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Falk EM, Staab EM, Deckard AN, Uranga SI, Thomas NC, Wan W, Karter AJ, Huang ES, Peek ME, Laiteerapong N. Effectiveness of Multilevel and Multidomain Interventions to Improve Glycemic Control in U.S. Racial and Ethnic Minority Populations: A Systematic Review and Meta-analysis. Diabetes Care 2024; 47:1704-1712. [PMID: 39190927 PMCID: PMC11362130 DOI: 10.2337/dc24-0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/27/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Racial and ethnic disparities in type 2 diabetes outcomes are a major public health concern. Interventions targeting multiple barriers may help address disparities. PURPOSE To conduct a systematic review and meta-analysis of diabetes self-management education (DSME) interventions in minority populations. We hypothesized that interventions addressing multiple levels (individual, interpersonal, community, and societal) and/or domains (biological, behavioral, physical/built environment, sociocultural environment, and health care system) would have the greatest effect on hyperglycemia. DATA SOURCES We performed an electronic search of research databases PubMed, Scopus, CINAHL, and PsycINFO (1985-2019). STUDY SELECTION We included randomized controlled trials of DSME interventions among U.S. adults with type 2 diabetes from racial and ethnic minority populations. DATA EXTRACTION We extracted study parameters on DSME interventions and changes in percent hemoglobin A1c (HbA1c). DATA SYNTHESIS A total of 106 randomized controlled trials were included. Twenty-five percent (n = 27) of interventions were exclusively individual-behavioral, 51% (n = 54) were multilevel, 66% (n = 70) were multidomain, and 42% (n = 45) were both multilevel and multidomain. Individual-behavioral interventions reduced HbA1c by -0.34 percentage points (95% CI -0.46, -0.22; I2 = 33%) (-3.7 [-5.0, -2.4] mmol/mol). Multilevel interventions reduced HbA1c by -0.40 percentage points (95% CI -0.51, -0.29; I2 = 68%) (-4.4 [-5.6, -3.2] mmol/mol). Multidomain interventions reduced HbA1c by -0.39 percentage points (95% CI -0.49, -0.29; I2 = 68%) (-4.3 [-5.4, -3.2] mmol/mol). Interventions that were both multilevel and multidomain reduced HbA1c by -0.43 percentage points (95% CI -0.55, -0.31; I2 = 69%) (-4.7 [-6.0, -3.4] mmol/mol). LIMITATIONS The analyses were restricted to RCTs. CONCLUSIONS Multilevel and multidomain DSME interventions had a modest impact on HbA1c. Few DSME trials have targeted the community and society levels or physical environment domain. Future research is needed to evaluate the effects of these interventions on outcomes beyond HbA1c.
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Affiliation(s)
- Eli M. Falk
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
| | - Erin M. Staab
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
| | - Amber N. Deckard
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
| | - Sofia I. Uranga
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
| | - Nikita C. Thomas
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
| | - Wen Wan
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
| | | | - Elbert S. Huang
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
| | - Monica E. Peek
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
| | - Neda Laiteerapong
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
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Aje AA, Fakeye TO. Factors associated with disease knowledge and attitude among ambulatory patients with type 2 diabetes - a multicenter study. BMC Endocr Disord 2024; 24:158. [PMID: 39187848 PMCID: PMC11345965 DOI: 10.1186/s12902-024-01696-0] [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: 05/16/2023] [Accepted: 08/19/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Diabetes is a multifactorial disease state that requires adequate patient monitoring for improved health outcomes. Diabetes knowledge and attitude, and associated factors such as medication adherence, medication discrepancy, health literacy, and glycemic control were evaluated in this study. The selected factors were also compared with diabetes knowledge and attitude. METHODS A cross-sectional study was carried out among ambulatory diabetes patients in three tertiary healthcare facilities in Nigeria. An interviewer-administered semi-structured questionnaire was utilized for data collection. Data was analysed using descriptive and inferential statistics with the level of significance set at p < 0.05. RESULTS A total of 188 diabetes patients participated in the study; 51 (27.1%) at the Federal Medical Center, Abeokuta, 69 (36.7%) at the University College Hospital, Ibadan, and 68 (36.2%) at the University of Ilorin Teaching Hospital, Ilorin. One hundred and twelve (59.6%) female patients participated in the study and patients' average age was 58.69 ± 13.68 years. Medication discrepancy was observed among 101 (53.7%) patients. One hundred and three (54.8%), 47 (25.0%) and 38 (20.2%) had high, medium, and low medication adherence, respectively. Ninety-one (48.4%) had high health literacy. Mean diabetes knowledge score was 14.64 ± 2.55 points out of a maximum obtainable score of 18 points. Mean diabetes attitude of patients was 62.50 ± 6.86 points out of a maximum obtainable score of 70 points. Significant positive association was observed between diabetes knowledge and health literacy (Beta = 0.021, p = 0.029). Diabetes knowledge was higher in patients with higher level of formal education (p = 0.046), higher diabetes attitude (p < 0.001) and high health literacy (p = 0.002). Patients' diabetes attitude was higher in individuals older than 60 years of age (p = 0.029), and those with high health literacy (p = 0.005). CONCLUSIONS The diabetes patients displayed good disease knowledge, attitude and medication adherence. Average levels of health literacy and medication discrepancy was observed among the patients. Significant differences were observed between patients' diabetes knowledge and level of formal education, diabetes attitude, health literacy and age. Patients' health literacy was significantly associated with diabetes knowledge.
