Identification of Patients With Diabetes Who Benefit Most From a Health Coaching Program in Chronic Disease Management, Sydney, Australia, 2013

The Impact of Telemonitoring and Telehealth Coaching on General Nutrition Knowledge in Overweight and Obese Individuals: A Pilot Randomized Controlled Trial

(1) Background: General nutrition knowledge is a fundamental pillar of well-being and healthy lifestyles. This study aimed to measure the general nutrition knowledge questionnaire (GNKQ) scores of overweight and obese participants who joined a pilot randomized controlled trial (RCT) and the association between changes in GNKQ scores and changes in anthropometric measures. (2) Methods: A total of 30 and 25 participants had completed the trial at the 3- and 6-month visits, respectively. All participants enrolled in a randomized controlled trial (RCT) and received a hypocaloric-tailored diet and three online nutrition education sessions over 6 months. The participants were randomly divided into two groups: an intervention group supported with weekly telemonitoring and monthly telehealth coaching vs. a control group. The Arabic-validated GNKQ was used, covering four sections: dietary recommendations; food groups and nutrient sources; healthy food choices; and associations between the diet-disease relationship and weight. (3) Results: The findings show that both the intervention and control groups showed improvements in GNKQ scores over time, with the intervention group demonstrating significant increases in overall nutrition knowledge and specific areas, such as the diet-disease relationship and weight management, at 3 months. In addition, changes in GNKQ scores had a significant negative association with BMI and visceral fat percentage. The findings underline the benefits of supporting dietary weight loss interventions with telemonitoring and telehealth coaching, suggesting that an increase in nutrition knowledge may relate to lower body fat metrics. Nevertheless, the small sample size and high attrition rate of participants were the main limitations of this study, such that large populations are required to confirm the reliability of the obtained findings.

Influence of exercise prescription intervention based on WeChat on glycolipid metabolism and fitness of suboptimal-health teachers

Exercise is an effective means to promote health, but adherence is low. Due to the advantages of immediacy, economy and effectiveness, the use of WeChat social software has permeated into every aspect in daily life in China. To explore the influence of WeChat-based exercise prescription intervention mode on glycolipid metabolism and fitness of suboptimal-health teachers. 293 suboptimal-health teachers with senior professional titles were randomized to a control group (CG) or an experimental group (e.g.). The CG exercised on its own, while the e.g. adopted the exercise prescription intervention based on WeChat. The intervention period was 6 months. Finally, 264 cases were adhered to and completed, including 132 cases in the CG and 132 cases in the e.g.. The Suboptimal-Health Status Questionnaires-25 scores (SHSQ-25 scores), exercise adherence, subjective feelings, physical fitness, blood glucose and blood lipids were detected before and after intervention and compared between 2 groups. After the intervention, the SHSQ-25 scores in the e.g. was significantly decreased than those in the CG (P < .01). The complete exercise adherence in the e.g. was significantly higher than those in the CG (P < .01). After intervention, the subjective feelings of e.g. were significantly improved compared to CG (P < .05). The body shape, body function and physical quality in the e.g. was higher than those in the CG (P < .05). Total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) decreased significantly in the e.g. but not in the CG (P < .05). Fasting blood glucose (FBG) decreased significantly in the e.g. but not in the CG, with a significant difference between groups (P < .05). The subjects in the e.g. were very satisfied with WeChat management. WeChat-based exercise prescription intervention could improve SHS, exercise adherence, subjective feelings, physical fitness and glycolipid metabolism.

The effect of a single visit to a health coach on perceived health in 50-year old residents in a high-income country - a randomised controlled trial

OBJECTIVE

To evaluate the one-year-effect of a single visit to a health coach on perceived health and exercise level in 50-year-old citizens.

DESIGN

One factor design randomised controlled trial.

SETTING

Participants were randomly selected from the Swedish Population Register.

SUBJECTS

50-year-old residents of the town of Alingsås, Sweden (n = 105).

