Diabetes Empowerment Research Articles

Can a mobile application improve glucose-related and patient-reported outcome measures (PROMs) in people with type 1 diabetes mellitus? A randomized controlled trial using the mySugr® app.

Mobile applications (apps) have proven to be highly effective tools to empower patients with type 1 diabetes mellitus (T1DM) and enable them to achieve better self-care, quality of life (QOL), and glycemic control. The aim of the study is to examine whether mySugr®, an app for diabetes management, together with teleconsultations, can have a positive impact on these factors and, thereby, replace current clinical care. This study concerns an exploratory randomized clinical trial of 12 months' duration. People with T1DM using multiple daily injections were randomized to usual care (bolus calculator, five face-to-face visits) or intervention (mySugr® app, three face-to-face visits, and two teleconsultations). The main outcome was increase in empowerment assessed with the Diabetes Empowerment Scale Short Form questionnaire (DES-SF-S). Secondary outcomes were change in additional glucose-related (blood glucose monitoring, mean blood glucose, standard deviation, coefficient of variation (CV), and high and low blood glucose index) and patient-reported outcome measures (PROMs) (self-management, QOL, and distress). A total of 25 out of 28 participants completed the study (52% men, age 44.52 years, diabetes duration 21.28 years). At 12 months, no significant differences were identified in the change of DES-SF-S and additional PROMs between arms. Similarly, no differences were observed in glucose-related outcomes except for the change in CV at 9 (control - 1.87 ± 4.98 vs. intervention 5.89 ± 11.33, p = 0.008) and 12 months (control - 2.33 ± 3.54 vs. intervention 5.12 ± 11.32, p = 0.018). Adherence to and satisfaction with the app were high. Patients with diabetes using the mySugr® app and teleconsultation achieved similar results to those following usual care in empowerment, other PROMs, and most glucose-related outcomes, thus supporting its use in combination with face-to-face visits. The RCT was registered with ClinicalTrials.gov (NCT03819335, first registration 28/01/2019).

Psychometric properties of the Slovenian versions of the diabetes empowerment scale, long and short form, among the slovenian adults with type 2 diabetes

AimsTo determine the psychometric properties of the Slovenian versions of the Diabetes Empowerment Scale (DES), both the long form (S-DES-LF) and the short form (S-DES-SF). MethodsBetween April and September 2023, we recruited adults with type 2 diabetes (T2D) using convenient sampling in five primary health centres. We examined internal consistency, test-retest reliability, criterion validity, and discriminant validity. Confirmatory factor analysis (CFA) evaluated the fit of the one-and three-factor models for S-DES-SF and S-DES-LF, respectively. ResultsThe results of 288 individuals, with a mean age of 67 ± 9.2 years, including 132 men and 156 women, showed excellent internal consistency and strong test-retest reliability for both the S-DES-LF (Cronbach’s α=0.90; ICC=0.95) and S-DES-SF (α=0.91; ICC=0.92). Criterion validity of the S-DES-LF was confirmed through known-groups validity, with higher education (p=0.016) and absence of comorbid hypertension (p=0.034) associated with greater empowerment. Discriminant validity was demonstrated by the lack of significant correlations between the S-DES-LF and S-DES-SF scores with age or gender. CFA confirmed a good fit for the S-DES-SF's one-factor model but not for S-DES-LF three-factor model. ConclusionsS-DES-LF and S-DES-SF are valid and reliable tools for assessing diabetes empowerment in Slovenian people with T2D. Future research should further explore the convergent validity of scales.

A new approach in insulin pump education improves glycemic outcomes: a randomized controlled trial.