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Affiliation(s)
- Akinniyi A Aje
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.
| | - Titilayo O Fakeye
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
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Downs LO, Kabagambe K, Williams S, Waddilove E, Delphin M, Lumley SF, Ndungutse R, Kimono B, Newton R, Ko J, Martyn E, Carter J, Kemper A, Monteiro F, O'Regan S, Surey J, Sultan B, Story A, MacDonald D, Tu T, Seeley J, Dusheiko G, Maponga T, Andersson MI, Spearman CW, Tucker JD, Cohen C, Wang S, Adda D, Freeland C, Halford R, Jack K, Ghosh I, Elsharkawy AM, Matthews PC, Flanagan S. Peer support for people living with hepatitis B virus-A foundation for treatment expansion. J Viral Hepat 2024; 31:490-499. [PMID: 38798022 DOI: 10.1111/jvh.13952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/04/2024] [Accepted: 05/05/2024] [Indexed: 05/29/2024]
Abstract
Chronic hepatitis B infection (CHB) affects 300 million people worldwide and is being targeted by the United Nations 2030 Sustainable Development Goals (SDGs) and the World Health Organisation (WHO), working towards elimination of hepatitis B virus (HBV) as a public health threat. In this piece, we explore the evidence and potential impact of peer support to enhance and promote interventions for people living with CHB. Peer support workers (PSWs) are those with lived experience of an infection, condition or situation who work to provide support for others, aiming to improve education, prevention, treatment and other clinical interventions and to reduce the physical, psychological and social impacts of disease. Peer support has been shown to be a valuable tool for improving health outcomes for people living with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), but to date has not been widely available for communities affected by HBV. HBV disproportionately affects vulnerable and marginalised populations, who could benefit from PSWs to help them navigate complicated systems and provide advocacy, tackle stigma, improve education and representation, and optimise access to treatment and continuity of care. The scale up of peer support must provide structured and supportive career pathways for PSWs, account for social and cultural needs of different communities, adapt to differing healthcare systems and provide flexibility in approaches to care. Investment in peer support for people living with CHB could increase diagnosis, improve retention in care, and support design and roll out of interventions that can contribute to global elimination goals.
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Affiliation(s)
- Louise O Downs
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kenneth Kabagambe
- The National Organization for People Living with Hepatitis B (NOPLHB), Kampala, Uganda
| | | | | | | | - Sheila F Lumley
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Robert Newton
- Uganda Virus Research Institute, Entebbe, Uganda
- Department of Health Sciences, University of York, York, UK
| | - Joy Ko
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
| | - Emily Martyn
- London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Diseases, University College London Hospitals, London, UK
| | - Jessica Carter
- The Institute for Infection and Immunity, St George's University of London, London, UK
| | - Agnieszka Kemper
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
| | - Fernando Monteiro
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
| | - Sive O'Regan
- Find and Treat, University College London Hospitals, London, UK
| | - Julian Surey
- Find and Treat, University College London Hospitals, London, UK
- Institute for Global Health, University College London, London, UK
| | - Binta Sultan
- Department of Infectious Diseases, University College London Hospitals, London, UK
- Institute for Global Health, University College London, London, UK
| | - Alistair Story
- Find and Treat, University College London Hospitals, London, UK
| | - Douglas MacDonald
- Department of Hepatology, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Thomas Tu
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology, Sydney Infectious Diseases Institute, The University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia
- HepBCommunity.org, Sydney, New South Wales, Australia
- Hepatitis B Voices Australia, Melbourne, Victoria, Australia
| | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Geoffrey Dusheiko
- Department of Hepatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Tongai Maponga
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Cape Town, South Africa
| | - Monique I Andersson
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Chari Cohen
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
| | - Su Wang
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
- Cooperman Barnabas Medical Center, Florham Park, New Jersey, USA
| | - Danjuma Adda
- World Hepatitis Alliance, London, UK
- CFID/CCT Taraba, Tarabba, Nigeria
| | | | - Rachel Halford
- World Hepatitis Alliance, London, UK
- The Hepatitis C Trust, London, UK
| | - Kathryn Jack
- Hepatology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Indrajit Ghosh
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
- Find and Treat, University College London Hospitals, London, UK
| | - Ahmed M Elsharkawy
- Liver Unit and National Institute for Health Research Biomedical Research Centre at the University Hospitals Birmingham, University of Birmingham, Birmingham, UK
| | - Philippa C Matthews
- The Francis Crick Institute, London, UK
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
- Department of Infectious Diseases, University College London Hospitals, London, UK
| | - Stuart Flanagan
- Mortimer Market Centre, Central North West London NHS Foundation Trust, London, UK
- Department of Infectious Diseases, University College London Hospitals, London, UK
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Chen TT, Su WC, Liu MI. Patient-centered care in diabetes care-concepts, relationships and practice. World J Diabetes 2024; 15:1417-1429. [PMID: 39099822 PMCID: PMC11292325 DOI: 10.4239/wjd.v15.i7.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/11/2024] [Accepted: 05/13/2024] [Indexed: 07/08/2024] Open
Abstract
We still do not have comprehensive knowledge of which framework of patient-centered care (PCC) is appropriate for diabetes care, which elements of PCC are evidence-based, and the mechanism by which PCC elements are associated with outcomes through mediators. In this review, we elaborate on these issues. We found that for diabetes care, PCC elements such as autonomy support (patient individuality), cooperation and collaboration (system-level approach), com-munication and education (behavior change techniques), emotional support (biopsychosocial approach), and family/other involvement and support are critically important. All of these factors are directly associated with different patient outcomes and indirectly associated with outcomes through patient activation. We present the practical implications of these PCC elements.
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Affiliation(s)
- Tsung-Tai Chen
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan
| | - Wei-Chih Su
- Department of Gastroenterology, Taipei Tzu-Chi Hospital, New Taipei 23142, Taiwan
| | - Mei-I Liu
- Department of Pediatric Endocrinology, Mackay Children's Hospital, Taipei 10449, Taiwan
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Iwelomen O, Toniolo J, Preux PM, Beloni P. Therapeutic patient education programs on diabetes in sub-Saharan Africa: A systematic review. PLoS One 2024; 19:e0299526. [PMID: 38935594 PMCID: PMC11210798 DOI: 10.1371/journal.pone.0299526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/13/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Diabetes is a chronic disease associated with the potential for blindness, kidney failure, heart attacks, strokes, and lower limb amputations. The global prevalence of diabetes is rising, particularly in the sub-Saharan African (SSA) region, where accessing treatment and antidiabetic drugs is complex, leading to challenges in managing the condition. Intentional and structured therapeutic education has demonstrated its ability to enhance health outcomes in diabetes patients. Given the numerous healthcare deficiencies in sub-Saharan Africa, the authors have reevaluated the role of therapeutic patient education (TPE) in this context. METHODS This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We queried four databases between March 14 and June 30, 2023 and conducted Cochrane's Risk of Bias analysis on the included studies. Subsequently, a qualitative synthesis of the results was performed. RESULTS The final analysis included thirteen studies. Seven of these, which assessed glycemic control, reported statistically significant results. Additionally, other clinical parameters such as body mass index (BMI), blood pressure, and lipid levels also exhibited some significant improvements. Knowledge substantially increased following the intervention, while attitude, self-care practices, and medication adherence showed no significant improvements. Nurse-led and peer-led intervention programs produced positive outcomes, whereas technology-based intervention methods did not yield favorable results. CONCLUSION TPE programs in sub-Saharan Africa have a significant impact on both clinical and non-clinical outcomes in diabetes patients. However, the sustainability of these outcomes remains uncertain. Further research is needed to assess the long-term effects of TPE on diabetes patients.
