Diabetic Patients In Community Research Articles

Hand-held echocardiography-based heart failure screening in hypertensive or diabetic patients in community: a pilot study

Abstract Background There is lack of solid data on screening methods for preclinical heart failure (HF) in primary care settings. Standard echocardiography is not regarded as a routine test due to high cost and need of operation by specialists. Hand-held echocardiography (HHE) has been used in various clinical settings with easier access and lower price but has never been integrated into HF screening programme. Purpose This study aimed to explore the feasibility and cost-effectiveness of hand HHE-based HF screening strategies in patients with risk factors in community. Methods The registered patients with hypertension or diabetes at two Chinese community health service centres (CHSCs) who had not been diagnosed previously as HF were recruited. Every patient received symptom assessment (dyspnea and/or lower limb edema), blood test for N-terminal-probrain natriuretic peptide (NT-proBNP ≥ 125 pg/ml regarded as positive), and HHE for any indexed abnormality in the dedicated protocol with focused and semiquantitative scanning [i.e. left ventricular (LV) dilation, left atrial (LA) dilation, interventricular septum (IVS) thickening, LV systolic dysfunction by calipers, as well as region wall motion abnormality, valvular stenosis, ≥moderate valvular regurgitation, significant pericardial effusion by eyeballing). By using the results of all the three modalities for screening compared to the concurrent guidelines, the patients were categorized into HF stages A, B, or C as the "gold standard". Three screening strategies were proposed (Figure 1), of which Strategy I was designed as a single test, Strategy II as a combined test, and Strategy III as a stratified stepwise test. Diagnostic accuracy and cost-effectiveness of each strategy was calculated in comparison with the "gold standard". Results A total of 423 patients (70 ± 9 years; 46.6% males) were enrolled. There were 166 (39.2%) symptomatic patients, while 106 (25.1%) patients had elevated NT-proBNP. HHE abnormalities were found in 286 (67.0%) patients, of which IVS thickening was the most common finding (47.0%), followed by LA enlargement (30.0%). LV systolic dysfunction was identified in 18 (4.3%) patients. 232 (54.8%) and 59 (13.9%) patients were reclassified as HF stage B and C, respectively. As shown in Figure 2, the stepwise Strategy III of using symptoms for the first stratification, followed by choosing HHE or NT-proBNP test led to a 100% accuracy and a 35.6% reduction in cost. Conclusions HHE-based focused screening detects HF earlier in high-risk populations. The screening strategy combined with symptoms, NT-proBNP, and HHE is feasible for identifying underdiagnosed HF stage B or C that may be considered in primary care.Scheme of HF stage screening strategiesHF Screening and cost-effectiveness

Developing a nomogram for predicting depression in diabetic patients after COVID-19 using machine learning.

This study identified major risk factors for depression in community diabetic patients using machine learning techniques and developed predictive models for predicting the high-risk group for depression in diabetic patients based on multiple risk factors. This study analyzed 26,829 adults living in the community who were diagnosed with diabetes by a doctor. The prevalence of a depressive disorder was the dependent variable in this study. This study developed a model for predicting diabetic depression using multiple logistic regression, which corrected all confounding factors in order to identify the relationship (influence) of predictive factors for diabetic depression by entering the top nine variables with high importance, which were identified in CatBoost. The prevalence of depression was 22.4% (n = 6,001). This study calculated the importance of factors related to depression in diabetic patients living in South Korean community using CatBoost to find that the top nine variables with high importance were gender, smoking status, changes in drinking before and after the COVID-19 pandemic, changes in smoking before and after the COVID-19 pandemic, subjective health, concern about economic loss due to the COVID-19 pandemic, changes in sleeping hours due to the COVID-19 pandemic, economic activity, and the number of people you can ask for help in a disaster situation such as COVID-19 infection. It is necessary to identify the high-risk group for diabetes and depression at an early stage, while considering multiple risk factors, and to seek a personalized psychological support system at the primary medical level, which can improve their mental health.