INTERVENTION

The intervention group (n = 52) received a single one-hour visit to a health coach. The control group (n = 53) received no intervention.

MAIN OUTCOME MEASURES

Change over 12 months in the SF-36 dimensions physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, mental health, physical component summary and mental component summary. Reported health transition at follow-up. Change in exercise level.

RESULTS

The control group changed their perceived health more favourable than the intervention group in the following dimensions of the SF-36; general health (p = 0.0055-0.025), role-emotional (p = 0.034-0.040) and mental component summary (p = 0.033-0.073).

CONCLUSION

A single visit to a health coach does not improve perceived health or exercise-level in 50-year-old citizens. On the contrary it may make perceived health worse.Key pointsResearch on health coaching has emerged in the last 20 years, but is diverse and the characteristics of a successful health coaching intervention are still unknown.There is a lack of randomised controlled trials evaluating long-term effectiveness of health coaching.This randomised controlled trial concludes that a single visit to a health coach does not improve, but rather impairs, perceived health in 50-year olds.

Prediabetes and cardiovascular complications study: Highlights on gestational diabetes, self-management and primary health care

International collaboration on the prediabetes and cardiovascular complications study started in 2013. In 2017, a reflection was reported. Incompleteness of documentation and screening of antenatal cases for gestational diabetes mellitus (GDM) was concerning. Hence, further observations have been made that warrant an update. The objective of this review is to highlight gaps between clinical knowledge and practice in GDM, diabetes self-management and primary health care (PHC) for rural dwellers. We followed a descriptive field notes method. Antenatal records of patients screened for GDM with incomplete documentation were examined to determine incompleteness of data in those that also met the criteria for GDM risk assessment. Experiences on development of a diabetes register and education and notes on behavioural change wheel were also reviewed. Other data included cross-sectional evaluation of activities of daily living at two private hospitals. Up to 29% had high GDM risk factors, which fulfilled selection criteria for laboratory screening. Demographic data was complete in all women; however, incomplete documentation was observed with as much as 98% of basic data. High levels of physical activity were found in the population, and health lectures proved effective in food choices. The workforce need for diabetes care seems underestimated, but this may be better understood with reactivation of PHC services. The observations highlight behavioural change wheel issues on GDM and PHC services that need concerted focus. Two proposals are to advance the use of a ‘risk assessment and screening sheet’ for GDM screening and enlightenment of stakeholders on the central hub role of PHC in diabetes management.

Digital Health Coaching for Type 2 Diabetes: Randomized Controlled Trial of Healthy at Home

Digital health coaching is an intervention for type 2 diabetes mellitus (T2DM) that has potential to improve the quality of care for patients. Previous research has established the efficacy of digital interventions for behavior change. This pilot study addresses a research gap in finding effective and accessible behavioral interventions for under-resourced individuals with T2DM. We examined the impact of Healthy at Home, a 12-week phone and SMS-based (short message service) digital health coaching program, on insulin resistance which is an upstream marker for T2DM progression. We compared this intervention to usual diabetic care in a family medicine residency clinic in a randomized controlled trial. Digital health coaching significantly improved participants' calculated Homeostatic Model Assessment for Insulin Resistance (HOMA2-IR) by −0.9 ± 0.4 compared with the control group (p = 0.029). This significance remained after controlling for years diagnosed with T2DM, enrollment in Medicaid, access to food, baseline stage of change, and race (p = 0.027). Increasing access to digital health coaching may lead to more effective control of diabetes for under-resourced patients. This study demonstrates the potential to implement a personalized, scalable, and effective digital health intervention to treat and manage T2DM through a lifestyle and behavioral approach to improve clinical outcomes (http://clinicaltrials.gov, NCT04872647).