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Affiliation(s)
- Omomene Iwelomen
- Institute of Epidemiology and Tropical Neurology, Inserm U1094, IRD UMR270, University Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, OmegaHealth, Limoges, France
| | - Jean Toniolo
- Institute of Epidemiology and Tropical Neurology, Inserm U1094, IRD UMR270, University Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, OmegaHealth, Limoges, France
- Faculté de Médecine et Pharmacie, Département Universitaire de Sciences Infirmières, Université de Limoges, Limoges, France
| | - Pierre-Marie Preux
- Institute of Epidemiology and Tropical Neurology, Inserm U1094, IRD UMR270, University Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, OmegaHealth, Limoges, France
| | - Pascale Beloni
- Institute of Epidemiology and Tropical Neurology, Inserm U1094, IRD UMR270, University Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, OmegaHealth, Limoges, France
- Faculté de Médecine et Pharmacie, Département Universitaire de Sciences Infirmières, Université de Limoges, Limoges, France
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Thomson AM, Rioux BV, Hrubeniuk TJ, Bouchard DR, Sénéchal M. Does type 2 diabetes duration influence the effectiveness of an aerobic exercise intervention: Results from the INTENSITY study. PLoS One 2024; 19:e0304341. [PMID: 38843234 PMCID: PMC11156316 DOI: 10.1371/journal.pone.0304341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/10/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Studies suggest that longer durations of T2DM increase the risk of T2DM complications and premature mortality. However, whether T2DM duration impacts the efficacy of an aerobic exercise intervention is unclear. OBJECTIVE The purpose of this study was: 1) to compare changes in body composition, cardiorespiratory fitness, and glycemia between individuals with short- and long-duration T2DM after aerobic exercise and 2) to determine whether these changes were associated with changes in glycemia by T2DM duration. METHODS A secondary analysis of the INTENSITY study (NCT03787836), including thirty-four adults (≥19 years) with T2DM who participated in 28 weeks of aerobic exercise training for 150 minutes per week at a moderate-to-vigorous intensity (4.5 to 6.0 metabolic equivalents (METs)). Using pre-established cut-points, participants were categorized into two groups 1) short-duration T2DM (<5 years) or 2) long-duration T2DM (≥5 years). Glycemia was measured by glycated hemoglobin (HbA1c), body composition by BodPod, and cardiorespiratory fitness by a measure of peak oxygen consumption (VO2peak). All measurements were performed at baseline, 16 weeks, and 28 weeks. RESULTS Participants in the short-duration T2DM group experienced decreases in fat mass (kg) (p = 0.03), HbA1c (p = 0.05), and an increased relative VO2peak (p = 0.01). Those with long-duration T2DM experienced decreases in fat mass (kg) (p = 0.02) and HbA1c (p <0.001) and increased fat-free mass (p = 0.02). No significant differences were observed between groups in any outcomes. Changes in fat mass (r = 0.54, p = 0.02), and body fat percentage (r = 0.50, p = 0.02) were significantly associated with the change in HbA1c in those with a long-duration T2DM only. CONCLUSION Our results suggest T2DM duration did not differently impact the efficacy of a 28-week aerobic exercise intervention. However, changes in body composition were associated with better glycemia in individuals with longer T2DM duration only.
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Affiliation(s)
- Amy M. Thomson
- Cardiometabolic Exercise & Lifestyle Laboratory, Fredericton, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
| | - Brittany V. Rioux
- Cardiometabolic Exercise & Lifestyle Laboratory, Fredericton, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
| | - Travis J. Hrubeniuk
- CancerCare Manitoba, Canada
- Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Danielle R. Bouchard
- Cardiometabolic Exercise & Lifestyle Laboratory, Fredericton, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
| | - Martin Sénéchal
- Cardiometabolic Exercise & Lifestyle Laboratory, Fredericton, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
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Lind N, Christensen MB, Hansen DL, Willaing I, Nørgaard K. Peer support for adults with type 2 diabetes starting continuous glucose monitoring-An exploratory randomised controlled trial. Diabet Med 2024; 41:e15321. [PMID: 38576173 DOI: 10.1111/dme.15321] [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: 11/13/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
AIMS To explore the feasibility and potential benefits of a peer support programme for adults with insulin-treated type 2 diabetes (T2D) starting continuous glucose monitoring (CGM). METHODS This part of the Steno2tech study is an exploratory, single-centre, open-labelled, prospective, randomised controlled trial (RCT). A total of 60 participants were randomised 2:1 to 12 months of CGM with or without peer support. All participants received a 3-h diabetes self-management education course including a CGM part on how to use the CGM and interpret the CGM-derived data. Peer support consisted of three 3-h peer support meetings over the first 6 months of the study period with groups of three to six people. The exploratory outcomes included the acceptability and feasibility of the peer support intervention, and the between-group difference in change in several glycaemic, metabolic and participant-reported outcomes measured at baseline, 6 and 12 months. RESULTS The peer support intervention was found acceptable and feasible. Participants shared their experiences of using and interpreting CGM data and its association with health behaviour. While both groups had improvements in glycaemic, metabolic and participant-reported outcomes, there were no significant between-group differences. CONCLUSIONS Although feasible, we found no measured additional benefits when adding a peer support programme after starting CGM in this exploratory RCT including adults with insulin-treated T2D. Understanding the perceived effect of and preferences for a peer support intervention from the participants' points of view, including why individuals declined to participate, would be of value for future research.
