Cultural Perceptions and Diabetes Self-Care in Filipino Americans With Type 2 Diabetes: An Integrative Review for Diabetes Care and Education Specialists.

Reducing the rates of diabetes across the United States

Current diabetes care and education programs and expert clinical diabetes management guidelines focus on diabetes self-care behaviors and have yet to incorporate complementary therapies. Complementary therapies, such as music therapy, yoga, mindfulness, and art therapy, have been used globally for centuries and have positive metabolic and glycemic outcomes. In this mini-review, we describe complementary therapies successfully used in diabetes, identify current evidence-based practice gaps, and provide recommendations for incorporating complementary therapies into diabetes care. We thoroughly searched relevant PubMed and Google Scholar studies from 2004 to 2024. Our inclusion criteria were clinical trial studies using the search terms "diabetes self-management" OR "metabolic outcomes" OR "diabetes" OR "type of complementary therapy (music therapy, mindfulness, yoga or art therapy) OR population (type 1 diabetes, type 2 diabetes, prediabetes, diabetes)." We synthesized the evidence to determine complementary therapies (music therapy, mindfulness, yoga, or art therapy) that benefit individuals with diabetes. Findings showed that complementary therapies support diabetes-related psychological and cardiometabolic outcomes and enhance the Association of Diabetes Care and Education Specialists 7 Self-Care Behaviors for diabetes self-management, specifically healthy coping, monitoring, reducing risks, and problem-solving. Critical gaps included the lack of large-scale randomized controlled trials in North American diabetes self-management education programs. Complementary therapies have positive psychological and physiological health benefits for people living with diabetes, yet more randomized controlled trials are needed to assess their effectiveness on a large scale. In the interim, complementary therapies can be integrated into diabetes education, specifically as adjunctive hands-on therapies to enhance self-management behaviors and meet self-management goals.

Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care and Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association

33-LB: Using Telehealth to Deliver Diabetes Self-Management Education and Support (DSMES) In Rural Communities

BackgroundContinuous glucose monitoring (CGM) devices continuously sense and relay glucose concentration data from the interstitial fluid to a mobile phone or receiver. Older adults benefit from this continuous monitoring of glucose levels. Proper deployment of the sensing wire is facilitated by a specialized applicator.ObjectiveOur aim was to assess a new seventh-generation (G7) CGM device (Dexcom, Inc) for use by adults 65 years of age or older and certified diabetes care and education specialists (CDCESs). Ease of use related to intradermal insertion and mobile app setup will be assessed and compared to the fifth- and sixth-generation systems.MethodsFormal task analysis was conducted to enumerate the number and complexity of tasks associated with CGM deployment. We recruited 10 older adults with no prior CGM experience and 10 CDCESs to assess ease of use through hands-on insertion and initiation of a G7 system followed by a survey and, for older adults, a system usability scale survey.ResultsAbout half as many tasks are needed to deploy G7 compared to G6. Older adults and CDCESs reported overall high usability of the G7 CGM device. CDCESs noted G7’s easier setup compared to previous generations. The system usability scale score for the CGM system was 92.8, which reflects excellent usability.ConclusionsFor CDCESs and for older adults using the G7 CGM system, cognitive burden is relatively low and reduced compared to previous CGM systems. Easing of this burden and simplification of the glucose monitoring aspect of proper diabetes management will likely contribute to improved outcomes in this population.

To examine the relationships of health literacy to diabetes self-care behaviors (diet, physical exercise, foot care and blood glucose monitoring) through empowerment controlling for diabetes education. Potential mechanisms of how health literacy links to health outcomes have not clearly elucidated. A cross-sectional study design was used. Participants were recruited from three community health centers in South Korea from September 2016 to April 2017 using a convenience sampling method. A total of 136 people with diabetes aged 60 and above were participated in this study. The main study variables of health literacy, empowerment and diabetes self-care activities were assessed using self-reported questionnaires. This study applied a simple mediation analysis with a single covariate using the PROCESS macro, with health literacy entered as an antecedent variable, empowerment as a mediator, diabetes self-care behaviors as outcome variables and diabetes education as a covariate. After controlling for diabetes education, the indirect effects of health literacy to self-care behaviors through empowerment were significant when the self-care behaviors were particularly diet and physical exercise. Whereas, the indirect effects were not significant when the self-care behaviors were foot care and blood glucose monitoring. This study indicates that the people with higher health literacy were more empowered and those with higher empowerment were more likely to eat healthy foods and exercise. In the light of these findings, a health literacy-tailored empowerment enhancing program may be important targets for interventions promoting diabetes self-care behaviors of diet and physical exercise.

