Self-care practices of Chinese individuals with diabetes

Self-care practice and its barriers among diabetes patients in North East Ethiopia: A facility-based cross-sectional study

Diabetes prevention and management through self-care practice is critical to reducing severe complications and death due to diabetes. Data on the prevalence of self-care practices will help us to design and implement prevention and management strategies to foster adherence and compliance with the interventions. This study was intended to assess self-care preparation and its barriers among diabetes patients in Northeast Ethiopia. A facility-based cross-sectional study was conducted among diabetes patients visiting Debre Berhan Town Public Health Institutions from March 10, 2021- April 10, 2021. A systematic random sampling technique was utilized to select 392 samples. Data were collected using a structured questionnaire adapted from Summary of Diabetes Self-Care Activities Measures. Reliability analysis was done using Cronbach's alpha test, and the Hosmer and Lemeshow test also checked for model fitness. Bivariate and multivariable binary logistic regression was done to identify the factors associated with dietary practices. For all statistically significant tests, p- a value < 0.05 was used as a cut-off point. The mean age of the respondents was 47.1 years, with a standard deviation (SD) of ± 13.4 years. The mean adherence to self-care practice was 29.00 ± 10.37 SD. More than half, 218 (61.1%) of the study subjects had poor self-care practices. In the multivariable logistic regression analysis, being a governmental worker (AOR = 7.06 (1.61-30.9) and having social support from partners (AOR = 5.83(3.01-11.3) showed a statistically significant association with good self-care practice. The current study showed that the overall level of self-care practice of study subjects was poor. Therefore, health facilities should provide adequate health education and promotion activities to enhance patients' level of adherence. In addition, families, partners, or friends of diabetes patients should be informed about their essential roles in patients' self-care practice.

Diabetes self-care behaviours among people diagnosed with serious mental illness: A cross-sectional correlational study

WHAT IS KNOWN ON THE SUBJECT?: People diagnosed with serious mental illness have a high risk of diabetes and are more likely to develop type 2 diabetes at ages below 60 years. Effective diabetes self-care behaviours among people diagnosed with serious mental illness can improve glycaemic control and reduce vascular complications. Few studies have investigated diabetes self-care behaviours and their associations with health literacy and self-efficacy in people diagnosed with serious mental illness. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Diabetes self-care behaviours in people diagnosed with serious mental illness were suboptimal; the least frequently performed self-care activities were self-monitoring of blood glucose. Factors associated with diabetes self-care behaviours are gender, age, communicative and critical health literacy and self-efficacy. Self-efficacy is the strongest predictor of self-care behaviours among people diagnosed with comorbid serious mental illness and type 2 diabetes. WHAT ARE THE IMPLICATIONS OF PRACTICE?: Mental health nurses should assess diabetes-specific health literacy of people diagnosed with serious mental illness to ensure that they possess the knowledge and skills related to diabetes self-care. When treating young people and those with newly diagnosed type 2 diabetes, nurses should incorporate strategies to minimise their perceptions of diabetes-related distress and increase their confidence in managing comorbid diabetes. ABSTRACT: Introduction People diagnosed with serious mental illness (SMI) experience greater challenges in managing their type 2 diabetes mellitus (T2DM) than do those diagnosed with T2DM alone. Aim This study investigated diabetes self-care activities and the factors associated with these activities in people diagnosed with SMI in a hospital setting. Methods A cross-sectional correlational study was conducted among 126 people diagnosed with comorbid SMI and T2DM in Taipei, Taiwan, between October 2020 and April 2021. Data were collected using self-report questionnaires and a chart review. Three-step hierarchical multiple regression analysis was used to identify factors associated with diabetes self-care behaviours. Results Diabetes self-care behaviours in people diagnosed with SMI were suboptimal overall. Hierarchical multiple regression analyses revealed that age (β = 0.18, p = .037) and self-efficacy (β = 0.27, p = .004) significantly associated with diabetes self-care behaviours. Discussion Self-efficacy is the strongest predictor of self-care behaviours among people diagnosed with comorbid SMI and T2DM. Implications for Practice Mental health professionals should focus on enhancing confidence in managing comorbid diabetes in people diagnosed with comorbid SMI, especially young people and those with newly diagnosed T2DM.

Adherence to Oral Antidiabetic Drugs in Patients with Type 2 Diabetes: Systematic Review and Meta-Analysis

Poor adherence to oral antidiabetic drugs (OADs) in patients with type 2 diabetes (T2D) can lead to therapy failure and risk of complications. The aim of this study was to produce an adherence proportion to OADs and estimate the association between good adherence and good glycemic control in patients with T2D. We searched in MEDLINE, Scopus, and CENTRAL databases to find observational studies on therapeutic adherence in OAD users. We calculated the proportion of adherent patients to the total number of participants for each study and pooled study-specific adherence proportions using random effect models with Freeman-Tukey transformation. We also calculated the odds ratio (OR) of having good glycemic control and good adherence and pooled study-specific OR with the generic inverse variance method. A total of 156 studies (10,041,928 patients) were included in the systematic review and meta-analysis. The pooled proportion of adherent patients was 54% (95% confidence interval, CI: 51-58%). We observed a significant association between good glycemic control and good adherence (OR: 1.33; 95% CI: 1.17-1.51). This study demonstrated that adherence to OADs in patients with T2D is sub-optimal. Improving therapeutic adherence through health-promoting programs and prescription of personalized therapies could be an effective strategy to reduce the risk of complications.