To address the scarcity of continued education for insulin pump users, we developed and evaluated a new program (NP) for individuals transitioning to a different insulin pump. In a randomized, controlled 3-month study, adults with type 1 diabetes and suboptimal HbA1c received either NP or usual care program (UC). The NP was designed in collaboration with representatives of the target group and incorporated technical training, case-based learning, and peer experience sharing - encompassing two group sessions, and two follow-up telephone calls. The UC included a single training session led by the pump company with hotline assistance (clinic) but no structured follow-up. The primary endpoint was the difference in time in range (TIR) (70-180mg/dL (3.9-10.0 mmol/L)), measured by continuous glucose monitoring from baseline to 3 months post-course. Psychosocial self-efficacy was measured by the Diabetes Empowerment Scale (DES-SF). Thirty-nine participants (median age 43, 74% female) were included. Mean TIR increased significantly in the NP group and remained unchanged in the UC group (between-group difference in change was 13.5% [95% CI: 4.0 to 22.9], p = 0.0064). Psychosocial self-efficacy improved and HbA1c decreased only significantly in the NP group. Applying a novel education program at pump transition significantly improved glycemic outcomes and self-efficacy.

Improving Diabetes Equity and Advancing Care (IDEA) to optimize team-based care at a safety-net health system for Black and Latine patients living with diabetes: study protocol for a sequential, multiple assignment, randomized trial

BackgroundDiabetes is the eighth leading cause of death in the USA. Inequities driven by structural racism and systemic oppression have led to racial/ethnic disparities in diabetes prevalence, diagnosis, and treatment. Diabetes-self management training (DSMT), remote glucose monitoring (RGM), and tailored support from a community health worker (CHW) have the potential to improve outcomes. This study will examine the implementation of these interventions in a safety-net healthcare setting.MethodsUsing implementation science and racial equity principles, this study aims to (1) evaluate the appropriateness; (2) measure fidelity; and (3) compare the effectiveness of varying the combination and sequence of three interventions. An exploratory aim will measure sustainability of intervention adherence and uptake. This mixed-methods trial employs a sequential, multiple assignment randomized trial (SMART) design, patient focus group discussions, and staff interviews. Eligible Black/Latine patients will be recruited using patient lists extracted from the electronic medical record system. After a detailed screening process, eligible patients will be invited to attend an in-person enrollment appointment. Informed consent will be obtained and patients will be randomized to either DSMT or RGM. At 6 months, patients will complete two assessments (diabetes empowerment and diabetes-related distress), and HbA1c values will be reviewed. “Responders” will be considered those who have an HbA1c that has improved by at least one percentage point. “Responders” remain in their first assigned study arm. “Nonresponders” will be randomized to either switch study arms or be paired with a CHW. At 6 months participants will complete two assessments again, and their HbA1c will be reviewed. Twelve patient focus groups, two for each intervention paths, will be conducted along with staff interviews.DiscussionThis study is the first, to our knowledge, that seeks to fill critical gaps in our knowledge of optimal sequence and combinations of interventions to support diabetes management among Black and Latine patients receiving care at a safety-net hospital. By achieving the study aims, we will build the evidence for optimizing equitable diabetes management and ultimately reducing racial and ethnic healthcare disparities for patients living in disinvested urban settings.Trial registrationClinicalTrials.gov: NCT06040463. Registered on September 7, 2023.

The feasibility of a social media-based foot self-management education and support program for adults with diabetes: A partially randomized preference trial

AimTo assess the feasibility of Diabetic Foot Care Group (DFCG), a social media-based self-management education and support intervention, for people with diabetes (PWD) empowerment in diabetes-related foot ulceration prevention. MethodsA partially randomized preference trial was conducted among 32 PWD. DFCG was implemented through Facebook. Participants in the intervention group joined the DFCG in addition to their usual care, while the control group received usual care. Data were collected online using questionnaires on participants' DFCG acceptance, engagement and preliminary efficacy on nine diabetes foot care-related outcomes at baseline, one, and three months post-intervention. ResultsThe participants' study intervention acceptability and engagement rates were 84.2% and 55.2%, respectively. DFCG efficacy rate compared to usual care was 88.9% to 22.2%. Three diabetes foot care-related outcomes increased significantly in the intervention group three-month post-intervention: foot self-care adherence (p = 0.001, ηp2 = 0.35), preventive foot self-care practice (p = 0.002, ηp2 = 0.33), and physical health status (p < 0.02, ηp2 = 0.23). ConclusionDFCG is feasible and could effectively improve diabetes foot care-related outcomes. InnovationSocial media is an innovative approach healthcare professionals could utilize to virtually support PWD in ongoing learning and engagement in optimal foot self-care activities. Trial registrationClinicalTrials.gov, Identifier: NCT04395521

