected at baseline and the 12th week after discharge. The generalized estimating equation analysis was performed to assess the intervention effects.

Results

The intervention group has statistically significantly higher scores on the overall level of self‐management, dietary management, foot care, medication management and internal health locus of control, while a lower HbA1c level than the control group.

Investigation of Barriers and Facilitators to Medication Adherence in Patients With Type 2 Diabetes Across Different Health Literacy Levels: An Explanatory Sequential Mixed Methods Study

Type 2 diabetes (T2D) incurs tremendous healthcare costs associated with various complications due to poor blood sugar control. Medication adherence, which is correlated with patients’ health literacy, should be consistently practiced to achieve optimal control of blood sugar. A comprehensive understanding of specific communication and psychosocial factors related to medication-taking behaviors across different levels of health literacy among people with T2D will guide the development of effective interventions and strategies to enhance medication adherence. To understand barriers and facilitators to medication adherence in people with T2D across different health literacy levels, the Health Literacy Pathway Model was used to identify the psychosocial and communication factors that may influence medication adherence. This mixed methods study used an explanatory sequential design, including a quantitative survey followed by qualitative semi-structured interviews. Two hundred and five participants completed the survey questionnaire, and 23 participants completed semi-structured interviews. Confirmed by quantitative and qualitative data, having stronger self-efficacy and fewer concerns about medications, as well as experiencing fewer perceived barriers to medication-taking, are necessary for better medication adherence among those with low adherence. Our findings will be useful to tailor interventions for diabetes care through addressing concerns among low-adherent patients with low health literacy and emphasizing self-efficacy and perceived barriers to medication adherence among all low-adherent patients with T2D.

Dysglycemia and Abnormal Adiposity Drivers of Cardiometabolic-Based Chronic Disease in the Czech Population: Biological, Behavioral, and Cultural/Social Determinants of Health

In contrast to the decreasing burden related to cardiovascular disease (CVD), the burden related to dysglycemia and adiposity complications is increasing in Czechia, and local drivers must be identified. A comprehensive literature review was performed to evaluate biological, behavioral, and environmental drivers of dysglycemia and abnormal adiposity in Czechia. Additionally, the structure of the Czech healthcare system was described. The prevalence of obesity in men and diabetes in both sexes has been increasing over the past 30 years. Possible reasons include the Eastern European eating pattern, high prevalence of physical inactivity and health illiteracy, education, and income-related health inequalities. Despite the advanced healthcare system based on the compulsory insurance model with free-for-service healthcare and a wide range of health-promoting initiatives, more effective strategies to tackle the adiposity/dysglycemia are needed. In conclusion, the disease burden related to dysglycemia and adiposity in Czechia remains high but is not translated into greater CVD. This discordant relationship likely depends more on other factors, such as improvements in dyslipidemia and hypertension control. A reconceptualization of abnormal adiposity and dysglycemia into a more actionable cardiometabolic-based chronic disease model is needed to improve the approach to these conditions. This review can serve as a platform to investigate causal mechanisms and secure effective management of cardiometabolic-based chronic disease.

Building a House of Skills-A Study of Functional Health Literacy and Numeracy among Patients with Type 2 Diabetes in Hungary

The purpose of this study is to explore functional health literacy (FHL) and numeracy skills in an insulin-treated, type 2 diabetes mellitus (T2DM) patient population, and their impact on diabetes self-care activities. A non-experimental, cross-sectional quantitative design was used for this study. The sample consisted of 102 T2DM patients on insulin therapy, including 42 males and 60 females, with a mean age of 64.75 years (SD = 9.180) and an average diabetes duration of 10.76 years (SD = 6.702). Independent variables were sociodemographic variables (e.g., age, educational level, etc.) and diabetes and health-related factors (e.g., duration of diabetes (years), the frequency of blood glucose testing/day, etc.). For this study, the participants completed the reading comprehension exercise from the Short Test of Functional Health Literacy (S-TOFHLA) and the Shortened Version of the Diabetes Numeracy Test (DNT-15), which specifically evaluates the numeracy skills of patients living with diabetes. The associations between the variables were examined with Spearman’s rank correlation. Multivariate regression analysis was performed to examine whether measured FHL skills impact diabetes self-care activities. We found that DNT-15 test (β = 0.174, t(96) = 2.412, p < 0.018) had significant effect on the frequency of blood glucose testing/day. Moreover, the problem areas for patients with T2DM mostly included multi-step calculations according to food label interpretations, and adequate insulin dosage based on current blood glucose levels and carbohydrate intake. The results of regression analyses and Spearman’s rank correlation indicated that limited FHL and diabetes numeracy skills not only influenced the participants’ behaviors related to self-management, but they also affected their health outcomes. Thus, besides the personalization of insulin treatment, it is indispensable to provide more precise information on different types of insulin administration and more refined educational materials based on medical nutrition therapy.

[Adherence to healthy lifestyle behaviours in patients with type 2 diabetes in Spain]

OBJECTIVES

The aim of this study was to report on the main lifestyle components and related factors in adults with diabetes type 2 treated in Primary Care clinics in Spain.

