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Freeman-Hildreth Y, Aron D, Cola PA, Jr RB, Wang Y. Empowering diabetes management: The impact of patient-provider collaboration on type 2 diabetes outcomes through autonomy support and shared decision-making. PATIENT EDUCATION AND COUNSELING 2024; 127:108348. [PMID: 38870706 DOI: 10.1016/j.pec.2024.108348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 05/18/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Through the lens of self-determination theory, this quantitative study investigates how patient-provider collaboration through perceived shared decision-making (SDM) and autonomy support impact type 2 diabetes (T2D) outcomes. METHODS We sampled 474 individuals over 18 years old who self-identified as having T2D. Completed and valid responses were received from 378 participants from two separate groups in an online survey. Data was analyzed using the IBM Statistical Package for Social Sciences (SPSS), AMOS package, version 28, and Mplus, version 8.8. RESULTS Patient-provider collaboration through autonomy support improved treatment satisfaction (β = .16, ρ < .05) and self-management adherence (β = .43, ρ < .001). While collaboration through SDM improved treatment satisfaction (β = .25, ρ < .01), it worsened SM adherence (β = -.31, ρ < .001). The negative impact of SDM on self-management adherence was mitigated by our moderator, coping ability. However, coping ability minimally impacted treatment satisfaction and SM adherence when autonomous support was provided. CONCLUSIONS Autonomy support increases treatment satisfaction and self-management adherence. SDM enhances treatment satisfaction but may adversely affect self-management adherence. The study also suggests that coping ability can mitigate the negative effect of SDM on self-management adherence, although its influence is limited when autonomy support is provided by the provider. PRACTICAL IMPLICATIONS For providers, SDM and autonomy support permits shared power over treatment decisions while fostering independence over self-management tasks. Providers should evaluate patients' coping ability and adapt their approach to care based on the patient's coping capacity.
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Affiliation(s)
| | - David Aron
- Department of Medicine, Case Western Reserve University, Louis Stokes VA Medical Center, Cleveland, OH, USA
| | - Philip A Cola
- Weatherhead Department of Management, Design and Innovation, Case Western Reserve University, Cleveland, OH, USA
| | - Richard Boland Jr
- Weatherhead Department of Management, Design and Innovation, Case Western Reserve University, Cleveland, OH, USA
| | - Yunmei Wang
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
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AlRasheed AY, Hashim H, Alrofaie H. Adherence to Self-Monitoring of Blood Glucose and Its Related Factors Among Type 2 Diabetic Patients Attending Al-Ahsa Primary Health Care Centers in Saudi Arabia. Cureus 2024; 16:e65545. [PMID: 39188431 PMCID: PMC11346824 DOI: 10.7759/cureus.65545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Self-monitoring of blood glucose (SMBG) is a crucial component of diabetes management, but adherence remains suboptimal. This study aimed to evaluate adherence to SMBG among type 2 diabetic patients in Al-Ahsa, Saudi Arabia. METHODS A cross-sectional study was conducted among 398 type 2 diabetic patients attending primary healthcare centers. Data were collected through face-to-face or virtual interviews and electronic health records. Adherence levels were categorized as low, moderate, and high. RESULTS The majority of participants exhibited moderate adherence to SMBG (58.5%), while 27.1% had low adherence, and 14.3% were highly adherent. The use of oral hypoglycemic medications and insulin injections was associated with higher adherence (p<0.001). Comorbidities, physical exercise, diet, frequency of medical visits, and attendance at diabetes education sessions did not significantly influence adherence. CONCLUSIONS Suboptimal adherence to SMBG was observed among type 2 diabetic patients in Al-Ahsa. Targeted interventions addressing individual barriers and integrating technology may improve SMBG adherence and diabetes management.
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Affiliation(s)
| | - Hajer Hashim
- Obstetrics and Gynecology, King Faisal University, Al-Hofuf, SAU
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Zhu L, Pan Z, Shen F, Shen Y, Zhang W. Effects of family support system on the self-management behaviour of patients with T2DM: a multi-centre cross-sectional study in community settings. Fam Pract 2024; 41:114-122. [PMID: 38412362 DOI: 10.1093/fampra/cmae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The burden of type 2 diabetes mellitus (T2DM) in China continues to escalate. OBJECTIVE To investigate the impact of family support system on the self-management behaviour of patients with T2DM. METHODS In this cross-sectional study, 1,042 participants were sampled using a multistage stratified probability-proportionate-to-size method. On-site interviews were conducted using a structured questionnaire administered by 122 family doctors from 13 community health service centres in 8 administrative districts. A structural equation model was established to investigate the impact of individual factors and family support system on the self-management behaviour of T2DM patients. Statistical analysis was performed using the SPSS 25.0 software. RESULTS The self-management behaviour pass rate among individuals with T2DM was 40.9%. In terms of individual factors, those with a high school education level or above demonstrated higher self-management behaviour scores than those with a junior high school education level or lower. The structural equation model revealed a path of interactions among individual factors, family support system-related factors, and the self-management behaviour of patients with T2DM: Family function → Family support → Patients' self-management behaviour → Quality of life. The coefficient of the direct path from family function to family support was 0.74 (P < 0.001), while the coefficient of the direct path from family support to self-management behaviour was 0.68 (P = 0.001). CONCLUSION There is significant room for improvement in the self-management behaviour of T2DM patients in China. Family function can enhance the self-management behaviour of T2DM patients by promoting family support.