Quality of life and its influencing factors among diabetic patients two years after a self-management intervention in six provinces and cities in China: a follow-up study

Objective To analyze the quality of life (QoL) and its influencing factors among diabetes mellitus patients two years after undergoing a community-based diabetes self-management and to provide references for improving medical service to diabetes. Methods From August to October of 2013, 1 653 diabetic patients were recruited in 84 communities in three cities (Beijing, Shanghai and Chongqing) and three provinces (Jiangsu, Guangdong and Zhejiang) to carry out a 2-month diabetes self-management group intervention. A follow-up survey was conducted during September – December 2015 to analyze changes in QoL and its influencing factors before and after the self-management intervention. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was used in QoL evaluation. Results Among the 1 653 diabetic patients recruited in 2013, 1 603 (96.98%) completed a baseline survey, of which, 1 299 patients were followed up and 304 (18.96%) were lost to follow-up in 2015. Compared to those before the intervention, the patients′ median (quartile range, QR) of SF-36 physical health score increased significantly two years after the self-management intervention (76.50 [23.75] vs. 75.00 [25.00], Z = – 2.53; P = 0.011), but the patients′ median (QR) of SF-36 mental health score was not significantly different (78.44 [25.03] vs. 78.44 [23.31], P > 0.05). The results of unconditional multivariate logistic regression analysis demonstrated that two years after receiving the diabetes self-management intervention, the patients suffering from diabetes 5 years or more and smoking were less likely to have an increased physical health score, while those with an improved self-efficacy were more likely to have an increased physical health score; the patients with following characteristics were less likely to have an increased mental health score: female, with medication reimbursement by medical insurance for urban workers, having complication of other chronic disease, smoking, and being capable of self-injection of insulin or not needing insulin injection. Conclusion The quality of life was improved to a certain extent among a group of community diabetic patients in China two years after a self-management intervention and the improvement was influenced by the patients′ gender, major payer of the medication cost, disease course, comorbidity of other chronic diseases, self-efficacy, smoking, and self-injection of insulin.

Effect of High-quality Nursing on Compliance Behavior of Elderly Diabetic Patients in Community

Effect of High-quality Nursing on Compliance Behavior of Elderly Diabetic Patients in Community

Effects of the aquatic exercise program on diabetes self efficacy and self care behaviors in diabetic patients in community

Effects of the aquatic exercise program on diabetes self efficacy and self care behaviors in diabetic patients in community

Study on the effect of family doctor team service under medical association model on empowerment behavior and health status of elderly diabetic patients in community

Objective To explore the effect of family doctor team service in the medical association model on empowerment behavior and health status of elderly patients with diabetes in the community. Methods A total of 158 patients with diabetes who were diagnosed with free physical examination and were diagnosed as diabetic patients in 4 communities under the jurisdiction of Fuzhong Community Health Service Center From March 2018 to May 2018, we conveniently divided into intervention group (79 cases) and the control group (79 cases), according to whether or not to sign a family doctor. The control group was older people who did not sign up for a family doctor, the control group was given routine intervention according to the community chronic disease follow-up mode, while the intervention group gave the contracted family doctor on the basis of routine intervention, and carried out individual assessment, group management, group intervention, one-on-one guidance, and the body mass index, abdominal circumference, fasting blood glucose, HbA1c, self-management ability of the two groups were evaluated before intervention and 6 months after intervenation. Results There was no significant difference between the two groups before intervention (P >0.05). After 6 months of intervention,abdominal circumference, fasting blood glucose and HbA1c was (79.5±5.0) cm, (6.1±0.7) mmol/L, (6.3±0.6)% in the intervention group, (85.2±11.4) cm, (6.5±0.8) mmol/L, (6.8±0.7)% in the control group, and there was significant difference between the two groups (t=2.142, 3.345, 4.820, P<0.05 or 0.01); the self-empowerment ability and the self-management was (37.7±1.7), (44.3±6.8) in the intervention group, (30.1±2.5), (36.5±2.8) in the control group, and there was significant difference between the two groups (t=22.344, 9.427, P<0.01) . Conclusion The family doctor team service under the model of medical association can improve empowerment behavior of elderly diabetic patients in the community and improve their health status. Key words: Medical association; Family doctor team service; Diabetes; Empowerment behavior; Health status

Current status of self-management behaviors among patients with type 2 diabetes mellitus in community

