Effect of individualized diabetes education for type 2 diabetes mellitus: a single-center randomized clinical trial

The impact of health literacy interventions on glycemic control and self-management outcomes among type 2 diabetes mellitus: A systematic review

Diabetes imposes an increasing health and economic burden on individuals living with it and their societies worldwide. Glycemic control is necessary to reduce morbidity and mortality of type 2 diabetes mellitus (T2DM). Self-management is the primary tool for managing diabetes. Health literacy (HL) is the primary driver of self-management activities. The aim of this review is to evaluate the impact of HL interventions on glycemic control and self-management outcomes among T2DM. MEDLINE, CINAHL, PubMed, Cochrane, Scopus, and Web of Science were searched for eligible papers. Fifteen randomized controlled trials published in English between 1997 and 2021, used HL-driven intervention, and measured the level of glycohemoglobin A1c (HbA1c) and self-management of T2DM patients were included in this review. The findings showed that HL-driven intervention had a positive impact on glycemic control and improved self-management behaviors. The level of glycemic control and self-management skills were improved through individual and telephone-based intervention respectively. Community worker-led interventions were effective in improvements in diabetes knowledge and self-care behaviors; however, nurse-led interventions were effective in glycemic control. Better glycemic control is achieved in hospital settings compared to outpatient settings. HL interventions yielded better improvement in self-management among people with longer diabetes duration (more than 7 years). It was possible to achieve a large reduction in HbA1c level after a 3-month intervention in hospital settings. HL-driven interventions are effective in glycemic and diabetes self-management outcomes.

Personality and weight management in adults with type 2 diabetes: A systematic review

Aims

Managing weight in the context of type 2 diabetes presents unique hormonal, medicinal, behavioural and psychological challenges. The relationship between weight management and personality has previously been reviewed for general and cardiovascular disease populations but is less well understood in diabetes. This systematic review investigated the relationship between personality constructs and weight management outcomes and behaviours among adults with type 2 diabetes.

Methods

Medline, PubMed, Embase, PsycINFO and SPORTDiscus databases were searched to July 2021. Eligibility: empirical quantitative studies; English language; adults with type 2 diabetes; investigation of personality-weight management association. Search terms included variants of: diabetes, physical activity, diet, body mass index (BMI), adiposity, personality constructs and validated scales. A narrative synthesis, with quality assessment, was conducted.

Results

Seventeen studies were identified: nine cross-sectional, six cohort and two randomised controlled trials (N=6,672 participants, range: 30-1,553). Three studies had a low risk of bias. Personality measurement varied. The Big Five and Type D personality constructs were the most common measures. Higher emotional instability (neuroticism, negative affect, anxiety, unmitigated communion and external locus of control) was negatively associated with healthy diet and physical activity, and positively associated with BMI. Conscientiousness had positive associations with healthy diet and physical activity and negative associations with BMI and anthropometric indices.

Conclusions

Among adults with type 2 diabetes, evidence exists of a relationship between weight management and personality, specifically, negative emotionality and conscientiousness. Consideration of personality may be important for optimising weight management and further research is warranted.

Systematic review registration

www.crd.york.ac.uk/prospero/, identifier CRD42019111002.

Dietary Management Tools Improve the Dietary Skills of Patients with T2DM in Communities

Dietary management is of paramount importance in the prevention and control of type 2 diabetes mellitus (T2DM). This one-year cluster-randomized controlled trial aims to evaluate the effect of dietary management tools on the dietary skills of patients with T2DM. Twenty-two communities were randomly assigned to an intervention group and a control group, and participants in the intervention group received a food guiding booklet (G) and a dinner set (D). The frequency of dietary management tools usage was collected at baseline and every three months, and different use patterns were identified by a group-based trajectory model. A self-compiled diabetic dietary skills scale and blood glucose were collected at baseline, 3, and 12 months, and a using generalized linear mixed model (GLMM) to explore the influence factors of dietary skills and blood glucose. The finding revealed four dietary tool-usage patterns among the participants: Insist using G/D, Give up gradually G/D, Give up after use G, and Never use G/D. GLMM indicated that dietary skills were higher over time (p < 0.05), and in participants using the guiding booklet (p < 0.001) or dinner set (p < 0.001), or with higher education (p < 0.001). Additionally, blood glucose were lower among participants with higher dietary skills (p = 0.003), higher educational level (p = 0.046), and a 3000−5000 monthly income (p = 0.026). These findings support using food management tools like the guiding booklet and dinner set as a useful strategy in primary health care centers for individuals with T2DM to increase their dietary skills and blood glucose control.