Effectiveness of Health Coaching in Diabetes Control and Lifestyle Improvement: A Randomized-Controlled Trial

Background: The study aimed to look into the effectiveness of a 6-month health coaching intervention for HbA1c and healthy diet in the treatment of patients with type 2 diabetes. Methods: The study was carried out via a two-armed, randomized controlled trial that included 114 diabetic patients at a medical center in Taiwan. During the 6-month period, the intervention group had health coaching and usual care for 6 months, and the control group had usual care only. The outcome variables were HbA1c level and healthy diet for follow-up measurement in the third and sixth month. Results: The study discovered a significant decrease in HbA1c and health diet improvement after the 6-month health coaching. Patients in the intervention group decreased their daily intake of whole grains, fruits, meats and protein, and fats and oils while increasing their vegetables intake. Conclusions: Health coaching may be conducive to the blood sugar control and healthy diet of patients with type 2 diabetes. Further study on health coaching with higher-quality evidence is needed.

Global Perspectives on Improving Chronic Disease Prevention and Management in Diverse Settings

The Centers for Disease Control and Prevention (CDC) define chronic diseases as conditions that last 1 year or more and that require ongoing medical attention or limit activities of daily living, or both (1). Chronic diseases may be influenced by a combination of genetics, lifestyle and social behaviors, health care system factors, community influences, and environmental determinants of health (2). These risk factors often coexist and interact with each other. Therefore, a better understanding of determinants of chronic diseases such as tobacco use, unhealthy eating, and physical inactivity stands to benefit from effective strategies for improving primary, secondary, and tertiary disease prevention and management in diverse global settings (3). Strategies to prevent and manage chronic disease outcomes such as diabetes and cardiovascular diseases (CVDs) have global commonalities (4-7). The impact of chronic diseases is disproportionately evident in Black and Brown communities (8,9). Chronic disease prevention and management typically focus on behavioral interventions such as healthy eating, increased physical activity, and cessation of unhealthy practices such as tobacco and alcohol use (10-15). In 2020, the COVID-19 pandemic added to the fact that chronic diseases disproportionately affect low-resource communities, where many Black and Brown populations live (16,17). COVID-19 demonstrated that chronic disease disparities actually present as preexisting conditions in Black and Brown communities, who are disproportionately affected by COVID-19 outcomes. Although most of the articles in this Preventing Chronic Disease (PCD) collection were published before the pandemic, the insights they present, combined with the racial and ethnic data on the burden of COVID-19 thus far, support this reality. Many researchers and public health practitioners often consider the need to sufficiently address the relationships between chronic diseases and social, behavioral, and community factors (18). Global lessons in the prevention and management of chronic diseases, therefore, can help researchers and practitioners benefit from the shared lessons and experience derived from research and interventions conducted in different parts of the world. There are more than 7 billion people worldwide, who speak diverse languages and who have different nationalities, identities, and health systems. Yet, if we share challenges and opportunities for chronic disease prevention and management, many of the global adversities to improving health and well-being can be ameliorated, which is the purpose of this collection. The authors in this collection share lessons that represent experiences in diverse contexts across countries and regions of the world.

Psychological symptoms in Chinese nurses may be associated with predisposition to chronic disease: a cross-sectional study of suboptimal health status

BACKGROUND

Suboptimal health status (SHS) is a reversible state between ideal health and illness and it can be effectively reversed by risk prediction, disease prevention, and personalized medicine under the global background of predictive, preventive, and personalized medicine (PPPM) concepts. More and more Chinese nurses have been troubled by psychological symptoms (PS). The correlation between PS and SHS is unclear in nurses. The purpose of current study is to investigate the prevalence of SHS and PS in Chinese nurses and the relationship between SHS and PS along with predisposing factors as well as to discuss the feasibility of improving health status and preventing diseases according to PPPM concepts in Chinese nurses.

METHODS

A cross-sectional study was conducted with the cluster sampling method among 9793 registered nurses in Foshan city, China. SHS was evaluated with the Suboptimal Health Status Questionnaire-25 (SHSQ-25). Meanwhile, the PS of depression and anxiety were evaluated with Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) self-assessment questionnaires. The relationship between PS and SHS in Chinese nurses was subsequently analyzed.

