Impact of chronic disease self-management programs on type 2 diabetes management in primary care

SMS texting for uncontrolled diabetes among persons experiencing homelessness: Study protocol for a randomized trial

BACKGROUND

Diabetes mellitus (DM) is common among persons experiencing homelessness (PEH), often inadequately managed, and carries significant costs. mHealth strategies including short messaging service (SMS) texting have been feasible and acceptable, and improved control of chronic diseases including DM. SMS strategies for DM have not been tested among PEH despite the accessibility of mobile phones. We propose an SMS strategy could offer better communication, education, and information management; improve outreach; facilitate care coordination; explore barriers to care; and support behavior changes.

METHODS AND ANALYSIS

This mixed-methods (RCT and qualitative) study will be implemented in shelter-clinics in New York City in collaboration with community organizations, allowing for sustainability and scalability. Aim 1 will evaluate the efficacy of a 6-month SMS program for DM management versus an attention control on changes in HbA1c and adherence to DM self-care activities, medications, and appointments at 9 months in adult PEH with uncontrolled DM (n = 100). Outcomes will be measured at 0, 3, 6, &9 months. AIM 2 will assess patients' and providers' attitudes, acceptability, and experience of the program through semi-structured interviews with PEH (n = 20) and providers (n = 10).

DISCUSSION

DM is not well-addressed among PEH. SMS strategies for DM have never been tested in PEH despite evidence of their effectiveness and access to mobile phones among PEH. Results from this study will provide important empirical data to inform evidence-based strategies to avert personal suffering and significant costs. It will have broader policy implications in control of DM and other chronic diseases.

Building an understanding of goal-oriented care through the experiences of people living with chronic conditions

OBJECTIVE

To understand the concept of goal-oriented care (GOC) through the experiences of people with chronic conditions.

METHOD

Interviews with people living with chronic conditions (n = 50) were analyzed in two ways. A deductive approach based on GOC attributes generated in a concept analysis on GOC: goal-elicitation, goal-setting, goal-evaluation, patients' context, and patients' needs and preferences. An inductive approach based on a thematic analysis using descriptive phenomenology.

RESULTS

The phase of goal-elicitation was recognized by the participants, whereas goal-setting and goal-evaluation were experienced to a lesser extent. Regarding the underpinning attributes, mixed feelings were reported concerning the integration of the patient's context and the presence of their needs and preferences throughout the care process. The inductive analysis revealed specific attention to informing patients about their condition and treatment options and discussing goals in interprofessional collaboration.

CONCLUSION

Goal-elicitation was already present and seems to be a good foundation for GOC. More attention should be given to goal-setting and goal-evaluation.

PRACTICE IMPLICATIONS

Developing guidance by means of a workflow, tools, or questions might support people with chronic conditions and providers to underpin the entire care process with patients' personal goals.

Effects of patient education on the quality of life of patients with type 2 diabetes mellitus: A scoping review

INTRODUCTION

Patient education is an integral component of diabetes mellitus care. The emergence of different methods and characteristics of patient education has led to varying outcomes of quality of life (QoL). Herein, we systematically searched for published studies reporting patient education and its methods and characteristics for improving the QoL of patients with type 2 diabetes mellitus (T2DM).

METHOD

In this scoping review, eligible studies from six databases (PubMed, Scopus, Cochrane Library, Springer Link, Science Direct and Google Scholar) were identified. The keywords used in the search strategies were as follows: health education, health promotion, patient education, diabetes care, QoL, diabetes mellitus and type 2 diabetes mellitus. Two reviewers independently screened all references and full-text articles retrieved to identify articles eligible for inclusion.

RESULTS

A total of 203 articles were identified in the initial search. Of them, 166 were excluded after screening the titles and abstracts. Further full-text screening led to the subsequent removal of 22 articles, leaving 15 articles eligible for data extraction.

CONCLUSION

There is a broad array of methods of patient education for improving the QoL of patients with T2DM. Self-management education with supplementary supervision and monitoring effectively improves QoL. Future studies must emphasise the application of holistic education covering psychological distress, diet plan, and physical health.

