Diabetes Conversation Map Research Articles

The Effectiveness of Diabetes Conversation Map™ among Insulin Refusal Type 2 Diabetes Mellitus Patients

INTRODUCTION: Majority of patients with type 2 diabetes mellitus (T2DM) will eventually need insulin therapy to optimise their blood glucose level. However, there is difficulties in initiating an insulin therapy due to high refusal rate among these patients. Diabetes Conversation Maps (DCM), a tool designed to educate patients with diabetes and their family members is available in Malay language since 2008. Although DCM has been used in certain centres in Malaysia, their effectiveness has not been evaluated. Thus, we have conducted a study to assess effectiveness of DCM compared to standard counselling therapy in T2DM patients who initially refused insulin therapy by assessing acceptance rate post intervention. MATERIALS AND METHODS: A randomized control study was conducted on 88 adults T2DM patients who initially refused insulin therapy in primary care clinics in Johor. A total of 44 patients received group based education using a Malay version DCM whereas another 44 patients received standard individual education. Results were analysed using a Chi-square analysis and the significant result was set at p value of < 0.05. RESULTS: The response rate was 97.7% and there was a significant difference in insulin acceptance between these two groups. Eighty-six percent of T2DM patients in the intervention group education eventually accepted insulin initiation compared to only 11% in the control group (p < 0.001).CONCLUSION: Group education using Malay Diabetes Conversation Map on insulin initiation is effective in increasing acceptance among patients who initially refuse insulin treatment in primary care. We recommend using DCM as part of educational module to improve patient diabetic management.

The Life Diabetes Conversation Map Improves Control of Diabetes Among the Elderly: Challenges and Modifications for the Indonesian Community - An Integrative Review

The number of people who have diabetes has been increasing rapidly. Diabetes is a chronic illness that requires continuous intervention to prevent long-term complications and lower the financial burden of treatments. In the elderly, diabetes is linked to higher mortality, reduced functionality, and increased risk of hospitalization. Educational tools that cater to the elderly need to be used to improve the quality and outcomes of patient education among those with diabetes. This paper discussed strategies for improvement using the Life Diabetes Conversation Map in diabetes self-management education among the elderly with diabetes. We conducted a non-systematic search to find evidence from online databases using the keywords: diabetes conversation map, diabetes education, and elderly. Then, we discussed and conducted an integrative review of the Life Diabetes Conversation Map based on how it works, and the benefits and the feasibility or challenges for the Indonesian community. Our findings suggested that the Diabetes Conversation Map was an innovative patient educational tool that used interactive group participation to empower people with diabetes to become actively involved in managing the disease. The maps are a series of pictorial guides through which people engage in discussion and share their beliefs and their experiences of living with diabetes which has many benefits. Challenges for the Indonesian community included needing further innovation for proper language and cultural adjustment and integration into the Public Health Centers’ activities as a primary health care service. Along with these activities, elders could join cooking activities or regular aerobic exercise.
 Keywords: self-management education, Diabetes conversation maps, public health center activity, elderly

Lasting effects of a brief, scalable diabetes conversation map psychosocial intervention on health beliefs and health behaviors: A large randomized controlled trial in Taiwan.

The current study aimed to examine the effects of a conversation map (CM) psychosocial intervention on diet and exercise health beliefs and health behaviors among people with diabetes (PWD). Based on the Health Belief Model, this large-scale randomized controlled trial (N = 615) investigated whether an added 1-h theory-driven CM intervention (N = 308), compared with usual shared-care service only (N = 307), could significantly better improve PWD's diet and exercise health beliefs and health behaviors at 3-month posttest. Multivariate linear autoregression analysis demonstrated that, controlling for baseline, the CM group had significantly better diet (β= .270) and exercise (β= .280) health behaviors at 3-month posttest than the control group. The intervention effects on health behavior change were primarily mediated through desired changes in targeted health beliefs, as informed by the theory. For example, as regards diet, the CM group had significantly greater increases in perceived susceptibility (β= .121), perceived benefits (β= .174), and cues to action (β= .268), as well as greater decreases in perceived barriers (β= -.156), between pretest and 3-month posttest. In conclusion, future diabetes care may integrate brief theory-driven CM interventions, as in this study, into current shared-care practice to help PWD improve diabetes self-management health behaviors more effectively. Implications for practice, policy, theory, and research are discussed.