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Affiliation(s)
- Nanna Lind
- Department of Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Bechmann Christensen
- Department of Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Dorte Lindqvist Hansen
- Department of Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Ingrid Willaing
- Department of Health Promotion Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Nørgaard
- Department of Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Zhang ZC, Du QH, Jia HH, Li YM, Liu YQ, Li SB. A qualitative study on inner experience of self-management behavior among elderly patients with type 2 diabetes in rural areas. BMC Public Health 2024; 24:1456. [PMID: 38822296 PMCID: PMC11140989 DOI: 10.1186/s12889-024-18994-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/29/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND As a chronic metabolic disease, diabetes poses a serious threat to human health and has become a major public health problem in China and worldwide. In 2020, 30% of Chinese people (aged ≥ 60 years) reported having diabetes mellitus. Moreover, individuals with diabetes living in rural areas face a significantly higher mortality risk compared to those in urban areas. In this study, we explored the inner experience of self-management behaviors in elderly patients with type 2 diabetes in rural areas to inform targeted interventions. METHODS A phenomenological research design was used to explore the inner experience of self-management in rural elderly diabetes. Ten elderly diabetic patients were sampled from December 2022 to March 2023 in rural areas of Yangcheng County, Jincheng City, ShanXi Province, China. The seven-step Colaizzi phenomenological was used to analyze the interview data and generate themes. RESULTS Four themes emerged: "Insufficient self-management cognition", "Negative self-management attitude", "Slack self-management behavior", and "No time for self-management". CONCLUSION The level of self-management among elderly patients with type 2 diabetes in rural areas is low. Healthcare professionals should develop targeted interventions aimed at enhancing their cognitive levels, modifying their coping styles, and improving their self-management abilities to improve their quality of life.
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Affiliation(s)
- Zi-Chen Zhang
- Department of Nursing, Harbin Medical University (Daqing), Xinyang Road No. 39, Daqing, 163319, China
| | - Qiu-Hui Du
- Department of Nursing, Harbin Medical University (Daqing), Xinyang Road No. 39, Daqing, 163319, China
| | - Hong-Hong Jia
- Department of Nursing, Harbin Medical University (Daqing), Xinyang Road No. 39, Daqing, 163319, China.
| | - Yu-Min Li
- Department of Nursing, Harbin Medical University (Daqing), Xinyang Road No. 39, Daqing, 163319, China
| | - Yu-Qin Liu
- Department of Nursing, Harbin Medical University (Daqing), Xinyang Road No. 39, Daqing, 163319, China
| | - Shao-Bo Li
- Department of Nursing, Harbin Medical University (Daqing), Xinyang Road No. 39, Daqing, 163319, China
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Chen C, Zhou Y, Xu JY, Song HY, Yin XW, Gu ZJ. Effect of peer support interventions in patients with type 2 diabetes: A systematic review. PATIENT EDUCATION AND COUNSELING 2024; 122:108172. [PMID: 38320444 DOI: 10.1016/j.pec.2024.108172] [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: 07/17/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE This study aims to assess the effectiveness of a peer support intervention on the quality of life (QOL), self-management, self-efficacy, glycated hemoglobin (HbA1c), and depression in patients with type 2 diabetes mellitus (T2DM). METHODS A systematic review was conducted by searching 10 databases, namely PubMed, The Cochrane Library, Embase, Medline, CINHAL, Web of Science, Sinomed, CNKI, WanFang Data, and VIP for articles published from January 1974 to April 2023. RESULTS A total of 12 studies were included. A narrative synthesis of the results showed that peer support significantly improved QOL, self-management, self-efficacy, and HbA1c control in patients with T2DM, but had no significant effect on depression. CONCLUSION Peer support is an effective intervention for individuals with T2DM. Future research should focus on more rigorously designed and larger-sample studies. PRACTICE IMPLICATIONS Peer support proves to be effective for managing patients with T2DM. Current peer support interventions can provide valuable ideas that can guide the direction of future research.
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Affiliation(s)
- Chen Chen
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yuan Zhou
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Jia-Yi Xu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Hai-Yan Song
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xu-Wen Yin
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ze-Juan Gu
- School of Nursing, Nanjing Medical University, Nanjing, China; The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Kalyani RR, Allende-Vigo MZ, Antinori-Lent KJ, Close KL, Das SR, Deroze P, Edelman SV, El Sayed NA, Kerr D, Neumiller JJ, Norton A. Prioritizing Patient Experiences in the Management of Diabetes and Its Complications: An Endocrine Society Position Statement. J Clin Endocrinol Metab 2024; 109:1155-1178. [PMID: 38381587 DOI: 10.1210/clinem/dgad745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Indexed: 02/23/2024]
Abstract
Diabetes can be an arduous journey both for people with diabetes (PWD) and their caregivers. While the journey of every person with diabetes is unique, common themes emerge in managing this disease. To date, the experiences of PWD have not been fully considered to successfully implement the recommended standards of diabetes care in practice. It is critical for health-care providers (HCPs) to recognize perspectives of PWD to achieve optimal health outcomes. Further, existing tools are available to facilitate patient-centered care but are often underused. This statement summarizes findings from multistakeholder expert roundtable discussions hosted by the Endocrine Society that aimed to identify existing gaps in the management of diabetes and its complications and to identify tools needed to empower HCPs and PWD to address their many challenges. The roundtables included delegates from professional societies, governmental organizations, patient advocacy organizations, and social enterprises committed to making life better for PWD. Each section begins with a clinical scenario that serves as a framework to achieve desired health outcomes and includes a discussion of resources for HCPs to deliver patient-centered care in clinical practice. As diabetes management evolves, achieving this goal will also require the development of new tools to help guide HCPs in supporting PWD, as well as concrete strategies for the efficient uptake of these tools in clinical practice to minimize provider burden. Importantly, coordination among various stakeholders including PWD, HCPs, caregivers, policymakers, and payers is critical at all stages of the patient journey.
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Affiliation(s)
- Rita R Kalyani
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | | | | | | | - Sandeep R Das
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Phyllisa Deroze
- dQ&A, The Diabetes Research Company, San Francisco, CA 94117, USA
| | - Steven V Edelman
- Division of Endocrinology, Diabetes & Metabolism at the University of California at San Diego, San Diego, CA 92103, USA
| | - Nuha A El Sayed
- American Diabetes Association, Harvard Medical School, Boston, MA 02215, USA
| | - David Kerr
- Director of Digital Health, Diabetes Technology Society, Santa Barbara, CA 94010, USA
| | - Joshua J Neumiller
- Department of Pharmacotherapy, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA
| | - Anna Norton
- DiabetesSisters, #180, 1112 W Boughton Road, Bolingbrook, IL 60440, USA
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Schmid B, Njeim C, Vijayasingham L, Sanga LA, Naimi RK, Fouad FM, Akik C, Zmeter C, Perone SA, Larsen LB, Roswall J, Ansbro É, Perel P. Implementing (and evaluating) peer support with people living with noncommunicable diseases in humanitarian settings. J Migr Health 2024; 9:100229. [PMID: 38633280 PMCID: PMC11021823 DOI: 10.1016/j.jmh.2024.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
In line with the peer reviewers comments, the authors have added highlights in stead of an abstract. It was felt that it was better able to capture the findings and is more in line with the paper's target audience.