Two hundred and thirty nine patients with type 2 diabetes mellitus (T2DM) managed in the community health service centers of Huai′an city were selected for survey by random sampling method between January and December 2017. A self-designed questionnaire was used to assess self-management prescription. Patients received community management for 3 months. The rates of patients with not receiving diabetes health education, with healthy diet, with regular exercise, without monitoring blood glucose, with repeated hypoglycemic attacks were 44.8% (107/239), 23.0% (55/239), 46.4% (111/239), 54.8% (131/239) and 21.3%(23/108), respectively; and 51.9% (124/239) of the participants did not adhere to medication. The awareness rate of diabetic complications was 27.2% (65/239). Only 25.1% (60/239) and 15.1% (36/239) of the participants apply oral hypoglycemic agents and insulin rationally. The survey results indicate that the current status of self-management in community diabetic patients is relatively poor, it is necessary to strengthen standardized management of diabetic patients in community health institutions. Key words: Diabetes mellitus, type 2; Community health service; Self-management prescription; Blood glucose self-monitoring

Status survey of knowledge, attitude and practice of diabetes in community diabetic patients

Objective To explore the status quo of knowledge, attitude and practice (KAP) of diabetes in community diabetic patients, analyze its influencing factors, and provide a basis for community diabetes prevention and treatment. Methods Totally 820 diabetic patients from a community in Xuzhou were selected by cluster sampling and investigated with the general information questionnaire, diabetes knowledge questionnaire (DKQ) , Problem Areas Diabetes Scale (PAID) and Summary of Diabetes Self-Care Activities (SDSCA) between January and November 2017. SPSS19.0 was used for statistical analysis of data. Results The scores of diabetes KAP in the 820 community diabetic patients was (35.92±7.59) , (10.95±6.20) and (25.73±7.80) , respectively; and there was a positive correlation between knowledge and attitude, attitude and practice, and knowledge and practice (r=0.093, 0.102, 0.337; P<0.01) . There were significant differences in the scores of knowledge questionnaires of patients with different occupations, educational levels, living conditions, sleep time, course of diabetes, treatment methods and BMI (P<0.05) ; the score of attitude was statistically different among diabetic patients of different sex (P<0.01) ; and the score of practice was statistically different between diabetic patients with different course of disease, educational background, profession and treatment methods (P<0.01) . Conclusions The KAP level of diabetes in the diabetic patients from the community in Xuzhou was of a failure level. Therefore, diabetes educators should go to grassroots units, enhance health education, and improve the overall ability of community diabetic patients. Key words: Diabetes mellitus; Community; Knowledge; Attitude; Practice; Questionnaire survey

Investigation and analysis on the status of exercise of type 2 diabetes patients in a community in Shenzhen City

Objective To explore the status quo of exercise in type 2 diabetes patients in shenzhen, and analyze its influencing factors to provide clinical basis for the intervention of exercise therapy in type 2 diabetes patients. Methods A total of 500 patients with type 2 diabetes were selected by stratified random sampling.The knowledge, attitude and compliance of the subjects were investigated by self-designed questionnaire. Results The survey showed that the score of exercise knowledge of patients with type 2 diabetes was(6.38±0.71) points, and the level of sports knowledge was low.The sports attitude score of this group was (5.07±0.82) points, and sports beliefs were not good.The score of motor compliance in this group was (24.55±1.21) points, which was poor. Multiple linear regression analysis showed that age(P1=0.00), education level(P2=0.01), sports knowledge(P3=0.00) and sports attitude(P4=0.00) were the factors influencing the exercise compliance of the research object. Conclusions The status quo of exercise in patients with type 2 diabetes is not optimistic.In the future work, medical staff should give correct exercise guidance according to the actual situation of patients to improve their exercise compliance. Key words: Type 2 diabetes; Sports knowledge; Exercise faith; Exercise compliance

Application of a Cloud-Based Medication Adherence Improvement (MAI) System to Assist Diabetic Care in China