1820-LB: Evaluating an HCP Diabetes Training Program in Kasese, Uganda

Introduction &amp; Objective: Health Care Provider (HCP) diabetes educational sessions are core to the mission of Diabetes Empowerment International (DEInt) in Kasese, Uganda. Understanding HCP profiles and their barriers to diabetes education access is essential to shape a successful training program. We evaluated the profile of the HCPs that are trained as well as the feedback received regarding how the training is implemented in patient care. Methods: In person HCP diabetes seminars are held every 8 weeks DCA/DEINt Diabetes Education Center in Kasese, covering a curriculum of key topics related to care of diabetes. Each session hosts over 50 regional HCPs, and over 106 HCPs have attended 23 education seminars. Participant evaluations are performed for each seminar for impact on diabetes knowledge and patient care. Results: The average distance traveled for the conferences was 29.4 km [range 0.5-63.2 km]. The majority of participants are enrolled nurses (n=51, 48.11 %), followed by assistant nursing officers (n=20, 18.87 %), and enrolled midwives (n=11, 10.38 %). The remainder of participants have varied healthcare provider titles. The majority of HCPs reported that there was a diabetes trained doctor in the facility where they worked (n=62, 58.49 %). The mean number of diabetes patients supported was 40 [range 0-418]. A total of 8,733 people with diabetes are being served by the HCPs with 289 type 1 diabetes patients and 770 type 2 diabetes patients. The topics that attendees expressed the most confidence in managing patients with diabetes was checking blood sugars and hypoglycemia. Topics that attendees indicated that they would change how they treat diabetes patients was insulin pumps (n=55, 62.5%) and carbohydrate counting (n=54, 61.36 %). Conclusion: Our diabetes training programs supports a wide range of HCPs. HCP diabetes training can have a far-reaching impact on an underserved population of individuals with diabetes. Disclosure S. Narayanan: Employee; Dexcom, Inc. C. Basch: None. J. Baker: Speaker's Bureau; Insulet Corporation, Dexcom, Inc., Sanofi.

Person-Centred Diabetes Care: Examining Patient Empowerment and Diabetes-Specific Quality of Life in Slovenian Adults with Type 2 Diabetes.

Patient empowerment is crucial for promoting and strengthening health. We aimed to assess patient empowerment and diabetes-specific health-related quality of life (HRQoL) in adults with type 2 diabetes (T2D). A multi-centre, cross-sectional survey was conducted among adults with T2D in urban and rural primary care settings in Slovenia between April and September 2023. The survey utilised convenience sampling and included sociodemographic and clinical data, the Diabetes Empowerment Scale (DES), and the Audit of Diabetes-Dependent QoL (ADDQoL). The study included 289 people with T2D and a mean age of 67.2 years (SD 9.2). The mean overall DES score was 3.9/5 (SD 0.4). In a multivariable linear regression model, higher empowerment was significantly associated with residing in a rural region (p = 0.034), higher education (p = 0.028), and a lack of comorbid AH (p = 0.016). The median overall ADDQoL score was -1.2 (IQR [-2.5, -0.6]). The greatest negative influence of diabetes on HRQoL was observed in the domain 'Freedom to eat', followed by 'Freedom to drink', 'Leisure activities', and 'Holidays'. Despite high empowerment among adults with T2D, the condition still imposes a personal burden. Integrated primary care models should prioritise the importance of implementing targeted interventions to enhance diabetes empowerment, address comorbidities, and improve specific aspects of QoL among individuals with T2D.