Self-management Behavior Interventions for Type 2 Diabetes Mellitus: A Review

BACKGROUND: Diabetes mellitus is chronic diseases with serious complications and reduces the quality of life of patients. Evidence based strategies to enhance diabetes self-management may prevent complications and enhance the quality of life for patients is needed. AIM: This study to summarize the types of intervention strategies used to enhance diabetes self-management behaviors in adult individuals type 2 diabetes mellitus (T2DM). METHOD: This study was used Literature review randomized controlled trials study. PubMed, Scopus, Web of Science, and Cochrane Library data base were used. Jadad scale checklist was used to evaluate quality appraisal included in the study. RESULTS: Twenty-six randomized controlled trials studies were included in this review. Overall, quality of the studies was high-quality. Varied interventions included studies at different countries were found to enhance diabetes self-management behaviors in T2DM patients. In addition, almost type interventions were reported a significant enhancement diabetes self-management behaviors especially in adults with type 2 diabetes patients. CONCLUSION: Varied self-management behavior interventions in diabetes mellitus. This review suggested for investigate best intervention to enhance diabetes self-management behaviors in different cultural for best outcomes.

Self-management Education Program: The Case of Glycemic Control of Type 2 Diabetes

Objectives

Self-management education (SME) is recognized globally as a tool that enables patients to achieve optimal glucose control. While factors influencing the effectiveness of self-management interventions have been studied extensively, the impact of program length on clinical endpoints of patients diagnosed with diabetes is underdeveloped. This paper synthesized information from the existing literature to understand the effect of program length on glycated hemoglobin (HbA_1C) in adults with type 2 diabetes mellitus.

Methods

We searched Web of Science, PubMed, Scopus, MEDLINE, EMBASE, PsychINFO, and the Cochrane Central Register of Controlled Trials to identify relevant English language publications on diabetes self-management education published between January 2000 and April 2019.

Results

The review included 25 randomized controlled trials, with 64.0% reporting significant changes in HbA_1C. The studies classified as long-term (lasting one year and above) were associated with the greatest number of interventions achieving statistically significant (87.5% significant vs. 12.5% non-significant) differences in changes in HbA_1C between the intervention and the control subjects, recording an overall between-group HbA_1C mean difference of 0.6±0.3% (range = 0.2–1.2).

Conclusions

Our findings suggest that program length may change the effectiveness of educational interventions. Achieving sustained improvements in patients’ HbA_1C levels will require long-term, ongoing SME, and support.

Self-management of persons living with diabetes mellitus type 2: Experiences of diabetes nurse educators

Background

The global pandemic of diabetes mellitus type 2 (DM2) is the direct cause of significant health and economic problems for both governments and individuals owing to the high level of morbidity and mortality. South Africa has the second highest incidence of DM2 in sub-Saharan Africa.

Aim

This article describes the experiences of diabetes nurse educators in relation to self-management of DM2 of persons living with DM2.

Setting

This article involves nurse educators working in diabetes clinics in public and private hospitals in Nelson Mandela Bay Municipality, South Africa.

Methods

A semi-structured interview guide was used to collect data from a focus group interview comprising three participants and two individual interviews. The interviews were recorded with the permission of participants, transcribed and then coded using Tesch’s model of data analysis. Themes were agreed upon with the consensus of the researcher, two supervisors and an independent coder.

Results

Three themes were identified: (1) diabetes nurse educators have clear perceptions about the importance of self-management of DM2 of persons living with DM2, (2) there are factors that affect persons living with DM2 with respect to self-management and (3) there are ways in which professional nurses can assist persons living with DM2 in the self-management of their condition.

Conclusion

This article identified factors that diabetes nurse educators experienced in either assisting or hindering patients in self-management of their DM2. The diabetes nurse educators voiced their views on how professional nurses can provide support to the patients living with DM2.

Replicating group-based education interventions for the management of type 2 diabetes: a review of intervention reporting

AIMS

To assess the completeness of reporting of group-based education interventions for the management of type 2 diabetes.