Determining Acceptance of e-Mental Health Interventions in Digital Psychodiabetology Using a Quantitative Web-Based Survey: Cross-sectional Study

Background

Diabetes is a very common chronic disease that exerts massive physiological and psychological burdens on patients. The digitalization of mental health care has generated effective e-mental health approaches, which offer an indubitable practical value for patient treatment. However, before implementing and optimizing e-mental health tools, their acceptance and underlying barriers and resources should be first determined for developing and establishing effective patient-oriented interventions.

Objective

This study aims to assess the acceptance of e-mental health interventions among patients with diabetes and explore its underlying barriers and resources.

Methods

A cross-sectional study was conducted in Germany from April 9, 2020, to June 15, 2020, through a web-based survey for which patients were recruited via web-based diabetes channels. The eligibility requirements were adult age (18 years or older), a good command of the German language, internet access, and a diagnosis of diabetes. Acceptance was measured using a modified questionnaire, which was based on the well-established Unified Theory of Acceptance and Use of Technology (UTAUT) and assessed health-related internet use, acceptance of e-mental health interventions, and its barriers and resources. Mental health was measured using validated and established instruments, namely the Generalized Anxiety Disorder Scale-7, Patient Health Questionnaire-2, and Distress Thermometer. In addition, sociodemographic and medical data regarding diabetes were collected.

Results

Of the 340 participants who started the survey, 261 (76.8%) completed it and the final sample comprised 258 participants with complete data sets. The acceptance of e-mental health interventions in patients with diabetes was overall moderate (mean 3.02, SD 1.14). Gender and having a mental disorder had a significant influence on acceptance (P<.001). In an extended UTAUT regression model (UTAUT predictors plus sociodemographics and mental health variables), distress (β=.11; P=.03) as well as the UTAUT predictors performance expectancy (β=.50; P<.001), effort expectancy (β=.15; P=.001), and social influence (β=.28; P<.001) significantly predicted acceptance. The comparison between an extended UTAUT regression model (13 predictors) and the UTAUT-only regression model (performance expectancy, effort expectancy, social influence) revealed no significant difference in explained variance (F_10,244=1.567; P=.12).

Conclusions

This study supports the viability of the UTAUT model and its predictors in assessing the acceptance of e-mental health interventions among patients with diabetes. Three UTAUT predictors reached a notable amount of explained variance of 75% in the acceptance, indicating that it is a very useful and efficient method for measuring e-mental health intervention acceptance in patients with diabetes. Owing to the close link between acceptance and use, acceptance-facilitating interventions focusing on these three UTAUT predictors should be fostered to bring forward the highly needed establishment of effective e-mental health interventions in psychodiabetology.

Predictors of Adherence to Self-Care Behavior Among Patients with Diabetes at Public Hospitals in West Ethiopia

BACKGROUND

Diabetes is a typical chronic disease that needs integrated and multifaceted approaches. Self-care practices are fundamental to achieve good blood glucose control and prevent long-term complications. Therefore, the aim of the study was to determine the level and predictors of adherence to self-care behavior among patients with diabetes on follow-up at public hospitals of western Ethiopia.

PATIENTS AND METHODS

The cross-sectional study design was employed on a sample of 423 diabetic patients on follow-up at public hospitals of western Ethiopia. A systematic random sampling method was employed. The data were entered into Epi data version 3.1 and exported into Statistical Package for the Social Sciences window version 24 for analysis. All variables significant at p-value <0.05 in the bivariable were entered in multivariate regression analysis. Backward stepwise goodness of fit was used to ascertain the suitable variables in multiple linear regression analysis. Finally, multivariate linear regression analysis with adjusted B, CI at 95%, and the significance level was set at p <0.05. All predictive variables were reported in terms of adjusted R2.

RESULTS

The overall mean and standard deviation of adherence to self-care behavior was 23.09 ±6.55. Among the study participants, 42.70% had good self-care behavior. Self-efficacy (B=0.106, p<0.001), home blood glucose test (B=0.075, p<0.001), exercise per week (0.035, P<0.002), meal planning (B=0.039, P<0.001), dietary restriction (B=0.077, P<0.001), duration of diabetes<4 years (B=0.030, P<0.013), non-pharmacological intervention (B=0.055, P<0.011), and good appetite (B=0.039, P<0.045) were significant variables associated with adherence to self-care behaviors.

CONCLUSION

The overall level of adherence to self-care behavior was low. Therefore, we recommended that it is better if the national health policymaker focused on dietary management modality that engages patients' behavior change to develop self-care practices and closely monitoring of glucose level. Also, we recommended an additional longitudinal study incorporating a qualitative study that focused on behavioral changes.

Patient-perceived service needs and health care utilization in people with type 2 diabetes: A multicenter cross-sectional study