Efficacy of an Online Educational Intervention in Reducing Body Weight in the Pre-Diabetic Population of 18-45 Years Old, a Randomized Trial Protocol

Aim: to analyze the efficacy of an educational online intervention focused on lifestyle changes in reducing body weight from baseline to 6 months in the pre-diabetic population of 18−45 years old in Extremadura (Spain). Methods: a single-blind, multicenter randomized parallel-comparison trial with two intervention groups in a 1:1 ratio will be carried out. Participants will be randomly assigned to intervention A or B with 37 cases in each group according to inclusion criteria of being enrolled or working at Extremadura University, scoring >7 points on the Findrisc test and not having diagnosed diabetes mellitus or physical disabilities. Intervention-A group will have access to online information about healthy diet and exercise. Intervention-B group will have access to a six-session educational program regarding behavioral changes in diet and exercise habits. They will complete follow-up activities and have a personal trainer and motivation. The primary outcome will be identifying changes in body weight from baseline to 1 and 6 months and between groups. The secondary outcomes will be accomplishing regular physical activity (>30 min/day or >4 h/week), decreasing sugary food intake or avoiding it altogether, increasing vegetable/fruit intake and lowering HbA1c levels to non-diabetic status when necessary.

Assessment the effect of diabetes education on self-care behaviors and glycemic control in the Turkey Nursing Diabetes Education Evaluating Project (TURNUDEP): a multi-center study

BACKGROUND

Diabetes education in Turkey is provided by diabetes nurse educators in almost all healthcare organizations. However, the education is not standardized in terms of learning content, duration, and methods. This multi-center study was performed to assess the self-care behaviors and glycemic control following education provided to the patients with type 2 diabetes mellitus by diabetes nurse educators.

METHODS

This was a descriptive and cross-sectional study and included 1535 patients admitted to 28 public hospitals for the treatment of type 2 diabetes mellitus. The education was assessed by using a Patient Identification Form and Self-care Scale.

RESULTS

The proportion of individuals who received diabetes education within the last year was 78.5%, with 46.7% of them having received it once. Of the patients, 84.8% reported that they received diabetes education individually. It was found that the proportion of individuals who received education about oral antidiabetics (78.5%) and glucose testing at home (78.5%) was higher than the proportion of individuals who received education about exercise (58.8%) and foot care (61.6%). The status of diabetes education, education intervals, and the correlation of the education method with self-care and glycemic control was evaluated. Self-care and glycemic control levels were better among the patients who received diabetes education thrice or more and in patients who received education both individually and in a group (p < 0.05).

CONCLUSIONS

Approximately three-quarters of individuals with type 2 diabetes mellitus received education by diabetes nurse educators in Turkey. Diabetes education is positively correlated with self-care and glycemic control levels among patients with type 2 diabetes mellitus. Efforts for generalization and standardized education for all diabetes patients are necessary.

Effectiveness of training in disease management for patients with type 2 diabetes mellitus: A systematic review

INTRODUCTION

Diabetes mellitus (DM) is included in the disease group described as the pandemic of the century. Although disease management is possible, it can significantly reduce the quality of life when glycaemic control is poor. The objective of this systematic review was to examine the effectiveness of different educational programmes on the management of the disease among type 2 DM patients.

METHODS

In the literature review, the flow chart of PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) was used. A literature search was conducted from 2010 to 2020 using the Ulakbim National Database, Google Scholar, Scopus, PubMed, Library, Science Direct, Web of Science, Medline, Ebscohost and Cochrane Library, and 18 English randomised controlled studies were included.

RESULTS

Within the scope of these studies, it was found that individualised and face-to-face training and long-term follow-up after the training were effective on metabolic control. Peer support was also determined as an important factor in the efficacy of the training. In line with the training, the self-management and quality-of-life scores of the individuals with diabetes were positively affected.

CONCLUSIONS

It can be suggested that planned and regular training has a positive effect on metabolic control variables, self-management behaviours and quality of life of individuals with diabetes. Regular training for individuals with diabetes and follow-up for more than 6 months are recommended since they have a positive effect on the disease. It is also recommended to integrate peer support into training programmes.

Individual goal-based plan based on nursing theory for adults with type 2 diabetes and self-care deficits: a study protocol of a randomised controlled trial

INTRODUCTION

The prevalence and costs of type 2 diabetes are increasing worldwide. A cornerstone in the treatment and care of diabetes is supporting each patient in self-management. In Sweden, most patients with type 2 diabetes are cared for in the primary care setting, which is heavily burdened. Because of implementation difficulties regarding evidenced-based diabetes self-management education and support in this setting, there is a need for an instrument that is easy to use and implement. We developed an individual care plan based on the self-care deficit nursing theory of Dorothea Orem as an instrument to facilitate more individualised self-care support for patients with type 2 diabetes. In this study, we aim to determine whether a written, theory-based, individual goal-based plan for patients with type 2 diabetes and self-management deficits can affect their glycaemic control and health-related quality of life, as well as their experiences of living with diabetes and of support from diabetes care.