MATERIAL AND METHODS

A cross-sectional and multicentre study was performed on a consecutive sample of patients with type 2 diabetes attending 25 Primary Care clinics between April 2018 and April 2019. Data were collected by auditing the computerised medical records, and an interview. An analysis was carried out on adherence to 4 healthy lifestyle trends (Mediterranean diet, regular exercise, not smoking, and emotional well-being).

RESULTS

A total of 412 patients were included in the analysis (mean age 69 (SD 8.65) years; 50.2% men). Only a minority was highly adherent to the Mediterranean diet, 92 (22.3%). Regular physical activity was carried out by 189 (45.8%). A total of 361 (87.6%) were non-smoking, and 259 (62.8%) felt emotional well-being. A small number (9, 2.1%) of patients had not followed any of the healthy lifestyle recommendations, with 87 (21.1%) following one, 145 (35.1%) two, 128 (31%) three, and 43 (10.4%) all 4 healthy habits: diet, exercise, not smoking, and emotional well-being. Healthy lifestyle adherence was related to gender. Obesity is poorly associated with adherence to diet and physical activity. The results for age, time with the disease, socioeconomic status, and treatment regimen were not consistent.

CONCLUSIONS

This study suggest that adherence to a healthy lifestyle pattern in DM2 is low. Less than a quarter follow a healthy diet, and less than a half practice regular exercise. Gender is the variable that most influences a healthy lifestyle in DM2, but not age, time with the disease, or treatment regimen.

Socio-Demographic Characteristics and Body Weight Perceptions of Study Participants Benefitting Most from the Feel4Diabetes Program Based on Their Anthropometric and Glycaemic Profile Changes

The Feel4Diabetes program was comprised of a community-based screening and a two-year intervention phase aiming to prevent type 2 diabetes (T2D) in families at risk for diabetes across Europe. The current work aimed to identify the socio-demographic characteristics and body weight perceptions of participants who benefitted the most, achieving at least a 5% reduction in body weight, waist circumference and glycaemic indices (fasting plasma glucose, insulin, glycosylated haemoglobin levels), over two-year period. Following a two-stage screening procedure, 2294 high-risk parents were randomly allocated to standard care or more intensive intervention. The participants who benefitted most were living in Southern (OR 2.39–3.67, p < 0.001) and Eastern Europe (OR 1.55–2.47, p < 0.05), received more intensive intervention (OR 1.53–1.90, p = 0.002) and were younger (<40 years old) adults (OR 1.48–1.51, p < 0.05). Furthermore, individuals with tertiary education (OR 2.06, p < 0.001), who were unemployed (OR 1.62–1.68, p < 0.05) and perceived their body weight to be higher than normal (OR 1.58–3.00, p < 0.05) were more likely to benefit from the program. Lastly, males were more likely to show improvements in their glycaemic profiles compared to females (OR 1.40, p = 0.024). These findings point out the regions in Europe and the sociodemographic profile of individuals that benefitted the most in the current study, highlighting the need to prioritise regions in greater need for such interventions and also tailor future interventions to the characteristics and perceptions of the target populations.

Making sense of blood glucose data and self-management in individuals with type 2 diabetes mellitus: A qualitative study

AIMS AND OBJECTIVES

To describe individuals' with type 2 diabetes mellitus sense-making of blood glucose data and other influences impacting self-management behaviour.

BACKGROUND

Type 2 diabetes mellitus prevalence is increasing globally. Adherence to effective diabetes self-management regimens is an ongoing healthcare challenge. Examining individuals' sense-making processes can advance staff knowledge of and improve diabetes self-management behaviour.

DESIGN

A qualitative exploratory design examining how individuals make sense of blood glucose data and symptoms, and the influence on self-management decisions.

METHODS

Sixteen one-on-one interviews with adults diagnosed with type 2 diabetes mellitus using a semi-structured interview guide were conducted from March-May 2018. An inductive-deductive thematic analysis of data using the Sensemaking Framework for Chronic Disease Self-Management was used. The consolidated criteria for reporting qualitative research (COREQ) checklist were used in completing this paper.

RESULTS

Three main themes described participants' type 2 diabetes mellitus sense-making and influences on self-management decisions: classifying blood glucose data, building mental models and making self-management decisions. Participants classified glucose levels based on prior personal experiences. Participants learned about diabetes from classes, personal experience, health information technology and their social network. Seven participants expressed a need for periodic refreshing of diabetes knowledge.

CONCLUSION

Individuals use self-monitored glucose values and/or HbA1C values to evaluate glucose control. When using glucose values, they analyse the context in which the value was obtained through the lens of personal parameters and expectations. Understanding how individuals make sense of glycaemic data and influences on diabetes self-management behaviour with periodic reassessment of this understanding can guide the healthcare team in optimising collaborative individualised care plans.

RELEVANCE TO CLINICAL PRACTICE

Nurses must assess sense-making processes in self-management decisions. Periodic "refresher" diabetes education may be needed for individuals with type 2 diabetes mellitus.