METHODS

A previous systematic review of group-based education programmes for adults with type 2 diabetes identified eligible intervention studies. Data were extracted and assessed using the Template for Intervention Description and Replication ('TIDieR') checklist. Missing data were sourced from other published material, or by contacting authors.

RESULTS

Fifty-three publications describing 47 studies were included. No publications sufficiently described all items. Authors of 43 of the 47 included studies (91%) were contacted via e-mail to obtain missing data in order to complete the TIDieR checklist. Seven (16%) did not respond. Additional data were obtained for 33/47 studies (70%). Most studies (45/47, 96%) described the intervention duration and frequency, detailed the procedures and rationale (40/47, 85%), provided a brief intervention name and explained any individual tailoring (38/47, 81%), defined whether providers received training and adequately described how the programme was delivered (37/47, 79%). However, few described any modifications (28/47, 60%), whether the intervention was delivered as planned (27/47, 57%), where it was delivered (21/47, 45%), whether materials were provided (19/47, 40%), and who delivered the intervention (13/47, 28%).

CONCLUSIONS

Group-based education interventions for the management of type 2 diabetes are poorly reported. To translate effective research into practice, practitioners need sufficient detail to implement evidence-based interventions. Researcher adoption of the TIDieR checklist will assist the translation and replication of published interventions.

Participation of lower-to-middle wage workers in a study of Chronic Disease Self-Management Program (CDSMP) effectiveness: Implications for reducing chronic disease burden among racial and ethnic minority populations

BACKGROUND

Although the Chronic Disease Self-Management Program (CDSMP) improves chronic disease outcomes, little is known about CDSMP participation in populations less than 65 years of age. We explore study and CDSMP participation rates by demographic characteristics with younger (40-64 years old), lower-to-middle wage workers with chronic disease in a randomized clinical trial (RCT) conducted in North Carolina.

METHODS

Descriptive statistics and regression models were used to examine associations between demographic, chronic disease burden, and employment variables, and time-dependent study enrollment and intervention participation outcomes that ranged from initiating consent (n = 1,067) to CDSMP completion (n = 41).

RESULTS

Overall, participation among non-Whites was disproportionately higher (43%-59%) than that of Whites (42%-57%) relative to the age-matched racial composition of North Carolina (31% non-White and 69% White). Among participants randomized to the CDSMP, racial and ethnic minorities had the highest rates of participation. There were no significant demographic, chronic disease burden, or employment predictors among the participation outcomes examined, although this may have been due to the limited number of CDSMP workshop participation observations.

CONCLUSIONS

Extending the CDSMP to lower-to-middle wage workers may be particularly effective in reaching racial and ethnic minority populations, who complete the program to a greater extent than their White, non-Hispanic counterparts.

An iron triangle ROI model for health care

Objective

Few, if any, return on investment (ROI) analyses of health programs make systematic considerations of patient access, instead focusing principally on gains related to cost and quality. The objective of this study was to develop an open-source model that adds an estimation of gains in patient access to a traditional ROI analysis. A classification system for quantifying gains in patient access is proposed.

Materials and methods

An Excel-based ROI model was built that not only incorporated traditional ROI considerations – cost savings and patient cases avoided – but also addressed changes in patient access. The model was then applied in a case study using New Mexico Medicaid data and two proposed initiatives – a statewide health information exchange (HIE) and a community health worker (CHW) program that focused on chronic disease patients. Savings, Health, Outreach, and Access estimates were derived from the literature. ROI estimates were produced that also incorporated relative gains in patient access.

Results

Combined, the HIE and CHW programs are predicted to generate a positive ROI by the fourth year, growing to 45% by the program’s tenth year. Total estimated cumulative cost for both programs after 10 years is $9,555,226. Total estimated cumulative saving for both programs after 10 years is $11,332,899. Access-related costs begin moderately in year 1 at $122,766 and grow to $1,858,274 by year 10. The model estimates an Access score of 19 in year 1. This figure grew to 380 by year 10.