Objective: To evaluate the effects on medication adherence by employing a cloud-text messaging platform connecting to the pharmacy Enterprise Resource Planning (ERP) system and diabetic patients. Methods: We developed a cloud engine housing a continuously growing knowledge database of 5,245 drugs. This database is broken down to 5 different categories of text messages, providing contents of each drug’s 1) indication and dosage, 2) precautions and side effects, 3) relevant disease information, 4) relevant lab test interpretation, and 5) medication reminders. This cloud-based service was offered as Software as a Service (SaaS) by connecting to pharmacies’ ERP, allowing the engine to identify the patients in real-time who filled prescriptions within the drug store and auto-send text messages at dosage-adjusted intervals. During the past 8 months, 9,802 patients at 970 pharmacies in 8 cities received this intervention and medication adherence was measured by Proportion of Days Covered (PDC). Results: PDC of the study population was improved from 57.9% at baseline to 67.0% at last time, P&amp;lt;0.001. PDC changes were further categorized into various groups by medications of use and intervention durations (Table 1A and 1B), and a global adherence improvement was found. Conclusion: Text message-based knowledge delivery is an effective way to improve medication adherence for community diabetic patients. Disclosure Y. Li: None. J. Cao: None. W. Wang: None. Z. Wang: None. D. Li: None. H. Zhang: None. K. Liu: None.

Comprehensive management model of health behavior for diabetic patients in community

糖尿病是一种由多因素所致的慢性、终生性心身疾病，行为因素在疾病的发生、发展与转归过程中起到关键作用。立足于北京西罗园社区卫生服务中心组建的多学科健康管理团队建立了行为健康门诊 ，运用5A工作流程，融合健康教育、心理干预(心理疏导)、行为健康管理等手段，以糖尿病健康生活项目为实践，初步形成了糖尿病全科门诊－行为健康门诊之间相互转介、共同管理的糖尿病社区综合管理新模式。

A study on improving the management of type 2 diabetes by mobile health platform and peer support education

Objective To discuss the effect of improving self-management among type 2 diabetes by mobile health platform and peer support education. Methods Two hundred diabetic patients enrolled from community were assigned to mobile health platform with peer support education group(group A, 50 patients), peer support education group(group B, 50 patients), and control group(group C, 100 patients). Diabetes related knowledge, self-efficacy score, educational participation, and HbA1C level were compared among these three groups before and after nine months of intervention. Results Diabetes related knowledge, self-efficacy score, and educational participation were observably improved in group A(P<0.01). HbA1C in group A was stable, but it had no statistical significance. Conclusion The mobile health platform with peer support education helps to improve the effects of control and education in type 2 diabetic patients in community. (Chin J Endocrinol Metab, 2015, 31: 967-970) Key words: Peer support; Mobile health; Diabetes mellitus, type 2

Evaluation on the status quo of self monitoring of blood glucose and self-efficacy of diabetes patients in community

To investigate the status quo and influence factors of self monitoring of blood glucose (SMBG) and self-efficacy of diabetes patients' that participated in community diabetes self management group. Beijing, Shanghai, Chongqing, Jiangsu, Guangdong, and Zhejiang were selected as the study sites considering patients management experiences they had. 1 401 adult diabetes patients were recruited from communities via health records system screening, telephone notification, poster advertisement, letters invitation ways. Face to face questionnaire survey was applied to obtain patients' general information, diabetes history, diabetes knowledge awareness, SMBG, and self-efficacy information. Multiple linear regression was used to analyze the relationship between factors and self efficacy. There were 519 male patients (37.0%) and 882 female patients (63.0%) with an average age of (64.9 ± 8.9) years old. Patients lived in city accounted for 48.0% (672/1 401) and rural patients accounted for 52.0% (729/1 401). Patients who conducted SMBG accounted for 79.9% (1 120/1 401) and 33.3% (446/1 401) patients conducted blood glucose monitoring 1-3 times per month. Rural patients, primary school educated, and new rural cooperative medical system (NCMS) covered patients had a higher proportion of never conducting SMBG which were 21.9% (160/729), 24.2% (160/662), and 26.3% (125/475) , respectively. Scores of self-efficacy was (69.24 ± 16.30) (hundred-mark system) with a relative lower score in monitoring of blood glucose (64.09 ± 20.08) and foot care (63.63 ± 21.40), as well as a highest score in taking medicine and insulin injections (76.10 ± 22.00). Multiple regression analysis on self-efficacy and its related factors show a negative correlation between patients' place of residence and self-efficacy (β' = -0.076) and a positive correlation between education and self-efficacy (β' = 0.114) as well as between diabetes knowledge awareness and self-efficacy (β' = 0.193)(t = -2.46, 3.71, 7.18, P < 0.05). Community diabetes patients had a low self-efficacy and it was even lower among low economic and education degree patients. The worst parts were SMBG and foot care. Place of residence, education, and diabetes knowledge awareness are factors that influence patients' self efficacy.