The aim of this study was to investigate service needs and health care utilization among people with type 2 diabetes, further to identify the relationship between service needs and health care utilization.We used a self-reported questionnaire to collect data regarding demographic and diabetes characteristics, service needs toward self-management and follow-up care, and 4 health care utilizations during past year. Multiple linear regression and binary logistic regression were used to test the impacts of demographic and diabetes characteristics on service needs and health care utilizations, respectively. Spearman rank correlations were used to explore correlation between service needs and health care utilization.We recruited 1796 participants with type 2 diabetes from 20 community health centers across 12 cities of Sichuan Province in China. Needs of self-management and follow-up had significant positive correlations with health care utilization. Participants rated that nutrition was the most needed aspects of self-management (78.5%), and out-patient visit was the most popular type of follow-up (66.8%). Educational level and treatment modality were predictors of self-management needs. Low educational level (elementary school or blow, β = 0.11, P = .008; middle school, β = 0.10, P = .015) and insulin treatment (β = 0.08, P = .007) were positive factors of self-management needs. Younger age (age < 45 years old, β = 0.07, P = .046), being employed (β = 0.14, P < .001), and underdeveloped region (β = 0.16, P < .001) were positive factors of follow-up care needs. Elementary educational level (OR: 0.53; CI: 0.30-0.96) and underdevelopment region (OR: 0.01; CI: 0.01-0.07) were protective factors of general practitioner visit, in contrast, those factors were risk factors of specialist visit (elementary educational level, OR: 1.69; CI: 1.13-2.5; underdevelopment region, OR: 2.93; CI: 2.06-4.16) and emergency room visit (elementary educational level, OR: 2.97; CI: 1.09, 8.08; underdevelopment region, OR: 6.83; CI: 2.37-14.65).The significant positive relationship between service needs and health care utilization demonstrated the role of service needs in influencing health care utilization. When self-management education is provided, age, educational level, employment status, treatment modality, and region should be considered to offer more appropriate education and to improve health care utilization.

Beliefs related to insulin use in people with Type 2 Diabetes Mellitus

OBJECTIVES

to identify the beliefs of people with Type 2 Diabetes Mellitus related to insulin use.

METHODS

a descriptive, cross-sectional, quantitative-qualitative study based on Theory of Planned Behavior and performed with 32 participants using insulin. The data were analyzed and grouped into categories by beliefs similarity, counted from the frequencies.

RESULTS

118 behavioral, 60 normative and 97 control beliefs were issued. Among the behavioral beliefs, there was an advantage in keeping the diabetes under control and disadvantage, the pain of being pierced by the application of insulin. Regulations highlighted the children as referents who support the treatment. In control beliefs, it was observed that the application of insulin appears as easiness and difficulty to the treatment.Conclusions: the study will support the construction of a psychometric scale to measure the determinants of insulin use, revealing particularities for the structuring of educational interventions that contribute to adherence of the treatment verified in adequate glycemic control.

Effectiveness of Lilly Connected Care Program (LCCP) App-Based Diabetes Education for Patients With Type 2 Diabetes Treated With Insulin: Retrospective Real-World Study

Background

Diabetes poses heavy economic and social burdens worldwide. Mobile apps show great potential for diabetes self-management education. However, there is limited evidence for the effectiveness of providing general diabetes education through mobile apps.

Objective

The aim of this study was to clarify the effectiveness of Lilly Connected Care Program (LCCP) app-based diabetes education for glycemic control.

Methods

This retrospective cohort study included patients with diabetes recruited to the LCCP platform from September 1, 2018, to May 31, 2019. Each patient was followed for 12 weeks. According to the number of diabetes education courses they had completed, the patients were divided into the following three groups: group A (0-4 courses), group B (5-29 courses), and group C (≥30 courses). The main outcomes were the change in blood glucose at the 12th week compared with baseline and the differences in blood glucose at the 12th week among the three groups. The associations of the number of diabetes education courses completed with the average blood glucose and frequency of self-monitoring of blood glucose (SMBG) at the 12th week were assessed by multivariate linear regression analyses controlling for other confounding covariates. Univariate and multivariate linear regression analyses were used to assess factors influencing patients’ engagement in the diabetes education courses.

Results

A total of 5011 participants were enrolled. Their mean fasting blood glucose (FBG) and postprandial blood glucose (PBG) were significantly lower at the 12th week than at baseline (FBG, 7.46 [standard deviation (SD) 1.95] vs 7.79 [SD 2.18] mmol/L, P<.001; PBG, 8.94 [SD 2.74] vs 9.53 [SD 2.81] mmol/L, P<.001). The groups that completed more diabetes education courses had lower FBG (group B, β=−0.14, 95% CI −0.26 to −0.03; group C, β=−0.29, 95% CI −0.41 to −0.16; P for trend <.001) and PBG (group B, β=−0.29, 95% CI −0.46 to −0.11; group C, β=−0.47, 95% CI −0.66 to −0.28; P for trend <.001) and a higher frequency of SMBG at the 12th week (group B, β=1.17, 95% CI 0.81-1.53; group C, β=4.21, 95% CI 3.81-4.62; P for trend <.001) when compared with the findings in group A. Age and education were related to patients’ engagement in the diabetes education courses. Middle-aged patients (35-59 years old) and elderly patients (≥60 years old) completed more diabetes education courses (middle-aged group, β=2.22, P=.01; elderly group, β=2.42, P=.02) than young patients (18-34 years old).

Conclusions

LCCP app-based diabetes education is effective for glycemic control and SMBG behavior improvement in patients with type 2 diabetes receiving insulin therapy. Young patients’ engagement in the education courses was relatively low. We need to conduct in-depth interviews with users to further improve the curriculum.

RESILIENCE AND SELF-CARE IN PEOPLE WITH DIABETES MELLITUS

ABSTRACT Objective: to investigate the association between resilience and self-care in people with diabetes mellitus treated in Primary Health Care. Method: Cross-sectional study, sample consisting of 362 people, aged 18 years or older, diagnosed with diabetes for at least one year. Descriptive analyzes and comparison of means were performed, assuming statistical significance with a value of p <0.05. The Resilience Scale and Questionnaire on Diabetes Self-Care Activities were applied, containing six dimensions: general food, specific food, physical activity, blood glucose monitoring, foot care, medication use, plus three items on smoking. Data collection took place between December and May 2016, in ten Health Centers in a city in the south of the country. Results: among the 15 self-care activities, four showed a statistically significant association when compared to the average resilience, highlighting: healthy eating and professional guidance, desirable sweet consumption, blood sugar assessment as recommended. Conclusion: the results obtained highlight the relationship between high averages of resilience and adequate performance in the care of diabetes mellitus.