Psychosocial Self-efficacy and its Association with Selected Potential Factors Among Adults with Type 1 Diabetes: A Cross-Sectional Survey Study.

The management of type 1 diabetes, a non-preventable chronic disease, leads to a high physical and psychological burden on the individual. Digital health technology can improve a person's psychosocial self-efficacy and thereby contribute to improved diabetes self-care. The aim of this study was to explore associations between psychosocial self-efficacy and demographic-, disease specific-, well-being as well as digital health technology (DHT) related factors among adults with type 1 diabetes. A primarily web-based cross sectional survey was conducted among adults with type 1 diabetes in Sweden (n = 301). Psychosocial self-efficacy was assessed using the Swedish version of the Diabetes Empowerment Scale, Swe-DES-23. The survey also contained questions related to demographic-, disease specific-, well-being as well as digital health technology related variables. Higher well-being scores and lower HbA1c levels were associated with higher psychosocial self-efficacy in multiple linear regression analysis. In multivariate analysis, gender, body mass index, well-being scores, and HbA1c levels showed association with psychosocial self-efficacy. None of the DHT factors were found associated with psychosocial self-efficacy. In this study, higher well-being score and lower self-reported HbA1c levels were associated with higher psychosocial self-efficacy in both univariate- and multivariate analysis and accounted for 30% of the variation in psychosocial self-efficacy in the regression model. Thus, measures to improve psychosocial self-efficacy in adults with type 1 diabetes may help maintain their psychological well-being and blood glucose control.

Pragmatic Study Design to Assess the Effect of a mHealth Application on Empowerment of Noninsulin Treated Type 2 Diabetes People in a Low- and Middle-income Setup

Background: In low- and middle-income countries (LMICs), such as India, self-monitoring of blood glucose (SMBG) for people living with type 2 diabetes mellitus (T2DM) faces many barriers. mHealth applications that combine blood glucose (BG) assessment and the provision of actionable information can help overcome current challenges. Pragmatic study protocols assessing the medical value of mobile SMBG applications to deal with LMIC-specific challenges are missing. Aims and Objectives: This study will assess the impact of a mHealth application on diabetes empowerment using the Diabetes Empowerment Scale-Short Form questionnaire in noninsulin-treated people with T2DM in India. Methods: An observational, single-arm, prospective study will be conducted among adults (n = 100) with T2DM who have not been using a BG meter before and were on diet, exercise, or noninsulin antidiabetic therapy. After enrollment (baseline) and an 8-week control phase, the people participating in the study will receive the mobile phone-based BG assessment devices and will receive a training for the application. During the observational period of 12 weeks (20 weeks after baseline), the subjects will monitor their BG ranges with the devices and the mobile application. At baseline and weeks 8, 14, and 20, diabetes empowerment will be assessed as primary outcome. Health literacy, diabetes treatment satisfaction, and user experience, among others, will be examined as secondary outcomes. Discussion: Mobile applications have the potential to improve diabetes care due to their higher reach, but pragmatic study designs are needed to evaluate the effectiveness. Conclusions: The results of this pragmatic study will provide more patient-reported insights on the impact of mobile applications on diabetes self-management in LMIC.

Psychosocial Factors, Stress and Sleep Among Rural Appalachian Kentucky Residents with Type 2 Diabetes Mellitus.

Rural Appalachian residents experience higher rates of most chronic diseases, including type 2 diabetes mellitus (T2DM). Stress and sleep deficiency also are common in the region. To better understand these associated health burdens, the relationship among these conditions and psychosocial factors-such as depressive symptoms, distress, empowerment, and social support-was examined among Appalachian residents with T2DM. Using data collected from a community-based sample of Appalachian adults with T2DM, the study examined whether psychosocial factors were associated with perceived stress (Cohen Perceived Stress Scale) and self-reported sleep deficiency (Epworth Sleepiness Scale). Multilevel linear mixed effects regression modeling was used to test these associations. Depressive symptoms, distress, and social support were significantly associated with perceived stress, while diabetes empowerment was not associated with perceived stress. None of these psychosocial factors were found to be associated with sleep. To our knowledge, this is the first known study to examine the relationship among psychosocial factors and perceived stress and sleep in rural Appalachian people with T2DM. With a high prevalence of mental distress in Appalachia, the findings highlight the need to further examine depression, diabetes management, and social support in people with T2DM in rural regions like Appalachia.