To examine the correlation between colonial mentality and diabetes self-management among Filipino Americans with T2DM. Cross-sectional descriptive and correlational survey study. This cross-sectional study used the Colonial Mentality Scale for Filipino Americans to measure colonial mentality and the Diabetes Self-Management Questionnaire to measure self-management behaviours. The online survey was administered to Filipino Americans aged 18 or older with type 2 diabetes who resided in the United States. Recruitment was conducted from 2022 to 2023 through social media and Filipino American organisations. Data from 37 participants were analysed using descriptive statistics, an independent t-test, and Pearson's r correlation. There was a statistically negative moderate association between two manifestations of colonial mentality (internalised cultural/ethnic inferiority and cultural shame) and several diabetes self-management behaviours: glucose control, healthcare use, and overall self-management. Colonial mentality manifestations were greater in males than in females, although not statistically significant. This is the first study to empirically examine the association between colonial mentality and diabetes self-management in Filipino Americans.

Colonial mentality (CM) has been found to be an important factor for Filipino American mental health. However, the link between CM and mental health may be more complex and might be influenced by whether Filipino American individuals hold covert CM, overt CM, or both. Relatedly, although the Implicit Association Test has been used to capture the covert and automatic aspect of CM, suggesting that this component of CM is less amenable to accurate self-report and introspection, the validity of such a method and its ability to predict mental health variables has yet to be supported. Furthermore, the possibility that the link between overt CM and mental health may be dependent on the covert aspect of CM has yet to be empirically explored. Thus, I examined the construct validity and utility of the Colonial Mentality Implicit Association Test (CMIAT) as a measure of the covert aspect of CM and investigated the interactions between covert and overt CM in predicting mental health among a sample of 102 Filipino Americans. Results suggest that the CMIAT may be a valid and useful tool for capturing the covert and automatic component of CM and that covert CM may be moderating the link between overt CM and mental health. Implications for CM theory and for Filipino American mental health are discussed.

The purpose of this study was to identify the cultural values, traditions, and perceptions of diabetes risk and self-care among Filipino Americans in Hawaii with type 2 diabetes that facilitate or impede engagement in diabetes self-management behaviors and education classes. This qualitative study used 2 rounds of semistructured focus groups and interviews. Participants included 15 patients with type 2 diabetes recruited from a large health-maintenance organization in Hawaii and 7 health care and cultural experts recruited from the community. The taped and transcribed focus groups and interviews were coded thematically. Participants evaluated example materials for diabetes self-management education (DSME) with Filipino Americans. Several aspects of Filipino American culture were identified as central to understanding the challenges of engaging in self-management behaviors and DSME: (1) undertaking self-management while prioritizing the family and maintaining social relationships, (2) modifying diet while upholding valued symbolic and social meanings of food, (3) participating in storytelling in the face of stigma associated with diabetes, and (4) reconciling spiritual and biomedical interpretations of disease causality and its management. Respondents also emphasized the role of several qualitative aspects of perceived risk (eg, dread, control) in moderating their behaviors. Participants suggested ways to make DSME culturally relevant. Awareness of cultural values and qualitative aspects of perceived risk that influence Filipino Americans' engagement in diabetes self-care behaviors and classes may help to improve teaching methods, materials, and recruitment strategies.

The aim of this review was to describe how the coronavirus disease 2019 (COVID-19) lockdown affected the self-care behaviors of people living with type 2 diabetes. A systematic rapid review was conducted using four electronic databases. Studies reporting on the lockdown's impact on at least one of the self-care behaviors that were published from January 2020 through October 2021 were included. Findings were synthesized narratively, using the Association of Diabetes Care & Education Specialists ADCES7 Self-Care Behaviors as a framework. The methodological level of evidence and quality ratings of the articles were assessed using the Joanna Briggs Institute Appraisal Checklist. Fifteen articles were included. Most studies reported on at least five of the self-care behaviors. There were reported increases in diabetes-related stress, as well as in increases in dietary intake and changes in the timing of meals. Physical activity was reported to decrease. Overall, taking medications and glycemic self-monitoring of blood glucose (SMBG) were unaffected by the lockdown. Of the studies reporting glycemic outcomes, the lockdown appeared to have little negative effect. None of the articles assessed all the self-care behaviors. The self-care behavior of SMBG was the least assessed. Most articles had a medium level of evidence and a medium to high quality rating (scores >60%). The findings from this review found the COVID-19 lockdown had a variable impact on diabetes self-care behaviors. Because the potential for future COVID-19 surges and/or other virulent transmissible diseases remains a concern, health care providers should continue to address the importance of self-care behaviors to mitigate the risk of poor health outcomes in people with diabetes.