Factors Influencing Patients' Intentions to Use Diabetes Management Apps Based on an Extended Unified Theory of Acceptance and Use of Technology Model: Web-Based Survey

BACKGROUND

Diabetes poses heavy social and economic burdens worldwide. Diabetes management apps show great potential for diabetes self-management. However, the adoption of diabetes management apps by diabetes patients is poor. The factors influencing patients' intention to use these apps are unclear. Understanding the patients' behavioral intention is necessary to support the development and promotion of diabetes app use.

OBJECTIVE

This study aimed to identify the determinants of patients' intention to use diabetes management apps based on an integrated theoretical model.

METHODS

The hypotheses of our research model were developed based on an extended Unified Theory of Acceptance and Use of Technology (UTAUT). From April 20 to May 20, 2019, adult patients with diabetes across China, who were familiar with diabetes management apps, were surveyed using the Web-based survey tool Sojump. Structural equation modeling was used to analyze the data.

RESULTS

A total of 746 participants who met the inclusion criteria completed the survey. The fitness indices suggested that the collected data fit well with the research model. The model explained 62.6% of the variance in performance expectancy and 57.1% of the variance in behavioral intention. Performance expectancy and social influence had the strongest total effects on behavioral intention (β=0.482; P=.001). Performance expectancy (β=0.482; P=.001), social influence (β=0.223; P=.003), facilitating conditions (β=0.17; P=.006), perceived disease threat (β=0.073; P=.005), and perceived privacy risk (β=-0.073; P=.012) had direct effects on behavioral intention. Additionally, social influence, effort expectancy, and facilitating conditions had indirect effects on behavioral intention that were mediated by performance expectancy. Social influence had the highest indirect effects among the three constructs (β=0.259; P=.001).

CONCLUSIONS

Performance expectancy and social influence are the most important determinants of the intention to use diabetes management apps. Health care technology companies should improve the usefulness of apps and carry out research to provide clinical evidence for the apps' effectiveness, which will benefit the promotion of these apps. Facilitating conditions and perceived privacy risk also have an impact on behavioral intention. Therefore, it is necessary to improve facilitating conditions and provide solid privacy protection. Our study supports the use of UTAUT in explaining patients' intention to use diabetes management apps. Context-related determinants should also be taken into consideration.

The relationship between patients' perception of type 2 diabetes and medication adherence: a cross-sectional study in Japan

BACKGROUND

The self-management of type 2 diabetes mellitus (T2DM), which involves adherence to medical instructions on diet and nutritional advice, physical activity, medication regimen, and weight and stress management, is necessary for the treatment of T2DM.In this study, we investigated the relationship between patients' perceptions of their disease and their adherence to their medications. And we attempted to determine whether distinct subphenotypes of behavioral change of medication adherence can be discerned based on a patients' perceptions.

METHOD

A cross-sectional study using a questionnaire was conducted among 157 patients with T2DM from October 2015 to September 2017. Questionnaires were administered to assess the participants' demographic and clinical characteristics, medication adherence, diabetes knowledge, and perception of being diabetic. Principal component analysis (PCA) and cluster analyses were performed to classify medication adherence patterns in the total cohort. Multiple regression analyses were performed to identify the determinant factors of medication adherence.

RESULTS

PCA showed the interpretable medication adherence of patients with diabetes by using component 1 ("accessibility to medical treatment") and component 2 ("status of taking medicines"). We identified four groups that show significantly different medication adherence by using cluster analysis on the basis of the two components. Multiple regression analysis showed that body mass index (BMI), family history of diabetes, one factor of patient's perception (living an orderly life), and diabetes knowledge were found to be significant predictors of medication adherence in patients with T2DM.

CONCLUSIONS

In patients with T2DM, the patient's diabetes perception of "living an orderly life" is associated with medication adherence. A poor adherence group may be able to change their adherence to diabetes treatment by developing the perception of "living an orderly life."

Popular Diabetes Apps and the Impact of Diabetes App Use on Self-Care Behaviour: A Survey Among the Digital Community of Persons With Diabetes on Social Media

Introduction: This study aimed to identify popular diabetes applications (apps) and to investigate the association of diabetes app use and other factors with cumulative self-care behaviour. Methods: From November 2017 to March 2018, we conducted a web-based survey with persons 18 years of age and above. We recruited respondents via diabetes Facebook groups, online patient-forums and targeted Facebook advertisements (ads). Data on participants' demographic, clinical, and self-management characteristics, as well as on self-care behaviour and characteristics of the diabetes apps use were collected. Self-care behaviour was measured using a licensed version of the Summary of Diabetes Self-care Activities (SDSCA) questionnaire. The cumulative self-care score was calculated by summing up scores for "general diet," "specific diet," "exercise," "blood glucose testing," "foot care" and "smoking." To identify popular diabetes apps, users were requested to list all apps they use for diabetes self-management. Two sample t-test and multiple linear regression stratified by type of diabetes were performed to examine associations between app use and self-care behaviour, by controlling for key confounders. Results: One thousand fifty two respondents with type 1 and 630 respondents with type 2 diabetes mellitus (DM) entered the survey. More than half, 549 (52.2%), and one third, 210 (33.3%), of respondents with type 1 and 2 DM, respectively, reported using diabetes apps for self-management. "mySugr" and continuous glucose monitoring apps, such as "Dexcom," "Freestyle Libre," and "Xdrip+" were some of the most popular diabetes apps. In both respondent groups, the cumulative self-care behaviour score was significantly higher among diabetes app users (compared to non-users) and scores for three individual self-care components, namely "blood glucose monitoring," "general diet," and "physical activity" were significantly higher among diabetes app users than among non-users. After adjusting for confounding factors, diabetes app use increased the cumulative self-care score by 1.08 (95%CI: 0.46-1.7) units among persons with type 1 DM and by 1.18 (95%CI: 0.26-2.09) units among persons with type 2 DM, respectively. Conclusion: For both, persons with type 1 and type 2 diabetes, using diabetes apps for self-management was positively associated with self-care behaviour. Our findings suggest that apps can support changes in lifestyle and glucose monitoring in these populations.