RESULTS

Among the 9793 participants, 6107 nurses were included in the final analysis. The prevalence of SHS in the participants was 74.21% (4532/6107) while the symptoms of depression and anxiety were 47.62% (2908/6107) and 24.59% (1502/6107) respectively. The prevalence of SHS in the participants with depression and anxiety was significantly higher than those without the symptoms of depression (83.3% vs 16.7%, P < 0.001) and anxiety (94.2% vs 5.8%, P < 0.0001). The ratio of exercise habit was significantly lower than that of non-exercise habit (68.8% vs 78.4%, P < 0.001) in SHS group.

CONCLUSIONS

There is a high prevalence of SHS and PS in Chinese nurses. PS in Chinese nurses are associated with SHS. Physical exercise is a protective factor for SHS and PS so that the exercise should be strongly recommended as a valuable preventive measure well in the agreement with PPPM philosophy. Along with SDS and SAS, SHSQ-25 should also be highly recommended and applied as a novel predictive/preventive tool for the health measures from the perspectives of PPPM in view of susceptible population and individual screening, the predisposition to chronic disease preventing, personalization of intervention, and the ideal health state restoring.

For Physical Laborers with Type 2 Diabetes, Telephonic Health Coaching is not Enough to Improve A1C

OBJECTIVES

Telephonic health coaching has been studied extensively as an interventional approach for chronic disease management. No studies have been conducted evaluating the outcomes of a multiyear study on health coaching participation and glycated haemoglobin (A1C) changes. Chronic disease has been widespread in physical laborers, with a high onset of type 2 diabetes. The purpose of this study was to establish the efficacy of telephonic health coaching as a means to manage type 2 diabetes in adults with physical labor occupations.

METHODS

The eligibility criteria were: 1) Adults aged 20-80 during the study entirety; 2) A diagnosis of type 2 diabetes; and 3) Yearly A1C and Body Mass Index (BMI) testing via verified biometric screenings. Participants completing health coaching for at least 2 years during the study period were assigned to the experimental group and participants who only had yearly biometric screening were assigned to the control group.

RESULTS

From 2014-2018, 350 participants met the inclusion criteria. The mean age at baseline was 56 years (SD 8.26), with a mean baseline A1C of 7.14% for the test group, and 5.41% for the control group. Pre-post test changes saw an increase in A1C of 0.85% in the test group, and 0.95% in the control group. BMI changes were not statistically significant.

CONCLUSION

Further study is needed to refine current telephonic health coaching programs for disease management. This study suggests that the efficacy of telephonic health coaching in its current form is not enough to improve BMI outcomes in patients with diabetes, and over the phone coaching alone is insufficient to improve patient A1C levels and sustain them for long-term.

Prevalence of depression in patients with type 2 diabetes mellitus in Spain (the DIADEMA Study) : results from the MADIABETES cohort

OBJECTIVE

To estimate the prevalence of depression in patients diagnosed with type 2 diabetes mellitus (T2DM), and to identify sociodemographic, clinical and psychological factors associated with depression in this population. Additionally, we examine the annual incidence rate of depression among patients with T2DM.

METHODS

We performed a large prospective cohort study of patients with T2DM from the Madrid Diabetes Study. The first recruitment drive included 3443 patients. The second recruitment drive included 727 new patients. Data have been collected since 2007 (baseline visit) and annually during the follow-up period (since 2008).