Quality measures relating to diabetes care in America have not improved between 2005 and 2016, and have plateaued even in areas that outperform national statistics. New approaches to diabetes care and education are needed and are especially important in reaching populations with significant barriers to optimized care. A pilot quality improvement study was created to optimize diabetes education in a clinic setting with a patient population with significant healthcare barriers. Certified Diabetes Care and Education Specialists (CDCES) were deployed in a team-based model with flexible scheduling and same-day education visits, outside of the traditional framework of diabetes education, specifically targeting practices with underperforming diabetes quality measures, in a clinic setting significantly impacted by social determinants of health. A team-based and flexible diabetes education model decreased hemoglobin A1C for individuals participating in the project (and having a second A1C measured) by an average of -2.3%, improved Minnesota Diabetes Quality Measures (D5) for clinicians participating in the project by 5.8%, optimized use of CDCES, and reduced a high visit fail rate for diabetes education. Diabetes education provided in a team-based and flexible model may better meet patient needs and improve diabetes care metrics, in settings with a patient population with significant barriers.

Healthy People 2020 (HP2020) includes benchmarks for diabetes management. The objective of our study was to describe diabetes management among African American women, a patient group that carries a disproportionate diabetes burden. African American women with type 2 diabetes enrolled in dietary and weight management interventions. Self-report assessments of diabetes education, specialty care, self-care behaviors and advice. Associations between diabetes self-care behaviors and diabetes advice using Chi-square tests. Among 96 participants (age = 53 ± 9.4; BMI = 37.9 ± 7.3 kg/m(2)), reported diabetes education and foot exams were lower than HP2020 benchmarks, 48.9% vs 62.5% and 35.1% vs 74.8%, respectively and higher for dilated eye exams (70.1% vs 58.7%). The most frequently reported dietary advice was to increase fruit/vegetable intake (58%) and approximately 50% reported physical activity advice. Receiving no exercise advice was associated with greater odds of little or no physical activity (OR = 3.38) and planned exercises (OR = 2.65). Receipt of diabetes education and some specialty care were below national benchmarks while health care provider advice influenced patient self-care behaviors. Increasing diabetes education and specialty care should be included within existing efforts to address the excess diabetes burden experienced by African American women. Longitudinal studies exploring the relationship between health care provider advice and self-care behaviors are needed.