516-P: A One-Year Curriculum for Diabetes Self-Management Education to Promote Lasting Lifestyle Changes

The use of telehealth for Diabetes Self-Management Education and Support (DSMES) is expanding. There is a need among people with diabetes (PWD) to manage their diabetes, as they represent 20% of ICU admissions, 30% of hospitalized cases and have an increased risk of COVID-related mortality. While people at risk for diabetes or prediabetes may join a 1-year CDC accredited diabetes prevention program to make lifestyle changes to reduce their diabetes risk, PWD are often offered short-term DSMES programs that do not necessarily incorporate long-term goals. We developed a year-long intensive Diabetes Self-Management Education and Support (iDSMES) program combining Virtual Diabetes Conversation Map® and selected modified modules from the PreventT2® curriculum to suit PWD. The curriculum included 18 maps/modules. Our team of certified lifestyle coaches/diabetes educators/Conversation Map® Trainers used shared decision-making and problem-solving approaches to improve glycemic control and diabetes self-management. We hypothesized that iDSMES would improve diabetes outcomes in PWD. Fourteen PWD (12F/2M) with a BMI of 25 or above underwent the iDSMES in a group with their lifestyle coaches using the Zoom® platform. We collected their fasting blood glucose, weight, blood pressure, and physical activity minutes at each session (every three weeks) and assessed their Hemoglobin A1c quarterly. Nine PWD completed the iDSMES and lost an average of 8.8% of their initial body weight (a total of 203lbs) . We observed a 1% decrease in their A1c, 10mg/dL decrease in fasting blood glucose, and mm Hg decrease in systolic and diastolic blood pressure, respectively. There was also a 110-minute increase in their physical activity. A year-long iDSMES distance learning program effectively enhances lasting lifestyle changes to improve diabetes self-management in PWD. A 5-year follow-up is warranted to assess factors affecting the maintenance of accomplished lifestyle changes. Disclosure H.Sallam: None. W.Pan: None. M.L.Ferguson: None. W.Lee: None. K.H.Mckinney: None. H.Serag: None. Funding Texas Department of State Health Services (#HHS000740800001)

Effectiveness of educational programs using Diabetes Conversation Map tools on the health outcomes of people with type 2 diabetes: a systematic review protocol.

The objective of this review is to determine the effectiveness of educational programs using Diabetes Conversation Map on health outcomes of people with type 2 diabetes. Diabetes Conversation Map has been used in the context of diabetes self-management education as a resource for managing type 2 diabetes. There is a need to determine the effectiveness of this non-pharmacological intervention on health outcomes. This review will consider studies that focus on adults with type 2 diabetes, aged ≥18 years, in any context that implemented educational programs using Diabetes Conversation Map. The following outcomes will be explored: self-care, diabetes knowledge, empowerment, diabetes distress and quality of life, glycated hemoglobin, blood pressure, and body mass index as assessed by any validated instrument. This systematic review will be conducted in accordance with JBI methodology for systematic reviews of effectiveness. Any published and unpublished sources of information in English, Spanish, and Portuguese will be considered, with no geographical or cultural limitations. All identified studies will be collated and uploaded into EndNote and duplicates removed. Two independent reviewers will screen the studies based on their titles and abstracts, and then screen the full text against the inclusion criteria. Eligible studies will be critically appraised by two independent reviewers using the standard JBI critical appraisal instruments. Data will be extracted by two independent reviewers using the JBI data extraction tool. The study selection process will be presented using a PRISMA flow diagram. Studies will, where possible, be pooled in statistical meta-analysis. PROSPERO CRD42020154253.

Women’s accounts of the gestational diabetes experience – a South African perspective

Background. Considering the perspectives of African women affected by gestational diabetes mellitus (GDM) may facilitate the development of culturally sensitive interventions to address this public health concern. Objective. To identify the personal experiences, challenges, coping strategies and health decisions made by urban indigenous South African women affected by GDM. Methods. The experiences of urban African women ( n =10) previously affected by GDM were documented during focus group discussions. The Diabetes Conversation Map educational instrument was used to facilitate discussions. Sessions were audio-recorded, transcribed and thematically analysed. Results. Participants experienced shock and fear on diagnosis of GDM, but family support and sharing their experiences with their peers provided relief from anxiety. They were aware of the inconsistent implementation of GDM diagnostic procedures at tertiary hospitals and community health clinics, which exacerbated their confusion. Despite their initial difficulty in adjusting to a diet perceived as unpalatable, adopting a healthier lifestyle was considered a positive consequence of a GDM diagnosis. Healthy lifestyle changes were partially retained post partum and were reported to have a positive effect on other family members. The participants had little awareness of their long-term risk of developing diabetes mellitus and the need for regular follow-up screening. Unexpectedly, the majority of participants concurred that being HIV-positive would be less stressful than living with diabetes. Conclusion. Participants viewed being HIV-positive as preferable to having GDM, which may reflect the distress caused by inadequate pretest counselling, inconsistent health information, inconsistent screening practices and suboptimal support from healthcare professionals.