RESULTS

Depression was prevalent in 20.03% of patients (n=592; 95% CI 18.6% to 21.5%) and was associated with previous personal history of depression (OR 6.482; 95% CI 5.138 to 8.178), mental health status below mean (OR 1.423; 95% CI 1.452 to 2.577), neuropathy (OR 1.951; 95% CI 1.423 to 2.674), fair or poor self-reported health status (OR 1.509; 95% CI 1.209 to 1.882), treatment with oral antidiabetic agents plus insulin (OR 1.802; 95% CI 1.364 to 2.380), female gender (OR 1.333; 95% CI 1.009 to 1.761) and blood cholesterol level (OR 1.005; 95% CI 1.002 to 1.009). The variables inversely associated with depression were: being in employment (OR 0.595; 95% CI 0.397 to 0.894), low physical activity (OR 0.552; 95% CI 0.408 to 0.746), systolic blood pressure (OR 0.982; 95% CI 0.971 to 0.992) and social support (OR 0.978; 95% CI 0.963 to 0.993). In patients without depression at baseline, the incidence of depression after 1 year of follow-up was 1.20% (95% CI 1.11% to 2.81%).

CONCLUSIONS

Depression is very prevalent among patients with T2DM and is associated with several key diabetes-related outcomes. Our results suggest that previous mental status, self-reported health status, gender and several diabetes-related complications are associated with differences in the degree of depression. These findings should alert practitioners to the importance of detecting depression in patients with T2DM.

Utility of the Hospital Admission Risk Programme diabetes risk calculator in identifying patients with type 2 diabetes at risk of unplanned hospital presentations

BACKGROUND

Prevention of hospitalisation is an important aspect of type 2 diabetes (T2D) management.

AIMS

We retrospectively determined the utility of the Hospital Admission Risk Programme (HARP) diabetes risk calculator (HARP tool) in identifying patients with T2D more likely to have unplanned hospital presentations.

METHODS

The HARP tool includes a clinical assessment score (Part A) and a psychosocial and self-management impact score (Part B), and categorises patients into low, medium, high or urgent risk of acute hospitalisation. It was completed for T2D patients attending Royal North Shore Hospital, Sydney, in 2013.

RESULTS

Within the cohort of 278 patients (age 65.3 ± 10.5 years; 62.9% male; diabetes duration 10.7 ± 6.6 years), 67.3% were classified as low risk, 32.7% as medium risk and none as high or urgent risk. Following adjustment for confounders, a medium HARP score was associated with a 3.1-fold increased risk of unplanned hospital presentations in the subsequent 12 months (95% confidence interval: 1.35-7.31; P = 0.008). Part A scores were significantly higher for patients that presented to hospital compared to those that did not (14.2 ± 6.8 vs 11.4 ± 5.5; P = 0.034), whereas there was no difference in Part B scores (P = 0.860).

CONCLUSIONS

In patients with low and medium HARP scores, clinical features were more predictive of hospital presentations than certain psychosocial or self-management factors in the present cohort. Further studies are required to characterise unplanned hospitalisation in patients with higher HARP scores, or whether additional psychosocial assessments could improve the tool's predictability.

Using Theory to Explore the Determinants of Medication Adherence; Moving Away from a One-Size-Fits-All Approach

Non-adherence to prescribed medicines has been described as "a worldwide problem of striking magnitude", diminishing treatment effects and wasting resources. Evidence syntheses report current adherence interventions achieve modest improvements at best, and highlight the poor progress toward the longstanding aim of a gold-standard intervention, tailored to meet individual need. Techniques such as motivational interviewing and health coaching, which aim to facilitate patient-centred care and improve patient resourcefulness, have shown promise in supporting adherence, especially in patients with psychological barriers to medicine-taking, such as illness perceptions and health beliefs. Despite a plethora of research, there is little recognition that the nature and complexity of non-adherence is such that a one-size-fits-all approach to interventions is never likely to suffice. This commentary re-visits the call for adherence interventions to be tailored to meet individual need, by considering what this means for day-to-day practice and how this can be achieved. It provides an update on advances in psychological theory to identify the root cause of an individual's non-adherence to encourage matching of provided adherence support. It also provides a practical perspective by considering exemplars of innovative practice and evaluating the day-to-day practicalities of taking a novel approach.