Self-monitoring of blood glucose (SMBG) has increasingly been shown as one of the most powerful tools for achieving ideal glycemic control in patients with diabetes irrespective of diet control, oral hypoglycemic agents or insulin therapy1. It provides a timely reading of blood glucose levels and enables diabetes patients to more safely manage their condition, to detect hyperglycemia and hypoglycemia, and to generate information for adjusting medications, dietary content and physical activities. To date, results from most meta-analyses have shown the clinical benefits of SMBG on glycemic control1. People with type 2 diabetes who carried out SMBG were reported to have lower rates of non-fatal micro- and macrovascular events than those who did not carry out SMBG2. Thus, several academic bodies, including the International Diabetes Federation (IDF)3, have issued recommendations for the use of SMBG. However, patients as well as diabetes care professionals have found that carrying out the so-called standardized or structured SMBG, including frequencies, patterns and times, and matching it with individual clinical needs is very confusing and impractical. The clinical suggestions are even more difficult to implement in areas where diabetes patients receive no reimbursement for test strips and glucometers. In this regard, a simple, easy and structured SMBG, such as the so-called meals-based testing or paired testing that covers both preprandial and postprandial glucose levels and minimizes glycemic variability, is clearly preferable. It is widely acknowledged that proper use of SMBG is associated with a significant reduction of glycated hemoglobin (HbA1c), as compared with those not using SMBG. Likewise, structured SMBG, using a standardized approach, has been shown to be superior to free testing. In a study carried out in Japan, diabetes patients who were treated without insulin were randomized to carry out SMBG with no more than 10 blood glucose tests per month, specifically in the postprandial phase, as compared with those who carried out SMBG in a random manner. The data showed HbA1c reduction was significantly greater in those with a fixed structure as compared with those with free testing, showing the structured test was more beneficial4. Recently published results from the Structured Testing Program (STeP) study also confirmed that after a 12-month intervention in insulin-naïve type 2 diabetes patients, greater and significant reduction in mean HbA1c in the structured testing group was observed compared with that in the active control group5. In 2009, the IDF guideline for SMBG in non-insulin treated type 2 diabetes recommended several focused regimens, including five- and seven-point profiles, a staggered SMBG regimen, meal-based testing, detection/assessment fasting hyperglycemia, and detection of asymptomatic hypoglycemia3. Among these recommendations, meal-based SMBG (before and after selected meals), I believe, is the most appealing, because it helps people with diabetes understand the effects of their meals in association with treatment regimens, assists clinicians in identifying postprandial hyperglycemia, guides therapeutic adjustments and provides more timely feedback regarding medication changes. Recently, a group of European experts recommended two schemes of SMBG, ranging from less intensive to more intensive testing1, depending on whether patients are in states of newly-diagnosed diabetes by lifestyle control or by oral antidiabetic agents or by insulin therapies. The less intensive testing scheme involved one paired meal testing; that is, preprandial and postprandial testing, daily to 3–7 days per week, whereas the intensive testing recommended seven testing points a day with frequencies of a minimum of 3 days per week to 1 week per month. The expert group emphasized that intensity of testing should be adjusted based on the quality of metabolic controls, treatment approaches and the risk of hypoglycemia. Given the complexities of the clinical scenario, I would advocate the use of paired glycemic testing (or meal-based testing) before and 2 h after meals, preferably three times a week covering breakfast, lunch and dinner (Figure 1). These regimens could serve as a basic start for SMBG in patients with type 2 diabetes. These recommended regimens also enable the patient to monitor glycemic excursions and identify any effect of dietary content, physical activities or medications that might influence glycemic variability6. There is increasing evidence that postprandial hyperglycemia and glycemic variability are associated with impairment of endothelial function and subsequent macrovascular complications7. This phenomenon seems more critical for Asian diabetes patients, who might be more prone to having postprandial hyperglycemia8. In this regard, the IDF issued a revised version of the SMBG guideline in 2011 and recommended that glucose be measured 1–2 h after a meal with a target of 160 mg/dL (9.0 mmol/L)3. An example of paired glycemic testing of SMBG, covering breakfast, lunch and dinner, within 1 week. It should be emphasized that even though SMBG can improve patients’ awareness of hyperglycemia or hypoglycemia, this information can be challenging and might lead to anxiety and even self-blame1. Thus, SMBG can only be effective if reinforced by diabetes education. Only when the patient is fully informed about the treatment goals and how to achieve these goals can SMBG function as a tool to achieve better glycemic control. In conclusion, SMBG has been proven to be a practical tool to improve glycemic control in patients with type 2 diabetes. However, SMBG should be implemented in a structured, standardized approach ranging from more intensive to less intensive schemes. Thus, for non-insulin treated diabetes patients, a simple, acceptable alternative would be paired glycemic testing, measured before and 2 h after meals, covering three meals at least three times per week. A structured SMBG regimen, plus reinforcement through diabetes education, behavior and medication modifications might provide a useful measure for achieving better glycemic control. Further study to confirm that this regimen is practical and applicable is clearly warranted.

Isolation and Education During a Pandemic: Novel Telehealth Approach to Family Education for a Child With New-Onset Type 1 Diabetes and Concomitant COVID-19

This study’s primary purpose was to conduct a cross-sectional examination of the interplay among various Filipino American demographic characteristics (ex., gender identity, education level, and cultural generation identity) upon their experiences of colonial mentality and depression. An online survey was distributed through social media (Reddit and Instagram), comprising the Colonial Mentality Scale (David & Okazaki, 2006) and the PHQ-9 (Pfizer, 1999). A total of 63 participants were used in the study. One of the key findings of the current research study is that cis male Filipino Americans reported the highest mean colonial mentality score as compared to their cis female Filipino American counterparts and their LGBTQ Filipino American counterparts. Filipino Americans who had less than a college-level education had the highest level of self-reported depression as compared to Filipino Americans who had completed a college-level education or greater. There was also an interaction effect where the 1st generation cis male Filipino Americans reported higher mean depression scores as compared to 2nd generation cis male Filipino American counterparts. In contrast, the 1st generation cis female Filipino Americans report lower mean depression scores as compared to their 2nd generation cis female Filipino American counterparts. Similarly, the 1st generation LGBTQ Filipino Americans report lower mean depression scores as compared to their 2nd generation LGBTQ Filipino American counterparts. The research findings are discussed in the context of other prior research on cultural mentality and depression among Filipino Americans, along with how this informs culturally competent mental health treatment approaches and considerations when working with the Filipino American population.