Conclusion

Our model shows that a rough estimation of gains in to patient access can be incorporated to traditional ROI analyses. The results of our case study suggest that a CHW program and statewide HIE can generate a positive ROI for the state’s Medicaid program.

Self-Care and Self-Management Among Adolescent T2DM Patients: A Review

Uncontrolled hyperglycaemia can lead to macro- and microvascular complications. Adolescents with T2DM develop similar complications as in adults, including cardiovascular disease, stroke, myocardial infarction, renal insufficiency, and chronic renal failure. Although regular medical follow-up is essential to avoid long-term complications, patients with diabetes mellitus need to perform holistic self-care activities such as opting for a healthy diet, physical activity, self-monitoring, and proper medication. To the best of our knowledge, only a limited number of studies have focused on self-care activities and self-management, including self-care practices, supportive networks, and self-care education programs in adolescent with T2DM. Some of the studies focused on the appreciation of self-care in adolescents with T2DM. This review aimed to analyse self-care and self-management among adolescents with T2DM, and discuss the impact of self-care and self-management on glycaemic control. The difficulties faced by adolescents in self-managing their disease are also highlighted. Such information is essential for healthcare providers in promoting self-care practices among adolescents with T2DM. A thorough search of the literature was performed using three databases: Medline, Google Scholar, and Scopus. The articles focused on self-care and self-management of adolescents patients with T2DM aged between 12 and 19 years old were included. Findings from this review reveal that healthy food adaptation, adequate physical activity, proper medication practices, and regular glucose monitoring are the most common self-care practices. Parental involvement and clinician encouragement also contribute toward the practice of self-care and self-management among the adolescents with T2DM. In conclusion, independent self-management regimens and supportive networks for appropriate administration are vital factors to enhance clinical outcomes of adolescents with T2DM.

Improving the Documentation Process for Referrals into Diabetes Education: A Quality Improvement Project

The purpose of this project was to standardize the referral and documentation process for diabetes education in patients with type 2 diabetes. The goal was to refer all eligible patients with type 2 diabetes into diabetes education. A standardized template within the clinical note was created to capture if the patients had ever received diabetes education. Use of this template by the clinician improved documentation about diabetes education and increased referrals into diabetes education programs. The findings of this project can be applied to other primary care clinics to help increase the historically low referrals rates into diabetes education.

Impact of the self-care education program on quality of life in patients with type II diabetes

INTRODUCTION

Diabetes is an irreversible disease requiring lifetime self-care and rehabilitation. Patient education to improve their ability in administering self-care is also effective, lowering the risks of developing complications and promoting the quality of life. This study was conducted to assess the effect of self-care educational programs in promoting the quality of life of diabetic patients.

METHODS

In this pre-test/post-test intervention study design, 30 diabetes patients were included on the basis of a non-randomized sampling, using each subject as her/his own control. The self-care educational program was introduced to participants by researcher through two 55-min sessions. Quality of life by using Iranian Short Form Health Survey was assessed before and after the educational sessions. The paired t-test was used to compare the total and subscale mean scores of the Quality of life before and after the training.

RESULTS

Finding showed that there was a significant increase in General health (P=0.027), Physical role (P<0.001), Physical functioning (P=0.027), Social functioning (P=0.029) and Body pain (P=0.020).

CONCLUSION

The results from the present study demonstrate that structured patient education improves patients 'well-being' after the teaching program. Diabetes educational program should be a basis for the management of diabetes.

Improving diabetes care for people with intellectual disabilities: a qualitative study exploring the perceptions and experiences of professionals in diabetes and intellectual disability services

BACKGROUND

Globally, diabetes is increasing with concerns about the impact on outcomes, including premature death and the costs associated with managing the condition. Research indicates that adults with intellectual disabilities (ID) are two to three times more likely to develop diabetes; however, there has been limited focus on diabetes service utilisation in this population. The aim of this study is to explore the perceptions and experiences of diabetes and ID practitioners.