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Affiliation(s)
- Lan Zhu
- Department of General Practice, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
- Xietu Street Community Health Service Center, Xuhui District, Shanghai, China
| | - Zhigang Pan
- Department of General Practice, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Fulai Shen
- Research Center of Strengthening Foundation of Health, Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Shen
- New Exploration Project Team, Diabetes Management Community, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Wei Zhang
- School of Public Health, Fudan University, Shanghai, China
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Okati-Aliabad H, Nazri-Panjaki A, Mohammadi M, Nejabat E, Ansari-Moghaddam A. Determinants of diabetes self-care activities in patients with type 2 diabetes based on self-determination theory. Acta Diabetol 2024; 61:297-307. [PMID: 37855999 DOI: 10.1007/s00592-023-02186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023]
Abstract
AIMS In type 2 diabetes control, self-management is an effective way to minimize the risk of developing complications and improve the quality of life. Self-determination theory (SDT) proposed a promising explanatory framework to predict self-regulated behavior which was particularly relevant for self-management. This study aimed to investigate whether SDT constructs can affect the self-management and controlling glycated hemoglobin A1c (HbA1c) levels in type 2 diabetic patients or not. METHODS This cross-sectional study was conducted from August to December 2022 at two diabetes clinics in Zahedan. The study included 300 patients with type 2 diabetes. Data collection was done using a researcher-administrated questionnaire that included demographic data, diabetes self-care activities, and self-determination constructs including autonomous support, autonomous motivation, and perceived competence. RESULTS The mean of the overall score of self-care activities was 34.62 ± 11.86 out of a maximum of 70. Patients in the fourth quarter (wealthiest) of the socioeconomic status had the highest mean self-care score (P = 0.003). There was a significant relationship between diet score with perceived competence (P = 0.009). Perceived competence (P<0.001) and controlled self-regulation (P<0.001) were the predictors of exercise score in diabetes patients. Independent self-regulation (P<0.001, r = 0.21) and overall self-regulation (P = 0.001, r = 0.19) were significantly related to blood-glucose testing score. There was a significant relationship between foot care score with perceived competence (P = 0.048, r = 0.11) and autonomous support (P = 0.013, r = 0.14). Multiple regression showed that exercise was the predictor of HbA1c (P = 0.014). CONCLUSION Exercise is crucial for achieving good individualized glycemic control and reducing the risk of diabetes complications. The findings provided valuable insights into the determinants of self-care activities in patients with type 2 diabetes and underscore the need for interventions that address socioeconomic disparities, enhance perceived competence, and provide autonomy support to improve diabetes self-care.
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Affiliation(s)
- Hassan Okati-Aliabad
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Athare Nazri-Panjaki
- Student Research Committee, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Mahdi Mohammadi
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Elham Nejabat
- Khatam Al Anbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
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Sawaengsri N, Maneesriwongul W, Schorr EN, Wangpitipanit S. Effects of Telephone-Based Brief Motivational Interviewing on Self-Management, Medication Adherence, and Glycemic Control in Patients with Uncontrolled Type 2 Diabetes Mellitus in a Rural Community in Thailand. Patient Prefer Adherence 2023; 17:2085-2096. [PMID: 37644965 PMCID: PMC10461754 DOI: 10.2147/ppa.s418514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Owing to the increased prevalence of type 2 diabetes mellitus (T2DM) and the high proportion of patients with uncontrolled T2DM, effective interventions for disease management are needed. Objective The study aim was to test the effects of brief motivational interviewing (MI) on patients' self-management, medication adherence, and glycemic control. Methods A single-group repeated measures trial was used to examine the effects of usual care only and usual care plus telephone-based brief MI. Participants were 29 patients with uncontrolled T2DM recruited from a rural primary care setting in Nakhon Sawan, Thailand. Participants received usual care during the first 4 weeks, followed by usual care plus brief MI during weeks 4-8. Outcomes of self-management, medication adherence, fasting blood sugar (FBS) levels, and hemoglobin A1c (HbA1c) levels were assessed at baseline, 4 weeks, and 8 weeks. Data were analyzed using descriptive statistics, one-way repeated measures analysis of variance, and Friedman test. Results Significant changes in self-management (p < 0.001), medication adherence (p < 0.001), and FBS (p < 0.05) were observed over the 8-week study. In multiple comparisons, self-management was the only parameter significantly different across baseline, 4, and 8 weeks (p <0.05, <0.001, and <0.001, respectively); medication adherence was significantly different between 4 and 8 weeks (p < 0.05), and between baseline and 8 weeks (p < 0.001); and FBS was significantly different between 4 and 8 weeks (p < 0.05). HbA1c declined over the 8-week study, but not significantly. Conclusion An intervention combining telephone-based brief MI with usual care significantly increased self-management, medication adherence, and glycemic control (ie, FBS) after 4 weeks, whereas usual care only significantly increased self-management. Phone-based brief MI may be an effective way for healthcare providers to remotely enhance patients' self-management and glycemic control, thus reducing barriers related to time and geographic location.
