Diabetes Empowerment Research Articles

Long-term follow-up of a randomized clinical trial comparing glycemic excursion minimization (GEM) to weight loss (WL) in the management of type 2 diabetes

IntroductionWe previously reported the physical, psychological and behavioral 3-month post-treatment results of a randomized controlled trial comparing glycemic excursion minimization (GEM) versus conventional weight loss (WL) therapy in the management...

An Enhanced SMS Text Message-Based Support and Reminder Program for Young Adults With Type 2 Diabetes (TEXT2U): Randomized Controlled Trial.

BackgroundClinic attendance, metabolic control, engagement in self-management, and psychological health are suboptimal in young-onset (age of onset <40 years) type 2 diabetes.ObjectiveWe examined the effectiveness of an enhanced SMS text message–based support and reminder program in improving clinic attendance, metabolic control, engagement in self-management, and psychological health in young-onset type 2 diabetes.MethodsA 12-month, parallel-arm, randomized controlled trial comparing an enhanced, semipersonalized SMS text message–based intervention (incorporating 1-8 supportive and/or informative text messages per month) against standard care was conducted in a specialized clinic for young adult type 2 diabetes. The primary outcome was maintenance of 100% attendance at scheduled quarterly clinical appointments. Secondary outcomes included (1) metabolic indices, (2) pathology and self-monitored blood glucose (SMBG) data availability, and (3) psychosocial well-being.ResultsA total of 40 participants were randomized, and 32 completed their 12-month study visit. The average participant age was 32.7 (SD 5.1) years, 50% (20/40) were male, and baseline glycated hemoglobin A1c (HbA1c) was 7.3% (SD 1.9%) (56 mmol/mol, SD 20). A higher proportion of the intervention group achieved 100% attendance (12/21, 57%, vs 5/19, 26%, for the control group); Kaplan-Meier analysis demonstrated significantly greater cumulative attendance in the intervention group (P=.04). There were no between-group differences in HbA1c, BMI, lipids, or availability of pathology and SMBG data. Odds of recording an improvement in the Diabetes Empowerment Scale–Short Form score were higher in the intervention group at 6 months (odds ratio [OR] 4.3, 95% CI 1.1-17), with attenuation of this effect at study end (OR 3.1, 95% CI 0.9-11). Program acceptability was high; >90% of participants would recommend the program to new patients.ConclusionsAn enhanced SMS text message–based support and reminder program doubled scheduled clinic attendance rates for patients with young-onset type 2 diabetes. The program was highly acceptable and provided early support for patient empowerment but had no significant effect on measures of metabolic control or self-management.Trial RegistrationAustralian and New Zealand Clinical Trials Registry (ACTRN12618000479202); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373579

Effectiveness of empowerment-based intervention on HbA1c and self-efficacy among cases with type 2 diabetes mellitus: A meta-analysis of randomized controlled trials.

Objective:The aim of this study was to determine the effect of empowerment-based interventions on glucose metabolism control and psychosocial self-efficacy in people with type 2 diabetes mellitus (T2DM).Methods:The Cochrane Library, Embase, PubMed, and Web of Science electronic databases were searched up to 22 February 2021 for randomized controlled trials (RCTs) that evaluated the effectiveness of empowerment-based intervention versus conventional treatment in type 2 diabetes cases. At least two investigators independently screened the literature, extracted data and evaluated the methodological quality. We calculated the pooled effect size using the mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) through RevMan V 5.4.1.Results:Fifteen randomized controlled trials (RCTs) were eligible for inclusion in the present study. A total of 2344 adults (1128 in the intervention groups and 1216 in the control) were covered. Five of these studies involved 671 cases of psychosocial self-efficacy, and 4 studies included 622 cases of diabetes knowledge. The meta-analysis showed that compared to routine care, empowerment-based intervention was associated with reduced glycated hemoglobin levels (SMD −0.20; 95% CI −0.31 to −0.08; Z = 3.40, P < .001, I2 = 42%), increased diabetes empowerment scores (SMD 0.24; 95% CI 0.10–0.37; Z = 3.42, P < .001, I2 = 0%), and increased diabetes knowledge scores (SMD 0.96; 95% CI 0.55–1.36; Z = 4.61, P < .001, I2 = 80%).Conclusions:Empowerment-based intervention in adults with T2DM results in improvements in glycated hemoglobin, psychosocial self-efficacy and diabetes knowledge.