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Affiliation(s)
- Benjamin Schmid
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Lavanya Vijayasingham
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Leah Anku Sanga
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | - Carla Zmeter
- International Committee of the Red Cross, Beirut, Lebanon
| | - Sigiriya Aebischer Perone
- International Committee of the Red Cross, Geneva, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Éimhín Ansbro
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Pablo Perel
- Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Ziegler E, Bartzsch T, Trojan A, Usko N, Krahn I, Bütow S, Kofahl C. Self-help friendliness and cooperation with self-help groups among rehabilitation clinics in Germany (KoReS): a mixed-methods study protocol. BMJ Open 2024; 14:e083489. [PMID: 38508651 PMCID: PMC10961549 DOI: 10.1136/bmjopen-2023-083489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/11/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Self-help is an important complement to medical rehabilitation for people with chronic diseases and disabilities. It contributes to stabilising rehabilitation success and further coping with disease and disability. Rehabilitation facilities are central in informing and referring patients to self-help groups. However, sustainable cooperation between rehabilitation and self-help, as can be achieved using the concept of self-help friendliness in healthcare, is rare, as is data on the cooperation situation. METHODS AND ANALYSIS The KoReS study will examine self-help friendliness and cooperation between rehabilitation clinics and self-help associations in Germany, applying a sequential exploratory mixed-methods design. In the first qualitative phase, problem-centred interviews and focus groups are conducted with representatives of self-help-friendly rehabilitation clinics, members of their cooperating self-help groups and staff of self-help clearinghouses involved based on a purposeful sampling. Qualitative data collected will be analysed through content analysis using MAXQDA. The findings will serve to develop a questionnaire for a quantitative second phase. Cross-sectional online studies will survey staff responsible for self-help in rehabilitation clinics nationwide, representatives of self-help groups and staff of self-help clearinghouses. Quantitative data analysis with SPSS will include descriptive statistics, correlation, subgroup and multiple regression analyses. Additionally, a content analysis of rehabilitation clinics' websites will evaluate the visibility of self-help in their public relations. ETHICS AND DISSEMINATION The University Medical Center Hamburg-Eppendorf Local Psychological Ethics Committee at the Center for Psychosocial Medicine granted ethical approval (reference number LPEK-0648; 10.07.2023). Informed consent will be obtained from all participants. Results dissemination will comprise various formats such as workshops, presentations, homepages and publications for the international scientific community, rehabilitation centres, self-help organisations and the general public in Germany. For relevant stakeholders, practical guides and recommendations to implement self-help friendliness will derive from the results to strengthen patient orientation and cooperation between rehabilitation and self-help to promote the sustainability of rehabilitation processes.
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Affiliation(s)
- Elâ Ziegler
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thea Bartzsch
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alf Trojan
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Usko
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ines Krahn
- Network for Self-Help Friendliness and Patient Orientation in Health Care, Berlin, Germany
| | - Sabine Bütow
- German Working Group Self-Help Groups e.V, Gießen, Germany
| | - Christopher Kofahl
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Meyrowitsch DW, Thi Dang NA, Phong TV, Nielsen J, Søndergaard J, Cuong ND, Le Minh H, Vu TKD, Bygbjerg IC, Gammeltoft TM, Thanh ND. The effects of diabetes clubs on peer-support, disclosure of diabetes status, and sources of information regarding diabetes management: results of a pilot-intervention in rural Vietnam. Public Health 2024; 228:171-177. [PMID: 38364677 DOI: 10.1016/j.puhe.2023.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/13/2023] [Accepted: 12/29/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To measure the effects of diabetes clubs on peer support, disclosure of diabetes status, and the source of information regarding the management of diabetes among persons living with type-2 diabetes (T2D) in rural Vietnam. STUDY DESIGN A pre- and post-pilot intervention study was carried out in Thai Binh Province, Vietnam (n = 222). RESULTS Post-intervention, 57.7 % reported using experiences shared by other persons with T2D during the diabetes club sessions. Compared to pre-intervention, there was an increase in the proportion of persons with T2D who disclosed their diabetes status to friends and/or community members (an increase of 15.3 and 13.8 percentage points, respectively). The proportion of persons who reported gathering their own information regarding diabetes management without any support from others decreased from 15.7 % to 6.3 %. Those who reported a relative inside their home or a relative outside their household as their primary source of T2D-relevant information increased from 10.8 % to 18.6 % and from 2.7 % to 9.5 %, respectively. Persons who mentioned that they did not have a need for further support for their diabetes care increased from 18.5 % to 32.0 %. Specific support regarding diabetes-related knowledge received from family members, friends, and/or community members increased from 27.5 % to 62.2 % CONCLUSIONS: These findings suggest a promising potential for the implementation of diabetes clubs to enhance diabetes-relevant knowledge and the quality of self-management among persons living with T2D diabetes in rural areas of Vietnam.
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Affiliation(s)
- D W Meyrowitsch
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1353, Copenhagen K, Denmark.
| | - N-A Thi Dang
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
| | - T V Phong
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
| | - J Nielsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1353, Copenhagen K, Denmark
| | - J Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Denmark
| | - N D Cuong
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
| | - H Le Minh
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
| | - T K D Vu
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
| | - I C Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1353, Copenhagen K, Denmark
| | - T M Gammeltoft
- Department of Anthropology, University of Copenhagen, Øster Farimagsgade 5, DK-1353 Copenhagen K, Denmark
| | - N D Thanh
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
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Okeyo HM, Biddle M, Williams LB. Impact of Diabetes Self-Management Education on A1C Levels Among Black/African Americans: A Systematic Review. Sci Diabetes Self Manag Care 2024; 50:87-95. [PMID: 37994435 DOI: 10.1177/26350106231213400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
PURPOSE The purpose of this systematic review was to examine the impact of diabetes self-management education (DSME) programs on A1C levels of Black/African American adults with type 2 diabetes. METHODS Authors followed PRISMA guidelines and searched PubMed and CINAHL databases to identify articles published from 2000 to date. The primary outcome was A1C and participation in a DSME program among Black/African Americans with diabetes. RESULTS Nine high-quality randomized control trials (RCTs) were included in this review. Sample sizes ranged between 48 and 211. Studies reported Black/African American samples ranging from 23% to 57% (n = 4), 4 reported 100%, and 1 reported 96%. Most (56%) reported a statistically significant decline in A1C levels postprogram, whereas 44% noted insignificant changes. All the studies compared the DSME intervention effect to a control group or another type of diabetes self-management program. CONCLUSION The results suggest that DSME programs can be effective at lowering A1C levels in Black/African American adults; however, more research with larger sample sizes of Black/African Americans is warranted. The availability of meta-analyses and more RCTs could also further strengthen the external validity of this review. Additionally, future studies focused on A1C outcomes within DSME programs not combined with other self-management interventions among Black/African Americans can advance science regarding the impact of DSME programs among this disparate population.