METHODS

A series of 1:1 semi-structured interviews were undertaken in one Scottish health service area. In total, 29 qualitative interviews were conducted: 10 with diabetes practitioners from primary and secondary care, 14 from ID services and 5 from community care services regarding diabetes service provision for this population. Thematic content analysis was undertaken to identify the themes and subthemes.

RESULTS

Three main themes were identified: (1) enabling access to services to meet diabetes-related care needs of people with ID; (2) communication and service improvements between staff, patients and across services; and (3) providing person-centred diabetes care and developing adapted resources to increase patient self-care.

CONCLUSIONS

The findings of this study have important international implications in how diabetes practitioners plan and deliver services for people with ID and other vulnerable groups with limited cognitive ability and communication skills and difficulties in self-management. The findings highlight that access to diabetes education and adapted resources is needed, and if 'reasonable adjustments' are made to service provision and practice, people with ID can benefit from improved healthcare. Developing joint clinics to share knowledge and resources between diabetes and ID practitioners may improve service delivery and continuity of care, and thereby diminish the costs of not providing quality care.

Development and Implementation of a Collaborative Team Care Model for Effective Insulin Use in an Academic Medical Center Primary Care Network

Improving glycemic control across a primary care diabetes population is challenging. This article describes the development, implementation, and outcomes of the Diabetes Care Collaborative Model (DCCM), a collaborative team care process focused on promoting effective insulin use targeting patients with hyperglycemia in a patient-centered medical home model. After a pilot, the DCCM was implemented in 18 primary care practices affiliated with an academic medical center. Its implementation was associated with improvements in glycemic control and increase in insulin prescription longitudinally and across the entire population, with a >1% reduction in the proportion of glycated hemoglobin >9% at 2 years after the implementation compared with the 2 years prior ( P < .001). Facilitating factors included diverse stakeholder engagement, institutional alignment of priorities, awarding various types of credits for participation and implementation to providers, and a strong theoretical foundation using the principles of the collaborative care model.

Barriers to Self-management of Serious Mental Illness and Diabetes

OBJECTIVES

Individuals with serious mental illness (SMI) (major depressive disorder, bipolar disorder, schizophrenia), and diabetes (DM), face significant challenges in managing their physical and mental health. The objective of this study was to assess perceived barriers to self-management among patients with both SMI and DM in order to inform healthcare delivery practices.

METHODS

We conducted 20 in-depth interviews with persons who had diagnoses of both SMI and DM. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis with an emphasis on dominant themes.

RESULTS

Transcript-based analysis generated 3 major domains of barriers to disease self-management among patients with both DM and SMI: (1) personal level barriers (stress, isolation, stigma); (2) family and community level barriers (lack of support from family and friends); and (3) provider and health care system level barriers (poor relationships and communication with providers, fragmentation of care).

CONCLUSIONS

Care approaches that provide social support, help in managing stress, optimize communication with providers, and reduce compartmentalization of medical and psychiatric care are needed to help these vulnerable individuals avoid health complications and premature mortality.

Outside the exam room: policies for connecting clinic to community in diabetes prevention and treatment

The public health burden and racial/ethnic, sex, and socioeconomic disparities in obesity and in diabetes require a population-level approach that goes beyond provision of high-quality clinical care. The Robert Wood Johnson Foundation’s Commission to Build a Healthier America recommended 3 strategies for improving the nation’s health: 1) invest in the foundations of lifelong physical and mental well-being in our youngest children; 2) create communities that foster health-promoting behaviors; and 3) broaden health care to promote health outside the medical system. We present an overview of evidence supporting these approaches in the context of diabetes and suggest policies to increase investments in 1) adequate nutrition through breastfeeding and other supports in early childhood, 2) community and economic development that includes health-promoting features of the physical, food, and social environments, and 3) evidence-based interventions that reach beyond the clinical setting to enlist community members in diabetes prevention and management.

Effectiveness of peer support for improving glycaemic control in patients with type 2 diabetes: a meta-analysis of randomized controlled trials

Background

To assess the effects of peer support at improving glycemic control in patients with type 2 diabetes.