Health literacy and cardiovascular disease in type 2 diabetes—a cross-sectional study

Abstract Background The macrovascular complications are the main cause of death of diabetic patients. Health literacy is the capacity one can have in order to acquire, interpret, understand and communicate the information related to health, necessary for the diabetes control and, consequently, for the cardiovascular prevention. The main goal of this project is to understand the relationship between health literacy and the occurrence of cardiovascular events in a person with type 2 diabetes mellitus, as well as its relationship with adherence, enablement and quality of life. Methods Cross-sectional national pilot study of a prospective cohort, carried out in persons with DM2 selected by convenience in aleatory health regions. The Medical Term Recognition Test, the Summary of Diabetes Self-Care Activities, the Diabetes Empowerment Scale–short version-and the European Quality of Life–Visual analogue scale-were used. The Spearman correlation and the U of Mann Whitney test were used for statistical analysis. Results No significative relation was found between health literacy and the occurrence of cardiovascular events. However, people with previous isquemic coronary disease had an inferior evaluation in the literacy scale. People with more literacy were more predisposed to adhere to a specific diet, but not so much to physical activities. There was a significative relation between health literacy and the values of LDL (P = 0.046), age (P ≤ 0.001), education (P ≤ 0.001) and the Socio Economic Deprivation Index (P ≤ 0.001). Conclusions It is essential to continue to amplify the sample so that the longitudinal research can be achieved.

856-P: Long-Term Benefits of Multicomponent Integrated Care Program Participation on Diabetes Care Goals: The DIABEMPIC Program

Diabetes burden is greater in low- middle-income countries, where large gaps exist in achieving diabetes care goals. We examined a quality initiative multicomponent integrated care (MIC) program (DIABEMPIC, DIABetes EMPowerment and Improvement of Care) on diabetes care goals in adults with type 2 diabetes (T2D) implemented in a public primary care specialized diabetes clinic in Mexico City/Iztapalapa. DIABEMPIC is a 5-month empowerment-based program that includes an interdisciplinary case management team, diabetes self-management education, shared medical appointments, a patient-centered approach, and audit and feedback. At the end of the program patients continue routine care in public primary care units. We report the effect of the intervention on diabetes care goals at the end of the program and 18 months after the initial recruitment (long-term evaluation). Results: 704 patients with T2D completed the program, and 182 already have a long-term evaluation. The mean (SD) age of this subgroup was 57 (10.9) years, 67% female, 61% had elementary or less education, 68% had medium-low or lower socioeconomic status, mean diabetes duration was 13 (8) years, and mean A1c was 9.5% (2.2). After the program (n=182) systolic and diastolic blood pressure (-11, -4 mmHg respectively), A1c (-2.6%), and non-HDL cholesterol (-29 mg/dl) decreased significantly (p&amp;lt;0.0001). Clinical benefits persisted in long-term evaluation in systolic and diastolic blood pressure (-9, -3 mmHg respectively, p&amp;lt;0.0001), A1c (-1.4%, p&amp;lt;0.0001), and non-HDL cholesterol (-11 mg/dl, p=0.018). Conclusions: This quality-of-care initiative had valuable short and long-term effects on diabetes care goals in a real-world setting. The long-term impact is smaller than the impact observed at the end of the intervention. This work suggests further replication of the intervention and enhances the need to improve routine follow-up in primary health units after the participation in MIC programs. Disclosure R. Silva-tinoco: None. A. Gallardo-hernández: None. J. Ochoa-moreno: None. V. Delatorre-saldaña: None. T. Cuatecontzi-xochitiotzi: None. A. Gonzalez-cantu: None. C. Castillo-galindo: None. B. Pimentel-hernández: None. M. Romero-ibarguengoitia: None. A. Núñez-rodríguez: None. F. Orozco-gutiérrez: None.