METHODS AND ANALYSIS

The study design is a randomised controlled trial using a quantitative approach. A total of 110 patients will be included. Additionally, a qualitative interview study will be conducted 12 months after the intervention. The primary outcome will be glycosylated haemoglobin levels. Secondary outcomes will be health-related quality of life measured using the RAND-36, and the patient's experience of living with diabetes and of the support from diabetes care measured using the Diabetes Questionnaire. Quantitative data will be analysed using the paired t-test, unpaired t-test, and Mann-Whitney U test with IBM SPSS V.26.0 software. Qualitative content analysis will be used for qualitative data.

ETHICS AND DISSEMINATION

This study has been approved by the Ethical Review Authority in Uppsala, Sweden (Etikprövningsmyndigheten, Uppsala, Sverige) (Dnr: 2020-03421). The results will be disseminated in peer-reviewed publications.

TRIAL REGISTRATION NUMBER

ISRCTN10030245.

Q-Methodology and Psychological Phenotyping to Design Patient-Centered Diabetes Education for Persons With Type 2 Diabetes on Insulin Therapy

PURPOSE

The purpose of this study was to identify the psychological phenotypes of persons with type 2 diabetes (T2D) on insulin therapy to better inform personalized diabetes education strategies to improve self-management behaviors.

METHODS

Q-methodology, a research approach combining the quantitative rigor of statistical analysis with qualitative data on perception of diabetes self-management by persons with T2D on insulin therapy, was used. The Summary of Diabetes Self-Care Activity measure and A1C in the past 6 months were used to further describe self-management behaviors of each P-sample, Q-sorter. Of 160 statements, 33 Q-sample statements were selected as Q-set. Then, 37 P-samples (24 men; 13 women) were recruited from a university-affiliated diabetes clinic in South Korea. Data obtained from each P-sample with a Q-set and a Q-sorting table, a forced-choice normal distribution table, were analyzed using varimax rotation.

RESULTS

Forty-one percent of the variance was explained with 5 factors represented by 27 Q-sorters, explaining variance ranging from 5% to 17% for each factor: Factor A (n = 6): those showing self-management education need but possessing inadequate health literacy; Factor B (n = 4): those valuing lifestyle modification to control diabetes; Factor C (n = 5): those valuing antidiabetic medication to control diabetes; Factor D (n = 6): carpe diem, accepting diabetes as destiny; and Factor E (n = 6): those overestimating their competencies to control diabetes. Ten Q-sorters fell into either confounded or nonsignificant.

CONCLUSIONS

Tailoring messages and educational approaches based on patients' psychological phenotypes are necessary to promote optimal self-management behaviors.

Effect of educational interventions on knowledge of the disease and glycaemic control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Globally, type 2 diabetes has continued to increase, now accounting for over 90% of all diabetes cases. Though the magnitude of uncontrolled glycaemic levels in patients with type 2 diabetes is steadily rising, evidence showed that effectively controlled glycaemic levels can prevent complications and improve the quality of life of these patients. As little is known about the effect of educational interventions on this population, this systematic review and meta-analysis evaluated the effectiveness of educational interventions versus standard care on glycaemic control and disease knowledge among patients with type 2 diabetes.

METHODS

PubMed, Google Scholar, Cochrane Library, Scopus, African Journals Online and Wiley Online Library were searched. Two authors independently assessed within-trial risk of bias in each included study using revised Cochrane risk-of-bias tool for randomised trials. A random-effects model was employed to estimate combined effect sizes. Subgroup analyses were employed to investigate possible sources of heterogeneity between studies. The overall certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

A total of 19 trials with 2708 study participants were included in the review. Primary outcomes (glycaemic control) were reported in 18 trials. The pooled estimated impact of educational intervention on glycaemic levels using the random-effects model was -0.83 (95% CI: -1.17 to -0.49, p<0.001). Subgroup analyses revealed greater A1c reductions in those studies with intervention duration of up to 3 months and with empirical intervention designs. Educational interventions led to significant increases in participants' knowledge of type 2 diabetes (standardised mean difference: 1.16; 95% CI: 0.71 to 1.60; I2=93%).