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Affiliation(s)
- Naruemon Sawaengsri
- Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wantana Maneesriwongul
- Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Erica N Schorr
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Supichaya Wangpitipanit
- Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Lin M, Chen T, Fan G. Current status and influential factors associated with adherence to self-monitoring of blood glucose with type 2 diabetes mellitus patients in grassroots communities: a cross-sectional survey based on information-motivation-behavior skills model in China. Front Endocrinol (Lausanne) 2023; 14:1111565. [PMID: 37441499 PMCID: PMC10335788 DOI: 10.3389/fendo.2023.1111565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/16/2023] [Indexed: 07/15/2023] Open
Abstract
Objective Self-monitoring of blood glucose (SMBG) plays a vital role in the maintenance of blood glucose with type 2 diabetes mellitus(T2DM) and pre-diabetes patients. The study was intended to describe the current status of SMBG with T2DM and pre-diabetes patients in grassroots communities, explore the relationship between SMBG frequency and blood glucose level and apply information-motivation-behavior(IMB) model to analyze the potential influencing factors of SMBG compliance based on electronic questionnaires. Methods A cross-sectional study was conducted with 1388 T2DM and pre-diabetes patients who completed electronic questionnaires composed of demographics and IMB model content. Chi-square test, Mann-Whitney U test and multivariable logistic regression model analysis were utilized to explore deeply causes of SMBG compliance. Results The results of this study showed that among 1388 T2DM patients, only 26.2% (363/1388) patients reached SMBG standard, indicating low compliance with SMBG. Given that SMBG is one of the individual predictors of type 2 risk in prediabetes patients, this result suggests that the SMBG compliance rate needs to be improved. Patients with fixed occupation (OR=1.989, P=0.035), BMI in normal range (OR=1.336, P=0.049), smoking habit(OR=1.492, P=0.019), understanding SMBG frequency (OR=1.825, P<0.001), understanding control goal of blood glucose (OR=1.414, P<0.001), knowing all the functions of the blood glucose meter (OR=1.923, P<0.001), buying a blood glucose meter/test paper conveniently(OR=2.329, P=0.047), taking supplementary measurement when forgetting blood glucose test(OR=2.044, P=0.005), rotating all the fingers when measuring blood glucose (OR=1.616, P<0.001) and less pain at the needling site(OR=2.114, P<0.001)were independently promoting factors of adherence to SMBG. However, the lack of accessibility and convenience of blood glucose meter or heavy financial burden were blocking factors of adherence to SMBG. Moreover, there were still bottlenecks such as lack of health care knowledge and needle pricking pain. Conclusion This study verified the practicability of applying IMB model to SMBG with T2DM and pre-diabetes patients. Adherence to SMBG still remained to improved, and putting more emphasis in improvement of individual information, motivation and behavioral skills with patients might be beneficial to maintain better adherence to SMBG in long-term routine of diabetes self-management.