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Affiliation(s)
- Hilda M Okeyo
- University of Kentucky College of Nursing, Lexington, Kentucky
| | - Martha Biddle
- University of Kentucky College of Nursing, Lexington, Kentucky
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Kunik ME, Evans TL, Christie IC, True G, Bradford A, Vasudevan MM, Hundt NE. The impact of veteran support and resources for diabetes (iNSPiRED) on diabetes distress: Results from a randomized, parallel-group trial. Gen Hosp Psychiatry 2023; 85:55-62. [PMID: 37806018 DOI: 10.1016/j.genhosppsych.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE The primary objective of this research was to assess the impact of a novel, peer-directed intervention (iNSPiRED) on diabetes distress (DD) among veterans with type 2 diabetes and DD. Secondary objectives were to assess iNSPiRED's impact on anxiety, depression, and diabetes self-management behaviors. METHOD A single-blinded, randomized, parallel-group trial was conducted. Participants (n = 218) were recruited through a Veterans Affairs medical center and community agencies in a major metropolitan area from September 2019 through January 2022. Certified mental health peer specialists delivered iNSPiRED, a three-month goal-setting and resource navigation intervention. Outcomes were assessed at baseline, postintervention, and month six. Multilevel random-intercept linear regression models with treatment x time interaction terms were used to assess treatment effects. RESULTS Frequency of following a healthy eating plan was higher for iNSPiRED vs usual care at month three relative to baseline (B = 0.58; p = 0.03) after adjusting for race and socioeconomic status. No other treatment effects differed significantly from zero (ps ≥ 0.05). CONCLUSION Peer-directed interventions have the potential to deliver low-cost, highly scalable care. However, based on the largely negative findings of the current study, it is likely that more intense, multimodal interventions are needed to address DD.
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Affiliation(s)
- Mark E Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, M ichael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA.
| | - Tracy L Evans
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, M ichael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; UTHealth School of Public Health, 1200 Pressler St, 77030 Houston, TX, USA.
| | - Israel C Christie
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, M ichael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Gala True
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA; Southeast Louisiana Veterans Health Care System, 2400 Canal St, New Orleans, LA 70119, USA; Louisiana State University Health Sciences Center, 433 Bolivar St, New Orleans, LA 70112, USA.
| | - Andrea Bradford
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, M ichael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Madhuri M Vasudevan
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA.
| | - Natalie E Hundt
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, M ichael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA.
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Nagpal J, Rawat S, Gupta L, Negi A, Oraon DS. A stepped wedge cluster randomized trial to evaluate the effectiveness of a community leader-driven kit-based diabetes self-management education approach in improving diabetes control and care: study protocol for the DElhi Diabetes INTervention Trial (DEDINTT). Trials 2023; 24:673. [PMID: 37845694 PMCID: PMC10580654 DOI: 10.1186/s13063-023-07712-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Diabetes self-management education (DSME) helps patients self-manage their condition and improve outcomes/quality of life. However, access to DSME is limited, particularly in low-income areas. This study aims to develop a DSME training kit (EK-DIN), understand barriers to implementation, and evaluate the effectiveness and sustainability of community leader (CL)-based rollout using a stepped wedge cluster randomized trial format. METHODS AND ANALYSIS The mixed methods study will begin with a qualitative study to evaluate the facilitators and barriers towards CL-based DSME. The in-depth interview notes will be transcribed for thematic analysis. These results will be utilized for a stakeholder's workshop to develop the EK-DIN kit, a patient-interfacing app, and an implementation plan. Rollout will be conducted in 30 clusters in Delhi, preselected by the DEDICOM-II survey in 5 steps (6 clusters every 3 months: 2 each from each socio-economic category; randomly selected per sequence). A CL from each cluster will be trained in using the EK-DIN kit/app over 1 month. The trained CL will conduct DSME sessions among the cluster residents using the EK-DIN kits provided fortnightly for 3 months. Compliance and blood parameters data will be collected at baseline, 3 months after the intervention, and every quarter thereafter till completion. Change in HbA1c before and after the intervention will be evaluated as the primary outcome using the swCRTdesign package for R version 4.0.2 and the swSummary function. The sustainability of the effects will be evaluated using the change in quarterly parameters after intervention completion. DISCUSSION A positive result will set the template for a generalizable public health intervention with proven community effectiveness, sustainability, cost-effectiveness, and positive quality-of-life impact. While a negative result will require the testing of alternative approaches, it would still add substantially to existing knowledge on the subject. Given the diverse socio-cultural setting in which the trial is being proposed and the high power of the study, the results (positive or negative) should be widely applicable and have policy implications. TRIAL REGISTRATION CTRI/2023/07/054963. Date of Registration: 7th July 2023.