CONCLUSION

In the current review overall, educational interventions can potentially lead to improved glycaemic control levels in patients with type 2 diabetes despite heterogeneity across the studies. Besides, the findings showed that educational interventions could increase disease knowledge among patients with type 2 diabetes.

PROSPERO REGISTRATION NUMBER

CRD42020205838.

Effectiveness of training in disease management for patients with type 2 diabetes mellitus: A systematic review

INTRODUCTION

Diabetes mellitus (DM) is included in the disease group described as the pandemic of the century. Although disease management is possible, it can significantly reduce the quality of life when glycaemic control is poor. The objective of this systematic review was to examine the effectiveness of different educational programmes on the management of the disease among type 2 DM patients.

METHODS

In the literature review, the flow chart of PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) was used. A literature search was conducted from 2010 to 2020 using the Ulakbim National Database, Google Scholar, Scopus, PubMed, Library, Science Direct, Web of Science, Medline, Ebscohost and Cochrane Library, and 18 English randomised controlled studies were included.

RESULTS

Within the scope of these studies, it was found that individualised and face-to-face training and long-term follow-up after the training were effective on metabolic control. Peer support was also determined as an important factor in the efficacy of the training. In line with the training, the self-management and quality-of-life scores of the individuals with diabetes were positively affected.

CONCLUSIONS

It can be suggested that planned and regular training has a positive effect on metabolic control variables, self-management behaviours and quality of life of individuals with diabetes. Regular training for individuals with diabetes and follow-up for more than 6 months are recommended since they have a positive effect on the disease. It is also recommended to integrate peer support into training programmes.

The Effects of Dietary Education Interventions on Individuals with Type 2 Diabetes: A Systematic Review and Meta-Analysis

As the incidence and prevalence of diabetes increases, intervention through dietary education is becoming more important for diabetes control. This systematic review examines the evidence for the efficacy of dietary education interventions on diabetes control. The study subjects were patients with type 2 diabetes, and the main outcome variable was glycosylated hemoglobin level (HbA1c). The target studies were randomized controlled trials. Thirty-six studies were included in the analysis, of which 33 were included in the meta-analysis. The effect size between dietary education and general interventions was -0.42 (n = 5639, MD = -0.42; 95% CI -0.53 to -0.31) and was significantly different (Z = 7.73, p < 0.001). When subgroup analyses were performed following the application periods, intervention methods, and intervention contents, the mean differences in 4-6-month application, individual education, and diet-exercise-psychosocial intervention were -0.51, (n = 2742, 95% CI -0.71 to -0.32), -0.63 (n = 627, 95% CI -1.00 to -0.26), and -0.51 (n = 3244, 95% CI -0.71 to -0.32), respectively. Dietary education interventions provided for at least 3 months were highly effective in controlling HbA1c levels. Regarding the education method, individualized education was more effective, and contact or non-contact education may be applied for this. Combining diet, exercise, and psychosocial intervention is more effective than diet education alone.

The Effectiveness of Behavior Change Techniques Underpinning Psychological Interventions to Improve Glycemic Levels for Adults With Type 2 Diabetes: A Meta-Analysis

An existing systematic review and meta-analysis found a significant reduction in glycemic levels for adults with type 2 diabetes who received a psychological intervention over control conditions. To help develop effective interventions in the future, there is a need to understand the active ingredients which underpin these psychological interventions. We conducted a secondary meta-analysis including 67 randomized controlled trials (RCTs) reported in English. We reviewed the psychological intervention descriptions of the included studies of the existing review and extracted the behavior change techniques (BCTs) according to the BCT taxonomy (BCTTv1). We also extracted information on primary behavioral target versus primary outcome, and presence of fidelity assessment. The most frequent BCTs across RCTs were ‘social support (unspecified)’ (n=50), ‘problem solving’ (n=38) and ‘goal setting (behavior’) (n=30). These BCTs were independently associated with a significant reduction in glycemic levels (HbA1c) compared to control conditions, but not significantly different from studies that did not include these BCTs. Meta-regressions revealed no significant associations between HbA1c, and psychological intervention category (counselling versus cognitive behavioral therapy interventions) (p=0.84), frequency of BCTs per psychological intervention (p=0.29), primary behavioral target versus primary outcome (p=0.48), or presence of fidelity assessment (p=0.15). Social support (unspecified), problem solving, and goal setting (behavior) could be useful BCTs to develop psychological interventions for people with type 2 diabetes to improve glycemic levels. However, more research is required to understand which combination of individual BCTs are most effective for this population.

Systematic Review Registration

Registered with the international prospective register of systematic reviews registration (PROSPERO) CRD42016033619.