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Affiliation(s)
- Manxin Lin
- School of Public Health, Shantou University, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Tingting Chen
- School of Public Health, Shantou University, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Guanhua Fan
- Shantou University Medical College, Shantou, China
- Health Management Center of Outpatient Department, Cancer hospital of Shantou University Medical College, Shantou, China
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Thakur M, Modi VK. Biocolorants in food: Sources, extraction, applications and future prospects. Crit Rev Food Sci Nutr 2022; 64:4674-4713. [PMID: 36503345 DOI: 10.1080/10408398.2022.2144997] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Color of a food is one of the major factors influencing its acceptance by consumers. At presently synthetic dyes are the most commonly used food colorant in food industry by providing more esthetically appearance and as a means to quality control. However, the growing concern about health and environmental due to associated toxicity with synthetic food colorants has accelerated the global efforts to replace them with safer and healthy food colorants obtained from natural resources (plants, microorganisms, and animals). Further, many of these biocolorants not only provide myriad of colors to the food but also exert biological properties, thus they can be used as nutraceuticals in foods and beverages. In order to understand the importance of nature-derived pigments as food colorants, this review provides a thorough discussion on the natural origin of food colorants. Following this, different extraction methods for isolating biocolorants from plants and microbes were also discussed. Many of these biocolorants not only provide color, but also have many health promoting properties, for this reason their physicochemical and biological properties were also reviewed. Finally, current trends on the use of biocolorants in foods, and the challenges faced by the biocolorants in their effective utilization by food industry and possible solutions to these challenges were discussed.
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Affiliation(s)
- Monika Thakur
- Amity Institute of Food Technology, Amity University, Noida, Uttar Pradesh, India
| | - V K Modi
- Amity Institute of Food Technology, Amity University, Noida, Uttar Pradesh, India
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Zhang A, Wang J, Wan X, Zhang J, Guo Z, Miao Y, Zhao S, Bai S, Zhang Z, Yang W. Mediation Effect of Self-Efficacy Between Health Beliefs and Glycated Haemoglobin Levels in Elderly Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. Patient Prefer Adherence 2022; 16:3015-3026. [PMID: 36387053 PMCID: PMC9645127 DOI: 10.2147/ppa.s388967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To explore the mediating effect of self-efficacy in the relationship between glycated haemoglobin (HbA1c) levels and health beliefs in community elderly patients with type 2 diabetes. PATIENTS AND METHODS From January to March 2022, convenience sampling was adopted to investigate 200 elderly patients with type 2 diabetes in a community in Yangzhou, China. Data were collected using the Health Beliefs Questionnaire, Self-efficacy for Diabetes, and Medication Compliance Questionnaire. Laboratory parameters included HbA1c, fasting blood glucose, postprandial blood glucose, total cholesterol, triglyceride, high-density-lipoprotein cholesterol, and low-density-lipoprotein cholesterol levels. Correlation, linear regression, and mediation analyses were performed using SPSS 27.0. RESULTS HbA1c levels were higher in men (women vs men: 6.80% [6.08%, 7.73%] vs.7.30% [6.30%, 9.18%]) and employed (employed vs not employed vs retired: 7.60% [6.90%, 10.45%] vs 5.85% [5.40%, 6.95%] vs 7.10% [6.20%, 8.20%]) and low self-efficacy (low vs high: 13.1% [6.55%, 13.85%] vs 6.8% [6.10%, 7.70%]). HbA1c levels were negatively associated with health beliefs (r = -0.246) and self-efficacy (r = -0.240; p<0.01). Linear regression showed that perceived susceptibility, severity, benefit, and barriers, cues to action, and self-efficacy explained 50% of the variance in HbA1c levels after adjusting for sex and current work status. The mediation effect of self-efficacy was partial between health beliefs and HbA1c levels and accounted for 24.65% of the total effect (p < 0.001). CONCLUSION Health beliefs influenced the improvement of self-efficacy in older patients with type 2 diabetes mellitus, which in turn could improve HbA1c control. Self-efficacy plays a partial mediating role between health beliefs and Hba1c levels in elderly patients with type 2 diabetes.
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Affiliation(s)
- Anqi Zhang
- The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, 225003, People’s Republic of China
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu, 225009, People’s Republic of China
| | - Jinsong Wang
- The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, 225003, People’s Republic of China
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu, 225009, People’s Republic of China
- Yangzhou Commission of Health, Yangzhou, Jiangsu, 225009, People’s Republic of China
- Correspondence: Jinsong Wang, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, 225003, People’s Republic of China, Tel +86 15952771632, Email
| | - Xiaojuan Wan
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu, 225009, People’s Republic of China
| | - Jing Zhang
- Yangzhou Commission of Health, Yangzhou, Jiangsu, 225009, People’s Republic of China
| | - Zihe Guo
- Yangzhou Commission of Health, Yangzhou, Jiangsu, 225009, People’s Republic of China
| | - Yamin Miao
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu, 225009, People’s Republic of China
| | - Shuhan Zhao
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu, 225009, People’s Republic of China
| | - Shuo Bai
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu, 225009, People’s Republic of China
| | - Ziyi Zhang
- School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu, 225009, People’s Republic of China
| | - Weiwei Yang
- Community Health Service Center, Yangzhou, Jiangsu, 225003, People’s Republic of China
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