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Affiliation(s)
- Jitender Nagpal
- Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, 110016, India.
| | - Swapnil Rawat
- Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, 110016, India
| | - Lovely Gupta
- Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, 110016, India
| | - Avantika Negi
- Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, 110016, India
| | - Divya Shashi Oraon
- Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi, 110016, India
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Te V, Ma S, Por I, Van Damme W, Wouters E, van Olmen J. Diabetes care components effectively implemented in the ASEAN health systems: an umbrella review of systematic reviews. BMJ Open 2023; 13:e071427. [PMID: 37816569 PMCID: PMC10565207 DOI: 10.1136/bmjopen-2022-071427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVES Association of Southeast Asian Nations (ASEAN) is among the hardest hit low-income and middle-income countries by diabetes. Innovative Care for Chronic Conditions (ICCC) framework has been adopted by the WHO for health system transformation towards better care for chronic conditions including diabetes. We conducted an umbrella review of systematic reviews on diabetes care components effectively implemented in the ASEAN health systems and map those effective care components into the ICCC framework. DESIGN An umbrella review of systematic reviews and/or meta-analyses following JBI (Joanna Briggs Institute) guidelines. DATA SOURCES Health System Evidence, Health Evidence, PubMed and Ovid MEDLINE. ELIGIBILITY CRITERIA We included systematic reviews and/or meta-analyses which focused on management of type 2 diabetes, reported improvements in measured outcomes and had at least one ASEAN member state in the study setting. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted the data and mapped the included studies into the ICCC framework. A narrative synthesis method was used to summarise the findings. The included studies were assessed for methodological quality based on the JBI critical appraisal checklist for systematic reviews and research syntheses. RESULTS 479 records were found of which 36 studies were included for the analysis. A multidisciplinary healthcare team including pharmacists and nurses has been reported to effectively support patients in self-management of their conditions. This can be supported by effective use of digital health interventions. Community health workers either peers or lay people with necessary software (knowledge and skills) and hardware (medical equipment and supplies) can provide complementary care to that of the healthcare staff. CONCLUSION To meet challenges of the increased burden of chronic conditions including diabetes, health policy-makers in the ASEAN member states can consider a paradigm shift in human resources for health towards the multidisciplinary, inclusive, collaborative and complementary team.
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Affiliation(s)
- Vannarath Te
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
- Health Policy Unit, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
- Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
| | - Sokvy Ma
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Ir Por
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
- Management Team, National Institute of Public Health, Phnom Penh, Cambodia
| | - Wim Van Damme
- Health Policy Unit, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Edwin Wouters
- Department of Sociology, Centre for Population, Family & Health, University of Antwerp, Antwerp, Belgium
- Center for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
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Litchfield I, Barrett T, Hamilton-Shield J, Moore T, Narendran P, Redwood S, Searle A, Uday S, Wheeler J, Greenfield S. Current evidence for designing self-management support for underserved populations: an integrative review using the example of diabetes. Int J Equity Health 2023; 22:188. [PMID: 37697302 PMCID: PMC10496394 DOI: 10.1186/s12939-023-01976-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/26/2023] [Indexed: 09/13/2023] Open
Abstract
AIMS With numerous and continuing attempts at adapting diabetes self-management support programmes to better account for underserved populations, its important that the lessons being learned are understood and shared. The work we present here reviews the latest evidence and best practice in designing and embedding culturally and socially sensitive, self-management support programmes. METHODS We explored the literature with regard to four key design considerations of diabetes self-management support programmes: Composition - the design and content of written materials and digital tools and interfaces; Structure - the combination of individual and group sessions, their frequency, and the overall duration of programmes; Facilitators - the combination of individuals used to deliver the programme; and Context - the influence and mitigation of a range of individual, socio-cultural, and environmental factors. RESULTS We found useful and recent examples of design innovation within a variety of countries and models of health care delivery including Brazil, Mexico, Netherlands, Spain, United Kingdom, and United States of America. Within Composition we confirmed the importance of retaining best practice in creating readily understood written information and intuitive digital interfaces; Structure the need to offer group, individual, and remote learning options in programmes of flexible duration and frequency; Facilitators where the benefits of using culturally concordant peers and community-based providers were described; and finally in Context the need to integrate self-management support programmes within existing health systems, and tailor their various constituent elements according to the language, resources, and beliefs of individuals and their communities. CONCLUSIONS A number of design principles across the four design considerations were identified that together offer a promising means of creating the next generation of self-management support programme more readily accessible for underserved communities. Ultimately, we recommend that the precise configuration should be co-produced by all relevant service and patient stakeholders and its delivery embedded in local health systems.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Tim Barrett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK
| | - Julian Hamilton-Shield
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 2NT, UK
- The Royal Hospital for Children in Bristol, Bristol, BS2 8BJ, UK
- NIHR Bristol BRC Nutrition Theme, University Hospitals Bristol and Weston Foundation Trust, Bristol, B52 8AE, UK
| | - Theresa Moore
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
- Queen Elizabeth Hospital, Birmingham, B15 2GW, UK
| | - Sabi Redwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Aidan Searle
- NIHR Bristol BRC Nutrition Theme, University Hospitals Bristol and Weston Foundation Trust, Bristol, B52 8AE, UK
| | - Suma Uday
- Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jess Wheeler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
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Mannucci E, Candido R, Monache LD, Gallo M, Giaccari A, Masini ML, Mazzone A, Medea G, Pintaudi B, Targher G, Trento M, Turchetti G, Lorenzoni V, Monami M. 2023 update on Italian guidelines for the treatment of type 2 diabetes. Acta Diabetol 2023; 60:1119-1151. [PMID: 37233852 PMCID: PMC10290044 DOI: 10.1007/s00592-023-02107-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Edoardo Mannucci
- Diabetology, Azienda Ospedaliero-Universitaria Careggi, Careggi Hospital, University of Florence, Via Delle Oblate 4, 50141, Florence, Italy.
| | | | | | - Marco Gallo
- Endocrinology and Metabolic Diseases, Hospital of Alessandria, Alessandria, Italy
| | - Andrea Giaccari
- Endocrinology and Metabolic Diseases, Gemelli Hospital, Catholic University of Rome, Rome, Italy
| | | | | | - Gerardo Medea
- Società Italiana di Medicina Generale (SIMG), Florence, Italy
| | | | - Giovanni Targher
- Endocrinology, Diabetology and Metabolic Diseases, University of Verona, Verona, Italy
| | - Marina Trento
- Laboratory of Clinical Pedagogy, University of Turin, Turin, Italy
| | | | | | - Matteo Monami
- Diabetology, Azienda Ospedaliero-Universitaria Careggi, Careggi Hospital, University of Florence, Via Delle Oblate 4, 50141, Florence, Italy
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20
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Baker KM, Nassar CM, Baral N, Magee MF. The current diabetes education experience: Findings of a cross-sectional survey of adults with type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2023; 108:107615. [PMID: 36584557 DOI: 10.1016/j.pec.2022.107615] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/06/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To survey persons with type 2 diabetes (PWD) on their experiences with diabetes education to better understand what it means when a PWD says they have "had diabetes education." METHODS We conducted a cross-sectional descriptive study among a convenience sample of adult PWD receiving primary care and/or diabetes self-management education and support in a mid-Atlantic regional US healthcare system. Descriptive, bivariate, and regression analyses were used to describe and explore the diabetes education experience. RESULTS Participants (n = 498) were majority female, African American, and non-Hispanic. Half reported having "had diabetes education." Of those, 44% had only one session. Education was most often provided in clinical settings by a dietitian (68%) or doctor (51%), in one-on-one (70%) sessions. While most participants reported receiving core diabetes knowledge, fewer reported education on topics that are not related to their daily routine, such as what to do about diabetes medications when sick. CONCLUSION The self-reported diabetes education experience varies in content, modality, setting, and education provider. Education receipt is low, and for those who receive education, the amount is low. PRACTICAL IMPLICATIONS The diabetes education experience may fall short of the comprehensive US National Standards-recommended process. Innovative strategies are needed to address these gaps.