Community service team for standard management of diabetic patients in community

Objective To explore the impact of community service on diabetic patients studying the service team of community medical institutions for the standard management of patients with diabetes.Methods From March 2010 to March 2011,200 elderly patients with type 2 diabetes treated in community for the first time were selected,and then were randomly divided a experimental group and a control group,100 cases for each group.The control group received routine community nursing management.Firstly,a community service team was established,then the standard management was divided to carry out in the experimental group.The FBG,2hPG,HbA1c,and BMI et al.of both groups were compared before and 1 year after the experiment.The changes of the compliance behavior and daily life behavior,the command of diabetic knowledge,the rate of treatment compliance,satisfaction rate,and happiness index were analyzed.Results The FBG,2hPG,HbA1c,and BMI of the experimental group were(6.9 ± 1.0)mmol/L,(7.3 ± 1.3)mmol/L,(6.4± 0.8)％,and(21.8 ± 2.6)kg/m2,which were obviously lower than that of the control group.The experimental group had great improvement in unhealthy living habits and good command of diabetic knowledge.The rate of treatment compliance,satisfaction rate,and happiness index were 82％,88％,and 79％in the experimental group and 74％,71％,and 65％ in the control group,with statistical differences between the 2 groups(P ＜0.05).Conclusions The standard management of community service team for diabetic patients in community can increase the patients' self-care consciousness and play an important role in controlling the conditions of the patients with type 2 diabetes. Key words: Community service team; Diabetes mellitus; Standard management; Clinical analysis

Abstract 311: Facilitators and Barriers to Self-management of Patients with Type 2 Diabetes in Communities in China, a Qualitative Study

Background: Self-management has become a key strategy for caring chronic patients in community. However, little is known about peoples’ self-management experiences and their perceived cues and barriers to engagement in self-management. Objective: To explore issues patients with type 2 diabetes experienced in their self-management practices,to understand cues and barriers to engagement in self-management. Design: Qualitative study (Semi-structured interviews) Setting: 11 communities in Beijing, China Participants: Type 2 diabetes patients in community, aged &gt;18, no admission in past 90 days. Methods: 40 critical incident interviews were run during Apr to Sep in 2011 using purposive sampling (20 interviews with patients whose HbA1c well-controlled (&lt;6.5%), while 20 badly-controlled (≥8%)).Themes from interviews were identified using content analysis, which revealed cues and barriers to self-modification for diabetes management. Results: Implications for self- management practice included objectively understanding on the severity and complications of diabetes. In addition to family support such as supervision in family and fully-use of family resource, desires/duties to be responsible for whole family life as a breadwinner was emerged as a key cue to engagement in self-control. Barriers to engagement in self-management stemmed from financial burden to monitor blood glucose daily, dissatisfaction of HbA1c level after efforts, and malignant life events. It is worth mentioning that starving experience of difficult time with natural disasters in1960s- 1970s in China was identified also as a key barrier to engagement in diet management. Discussion and Conclusion: There was a strong desire for Chinese patients to comply with Chinese cultural norms; particularly those relating to family value. It was the patients’ power to be involved in self-management that they could devote their healthy life to family duty. Everyone had his/her own history so experiences in past shaped patients’ behaviors now. The findings highlighted the importance of understanding the family value and the personal experiences as facilitators and barriers to self-management of Chinese patients with type 2 diabetes living in community.