The Effect of Diabetes Management Shared Care Clinic on Glycated Hemoglobin A1c Compliance and Self-Management Abilities in Patients with Type 2 Diabetes Mellitus.

We aim to evaluate the impact of diabetes management shared care clinic (DMSCC) on glycated hemoglobin A1c (HbA1c) compliance and self-management abilities in patients with type 2 diabetes mellitus (T2DM). This study was a prospective cohort study of patients with T2DM participating in the DMSCC. At baseline and after management, the HbA1c levels were measured, the HbA1c compliance rate were calculated, and the Summary of Diabetes Self-Care Activities-6 (SDSCA-6), Diabetes Empowerment Scale-DAWN Short Form (DES-DSF), and Problem Areas in Diabetes Scale-Five-item Short Form (PAID-5) were completed. These pre- and post-management data were compared. A total of 124 eligible patients were enrolled. After the diabetes management of DMSCC, the average HbA1c decreased and the HbA1c compliance rate increased significantly (P < 0.01). SDSCA-6 showed significant improvement in physical activity, glycemic monitoring, smoking (P < 0.01), and taking medication (P < 0.05). DES-DSF suggested a greater willingness to try to effectively treat diabetes (P < 0.05). PAID-5 indicated significant improvement in diabetes-related emotional distress. DMSCC can help patients with T2DM reduce HbA1c, increase HbA1c compliance, improve diabetes self-management behaviors, empowerment, and diabetes-related emotional distress and serve as an effective exploration and practice of diabetes self-management education and support.

PERCEIVED COGNITIVE FUNCTION: RELATIONSHIPS WITH DIABETES COMPLICATIONS AND SELF-EFFICACY IN LATINX OLDER ADULTS

Abstract Cognitive dysfunction is a concern for individuals with type 2 diabetes (T2DM) and can affect diabetes self-management. However, it is often overlooked clinically and remains relatively understudied in Latinx older adults as a complication of T2DM. This project sought to explore the relationships between perceived cognitive dysfunction and its effects on self-efficacy and complications of T2DM in older Latinx adults. This was part of an analysis of baseline data from a larger randomized controlled trial investigating an cognitive rehabilitation intervention for older adults with T2DM. A total of 87 participants (mean age 67.3 +/- 5.4) completed a survey consisting of the Diabetes Empowerment Scale - short form (self-efficacy); PROMIS Bank v.2 - Cognitive Function (perceived cognitive function); and a self-report of number and type of diabetes complications. Participants had lower perceived cognitive dysfunction than the general population (Mean total score: 36.6 +/- 7.9); low self-efficacy (mean total score: 2.3 +/- 0.7) and reported at least 2 complications related to T2DM. Greater perceived cognitive dysfunction was related to lower self-efficacy (p = 0.04). Diabetes duration was positively associated with self-efficacy (p = 0.03), but not perceived cognitive dysfunction (p = 0.22). Self-efficacy was positively associated with number of diabetes complications (p = 0.03). Irrespective of diabetes duration, patients with more severe perceived cognitive dysfunction reported lower self-efficacy (p = 0.03) than those with lower levels of cognitive dysfunction. Assessment of cognitive function may help inform patient education interventions for Latinx older adults to improve the self-efficacy and potentially reduce complications.

