Diabetes Care Activities Research Articles

Basic Diabetes Knowledge and Care Activities on Caregiver’s Missed Work and School Absenteeism– a Pilot Study

Basic Diabetes Knowledge and Care Activities on Caregiver’s Missed Work and School Absenteeism– a Pilot Study

Parent-Child Relationship Quality as a Mediator of the Association between Perceived Stress and Diabetes Self-Management in Adolescents With Type 1 Diabetes.

Diabetes self-management is suboptimal in adolescents with type 1 diabetes (T1D), including those in China. The aim of the study was to investigate the impact of parent-child relationship quality on diabetes self-management. Data were collected by a self-report survey among 122 Chinese adolescents from April to July 2017. The data were analyzed using a one-way analysis of variance, descriptive analyses, correlation analyses, and mediation analyses. The mean age was 13.8 (range, 10-18) years, and the mean diabetes duration was 4.1 (±3.1) years. About half of the adolescents with T1D experienced high levels of perceived stress. Parent-child relationship quality mediated the associations between perceived stress and collaboration with parents, diabetes care activities, and diabetes communication on aspects of diabetes self-management (ps < 0.05). To reduce the negative impacts of perceived stress on diabetes self-management in this population, parent-child relationship quality should be considered an important element of family-based interventions and clinical practice.

A cross sectional study reveals severe disruption in glycemic control in people with diabetes during and after lockdown in India

Background and aims: Uncontrolled diabetes has been associated with poorer clinical outcomes in COVID-19. We aimed to evaluate and assess the impact of COVID-19 pandemic on management of diabetes and challenges faced by people with diabetes in India during and after the lockdown phase.Methods: A cross-sectional study based on an online questionnaire survey was designed. The questions collected socio-demographic details, medical and social history, and impact of the pandemic on medical and social life from 1582 participants. Linear regression was employed to evaluate association of different parameters with the change in glycemic levels.Results: The frequency of clinical visits during the COVID-19 pandemic were reduced in 87.28% of participants. 92.45% of participants were able to monitor their blood glucose levels (BGLs) in which 78.42% (49.35%, 20.91%, and 8.16%) participants experienced an increase in BGL (mild, moderate, and severe respectively). Only 47.41% of participants possessed the digital glucometer at home. 69.07% of participants reported a decrease in physical activity while 46.88% reported an increase in food intake. 80.06% of participants were able to buy all medicines and 29.80% were gone for virtual consultations while 87.81% reported that they didn’t have access to healthcare services. Overall, 89.47% participants experienced disruption in therapy. A highly significant correlation (r = 0.89, p = 0.0145) was found between increasing age and reporting of higher BGLs.Conclusion: This study provides a firsthand evidence of major disruption in diabetes care activities during and after the lockdown phase in India and increased risk of poorer clinical outcomes, if infected by SARS-CoV-2.

Perceived stress and self-efficacy are associated with diabetes self-management among adolescents with type 1 diabetes: A moderated mediation analysis.

The aims of this study were to: (a) determine if self-efficacy mediates the relationship between perceived stress and diabetes self-management in adolescents with type 1 diabetes (T1D); and (b) explore whether perceived stress moderated the self-efficacy and diabetes self-management relationship. Non-experimental, descriptive correlational design, conducted from January-December 2016. Guided by the Adaptation to Diabetes framework, data on demographic and clinical characteristics, perceived stress, self-efficacy and diabetes self-management were collected. Descriptive analyses and regression analyses were generated by SPSS Version 22. Structural equation modelling was implemented with the MPlus program. There was no direct effect of perceived stress on diabetes self-management; however, self-efficacy mediated the relationship between perceived stress and diabetes self-management. Adolescents who had high self-efficacy and low perceived stress demonstrated better diabetes care activities and diabetes communication than would be predicted from the main effects of self-efficacy and perceived stress alone. Decreasing perceived stress and improving self-efficacy are important strategies to improve diabetes self-management in adolescents with T1D. Adolescents with T1D experience considerable stress with daily self-management demands. This study highlights the mediating role of self-efficacy on perceived stress and diabetes self-management. Assessment of perceived stress and self-efficacy in self-management tasks in adolescents with T1D may help nurses individualize self-management education and support. Incorporating strategies to promote stress management and self-efficacy in diabetes education may also improve diabetes self-management.