930-P: Improving Access and Communication through Telehealth for Pediatric Type 1 Diabetes (T1D): Twelve-Month Outcomes

Improving access for diabetes care may help youth with poor glycemic control. Telehealth can expand access to care. Youth with T1D, Medicaid, and initial A1c 9-12% had quarterly diabetes goal setting and monthly telehealth glucose review/goal reinforcement. Over 12 mo we measured A1c q 3mo and assessed diabetes empowerment (1-5; higher=greater self-efficacy), diabetes distress (1-6; higher=greater), and intervention satisfaction (1-5; higher=greater). Youth (N=32, 56% male, 53% AA), aged 5-22 yr, had T1D for 5.1±3.5 years, baseline mean A1c 10.7±1.5%; 19% on CSII and 34% on CGM. At baseline, participants reported low levels of distress (mean 1.9 youth, 2.1 parents) and high self-efficacy (mean 4.2). There were no effects of intervention on distress or self-efficacy at 12-months for youth (p=0.11) or parents (p=0.36). There was no correlation between youth/parent distress scores. Baseline A1c correlated positively with youth burden and negatively with motivation: “takes too much mental/physical energy”(r=0.65, p=0.02); “controls my life” (r=0.70, p=0.008); “I can find ways to feel better about diabetes” (r=-0.67, p&amp;lt;0.02); “I know what helps me stay motivated” (r=-0.69, p=0.01). In contrast, baseline A1c correlated negatively with parental frustration and worry: “I’m the only one who takes responsibility” (r=-0.46, p&amp;lt;0.05); “worrying others will blame me if diabetes not well-controlled” (r=-0.57, p=0.03). A1c did not change and there were no differences in ED/hospitalizations compared to 2 years prior. However, participants reported satisfaction with the intervention (mean 4.3). While well received by families, a monthly telehealth intervention failed to impact A1c. Parental worry and frustration was higher in children with better A1c levels. Identifying ways to maintain parent involvement in diabetes care and enhance mental health support may help diabetes control and burden of disease. Future work should explore the long-term impact of telehealth support. Disclosure L. E. Rasbach: None. L. C. Page: None. M. Freemark: Advisory Panel; Self; Rhythm Pharmaceuticals, Inc., Research Support; Self; Rhythm Pharmaceuticals, Inc. V. Purrington: None. M. Griffis: None. A. Annas: None. R. Hall: None. R. Benjamin: None. Funding Duke University School of Medicine

570-P: Impact of Psychosocial Factors, Self-Efficacy, Knowledge, and Nutrition Using 12-Week Courses on Diabetes Management for Veterans

Background: Approximately 25% of U.S. veterans have diabetes and suffer from psychosocial complications. The Diabetes Empowerment Group (DEG), developed by Loma Linda VA Hospital’s Behavioral Medicine Service, is a 12-week interdisciplinary group to help veterans manage their diabetes. Curriculum included values assessment, SMART goal setting, stress management, problem solving, mindful eating and nutritional education. Methods: Veterans attended their respective 12-week DEG group. Hemoglobin A1c levels were measured and participants completed QI measures at the beginning and end of their group cycles. Scores on QI measures were used to determine if group content impacted veterans’ HbA1c levels, diabetes-related psychosocial self-efficacy, knowledge, emotional distress, confidence to perform management behaviors and depressive symptoms. Paired sample t-tests compared pre- and post-group values. Results: Eighty veterans completed lab work and QI measures. Significant mean differences were found between scores on pre- and post-treatment measures for A1c levels, depressive symptoms, diabetes knowledge, distress, psychosocial self-efficacy and confidence to manage their diabetes. Post-treatment scores were significantly lower than pre-treatment scores for A1C levels, depressive symptoms, and diabetes distress. Post-treatment scores were significantly higher than pre-treatment scores for diabetes knowledge, psychosocial self-efficacy, and confidence. Conclusion: Findings expand on a previous QI study and demonstrate the efficacy of the DEG group at helping manage diabetes, reducing biopsychosocial complications and increasing knowledge. Future options for QI include evaluation of future programs (e.g., Diabetes Support Grp and DEG mobile app) to support current and alumni group members with maintenance of diabetes management skills learned. Disclosure N. Farrell: None. J. S. Shaheed: None. J. Davis: None. G. Valencia: None. R. Clark: None. D. J. Colella: None.

Moderating the relationship between diabetes distress and mastery: the role of depression and empowerment

ABSTRACT Type 2 diabetes is a chronic condition primarily self-managed by the individual. Mastery is a protective factor linked to better control of chronic conditions, effective self-management and improved medication adherence. Mastery appears increasingly important as treatment regimens and self-management demands become more complex and burdensome. Diabetes distress negatively impacts self-management, glycaemic control and treatment adherence. Understanding the relationship between diabetes distress and mastery may provide opportunities to improve condition management and adherence . This relationship may be impacted by other factors affecting the individual's perceived sense of control over their condition. This study examined the role of diabetes empowerment and depression in the relationship between diabetes distress and mastery. Data were drawn from a randomised controlled trial of 131 adults with type 2 diabetes transitioning to injection therapy. Participants completed measures of diabetes distress , mastery , depression and empowerment . Diabetes distress and depression were negatively associated with mastery, whilst diabetes empowerment was positively associated . A significant interaction effect (b = .024, t(112) = 3.79, p = <.005) confirmed the relationship between diabetes distress and mastery was moderated by depression. Findings highlight the additive deleterious effects of depression. Interventions to improve mastery among those living with type 2 diabetes should address diabetes distress and depression to optimise outcomes.