A Causal Model of Health Literacy among Thai Older Adults with Uncontrolled Diabetes

Uncontrolled diabetes among older adults leads to acute and chronic complications that threaten health and life. Health literacy is crucial to managing health and making successful behavior changes for optimal diabetes outcomes. However, a clear understanding of multiple factors and their mechanisms to influence health literacy is lacking. This descriptive cross-sectional study aimed to test a Model of Health Literacy among Thai Older Adults with Uncontrolled Diabetes and examined the influencing pathways of cognitive function, diabetes knowledge, provider-patient communication, empowerment perception, social support, Internet use, and social engagement regarding health literacy. The sample consisted of 259 older Thai adults with uncontrolled diabetes. Data were collected using a demographic data form, the European Health Literacy Survey Questionnaire, the Diabetes Knowledge Scale, the Diabetes Empowerment Process Scale, the Provider-patient Communication Scale, the Social Support Questionnaire, the Montreal Cognitive Assessment-Basic Test, the Internet Use Questionnaire, and the Being Actively Engaged with Society Subscale of the Active Ageing Scale for Thai People. Data were analyzed using descriptive statistics and structural equation modeling with AMOS. The results showed that the model explained 76% of the quality of life variance. Diabetes knowledge and cognitive function directly affected health literacy. Health literacy was indirectly affected by provider-patient communication and empowerment perception through diabetes knowledge, social engagement through cognitive function, and Internet use through cognitive function and diabetes knowledge. Nurses can develop strategies by integrating Internet use and social engagement in empowerment communication programs to improve diabetes knowledge and cognitive function toward higher health literacy in this population.

From fixer to facilitator: an interpretative phenomenological study of diabetes person-centred counselling and empowerment-based education.

The purpose of this study is to explore the professional and personal experiences of multidisciplinary healthcare professionals during and following diabetes counselling and empowerment-based education. Everyone who had participated in a diabetes counselling and empowerment course between 2008-2016 was invited to respond to an online survey and follow-up telephone interview if willing. Interviews were recorded and transcribed verbatim. The research team used interpretative phenomenology to identify core themes from both the survey and telephone interviews and which captured the impact of empowerment-based education. 22 doctors, nurses, dieticians, and psychologists completed an online questionnaire. 10 subsequently took part in telephone interviews. Empowerment-based education changed them from fixers to facilitators. Their transformation included a sense of becoming authentic, 'being the way I want to be' in clinical practice and becoming more self-reflective. This affected them personally as well as reinvigorating them professionally. The participants described a personal and professional journey of transformation that included discovering their person-centred philosophy. They adopted a consultation structure that empowered people with diabetes to care for themselves. It can be speculated that participants' experience of transformation may also guard against professional burnout.

Serial mediation roles of empowerment and self-care activities connecting health literacy, quality of life, and glycemic control in people with type 2 diabetes.

Health literacy, empowerment, and self-care activities are likely the crucial concepts affecting the quality of life and glycemic control in people with type 2 diabetes (T2D). However, evidence demonstrating the mechanisms underlying these concepts is scarce. The aim of this study was to test the serial mediation roles of empowerment and self-care activities on the relationships between health literacy and quality of life and between health literacy and hemoglobin A1c (HbA1c) in people with T2D. A cross-sectional study was conducted among 319 people with T2D in Guangzhou, China, from July 2019 to January 2020. Data were collected using the Health Literacy Scale, the Diabetes Empowerment Scale-Short Form, the Summary of Diabetes Self-Care Activities Measure, and the Adjusted Diabetes-Specific Quality of Life Scale. RStudio 4.2.1 was used for serial mediation analysis. The dimension of communicative health literacy accounted for the most total variance (β = 0.810, p < .001) in the construct of health literacy. The serial multiple mediation of empowerment and self-care activities in the associations between health literacy and quality of life (β = -.046, p = .019) and between health literacy and HbA1c (β = -.045, p = .005) were statistically significant. This study emphasized the vital role of communicative health literacy when improving health literacy in people with T2D. Diabetes care and education specialists could implement empowerment approaches and flexible self-care strategies to improve the quality of life and glycemic control in people with T2D. Enhancing health literacy was suggested as a favorable strategy for promoting empowerment and self-care activities in people with T2D.