Validation of diabetes medication self-efficacy scale in Chinese with type 2 diabetes

AIMS

Greater diabetes medication self-efficacy has been shown to associate with better medication adherence, which is critical for disease control for people living with type 2 diabetes (T2D). The Diabetes Medication Self-efficacy Scale (DMSS) is a 19-item instrument to measure diabetes medication self-efficacy. The aim of the current study was to translate the DMSS into Chinese and validate the Chinese version of DMSS (CDMSS) among Chinese T2D patients.

METHODS

The CDMSS was translated using forward-backward method, and its validity and reliability were assessed among 257 Chinese T2D patients. Exploratory factor analysis, Cronbach's α and Spearman's rank correlation coefficients were used to evaluate the psychometric properties of CDMSS. Receiver operating characteristic analysis was used to assess the discrimination of CDMSS for medication adherence and glycemic control.

RESULTS

Exploratory factor analysis has generated a one-factor structure of the 11-item version of CDMSS (CDMSS-11), which accounted for 63.1% of the variance. The Spearman's rank correlation coefficient between the original 19-item and 11-item scale was 0.96. The Cronbach's α for internal consistency was 0.94, and the test-retest reliability coefficient was 0.76. The CDMSS-11 score was significantly correlated with diabetes distress, medication adherence, as well as blood levels of fasting plasma glucose and hemoglobin A1c (both P<0.001). The area under receiver operating characteristic curve and its corresponding 95% CI was 0.79 (0.73-0.84) for medication adherence, and it was 0.65 (0.57-0.72) for better glycemic control.

CONCLUSION

The CDMSS-11 is a valid and reliable measure to assess medication self-efficacy among Chinese T2D patients.

The association of diabetes-related self-care activities with perceived stress, anxiety, and fatigue: a cross-sectional study

PURPOSE

Many people with type 2 diabetes (T2DM) do not sustain sufficient diabetes-related self-care activities (DRSCA) in their daily lives. To provide additional information about the positive influence of DRSCA, this study was conducted to examine whether DRSCA were associated with reduced perceived stress, anxiety, and fatigue among people with T2DM and to explore the level of DRSCA, perceived stress, anxiety, and fatigue and their association with background information.

PATIENTS AND METHODS

This study was a cross-sectional survey including 251 participants aged 18 years and older recruited from two hospitals in the eastern part of China. The study utilized self-report questionnaires that consisted of background information, DRSCA, perceived stress, anxiety, and fatigue. Hierarchical multiple regression analysis was conducted to explore the association of DRSCA with perceived stress, anxiety, and fatigue while adjusting for background information.

RESULTS

The results indicated that the level of self-care activities, stress, and fatigue was around middle level. The prevalence of anxiety was 19%. A high level of DRSCA was likely to reduce perceived stress but was not linked to anxiety and fatigue. Women were more susceptible to stress and anxiety, and people who had diabetes for >5 years were more likely to have anxiety. The background information included diabetes duration, standardized diabetes education, and high social support, all of which are factors that may influence DRSCA.

CONCLUSION

The findings suggest that improving the level of DRSCA might effectively reduce perceived stress. The potential benefits of DRSCA can provide both motivational and evaluative data for self-care programs. In addition, the findings show that DRSCA were not linked to anxiety and fatigue, which implies that their positive influence on anxiety and fatigue may be offset by the load of frequent DRSCA. It is suggested that helping patients to make tailored plans to integrate DRSCA into their daily lives is needed. Meanwhile, in the background information, it is suggested that standardized diabetes education and high social support can benefit DRSCA; in improving psychological health, more attention should be paid to women and patients with diabetes duration <5 years.

Knowledge and practice of patients with diabetes mellitus in Lebanon: a cross-sectional study

Background

The objective of this study was to assess the knowledge and practice of Lebanese patients living with diabetes mellitus in regards to their diabetes self- management.

Methods

A cross-sectional study, conducted between January and June 2015, enrolled 207 urban adult patients with diabetes mellitus from community pharmacies while purchasing their diabetes medications. Their knowledge and self-management practices were assessed using a structured anonymous interview survey questionnaire.

Results

The mean age of the participants was 60.2 ± 15.5 years, and the Male/Female ratio was 1.38. The mean knowledge score was 2.34 ± 0.88 points (out of 6). Very few participants (17.4%) knew their current medication side effects. The mean practice score was 5.86 ± 1.77 points (out of 8). Only 15.9% of patients reported current physical activity. A multiple linear analysis showed that those with a university degree had a significantly higher knowledge (Beta = 0.448, p = 0.001) and practice score (Beta = 0.523 p = 0.047) than those with intermediate or primary schooling. Those who reported following a special diabetes diet had a higher knowledge score (Beta = 0.482, p < 0.001) than those who did not. Knowledge score and practice score were highly correlated (Beta = 0.844, p < 0.001). There was no significant differential by gender and age for knowledge and practice scores.