Patient factors associated with diabetes medication adherence at different health literacy levels: a cross-sectional study at a family medicine clinic

BACKGROUND

Type 2 diabetes (T2D) incurs tremendous health costs associated with various complications due to poor diabetes control. Medication adherence, which is correlated with patients' health literacy, should be consistently practiced achieving optimal diabetes control. A deeper understanding of the specific communication and psychosocial factors related to medication-taking behaviors across different levels of health literacy among people with T2D will guide the development of effective interventions and strategies to enhance medication adherence.

OBJECTIVES

This cross-sectional study aimed to identify salient patient factors associated with diabetes medication adherence across different levels of health literacy.

METHODS

A questionnaire was administered via a face-to-face approach with 205 participants at a family medicine clinic. Study participants were all above 20 years of age with T2D, were prescribed at least one oral diabetes medication, and understood English. The questionnaire assessed participants' health literacy, self-efficacy for medication use, beliefs in medicines, patient-provider communication, perceived barriers to medication adherence, and self-reported medication adherence. Separate analysis of covariance was used to compare the mean scores of patient factors related to medication adherence across people with different health literacy levels.

RESULTS

The mean age of participants was 61 years old, and the majority of the participants were female (57%), White (75%), and college educated (62%). Thirty-three percent of the participants had adequate health literacy, but only 43% of them reported high adherence to their diabetes medications. Analysis of covariance showed that having stronger self-efficacy (P < 0.001), lower concern beliefs about medication (P = 0.047), and fewer perceived barriers to medication-taking (P < 0.001), are necessary for better medication adherence.

CONCLUSION

Findings suggest that practitioners should address concern beliefs among low-adherent patients with low health literacy, help improve self-efficacy, and address perceived barriers to medication adherence among all low-adherent patients to optimally support patients' diabetes care.

A partnership-oriented and culturally-sensitive communication style of doctors can impact the health outcomes of patients with chronic illnesses in Indonesia

OBJECTIVES

A partnership-oriented communication style is globally recommended for medical practice. A culturally-sensitive doctor-patient communication guideline is also needed for Southeast Asia. The 'Greet-Invite-Discuss' guideline was established and tested with primary care doctors and their patients in Indonesia.

METHODS

In this mixed-methods study, doctors were trained according to the 'Greet-Invite-Discuss' guideline, while patients received standard treatment. Two groups of fifteen doctors were assigned to have consultations with 45 patients with hypertension or 51 patients with type-2 diabetes mellitus. Doctors' self-assessment and patients' perceptions and their clinical outcomes were longitudinally measured. Six focus group discussions were conducted to explore doctors' and patients' experiences.

RESULTS

Doctors' self-assessments and patients' perceptions of doctors' communication skills increased significantly (p < 0.05). Moreover, patients' blood pressure or fasting blood glucose levels decreased significantly (p < 0.05), except the two-hour blood glucose levels (NS). Qualitatively, doctors demonstrated more partnership and culturally-sensitive communication, and patients expressed more satisfaction, increased comprehension and self-management, of their chronic illnesses.

CONCLUSIONS

The 'Greet-Invite-Discuss' guideline was useful for primary care doctors for a more partnership-oriented and culturally-sensitive communication with patients in chronic care management.

PRACTICE IMPLICATIONS

Using a partnership-oriented and culturally-sensitive communication guideline, doctors can improve their communication skills with their patients towards optimum health outcomes.

Self-Care Adherence And Barriers To Good Glycaemic Control In Nepalese Type 2 Diabetes Mellitus Patients: A Hospital-Based Cross-Sectional Study

PURPOSE

The patient believes in adherence to medication rather than to self-care adherence and lifestyle changes for the management of diabetes. This study was carried out to establish the association of self-care adherence and their barriers in poor glycemic control in our diabetic population.

PATIENTS AND METHODS

This cross-sectional study was conducted among 480 already diagnosed diabetes outpatients attended in our two hospitals. Glycaemic control was defined by levels of HbA1c. Socio-demographic data, lifestyle variables and anthropometric measurements were recorded using a standard questionnaire. Fasting blood glucose, HbA1c and lipid profiles were estimated using the manufacturer's guideline. Student's t-test and one-way ANOVA were used for comparison between different groups and the correlation was established by Spearman correlation. Risk factors associated with poor glycaemic control were verified by logistic regression analysis.

RESULTS

The mean HbA1c of the study population was 7.4±1.3% and 65.4% had poor glycaemic control with mean 8.0±1.1%. Higher HbA1c levels were significantly associated with duration of diabetes, a number of drugs used, patient-physician relationship and knowledge about diabetes. The poor glycaemic control was significantly associated with low adherence of following the meal plan, regular medication and regular exercising (p<0.001). Among all the barriers, a too busy schedule for following the meal plan, taking medications and exercising regularly was significantly correlated with HbA1c levels. Multivariable logistic regression analysis showed irregular meal plan (OR=5.27), irregular exercise (OR=2.25), number of medication used (OR= 0.19) and lesser extent patient-physician relationship (OR=2.68) were independent risk factors for poor glycaemic control.

CONCLUSION

The poor glycaemic control was associated with poor adherence to self-care adherence and their barriers in our diabetic population. Integrated knowledge on diabetes management should be targeted to improve glycaemic control in our communities.