Psychometric Assessment of the Diabetes Empowerment Scale among Iranian Adolescents with Type 1 Diabetes

Background Adverse effects of problems caused by chronic diseases can be reduced by increasing patient empowerment. The aim of the present study was to assess psychometric properties of Gothenburg Young Persons Empowerment Scale (GYPES) among Iranian adolescents with type 1 diabetes. Materials and Methods: This is an applied descriptive study with psychometric assessment and test validation design. The study population consisted of 150 patients with type 1 diabetes referred to medical centers in Isfahan, Iran. Samples were selected using convenience sampling and based on inclusion criteria. The Persian version of the scale was developed based on the model of the World Health Organization (WHO). The validity of the scale was assessed by calculating the content validity index, face validity, and factor analysis. The reliability of the scale was also assessed by test-retest and Cronbach's alpha test. The collected data were analyzed using SPSS version 21.0 in two descriptive and inferential levels. Results: The content validity index (CVI) was more than 0.8 for each item except Item 12. Based on the results of exploratory factor analysis (EFA), none of the common values ​​was less than 0.5. The results of Pearson correlation test also showed a positive and significant relationship between the two stages of the questionnaire (P = 0.001). Cronbach's alpha method was used to measure the internal consistency of the whole instrument (0.725), and its dimensions (0.62-0.83). Conclusion The 14-item GYPES among Iranian adolescents with type 1 diabetes was approved and has acceptable validity and reliability. Therefore, this scale can be used as a valid tool, in the field of care and research, to empower adolescents with type 1 diabetes.

The Quebec Diabetes Empowerment Group Program: Program Description and Considerations Regarding Feasibility and Acceptability of Implementation in Primary Health Care Settings.

Introduction: Diabetes is a highly prevalent chronic disease that frequently coexists with other medical conditions and implies a high burden for patients and the healthcare system. Clinicians currently are challenged to provide effective interventions that are both multidisciplinary and empower patient self-care. The Diabetes Empowerment Group Program (DEGP) was developed with the aims of fostering patient engagement in diabetes self-care through the lens of empowerment and to support the empowerment of patients with diabetes by providing multidisciplinary group-based care. This research's objectives were to: (1) develop a comprehensive description of the DEGP for potential adopters, and (2) explore the factors influencing the feasibility and acceptability of implementing it in other healthcare settings in Montreal.Methods: A qualitative descriptive study was conducted, following a participatory approach. Data were obtained from: (1) semi-structured interviews with 14 patients who participated in the pilot program; (2) from semi-structured group interviews with patient partners, healthcare professionals, and other stakeholders from 4 Montreal family medicine groups, and (3) discussions among the participatory research team during various knowledge translation activities. Inductive content analysis of the data was performed.Results: The DEGP identified seven key elements: medical visit, continuity of care, group-based dynamics, multi-disciplinarity, clinician facilitation, patient-centered agenda, and a theoretical framework of empowerment. The content and organization of the group visits were conceived to address each of these four domains. The empowerment framework comprises four domains of self-care: emotional (attitude), cognitive (knowledge), behavioral (skills), and relational (relatedness). Factors impacting the feasibility and acceptability of implementing the DEGP in other primary care settings were identified.Discussion: The DEGP fits within the discourse around the need for more patient-centered programs for people living with diabetes, following a more comprehensive empowerment model. This research could facilitate the development or adaptation of similar programs in other settings.

Efficacy and Safety of a Decision Support Intervention for Basal Insulin Self-Titration Assisted by the Nurse in Outpatients with T2DM: A Randomized Controlled Trial.