Conclusions

The knowledge and practice scores of patients with diabetes mellitus were not satisfactory. Well-targeted interventions are needed, such as improving the communication between the pharmacist and people living with diabetes. The observed low adherence to physical exercise among patients with diabetes should also be addressed.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5416-7) contains supplementary material, which is available to authorized users.

Development and psychometric evaluation of a new instrument to assess nutritional perceptions and behaviors of diabetic men

BACKGROUND

It is obvious that unhealthy nutritional behaviors have caused the increasing incidence of diabetes. This study aimed to design the Measure of Nutritional Perceptions and Behaviors in diabetic men and to evaluate its psychometric properties.

METHODS

A questionnaire was developed within 7 factors. Three methods of face validity, content validity, and construct validity were employed to ensure the validity of the scale. 206 men with diabetes completed the questionnaires. Internal was used to evaluate the reliability of the scale.

RESULTS

The mean age of men was 58.26 (9.74) years. Results showed that each item in the final questionnaire was highly correlated with the total score of each dimension P<0.05. Moreover, factor analysis led to the extraction of 36 items with acceptable factor loadings in the range of 0.41 to 0.84, which could account for 51% of the total variance. The Cronbach's alpha coefficient equal to 0.83 was obtained for the whole scale.

CONCLUSION

The reliability and validity of diabetic men's beliefs about healthy nutritional behaviors were desired and the overall structure of the questions was confirmed. This questionnaire can be used to identify individuals at risk for unhealthy nutritional behaviors and also to conduct and evaluate the impact of educational interventions.

Illness perception, risk perception and health promotion self-care behaviors among Chinese patient with type 2 diabetes: A cross-sectional survey

AIM

To explore illness perception and perceived risk of developing diabetes complications in relation to health-promoting self-care behaviors among Chinese patients with type 2 diabetes.

BACKGROUND

Illness and risk perceptions are important determinants of various health behaviors. However, few studies have simultaneously examined the impacts of these two constructs on self-care among diabetic patients.

METHODS

Data were collected on participants' characteristics, illness perception, risk perception, and health-promoting self-care behaviors over 6months among 304 subjects from three general hospitals.

RESULTS

Significant associations between illness perception and risk perception were observed. Illness perception and/or risk perception explained an independent, small but significant proportion of the variance in each health-promoting self-care behavior.

CONCLUSION

One's perceptions of illness and future risk might be influential in understanding health-promoting self-care among diabetic patients. It may be useful to improve self-management by tailoring intervention content to individuals' illness-related perceptions.

Cultural issues and other factors that affect self-management of Type 2 Diabetes Mellitus (T2D) by Chinese immigrants in Australia

AIMS

To investigate the influence of cultural and other factors on diabetes self-management behaviors among Australian Chinese immigrants with T2D.

METHODS

A cross-sectional survey was conducted between June and October 2015. The questionnaire comprised several validated scales examining aspects of self-management practice including medication adherence, acculturation and demographics. Participants were recruited from the community and Diabetes Center of the Royal Prince Alfred Hospital (RPAH), Sydney, Australia.

RESULTS

Of the 139 participants, a majority were female, from mainland China, with high school level education and a mean age of 64 (SD±12) years. Participants were found to have poor self-management practices generally but moderate medication adherence. 13.7% of participants reported incorporating TCM into their diabetes treatment and 24% reported a cultural shame surrounding a diabetes diagnosis. Higher levels of acculturation predicted better medication adherence, whereas stronger beliefs in TCM predicted poorer medication adherence. Gender, education level and duration of diabetes were also predictors of diabetes self-management behaviors.

CONCLUSIONS

This study provided insight into cultural influences on diabetes self-management and medication taking among Chinese immigrants in Australia. Health care providers should take these into account in delivering culturally sensitive care and advice to achieve better health outcomes.

Characteristics of Chinese m-Health Applications for Diabetes Self-Management

PURPOSE

To examine the features and types of health information provided in Chinese diabetes mobile applications (apps) for patients' self-management.

MATERIALS AND METHODS

Through multiple rounds of screening, we identified a total of 95 relevant iOS (Apple, Cupertino, CA) and Android™ (Google, Mountain View, CA) apps and examined each app's features and health information types based on each app's description in the app stores. We used a 15-feature algorithm to evaluate the apps' abilities for supporting diabetic patients' self-management, based on U.S. national standards for diabetes self-management. We also adapted the health information wants framework to analyze the types of information that the apps provided for diabetic patients.

RESULTS

Diabetes education was the most common feature, provided by 75% of the apps. Blood glucose checking was enabled by 65% of the apps. Diet management, insulin checking, and physical activity monitoring were enabled by 53%, 49%, and 44% of the apps, respectively. Only a small percentage of the apps enabled psychosocial support (29%) or tracking of blood pressure (14%), cholesterol (14%), or body mass index (11%). None of the apps provided all seven types of information posited by the health information wants framework. Only a small percentage of the apps provided information about psychosocial support (29%), healthcare providers (24%), or healthcare facilities (24%). Information about complementary and alternative medicine was the least likely type of information provided in the apps, with only 7% of the apps providing this type of information.

CONCLUSIONS

Our findings have important implications for improving the quality of Chinese diabetes mobile apps to facilitate patients' self-management.