Student pharmacists' service-oriented learning at a camp for children with type 1 diabetes mellitus

Background and purposeTo describe advanced pharmacy practice experience (APPE) students' active learning engagement and changes in self-reported comfort with diabetes care activities by attending an overnight camp for children with type 1 diabetes mellitus (T1DM). Educational activity and settingFourth-year pharmacy students spend one or two weeks at an overnight camp for children ages six to 18 years with T1DM as part of their APPE and assist with diabetes care activities while participating in daily living activities. Students complete a survey one week before and one week after camp where they self-report their comfort level performing 16 different diabetes-related tasks. FindingsStudents (n = 21) participate in hands-on active learning while volunteering at a camp for children with diabetes. Before camp, 40–61% of students reported comfort with diabetes care activities related to pharmacotherapy, monitoring, and lifestyle management. After camp, the percent of students reporting comfort with these tasks increased to 78–96%. Specific items with greatest improvement were: when to monitor ketone levels (+79%), use of insulin pens and pumps (+64%), treatment of hypoglycemia (+50%), and carbohydrate counting (+50%). SummaryBy attending and participating at an overnight camp for children with T1DM, APPE students self-report gain in comfort in performing many diabetes care-related tasks.

Developing Distributed Expertise Coordination Models of Diabetes Care Teams

With the increasing rate of diabetes diagnoses, more patients and healthcare providers are exchanging information. There is a need to understand these diabetes team coordination processes to help facilitate optimal patient care. However, prior to evaluating team coordination processes, it is essential to first define the members of the team. The purpose of this research is to use social network analysis tools to determine the most common and critical diabetes care team members from the practicing healthcare professional perspective. Using participant rankings and measures of centrality (in-degree and in-strength), it was found that the key roles include primary care providers, registered dietitians, registered nurses, pharmacists, endocrinologists, and social workers. The results of this work highlight the importance of coordinating multiple expertise roles and information flow pathways when enhancing diabetes care activities.

Factors Associated with Self-Management in Adolescents with Type 1 Diabetes

Abstract Introduction: Diabetes is one of the most common chronic diseases that is also highly prevalent among adolescents. The present study was conducted to determine the relationship between demographic characteristics and self-management in adolescents with type 1 diabetes. Methods: This descriptive-analytical study was conducted on 426 adolescents with type 1 diabetes aged 13 to 18, and diagnosed for at least one year. The research tools included a demographic information form covering the patients’ personal, family, and health details, and the Self-Management of type 1 Diabetes in Adolescence (SMOD-A) with five subscales of collaboration with parents, diabetes care activities, diabetes problem-solving, diabetes communication, and diabetes goals. The content validity of the measure was then evaluated by a group of experts and found to be acceptable (SCVI = 98%). In the assessment of the measure›s reliability, the intraclass correlation showed an overall Cronbach’s alpha of 0.88. The test-retest showed a consistency of 0.73 for the measure. Results: The results obtained showed that the presence of another diabetic member in the family leads to higher levels of self-management in some dimensions, including problem-solving, communication, and goals, yet to lower levels in some others, including collaboration with parents and diabetes care activities. A direct relationship was observed between the duration of time since the diagnosis and the scores obtained by the adolescents. An inverse relationship was observed between the type of physician in charge and the scores obtained in the subscales of collaboration with parents, problem-solving, communication, and goals. The scores obtained were directly related to having a school health record and having access to diabetic care tools at school. Family income was found to be directly related to diabetes care activities and inversely to problem-solving, communication and goals. P of ≤ 0.05 was considered significant for all relationships. Conclusions: Self-management was found to be moderate to good among Iranian adolescents with type 1 diabetes; however, it could be further improved with the support of both families and medical teams involved.