The relationship between psychological resilience and quality of life among the Chinese diabetes patients: the mediating role of stigma and the moderating role of empowerment

BackgroundAlthough some factors, such as stigma and empowerment, influence the complex relationship between psychological resilience and quality of life, few studies have explored similar psychological mechanisms among patients with diabetes. Therefore, this study explored the mediating role of stigma and the moderating role of empowerment in the psychological mechanisms by which psychological resilience affects quality of life.MethodsFrom June to September 2022, data were collected by multi-stage stratified sampling and random number table method. Firstly, six tertiary hospitals in Wuhu were numbered and then selected using the random number table method, resulting in the First Affiliated Hospital of Wannan Medical College being selected. Secondly, two departments were randomly selected from this hospital: endocrinology and geriatrics. Thirdly, survey points were set up in each department, and T2DM patients were randomly selected for questionnaire surveys. In addition, we used the Connor-Davidson Elasticity Scale (CD-RISC) to measure the psychological resilience of patients, and used the Stigma Scale for Chronic Illness (SSCI) to measure stigma. Empowerment was measured by the Diabetes Empowerment Scale (DES). Quality of Life was assessed by the Diabetes Quality of Life Scale (DQoL). We used SPSS (version 21) and PROCESS (version 4.1) for data analysis.Results(1) Psychological resilience was negatively correlated with stigma and quality of life, and positively correlated with empowerment. Stigma was positively associated with empowerment and quality of life. Empowerment was negatively correlated with quality of life. (2) The mediation analysis showed that psychological resilience had a direct predictive effect on the quality of life, and stigma partially mediated the relationship; Empowerment moderates the first half of "PR → stigma → quality of life"; Empowerment moderates the latter part of "PR → stigma → quality of life."ConclusionsUnder the mediating effect of stigma, psychological resilience can improve quality of life. Empowerment has a moderating effect on the relationship between psychological resilience and stigma, and it also has a moderating effect on the relationship between stigma and quality of life. These results facilitate the understanding of the relationship mechanisms between psychological resilience and quality of life.

An educational programme and patient‐reported outcomes using flash glucose monitoring and automated bolus calculation in type 1 diabetes

AbstractIntroduction: Our primary aim was to describe the educational programme and user's guide for decision support for persons with type 1 diabetes who commence carbohydrate counting with automated bolus calculator (ABC) and flash (intermittently scanned) glucose monitoring (isCGM). The programme was developed for the ABC Flash trial, conducted in The Capital Region of Denmark in 2018–2020. We also aimed to evaluate the impact of the programme and the combined interventions on patient‐reported outcome parameters.Methods: The programme and user's guide are described in detail. In total, 35 adults with type 1 diabetes and sub‐optimal HbA1c treated with multiple daily insulin injections completed the 26‐week educational programme on initiating ABC and isCGM. Patient‐reported outcomes were self‐evaluated before and after (Audit of Diabetes Dependent Quality of Life questionnaire, Diabetes Treatment Satisfaction Questionnaire, Problem Areas in Diabetes and Diabetes Empowerment Scale). Changes over time in the different sub‐areas of diabetes‐related burden on quality of life, treatment satisfaction, diabetes‐related distress and psychosocial self‐efficacy were analysed.Results: During participation in the educational programme on initiating ABC and isCGM, diabetes‐related burden on work and sex life and several treatment satisfaction and psychosocial self‐efficacy sub‐areas improved.Conclusion: Implementation of the educational programme and initiating combined intervention with carbohydrate counting with ABC and isCGM improve treatment satisfaction and different psychosocial areas among persons with type 1 diabetes. Copyright © 2023 John Wiley &amp; Sons.