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Affiliation(s)
- Kelley M Baker
- MedStar Health Institute for Quality and Safety, 10980 Grantchester Way, Columbia, MD 21044, USA.
| | - Carine M Nassar
- MedStar Health Diabetes and Research Institutes, 100 Irving Street NW, EB 4114, Washington, DC 20010, USA.
| | - Neelam Baral
- MedStar Washington Hospital Center, Department of Medicine, 110 Irving Street NW, Washington, DC 20010, USA.
| | - Michelle F Magee
- MedStar Health Diabetes and Research Institutes, 100 Irving Street NW, EB 4114, Washington, DC 20010, USA; Georgetown University School of Medicine, Department of Medicine, 3900 Reservoir Road NW, Washington, DC 20007, USA.
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21
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Tang TS, Afshar R, Elliott T, Kong J, Gill S. From clinic to community: A randomized controlled trial of a peer support model for adults with type 2 diabetes from specialty care settings in British Columbia. Diabet Med 2022; 39:e14931. [PMID: 36052812 DOI: 10.1111/dme.14931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/12/2022] [Accepted: 07/31/2022] [Indexed: 11/30/2022]
Abstract
AIMS To examine the impact of a 12-month peer-led diabetes self-management support intervention delivered via telephone amongst adults with type 2 diabetes (T2D) from specialty care settings in British Columbia (BC). METHODS One-hundred ninety-six adults with T2D were randomly assigned to either a 12-month Peer-Led, Empowerment-based, Approach, to Self-management Efforts in Diabetes (PLEASED) intervention or a usual care condition. PLEASED involved weekly telephone contacts from a peer leader (PL) in the first 3 months followed by bi-weekly telephone contacts in the last 9 months. Assessments were conducted at baseline, 3 and 12 months. The primary outcome was HbA1c ; secondary outcomes included diabetes distress (DD), ApoB, systolic and diastolic blood pressure (BP), body mass index, waist circumference and depressive symptoms. RESULTS No within or between group changes were observed for HbA1c at 3 or 12 months. However, amongst participants with HbA1c ≥ 69 mmol/mol (8.5%), the PLEASED group significantly lowered their HbA1c at 12 months [-11.7 mmol/mol (-1.07%); 95% CI: -20.7, -2.5 (-1.89, -0.23); p = 0.016] compared to usual care. Amongst secondary outcomes, within-group improvements in overall DD were found at 3 months (-0.21; 95% CI: -0.35, -0.08; p = 0.002) for the PLEASED group and at 12 months for both groups (PLEASED: -0.35; 95% CI: -0.49, -0.21; p < 0.001 and control: -0.33; 95% CI: -0.47, -0.19; p < 0.001), however, no between-group differences were observed. The PLEASED group improved systolic BP at 12 months (-5.4 mm Hg; 95% CI: -10.0, -0.8; p = 0.023) compared to usual care. CONCLUSIONS Participation in a peer support intervention in diabetes delivered via telephone leads to long-term improvements in HbA1c amongst high-risk adults with T2D living in BC. TRIAL REGISTRATION The study was registered on clinicaltrials.gov (NT02804620).
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Affiliation(s)
- Tricia S Tang
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rowshanak Afshar
- Department of Family Medicine, University of British Columbia, West Vancouver, British Columbia, Canada
| | - Thomas Elliott
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Kong
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabrina Gill
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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22
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Majjouti K, Küppers L, Thielmann A, Redaélli M, Vitinius F, Funke C, van der Arend I, Pilic L, Hessbrügge M, Stock S, Weltermann B, Wild D. Family doctors’ attitudes toward peer support programs for type 2 diabetes and/or coronary artery disease: an exploratory survey among German practitioners. BMC PRIMARY CARE 2022; 23:220. [PMID: 36045339 PMCID: PMC9427433 DOI: 10.1186/s12875-022-01827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022]
Abstract
Background Type 2 diabetes (T2D) and coronary artery disease (CAD) are chronic illnesses where adherence to a healthy lifestyle is crucial. If organisational and cultural factors are well managed, Peer support programs (PSP) can improve self-management, quality of life, and health outcomes. In preparation for launching a PSP, we surveyed family doctors (FD) about their attitudes toward such a program and about potential barriers, and facilitators. Methods In March 2020 we surveyed 896 FDs from five university teaching practice networks in North-Rhine Westphalia, Germany, via an anonymous web-based survey. The questionnaire addressed details of PSPs, including suitable patients and FDs‘role. Data were analysed using descriptive and inferential statistics; qualitative material underwent content analysis by two researchers. Results A total of 165 FDs responded (response rate: 18.4%), 97% were practice owners. Respondents viewed PSPs positively (T2D: 92.0%, CAD 89.9%), especially for patients with poor self-structuring (82.7%), low motivation (76.3%) and few social contacts (67.6%). On average, FDs were able to identify 4.0 ± 3.2 patients as potential group leaders. Major facilitators reported included motivation by peers (92.5%), exercise (79.1%), and social contacts (70.1%). Waning interest over time (73.1%) and poor motivation (70.9%) were considered barriers. The majority of FDs would recommend PSPs to their patients (89.5%). They considered such a program a valuable addition to current care (79.7%). The percentage of FDs’ who expected long-term benefits for their workload was relatively low (37.6%). Conclusions In an exploratory survey among German FDs on PSPs, respondents viewed PSPs as a valuable add-on for T2D and CAD patients, while not expecting a positive impact on their workload. Communication with FDs on PSPs may need to highlight anticipated implementation outcomes such as benefits of PSPs to the practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01827-3.
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