Dietary and physical activity of adult patients with type 2 diabetes in Zhejiang province of eastern China: Data from a cross-sectional study

AIMS/INTRODUCTION

Lifestyle management helps improve the clinical outcome of patients with type 2 diabetes. The present study aimed to obtain lifestyle data on the dietary and physical activity of adult type 2 diabetes patients in Zhejiang province of eastern China for better patient education and improvement of clinical management.

MATERIALS AND METHODS

A cross-sectional survey of 607 adult type 2 diabetes patients was carried out in 12 hospitals within eight cities of Zhejiang province. Data were collected for sex, age, basic physical measurement (blood pressure, height, weight, waist circumference and hip circumference), dietary favor and habit (vegetarian diets vs meat diets, preference of salty or light flavors), detailed dietary intake (24-h recall method), as well as the weekly physical activity.

RESULTS

The mean age of the patients in the analysis was 56.39 ± 12.29 years, and 38.71% of the patients had higher levels of body mass index than recommended. The average daily total energy intake was 1887.71 ± 575.10 kcal. The percentage of calories from carbohydrate, protein and fat were 61.36 ± 11.59%, 13.29 ± 3.37% and 25.35 ± 11.16%, respectively. For physical activity, the patients generally spent most of their daily time sitting and sleeping, and the time for moderate vigorous activity was limited.

CONCLUSIONS

Adult patients with type 2 diabetes in Zhejiang province have a relatively high carbohydrate and low protein diet, with very limited physical activity. Patient education to achieve a better lifestyle intervention needs to improve in this region.

Glycemic control and self-monitoring of blood glucose in Chinese patients with type 2 diabetes on insulin: Baseline results from the COMPASS study

AIMS

Self monitoring of blood glucose (SMBG) is not widely utilized in insulin-treated patients with type 2 diabetes. In this analysis, we evaluated the current state of SMBG in Chinese adults with type 2 diabetes treated with insulin.

METHODS

The 2-phase COMPASS study involved 24 centers across 10 provinces and cities in China. In the first phase, a cross sectional survey was carried out in type 2 diabetes patients receiving insulin treatment. The inclusion criteria for the study subjects in the first phase were: type 2 diabetes, insulin treatment for ≥ 3 months, and age ≥ 18 years. Evaluation was made on the status of SMBG and insulin therapy in these patients by a questionnaire.

RESULTS

A total of 2819 patients (age 58.2 ± 10.8 years; 49.6% females; BMI 24.6 ± 3.4 kg/m(2)) with insulin-treated type 2 diabetes were recruited in phase I of this study. The majority of patients (80.4%) were receiving insulin treatment for at least 6 months. At baseline, the mean HbA1c was 8.5 ± 1.9% and 54.6% of patients had an HbA1c above 8%. 50.4% of the cohort had diabetes for at least 10 years, and fewer of these patients achieved HbA1c <7.0% (53 mmol/mol). At baseline, 65.8% of patients reported that daily SMBG frequency was performed on a random basis. 59.2% of patients reported that they occasionally, rarely or never follow their physician's instructions regarding SMBG. Hypoglycemia occurred in over 50% of patients, although in 71.8% of patients this was a rare occurrence.

CONCLUSIONS

There is low utilization of SMBG in Chinese adults with insulin-treated type 2 diabetes, with approximately two-thirds of patients reporting irregular use of SMBG. This is in line with an overall poor level of glycemic control.

Association between patients' beliefs and oral antidiabetic medication adherence in a Chinese type 2 diabetic population

PURPOSE

The objective of this study was to identify, using the theory of planned behavior (TPB), patients' beliefs about taking oral antidiabetic drugs (OADs) as prescribed, and to measure the correlations between beliefs and medication adherence.

PATIENTS AND METHODS

We performed a cross-sectional study of type 2 diabetic patients using structured questionnaires in a Chinese tertiary hospital. A total of 130 patients were enrolled to be interviewed about TPB variables (behavioral, normative, and control beliefs) relevant to medication adherence. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). Spearman's rank correlation was used to assess the association between TPB and MMAS-8. Logistic regression analysis was performed to examine the relationship between different variables and MMAS-8, with statistical significance determined at P<0.05.

RESULTS

From 130 eligible Chinese patients with an average age of 60.6 years and a male proportion of 50.8%, a nonsignificant relationship between behavioral, normative, and the most facilitating control beliefs and OAD adherence was found in our study. Having the OADs on hand (P=0.037) was the only facilitating control belief associated with adherence behavior. Being away from home or eating out (P=0.000), not accepting the disease (P=0.000), ignorance of life-long drug adherence (P=0.038), being busy (P=0.001), or poor memory (P=0.008) were control belief barriers found to be correlated with poor adherence. TPB is the only important determinant influencing OAD adherence among all the factors (P=0.011).

CONCLUSION

The results indicate that the TPB model could be used to examine adherence to OADs. One facilitating control belief, and most of the barrier control beliefs of TPB were related to medication adherence among Chinese type 2 diabetes inpatients. It will be helpful to understand patients' self-medication and provide methods to develop instruments for identifying factors that influence OAD adherence.