Diabetes conversation map - a novel tool for diabetes management self-efficacy among type 2 diabetes patients in Pakistan: a randomized controlled trial

BackgroundThis study aimed to measure the effect of diabetes education using the novel method of “diabetes conversation map (DCM)” as compared to routine counselling (RC) on diabetes management self-efficacy (DMSE) among patients living with type 2 diabetes in Karachi, Pakistan.MethodsA parallel arm randomized controlled trial among patients with type 2 diabetes aged 30–60 years, with HbA1c > 7%, diagnosed for at least 5 yrs., was conducted at the national institute of diabetes and endocrinology in Karachi, Pakistan. A total 123 type 2 diabetes patients were randomized into DCM (n = 62) or RC (n = 61). Four weekly diabetes control sessions of 40 min each using the DCM or RC was provided. DMSE was measured using a validated Urdu language DMSE tool at baseline and after three months of the randomization. Change in DMSE and HbA1c levels within groups (pre-post) and between the groups after 3 months of enrollment was compared.ResultsBaseline characteristics except HbA1c were similar between the two arms. After 3 months of enrollment, there was no change in the DMSE score in the RC arm however, significant increase in DMSE score was noted in the DCM arm (P = < 0.001). The average difference (95% confidence interval) in DMSE score between the DCM and RC arm was 33.7(27.3, 40.0; p = < 0.001) after 3 months of the enrollment. Difference in HbA1c within groups was not significant.ConclusionsDCM significantly improved DMSE among type 2 diabetes patients in a developing country setting like Pakistan. Healthcare workers caring for type 2 diabetes patients need to be trained on DCM to effectively utilize this novel tool for educating diabetes patients.Trial registrationThis trial was prospectively registered. ClinicalTrials.gov Identifier: NCT03747471. Date of registration: Nov 20. 2018.

Effect of diabetic counseling based on conversation map as compared to routine counseling on diabetes management self-efficacy and diabetic distress among patients with diabetes in Pakistan: a randomized controlled trial (study protocol)

BackgroundNovel interactive and pictorial health education tool named Diabetes Conversation Map (DCM) might be effective for the improvement of diabetes management self-efficacy (DMSE) and diabetes distress (DD) among diabetic patients in lower middle-income setting. This study protocol will assess the effectiveness of DCM as compared to routine care (RC) to improve DMSE, decrease DD and glycated hemoglobin (HbA1c) among patients with type 2 diabetes (T2DM).MethodsThis will be two arms randomized controlled trial, conducted at national institute of diabetes and endocrinology (NIDE) in Karachi, Pakistan. A sample of 120 T2DM patients of age 30–60 years with suboptimal diabetes control will be screened through eligibility criteria and DD screening tool. Patients who fulfill the eligibility criteria and have diabetes distress will be randomized into interventional and control arm. The intervention arm will receive four education sessions (40 min each) using DCM for 4 weeks duration of enrollment. Controlled arm will receive RC. DMSE and DD will be measured using the validated Likert tools at baseline and after 3 months of enrollment. Latest results of HbA1c will be retrieved from the respective medical record files at baseline and 3 months. Change in DMSE, DD scores and HbA1c levels within groups (pre-post) and between the groups after 3 months of enrollment will be compared. Multivariable linear regression will be conducted to adjust for any potential confounders.DiscussionIn a study in UK, 70% of the patients with diabetes reported DCM had helped them in controlling their diabetes and recommended this method to teach other patients with diabetes also. In China, a study found that patients with diabetes who received DCM based education had significantly lower DD and significantly higher diabetes empowerment score after six months of the intervention as compared to the traditional counselling. A cross sectional study conducted in Pakistan also demonstrated that teaching based on DCM was useful in improving the knowledge, attitude and practices of patients with T2DM. Besides, no other study has evaluated the effectiveness of these novel tools for DMSE and diabetes distress DD in well-designed, sufficiently powered clinical trials.Trial registrationClinicalTrials.gov Identifier: NCT03747471. Date of registration: Nov 20. 2018. Version and Date of Protocol: Version 1, IRB Approval date 28 June 2018.