Adolescent Information Management and Parental Knowledge in Non-Latino White and Latino Youth Managing Type 1 Diabetes

The objective of this study is to examine associations between adolescents' regulation of information about their type 1 diabetes (adolescent disclosure, secrecy), parental knowledge about their adolescent's diabetes management, diabetes outcomes (adherence, HbA1c), and depressive symptoms in Non-Latino White and Latino families. In all, 118 adolescents (56 = Latino, 62 = Non-Latino White) completed surveys of disclosure to and secrecy from parents, parental knowledge of adolescent diabetes management, adherence, and depressive symptoms, and mothers completed measures of maternal knowledge and adolescent adherence. Glycemic control was extracted from medical records. Adolescents also completed structured interviews about parental knowledge about their diabetes-related problems. Interviews revealed that adolescent disclosure is the primary method by which parents gain knowledge about adolescent diabetes management problems. Adolescent disclosure to and secrecy from parents were uniquely associated with diabetes management and depressive symptoms independent of parental knowledge across ethnic groups; maternal reports of knowledge about her adolescent's diabetes care activities were associated with diabetes management independent of adolescent disclosure and secrecy. Adolescent information management strategies are a primary means by which parents gain knowledge about diabetes, which may facilitate more effective management.

Self-Management in Early Adolescence and Differences by Age at Diagnosis and Duration of Type 1 Diabetes

The purpose of the study was to describe the frequency of diabetes self-management activities, processes, and goals among early adolescents. In addition, differences in self-management by age at diagnosis and duration of diabetes were explored. A cross-sectional design was used to analyze baseline data from 320 adolescents with T1DM enrolled in a multisite clinical trial. Participants completed questionnaires on demographic/clinical characteristics and self-management. There was a transitional pattern of self-management with a high frequency of diabetes care activities, problem solving, and goals and variable amounts of collaboration with parents. After controlling for therapy type and age, youth with short diabetes duration reported performing significantly more diabetes care activities than individuals with a longer duration. Individuals with short diabetes duration had more frequent communication than individuals with a longer duration, which was associated with diagnosis in adolescence. Among those diagnosed as school age children, those with short diabetes duration reported significantly more diabetes goals than those with a longer duration. A more specific understanding of self-management may help clinicians provide more targeted education and support. Adolescents with a long duration of diabetes need additional self-management support, particularly for diabetes care activities and communication.

Patient Time Costs Associated with Sensor-Augmented Insulin Pump Therapy for Type 1 Diabetes

Sensor-augmented pump therapy (SAPT) leads to lower glycated hemoglobin levels than multiple daily injections of insulin (MDI) in patients with type 1 diabetes. Patient time and costs associated with SAPT are not known. We compared time spent on diabetes-related care, changes in time, and associated patient time costs between patients randomly assigned to SAPT or MDI. DESIGN, SETTING, AND PARTICIPANTS. During a 52-week clinical trial, participants aged 7 to 70 years (n = 483) reported total time per week spent on diabetes-related care. Patient time, including comparisons during pump initiation, 52-week patient time costs, and changes in weekly time estimates after pump initiation. At baseline, patients in the MDI group reported spending an average of 4.0 hours per week on diabetes-related care. During the pump initiation period (weeks 1-7), SAPT patients spent 1.9 hours more per week than MDI patients (95% confidence interval [CI], 1.2-2.6). After the initiation period (weeks 8-52), SAPT patients spent 1 hour more per week (95% CI, 0.4-1.7) than MDI patients (i.e., 4.4 v. 3.4 hours); patients in both groups spent progressively less time on diabetes-related care by 1.2 minutes per week (95% CI, -1.7 to -0.7). Overall, mean time costs per person were $4600 with the SAPT group and $3523 with the MDI group (difference, $1077; 95% CI, $491-$1638). Time spent on specific activities was not collected, and the estimates do not explicitly account for caregiver time associated with diabetes care activities. Patients receiving SAPT v. MDI spent approximately 2 hours more per week on diabetes-related care during pump initiation and 1 hour more per week thereafter, resulting in higher patient time costs.