Effect of nursing intervention in improving early diagnosis of diabetic nephrosis

Objective To block or postpone the process of diabetic nephrosis (DN) by nursing intervention and reduce the occurrence of final stage of renal failure. Methods Health education on DN prevention and treatment was implemented in the public benefit activities on World Renal Disease Day, World Diabetes Day and Nurses' Day and among the non-hospitalized diabetes patients in the community irregularly.Early DN would be diagnosed if urinary protein test was negative and urinary mALB was 20 ～200 μg/min or 30 ～ 300 mg/24 h (the normal value is less than 10 μg/min). Clinical DN would be diagnosed if urinary protein test was positive and urinary mALB was more than 200 μg/min or 300 mg/24 h. Both groups received nursing intervention of diet and controlling blood pressure, blood glucose and blood lipid. The reversion of nephrosis and lesion were compared between the two groups after intervention. Results There was no significant difference in awareness of DN knowledge between the two groups (P ＞ 0. 05) before intervention. Patients with early DN obtained better reversion of nephrosis and lower urinary mALB than those with clinical DN. There was significant difference between the two groups after intervention (P ＜ 0. 01). Conclusions The occurrence of final renal failure will be reduced if DN process is blocked or postponed. The publicity of knowledge of DN prevention and treatment, improvement of the awareness and regular test of urinary mALB are most important. Key words: Diabetes nephrosis; Nursing intervention; Early diagnose

Research in effect of Chinese medicine nursing intervention on community diabetes patients

Objective To investigate the significance of Chinese medicine nursing intervention on community diabetes patients in order to improve their quality of life. Methods 216 non- hospitalized community diabetic patients with clear diagnosis were divided into the experimental group and the control group with 108 cases in each group. The experimental group was given medication treatment and health ed-ucation as well as Chinese medicine intervention, the control group was only given medication treatment ac-cording to doctors' advice, the body weight index, biochemical index, medical compliance rate and their changes with time were compared after 6,12,18,24 months of follow-up. Results after two-year follow-up, the body mass index, blood glucose and HbAlc of both groups declined, the experimental group was lower than the control group, patients compliance of both groups increased, blood pressure change of both groups was not obvious, the difference was not significant. Conclusions Long-term implementation of Chinese medicine nursing on diabetes patients have significant effect, which is worthy of wide application in the community. Key words: Community; Diabetes; Chinese medicine; Nursing

Application of peer education in guiding community diabetic patients to adopt diet therapy using food exchange method

Objective To use peer education to guide community diabetic patients to adopt diet therapy using food exchange method in order to explore effective method for diet therapy of diabetes mellitus. Meth-ods 91 diabetic patients were selected using simple sampling method and randomly divided into the peer ed-ucation(45 cases) and the common education group(46 cases), the two groups adopted food exchange method for diet therapy for 1 year. The blood glucose, blood lipid, glycosylated hemoglobin and body weight index were compared between the two groups using t test. Results The blood glucose, blood lipid, glycosylated hemoglobin and body weight index all decreased in the two groups after intervention, but the the decreased de-gree in the peer education group was more obvious. The fasting blood glucose, 2 hour postprandial blood glu-cose, glycosylated hemoglobin, triglyceride, low-donordensity lipid protein and body weight index in the peer education were lower thanthose of the common education group, but HDL-C was higher. Conclusions Peer education is more effective in health education of food exchange method. Key words: Peer education; 2 type diabete mellitus; Food exchange method; Community health service

Survey on self-care behavior and self-among type 2 diabetes patients in community

Objective To investigate the level of self-care behaviors and self-efficacy among adult type 2 diabetes patients in community and discuss current problems.Methods A convenient sample of 85 patients with type 2 diabetes in Haiyuncang community was interviewed,using diabetes self-care scale and diabetes self-efficacy scale.Totally 85 questionnaires were got and underwent analysis.Results The index score of self-care behaviors and self-efficacy among adult type 2 diabetes patients in community were 66.98% and 69.02%.There were no significant difference in self-care behaviors of patients whether they attended diabetes lectures or not.Self-efficacy correlated significantly with self-care behaviors.Conclusions The self-care behaviors and self-efficacy of diabetes patients need to be improved,and diabetes education in community should be emphasized and carried out effectively. Key words: Community; Type 2 diabetes meilitus; Self-care behaviors; Self-efficacy

Spring 2007 Meeting of the Association of British Clinical Diabetologists

Spring 2007 Meeting of the Association of British Clinical Diabetologists