An Evaluation of the Diabetes Conversation Map Program—Health Outcomes and Health Care Utilization during a Four-Year Follow-Up

Background: Diabetes Conversation Map™ (Map™) is a global education program that engages patients with type 2 diabetes Mellitus (T2DM) in group-based discussions on diabetes-related topics. This study compares outcomes annually between participants and matched controls over a 4-year period. Methods: This was a retrospective cohort study of 11,053 Clalit Health Services members with T2DM who enrolled in the Map™ program between 1.1.2010 and 4.1.2016. The associations between program participation and annual laboratory test results (HbA1c, glucose and LDL levels), health behaviors (frequency of glucose and HbA1c testing), and healthcare utilization (hospital, physician and specialist visits) were assessed between cases and controls using regression analysis. Results: The Map™ group had significantly improved HbA1c, glucose, and LDL levels and more frequent blood glucose testing each year up to 36 months post-enrollment compared to matched-controls. They also had significantly fewer annual primary care visits but more annual ophthalmologist and nutritionist visits up to 24, 36, and 48 months post-enrollment, respectively, compared to matched-controls. The annual frequency of hospital admissions and length of hospital stay was lower up to 36 and 48 months post enrollment, respectively, in the Map™ group compared to matched-controls. Conclusions: Participation in the Map™ program was associated with improved clinical outcomes, behaviors, and healthcare utilization for at least 24 months, suggesting that an intervention booster may be needed beyond this time period. These findings support the significant impact of the Map™ program on the lives of patients with T2DM. Disclosure E. Srulovici: None. M. Leventer-Roberts: None. B. Curtis: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. X. He: None. M.B. Hoshen: None. M. Rotem: None. I. Gofer: None. E. Shadmi: None. C. Key: None. N. Levin-Iaina: Employee; Self; Eli Lilly and Company. A. Strizek: None. B.S. Feldman: None.

Long-term effectiveness of the diabetes conversation map program: A prepost education intervention study among type 2 diabetic patients in Taiwan: Erratum.

Long-term effectiveness of the diabetes conversation map program: A prepost education intervention study among type 2 diabetic patients in Taiwan: Erratum.

Evaluating the Impact of Diabetes Self-Management Education Methods on Knowledge, Attitudes and Behaviours of Adult Patients With Type 2 Diabetes Mellitus.

Diabetes self-management refers to all activities patients undertake to care for their illness, promote health and prevent the long- and short-term effects of diabetes. This study compared the effectiveness of 2 diabetes self-management education methods by examining changes in glycated hemoglobin (A1C) levels and knowledge, attitudes and behaviours (KABs) after traditional group education (TE) or with diabetes conversation maps (CMs). The CMs group was postulated to show greater decrease in A1C levels and improved KABs scores compared to the TE group. A sample of 21 eligible clients from Diabetes Care Guelph were randomly assigned into 2 groups: 10 receiving education through CMs and 11 through TE. Changes in knowledge and attitude were determined by using questionnaires and repeated-measures pretest and post-test design before and after the education sessions. Changes in A1C levels were determined by comparing values at baseline and at 3 months after receiving diabetes education. Two focus groups were conducted to obtain participants' perceptions of the education methods and self-reported KAB changes. Significant differences in knowledge and attitude score changes were observed from baseline/initial education and after 3 months. Both groups had significant decreases in A1C levels from baseline to 3 months afterward. Focus groups revealed themes common to both groups, such as benefits of early education, the need for multiple lifestyle behaviour changes and feelings about social support. CMs had a significant impact and are effective for group education. The changes observed may lead to improved diabetes self-management, thus reducing costly health complications related to poorly controlled diabetes.

Long-term effectiveness of the Diabetes Conversation Map Program: A prepost education intervention study among type 2 diabetic patients in Taiwan.

Health education is compulsory for patients with chronic and life-threatening disease, especially for those with diabetes mellitus (DM). This study aimed to examine the long-term effectiveness of the Diabetes Conversation Map Program (DCMP) among DM patients in Taiwan.A quasi-experimental research design using convenience sampling and nonrandom group assignment was applied to recruit 95 type 2 diabetic subjects from a hospital in Taiwan. In addition to routine care, the experiment group (n = 49) received 7 sessions of DCMP that delivered over 2 months, while the control group (n = 46) received only routine care during the same period. We conducted structured questionnaire survey and reviewed medical record at 3 time points (before DCMP, 3 days after DCMP, and 3 months after DCMP completion) to collect the effectiveness data. The effectiveness was determined using the generalized estimating equation model.We found that improvements in the body mass index, blood glucose, glycated hemoglobin, self-monitoring of blood glucose, and diabetic health literacy in the DCMP group compared with controls (all P values <.05), with no significant changes in depressive symptoms. The positive effects were further maintained for 3 months after DCMP.The findings may serve as a reference for helping healthcare professionals provide appropriate interventions to improve adaptation processes and clinical outcomes for DM patients.