Cognitive-Behavioral Therapy for the Treatment of Depression and Adherence in Patients With Type 1 Diabetes

Depression is one of the most common psychological problems affecting individuals with type 1 diabetes, and it is associated with treatment nonadherence and worse clinical outcomes. The research on treating depression or nonadherence in adults with type 1 diabetes is limited. We adapted an evidence-supported treatment, individual cognitive-behavioral therapy for adherence and depression (CBT-AD), for type 1 diabetes and examined its feasibility, acceptability, and potential for an effect. The pilot study included 9 patients with a DSM-IV diagnosis of major depression, dysthymia, or residual depressive symptoms despite treatment with an antidepressant; a diagnosis of type 1 diabetes per patient self-report; and a glycosylated hemoglobin A1c (HbA1c) level of 8.0% or greater. Patients were referred by their diabetes care providers to a behavioral medicine specialty setting and received 10 to 12 sessions of CBT-AD. Main outcome measures included percent of eligible participants who enrolled in the study, session attendance, independently-rated Montgomery-Asberg Depression Rating Scale (MADRS) score, self-reported adherence to diabetes care activities, and adherence to self-monitoring of blood glucose levels. Data were collected from June 27, 2008, through March 31, 2010. There was a clinically meaningful decrease in depression severity (mean [SD] MADRS score decrease from 26.0 [4.73] to 12.3 [7.37], Cohen d = 2.90), demonstrated improvements in diabetes self-care (increase in blood glucose monitoring from 65.0 [26.72] to 82.7 [22.75], Cohen d = -0.66, and a difference in self-reported percent insulin doses in the past 2 weeks from 77.1 [29.84] to 87.1 [23.6], Cohen d = -0.34), and possible improvement in glycemic control (decrease in HbA1c levels from 9.6 [1.32] to 9.0 [1.04], Cohen d = 0.45). These preliminary results provide evidence for the acceptability, feasibility, and potential utility of CBT-AD for patients with type 1 diabetes and depression. clinicaltrials.gov Identifier: NCT01527981.

Self-management of Type 1 Diabetes Across Adolescence

The purpose of this study was to examine differences in self-management behaviors (Collaboration with Parents, Diabetes Care Activities, Diabetes Problem Solving, Diabetes Communication, and Goals) between early, middle, and late adolescence. The role of regimen and gender as covariates in self-management behaviors was also examined. This was a secondary analysis with a cross-sectional descriptive survey design. A sample of 504 participants ages 13 to 21 years from the Self-Management of Diabetes-Adolescent instrument development study were analyzed to determine self-management behaviors in early, middle, and late adolescence. This study was partially guided by the Self and Family Management Framework. This framework contains broad conceptual areas that are thought to pose a risk to or have a protective influence on self-management and family management behaviors and associated outcomes. Significant findings included a decline between early, middle, and late adolescence in the Collaboration with Parents scale as well as an increase between early and late adolescence on the Diabetes Problem Solving scale. Regimen was a significant covariate for Collaboration with Parents, Diabetes Care Activities, and Diabetes Problem Solving, and gender was a significant covariate for Diabetes Care Activities and Diabetes Communication. Clinicians should consider the influence of adolescent stage and development on self-management when educating adolescents. Youth and their families should be educated to consider the implications that regimen will have on daily self-management when making treatment decisions. Furthermore, gender variations can necessitate different educational approaches to meet different needs. Future research should identify other variables that can influence self-management at different points across adolescence.

A new self-report measure of self-management of type 1 diabetes for adolescents.