Factors Influencing Self-Management in Chinese Adults with Type 2 Diabetes: A Systematic Review and Meta-Analysis

Diabetes is a major public health problem in China. Diabetes self-management is critical for patients to achieved better health outcomes, however, previous studies have shown suboptimal diabetes self-management performance. We conducted a systematic review and meta-analysis to identify factors associated with diabetes self-management in Chinese adults. The results showed that confrontation, resignation, overall health beliefs, perceived susceptibility, perceived barriers, and self-efficacy were factors associated with overall diabetes self-management performance and six aspects of diabetes self-management behaviors. There is some limited evidence to suggest that provider-patient communication, married individuals, higher educational level, and higher household income level may also be linked to better diabetes self-management practice. Having healthcare insurance and utilizing chronic illness resources generally appeared to have a favorable effect on diabetes self-management performance. In addition, there were a number of factors for which the evidence is too limited to be able to ascertain its strength of association with diabetes self-management practice. The findings of this review suggest that diabetes self-management behaviors are affected by a wide range of personal and environmental factors, which allow health care providers to develop theory-based strategies to improve diabetes-self-management behaviors in this population.

[Self-care among patients enrolled in a self-monitoring blood glucose program]

This cross-sectional study checks specific self-care activities of patients with diabetes mellitus enrolled in a self-monitoring blood glucose program from August to December 2012 in two Primary Health Care units in the interior of São Paulo, Brazil.The sample was composed of 74 female and male individuals, aged 18 years old or older. The Summary of Diabetes Self-Care Activities Questionnaire was used. It contains six dimensions: general diet, specific diet, physical activity, blood glucose monitoring, foot care, medication usage, plus three items about smoking. Eight out of the 15 self-care activities were within desirable levels, namely: healthy diet, not eating sweets, blood glucose testing and as frequently as recommended, drying between toes after washing feet, and taking medications (three items).The results enabled the identification of gaps in specific self-care activities among patients with diabetes mellitus.

Improved self-management skills in Chinese diabetes patients through a comprehensive health literacy strategy: study protocol of a cluster randomized controlled trial

Background

Diabetes self-management often involves the interpretation and application of oral, written, or quantitative information. Numerous diabetes patients in China have limited health literacy, which likely leads to poorer clinical outcomes. This study is designed to examine the efficacy and cost-effectiveness of addressing health literacy to improve self-management skills and glycemic control in Chinese diabetes patients.

Methods/design

This is a cluster randomized controlled trial (RCT) conducted in 20 community healthcare sites in Shanghai, China. Overall, 800 diabetes patients will be randomized into intervention and control arms and will have a baseline hemoglobin A1c (HbA1c) assay and undergo a baseline survey which includes measures of health literacy and diabetes numeracy using revised Chinese versions of the Health Literacy Management Scale and Diabetes Numeracy Test Scale. During the 1-year period of intervention, while the control group will receive usual care, the intervention group will be supplemented with a comprehensive health literacy strategy which includes i) training healthcare providers in effective health communication skills that address issues related to low literacy, and ii) use of an interactive Diabetes Education Toolkit to improve patient understanding and behaviors. Assessments will be conducted at both patient and healthcare provider levels, and will take place upon admission and after 3, 6, 12, and 24 months of intervention. The primary outcome will be the improvement in HbA1c between Intervention group and Control group patients. Secondary outcomes at the patient level will include improvement in i) clinical outcomes (blood pressure, fasting lipids, body mass index, weight, smoking status), ii) patient reported self-management behaviors, and iii) patient-reported self-efficacy. Outcomes at the provider level will include: i) provider satisfaction and ii) intensity and type of care provided. The effects of the intervention will be examined in multivariable general linear models. Both cost-effectiveness and cost-utility analyses will be performed.

Discussion

The main strengths of this study are its large sample size and RCT design, involvement of both patients and healthcare providers, and the long term follow-up (24-months). This project will help to demonstrate the value of addressing health literacy and health communication to improve self-management and clinical outcomes among Chinese diabetes patients.

Trial registration

ISRCTN76130594, Registration date: Sept 22, 2014.

Electronic supplementary material

The online version of this article (doi:10.1186/1745-6215-15-498) contains supplementary material, which is available to authorized users.

Awareness, treatment, control of diabetes mellitus and the risk factors: survey results from northeast China

BACKGROUND

The awareness, treatment and control of diabetes mellitus (DM) can effectively reflect on the social status of diabetes conditions. Although several researchers have investigated the awareness, treatment and control rates of diabetes mellitus in China, little is known about their association with risk factors. This study aims to examine the relationship between risk factors and awareness, treatment and control of diabetes mellitus in northeast China.

METHODS

A cross-sectional survey was conducted in 2012. Multistage stratified random cluster sampling design was used to select participants aged 18 to 79 years old. The analysis was based on a representative sample of 1,854 adult subjects. Multivariable logistic regression analysis was used to examine socio-demographic factors associated with the levels of awareness, treatment and control of diabetes mellitus.

RESULTS

The awareness, treatment, and control rates of diabetes mellitus were 64.1%, 52.9% and 44.2%, respectively. In the multivariable logistic regression analysis, family history of diabetes was significantly positively associated with awareness (OR, 2.145; 95% CI, 1.600-2.875) and treatment (OR, 2.021; 95% CI, 1.559-2.619) of diabetes mellitus, while negatively associated with control (OR, 0.671; 95% CI, 0.529-0.951). Cigarette smokers and alcohol drinkers were less likely than non-smokers and non-drinkers to be aware of their blood glucose levels (OR, 0.895, 0.614; 95% CI, 0.659-1.216, 0.446-0.844, respectively). Participants who frequently exercise were more likely to be aware of their diabetic conditions than people who never or rarely exercise (OR, 2.003; 95% CI, 1.513-2.651).

CONCLUSIONS

We found that the awareness and treatment of diabetes mellitus were positively associated with age and were high in participants with a family history of diabetes and those who exercise frequently, but low for cigarette smokers and alcohol drinkers. Participants with a family history of diabetes had their diabetic condition poorly controlled.