Methods

Relevant electronic databases were sought for this investigation up to Dec 2014. Randomized controlled trials involving patients with type 2 diabetes that evaluated the effect of peer support on glycated hemoglobin (HbA1c) concentrations were included. The pooled mean differences (MD) between intervention and control groups with 95% confidence interval (CI) were calculated using random-effects model. The Cochrane Collaboration’s tool was used to assess the risk of bias.

Results

Thirteen randomized controlled trials met the inclusion criteria. Peer support resulted in a significant reduction in HbA1c (MD −0.57 [95% CI: −0.78 to −0.36]). Programs with moderate or high frequency of contact showed a significant reduction in HbA1c levels (MD −0.52 [95% CI: −0.60 to −0.44] and −0.75 [95% CI: −1.21 to −0.29], respectively), whereas programs with low frequency of contact showed no significant reduction (MD −0.32 [95% CI: −0.74 to 0.09]). The reduction in HbA1c were greater among patients with a baseline HbA1c ≥ 8.5% (MD −0.78 [95% CI: −1.06 to −0.51]) and between 7.5 ~ 8.5% (MD −0.76 [95% CI: −1.05 to −0.47]), than patients with HbA1c < 7.5% (MD −0.08 [95% CI: −0.32 to 0.16]).

Conclusions

Peer support had a significant impact on HbA_1c levels among patients with type 2 diabetes. Priority should be given to programs with moderate or high frequency of contact for target patients with poor glycemic control rather than programs with low frequency of contact that target the overall population of patients.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1798-y) contains supplementary material, which is available to authorized users.

Psychological aspects of diabetes care: Effecting behavioral change in patients

Patients with diabetes mellitus (DM) need psychological support throughout their life span from the time of diagnosis. The psychological make-up of the patients with DM play a central role in self-management behaviors. Without patient’s adherence to the effective therapies, there would be persistent sub-optimal control of diseases, increase diabetes-related complications, causing deterioration in quality of life, resulting in increased healthcare utilization and burden on healthcare systems. However, provision of psychosocial support is generally inadequate due to its challenging nature of needs and demands on the healthcare systems. This review article examines patient’s psychological aspects in general, elaborates in particular about emotion effects on health, and emotion in relation to other psychological domains such as cognition, self-regulation, self-efficacy and behavior. Some descriptions are also provided on willpower, resilience, illness perception and proactive coping in relating execution of new behaviors, coping with future-oriented thinking and influences of illness perception on health-related behaviors. These psychological aspects are further discussed in relation to DM and interventions for patients with DM. Equipped with the understanding of the pertinent nature of psychology in patients with DM; and knowing the links between the psychological disorders, inflammation and cardiovascular outcomes would hopefully encourages healthcare professionals in giving due attention to the psychological needs of patients with DM.

Iranian patients require more pertinent care to prevent type 2 diabetes complications

Background. Accurate care of patients with type 2 diabetes may reduce risk of complications. This study was conducted to envisage current status of cares that are provided for a sample of Iranian patients with type 2 diabetes and highlight the domains that need to be focused on in the country's national type 2 diabetes care program. Methods. Behavioral risk factors and diabetes related complications were investigated among 234 randomly selected type 2 diabetic patients residing in the city of Khoy, Northwest of Iran. Data were collected by a semistructured questionnaire in face to face or telephone interview. Proportions and confidence intervals of the observed difference were calculated by the Confidence Interval Analysis (CIA) software version 2.2.0. Results. Diabetes complications were evident amongst 67.2% of the patients. Inappropriate dietary pattern, insufficient physical activity, and anxiety were reported by 26.5%, 74.8%, and 69.7% of the respondents. Quality of life was reported to be affected in 94.6% of the respondents but its burden was significantly greater in females (P < 0.001, 95% CI of the difference: −0.75 to −0.53). Conclusions. The findings reflect discrepancies in providing the required care for the studied Iranian patients with type 2 diabetes to prevent their disease's complications.