The development of instruments to measure self-management in youth with type 1 diabetes has not kept up with current understanding of the concept. This study aimed to report the development and the testing of a new self-report measure to assess the Self-Management of Type 1 Diabetes in Adolescents (SMOD-A). Following a qualitative study, items were identified and reviewed by experts for content validity. A total of 515 adolescents, 13 to 21 years old, participated in a field study by completing the SMOD-A (either once or twice) and additional measures of diabetes-related self-efficacy (Self-Efficacy for Diabetes Scale), quality of life (Diabetes Quality of Life for Youth Questionnaire), self-management (Diabetes Self-Management Profile), and adherence (Self-Care Inventory). Data were collected also on metabolic control (glycosylated hemoglobin [HbA1c]). The content validity index was .93. Exploratory alpha factor analyses revealed five subscales: Collaboration With Parents, Diabetes Care Activities, Diabetes Problem Solving, Diabetes Communication, and Goals (alpha = .71 to .85). The stability of the SMOD-A ranged from .60 to .88 at 2 weeks (test-retest) to .59 to .85 at 3 months. Correlations of SMOD-A subscales with Self-Efficacy for Diabetes Scale-Diabetes; Diabetes Quality of Life for Youth Questionnaire satisfaction, impact, and worry; Diabetes Self-Management Profile; and Self-Care Inventory were generally significant and in the expected direction. Collaboration with parents and HbA1c values were related significantly and positively (r = .11); all other SMOD-A subscales were related significantly and negatively to HbA1c (r = -.10 to -.26), demonstrating that better self-management is associated somewhat with better metabolic control and supporting construct validity of the new measure. The SMOD-A has been found to be a reliable, stable, and valid measure of SMOD-A.

Mental health nurses’ diabetes care skills – a training needs analysis

This article explores mental health nurses' diabetes training needs. A survey of inpatient and community mental health nurses was undertaken using a 16-item self-reporting questionnaire. Two hundred and twenty questionnaires were sent out and 138 returned, providing a response rate of 63%. Analysis shows that mental health nurses are currently involved in a range of diabetes care activities, however, their knowledge and skills may not be up to date. Mental health nurses also report the growing impact of diabetes care on their workload. Areas of identified training needs include taking blood glucose readings, giving dietary advice, liaison with diabetes nurse specialists and weight management. Mental health services and education providers need to consider developing specific training courses for mental health nurses.

Baseline Quality-of-Care Data From a Quality-Improvement Program Implemented by a Network of Diabetes Outpatient Clinics

OBJECTIVE—To describe patterns of diabetes care and implement benchmarking activities at the national level.RESEARCH DESIGN AND METHODS—A total of 86 clinics participated, all using electronic medical records. Quality indicators were identified, and software was developed, enabling the extraction of the information needed for quality-of-care profiling.RESULTS—Overall, 114,249 patients with type 2 diabetes were seen during 2004. A1C was measured at least once in 88.0% of the patients, lipid profile in 64.6%, blood pressure in 77.2%, and microalbuminuria in 48.1%. Overall, 43.1% of individuals had A1C ≤7.0%, 36.6% had blood pressure ≤130/85 mmHg, and 29.8% had LDL cholesterol <100 mg/dl. Only 5.5% of the patients had achieved all the favorable outcomes. Wide between-center variation was documented for all indicators.CONCLUSIONS—This study is the first step of a nationwide quality-improvement effort and documents the possibility of obtaining standardized information to be used for diabetes care profiling and benchmarking activities.

A multinational assessment of complications in type 1 diabetes: the DiaMond substudy of complications (DiaComp) Level 1

The objectives of this study were to describe the global geographic variation of microvascular and macrovascular complications in childhood onset type 1 diabetes (T1D) and to relate any such variation to diabetes care activities such as self blood glucose monitoring and intensive insulin therapy. The DiaComp study is a multinational (17 countries) cross-sectional study of complications in T1D (n=2,657). All participants were diagnosed at < 15 years of age and had a diabetes duration of 5-24 years when surveyed. Complications were assessed by self-report of physician diagnosis. Twenty-two centres in 17 countries achieved at least a 67% response rate and are included in the analyses. Central European centres exhibited high rates of retinopathy (Lithuania=31.6%, Romania=24.2%), laser treatment (Lithuania=25.4%) and neuropathy (Lithuania=29.9%, Romania=12.4%) in those with short duration of diabetes (5-15 years), as did Cuba for neuropathy (15.4%). For retinopathy the geographic variation in the short-duration group was also pronounced, ranging from 1.6% in Italy to 41.6% in Lithuania, and from 0% in Brazil, Italy and Australia, to 29.9% in Lithuania for laser treatment. Variation was less dramatic for the prevalence of complications in the long-duration group (15-25 years). Hypertension and duration were strong consistent predictors of all complications, while women had higher prevalence for half the complications (retinopathy, laser treatment and renal disease). Intensive insulin therapy and self-monitoring of blood glucose showed little association with prevalence of complications. In conclusion, this first population-based account of the geographic variation of T1D complications has demonstrated substantial variation. However, the healthcare practice variables that were measured contributed little toward explaining this variation.