Educational interventions for knowledge on the disease, treatment adherence and control of diabetes mellitus.

Objective: to assess the effect of educational interventions for knowledge on the disease, medication treatment adherence and glycemic control of diabetes mellitus patients. Method: evaluation research with "before and after" design, developed in a sample of 82 type 2 diabetes mellitus patients. To collect the data, the Brazilian version of the Diabetes Knowledge Scale (DKN-A), the Measure of Adherence to Treatments and the electronic system at the place of study were used. The data were collected before and after the end of the educational interventions. The educational activities were developed within 12 months, mediated by the Diabetes Conversation Maps, using the Cognitive Social Theory to conduct the interventions. Results: the knowledge on the disease (p<0.001), the medication treatment (oral antidiabetics) (p=0.0318) and the glycated hemoglobin rates (p=0.0321) improved significantly. Conclusion: the educational interventions seem to have positively contributed to the participants' knowledge about diabetes mellitus, the medication treatment adherence and the glycated hemoglobin rates.

Effects and predictors of the diabetes conversation map education tools for maintaining glycemic control in patients with type 2 diabetes

Effects and predictors of the diabetes conversation map education tools for maintaining glycemic control in patients with type 2 diabetes

Improvement of glycemic control in Taiwanese patients using modified Diabetes Conversation Map® tools

Improvement of glycemic control in Taiwanese patients using modified Diabetes Conversation Map® tools

Effectiveness of the Diabetes Conversation Map education tools on diabetes-related parameters of outpatients with diabetes

Effectiveness of the Diabetes Conversation Map education tools on diabetes-related parameters of outpatients with diabetes

Investigating the results of utilizing diabetes conversation map for patient blood glucose management

Investigating the results of utilizing diabetes conversation map for patient blood glucose management

The effect on condition control among type 2 diabetic patients using diabetes conversation map tools

The effect on condition control among type 2 diabetic patients using diabetes conversation map tools

Impact of "Conversation Maps" on diabetes distress and self-efficacy of Chinese adult patients with type 2 diabetes: a pilot study.

The objective was to compare Diabetes Conversation Maps-based education and traditional education in Chinese patients with type 2 diabetes. A total of 53 outpatients were randomized to the intervention group (Diabetes Conversation Maps-based education) and control group (traditional education). In the intervention group, six 1-hour sessions covering diabetes overview, living with diabetes, risk factors and complications of diabetes, starting insulin treatment, foot care, and healthy eating and exercise were provided during 4 weeks. The participants had to attend at least four sessions, followed by a monthly follow-up telephone call in the subsequent 3 months. In the control group, six 1-hour diabetes classes covering similar topics as those in the intervention group were provided over 4 weeks. Each participant needed to attend at least four sessions. A1C was assessed at baseline, 3 months and 6 months after the last educational session/class. Psychosocial metrics and self-care activities were evaluated at baseline and 6 months after the last educational session/class. Forty-six participants finished the study. After 6 months, the total score of diabetes distress scale was significantly lower and total score of diabetes empowerment scale-short form was significantly higher in the intervention group than the control group. The 3 months A1C was significantly lower in the intervention group than the control group. However, the 6 months A1C did not reach a statistically significant difference between groups. Compared to traditional education, Diabetes Conversation Maps were more effective in improving psychosocial metrics and 3-month A1C.

The Journey to Control

Diabetes mellitus (DM) is a lifelong metabolic disorder characterized by persistently increased serum glucose levels related to a shortage of insulin in the body (Meetoo &amp;amp; Allen, 2010). Research has found that individuals with a diagnosis of diabetes mellitus (DM) present to the hospital more often than individuals without DM. These hospital visits also tend to be lengthier and more serious in nature. Glycemic control is critical to avoid complications of inpatient hyperglycemia and to lower the risk of long-term complications associated with poor sugar control. Poor outcomes that have been associated with hyperglycemic patients staying in the hospital setting include increased rates of nosocomial infections, sepsis, and an increased length of stay. Strict glycemic control in the hospital that is modified daily according to each diabetic patients needs and clinical situation can significantly reduce the risks for these poor outcomes (Johnston &amp;amp; Van Horn, 2011). Also, patients who understand their disease are more likely to take ownership of their health care problems, understand their treatment options, modify their behaviors, and take their medications more regularly. Tight glycemic control will be tackled through the methods of a redesigned meal delivery program, accurate insulin administration, the implementation of the diabetes conversation map program, and by giving patients a diabetic workbook upon discharge.