Impact of a multicomponent integrated care delivery program on diabetes care goals achievement: a primary care quality improvement initiative

AimTo evaluate the impact of multicomponent integrated care (MIC) delivery program in a primary care real-life setting on diabetes care goals. MethodsPatients with T2D and usual primary care from the public health system in Mexico were invited to participate in a five-month ambulatory MIC quality initiative (DIAbetes Empowerment and Improvement of Care program, DIABEMPIC). Results841 patients who finished the program and with complete data were analyzed. The patients had a mean decrease in hemoglobin A1c, systolic and diastolic pressure, and LDL-cholesterol of 2.4%, 9 mmHg, 3 mmHg, and 22.5 mg/dL, respectively (p < 0.001). The achievement of the optimal triple target goal increased from 1.8% to 26.7% (p < 0.001). In the adjusted analysis, the diabetes knowledge and global self-care behavior score post-intervention, as well as the increment of global self-care behavior score were associated with the optimal composite risk factor control achievement. ConclusionThe incorporation of diabetes therapeutic education interventions to improve self-care behaviors along with adequate treatment intensification in diabetes care are fundamental to attaining optimal risk factor control and attenuating disease burden.

Self-Empowerment And Coping Strategies In Type 2 Diabetes Mellitus Patients

Diabetes Mellitus is a chronic disease that can harm the body, both physically and psychologically (stress). DM patients will carry out adaptive coping strategies to properly manage treatment or therapy. The process of self-empowerment in people with type 2 diabetes mellitus will appear when they have information or knowledge about the disease so that it can influence the patient's self-skills for further treatment. This study aimed to analyze the relationship between self-empowerment and coping strategies in patients with type 2 diabetes mellitus. The design of this study was an analytical observational study using a cross-sectional method. The sampling technique used is consecutive sampling. The sample of this study was type 2 DM patients with 84 respondents. The instrument used in this study is the Diabetes Empowerment Scale-Long (DES-LF) questionnaire and the Cope Inventory questionnaire. Data were analyzed using the Spearman test. Self-empowerment and coping strategies in type 2 diabetes mellitus patients showed close to maximum results. In the results of the study, it was found that there was no significant relationship between self-empowerment and coping strategies in type 2 DM patients with p = 0.086. It means that other factors can influence coping strategies. Health services can educate patients about the importance of coping strategies for DM clients so that they can reduce the impact of DM disease

Significant reduction in diabetes distress and improvements in psychosocial outcomes: A pilot test of an intervention to reduce diabetes distress in adults with type 1 diabetes and moderate-to-severe diabetes distress (REDUCE).

To pilot-test an intervention, co-designed with people with type 1 diabetes (T1DM) and diabetes specialist nurses, to reduce diabetes distress (DD) in adults with T1DM and moderate-to-severe DD. A group-based programme to reduce DD in people with T1DM and moderate-to-severe DD (REDUCE) was pilot-tested in four groups with five bi-weekly two and a half-hour meetings facilitated by two trained diabetes specialist nurses. Data collection included baseline and post-intervention questionnaires measuring DD and psychosocial outcomes and semi-structured interviews with participants post-intervention (n = 18). Data were analysed using descriptive statistics and systematic text condensation. Twenty-five adults with T1DM participated in the study. The median age and diabetes duration of participants were 50 (IQR: 32;57.5) years and 26 (IQR: 18;45) years, respectively. Seventeen (68%) were women. The pilot study showed a significant reduction in DD (measured by Type 1 Diabetes Distress Scale) between baseline and post-intervention from 2.6 ± 0.7 to 1.9 ± 0.6 (mean ± SD) (p < 0.001). The largest reductions were seen on the subscales: powerlessness 1.2 ± 1.1, eating distress 0.9 ± 1.2 and fear of hypoglycaemia 0.8 ± 1.0 (mean ± SD). Significant improvements were also seen for quality of life, diabetes empowerment and emotion regulation. Qualitative data showed that REDUCE supported participants in verbalizing emotions and seeing worries in a more constructive perspective. Acknowledgement of negative diabetes experiences eased negative self-judgments. Sharing experiences among peers increased relatedness and reduced loneliness. Participation in REDUCE was associated with significant reduction in DD and significant increase in quality of life. Larger scale studies are planned to determine sustained effectiveness of REDUCE.