The association of patient trust and self-care among patients with diabetes mellitus.

BackgroundDiabetes requires significant alterations to lifestyle and completion of self management tasks to obtain good control of disease. The objective of this study was to determine if patient trust is associated with reduced difficulty and hassles in altering lifestyle and completing self care tasks.MethodsA cross-sectional telephone survey and medical record review was performed to measure patient trust and difficulty in completing diabetes tasks among 320 medically underserved patients attending diabetes programs in rural North Carolina, USA. Diabetes tasks were measured three ways: perceived hassles of diabetic care activities, difficulty in completing diabetes-related care activities, and a global assessment of overall ability to complete diabetes care activities. The association of patient trust with self-management was examined after controlling for patient demographics, physical functioning, mental health and co-morbidities.ResultsLevel of patient trust was high (median 22, possible max 25). Higher trust levels were associated with lower levels of hassles (p = 0.006) and lower difficulty in completing care activities (p = 0.001). Patients with higher trust had better global assessments of overall ability to complete diabetes care activities (p < 0.0001).ConclusionHigher patient trust in physicians is associated with reduced difficulty in completing disease specific tasks by patients. Further studies are needed to determine the causal relationship of this association, the effect of trust on other outcomes, and the potential modifiability of trust

Impact of a Diabetes Certificate Program on Pharmacists' Diabetes Care Activities

Objectives. The objective of this study was to evaluate the effects that skills development and education acquired during a diabetes certificate program had on pharmacists' delivery of diabetes care. Methods. To evaluate the program's effect, a survey was administered as a pretest to a group of pharmacists (N=30) beginning the program. In addition, the survey was administered to all pharmacists completing the certificate program in the last four years (N=126). Survey questions focused on the provision of services, patient contact, and reimbursement. Results. Pharmacists who completed the program reported higher rates of providing consistent blood glucose management, nutrition education, and patient goal setting. In addition, a higher percentage reported documenting and billing for diabetic-related services. Conclusion. The diabetes certificate program in this study had a positive impact on pharmacists' provision of diabetes care services to patients.

The challenges of teaching clients with cerebrovascular accidents to manage their diabetes.

Cerebrovascular accident is a major cause of morbidity and mortality in adults, and occurs more frequently in persons with diabetes. The numerous resulting cognitive, perceptual, communicative, and motor disturbances present a challenge to the individual's ability to learn and carry out aspects of diabetes care and other personal care activities. Different educational strategies can be used depending on the impairments that are present and the needs of the individual. The major goal of these interventions is to help the individual achieve an optimal level of independence, emotional well-being, and overall quality of life. After a thorough assessment to identify the remaining abilities, the educator should collaborate with clients and their families to plan and implement ability enhancing and ability compensating strategies.

Diabetes self-management and hospitalization.

This descriptive survey sought to determine the desires, concerns and experiences of persons with diabetes regarding retention of self‐management during potential and prior hospitalization. Seventy‐three members of an American Diabetes Association chapter completed a questionnaire consisting of both closed‐ended and open‐ended items. Although the subjects were generally self‐managing and compliant at home, they held a diversity of beliefs about self‐management during hospitalization. Those who had been hospitalized had most diabetes care activities performed by the staff members. Assessing desires, competence and readiness of persons with diabetes for self‐management during hospitalization and possible nursing and hospital system changes are suggested to support self‐management when indicated.