ObjectiveThe main aim of this study was to evaluate a combined fasting blood glucose based dosage self-titration setting and decision supported telephone coaching intervention on glycemic control and diabetes self-management skills, compared to the conventional care.MethodsA 12-week, single-blinded, randomized controlled trial was conducted on adults with type 2 diabetes (T2DM) primarily treated with basal insulin. After randomization, the intervention group (IG, n = 426) received a basal insulin self-titration decision support intervention administered by the Diabetes Specialty Nurses while the control group (CG, n = 423) received conventional care for 12 weeks, both included five telephone interviews. The primary efficacy endpoint was the effect of intervention on glycemic control, measured as the change in glycated hemoglobin (HbA1c) from baseline to Week 12 (after intervention) compared to the control group. Other endpoints included comparisons of the effects of intervention on fasting plasma glucose (FPG), postprandial plasma glucose (PPG), body weight, Michigan diabetes knowledge test (MDKT), diabetes empowerment scale-short Form (DES-DSF), and summary of diabetes self-care activities (SDSCA). Changes in the primary and secondary outcomes were compared using the t-test for continuous variables with a normal distribution and χ2-test for categorical variables.ResultsThe IG showed more improvements on mean HbA1c, compared to the CG (−2.8% vs −1.8%), so did the FPG, PPG, MDKT, DES-DSF and SDSCA (all P<0.01) after the 12-week follow up. Though the final mean insulin dose in the IG was higher than the CG at the end of the study (0.32 U/kg vs 0.28 U/kg), the changes of body weight were similar between the two groups (0.46kg vs 0.40kg, P=0.246), and the proportion of patients with hypoglycemia events during the whole trial were similar (20.65% vs 17.73%, P=0.279).ConclusionDecision supporting of basal insulin glargine self-titration assisted by Diabetes Specialty Nurses is effective and safe in patients with T2DM. Decision supported telephone coaching intervention offers ongoing encouragement, guidance, and determination of relevant sources of decisional conflict, facilitating adjusting the insulin dose.

The Effects of Diabetes Empowerment and Health Perception on Diabetes Self-Care Behavior in Community Diabetic Elderly

The Effects of Diabetes Empowerment and Health Perception on Diabetes Self-Care Behavior in Community Diabetic Elderly

Relationship Between Diabetes, Stress, and Self-Management to Inform Chronic Disease Product Development: Retrospective Cross-Sectional Study

BackgroundTechnology is rapidly advancing our understanding of how people with diabetes mellitus experience stress.ObjectiveThe aim of this study was to explore the relationship between stress and sequelae of diabetes mellitus within a unique data set composed of adults enrolled in a digital diabetes management program, Livongo, in order to inform intervention and product development.MethodsParticipants included 3263 adults under age 65 who were diagnosed with diabetes mellitus and had access to Livongo through their employer between June 2015 and August 2018. Data were collected at time of enrollment and 12 months thereafter, which included demographic information, glycemic control, presence of stress, diabetes distress, diabetes empowerment, behavioral health diagnosis, and utilization of behavioral health-related medication and services. Analysis of variance and chi-square tests compared variables across groups that were based on presence of stress and behavioral health diagnosis or utilization.ResultsFifty-five percent of participants (1808/3263) reported stress at the time of at least 1 blood glucose reading. Fifty-two percent of participants (940/1808) also received at least 1 behavioral health diagnosis or intervention. Compared to their peers, participants with stress reported greater diabetes distress, lower diabetes empowerment, greater insulin use, and poorer glycemic control. Participants with stress and a behavioral health diagnosis/utilization additionally had higher body mass index and duration of illness.ConclusionsStress among people with diabetes mellitus is associated with reduced emotional and physical health. Digital products that focus on the whole person by offering both diabetes mellitus self-management tools and behavioral health skills and support can help improve disease-specific and psychosocial outcomes.

The effectiveness of a smartphone-based online peer group on type II diabetes mellitus patients self-empowerment in a primary healthcare center in Indonesia

Objective: Self-empowerment is an important factor that influences a person's ability to perform effective diabetes management. One effort that can be done to improve self-empowerment is by providing a smartphone-based online peer-group. This research determined the effect of smartphone-based online peer groups on type 2 diabetes mellitus (T2DM) patients self-empowerment in four primary healthcare centers in Indonesia. Methods: This quasi-experimental research was conducted in four healthcare centers in Indonesia. The total sample was 71 divided into two groups (control and intervention). The control group received standard education from the healthcare center, whereas the intervention group underwent an online peer-group. Self-empowerment was measured before and after intervention using the Diabetes Empowerment Scale-Short Form (DES-SF) questionnaire (Indonesian version). General Linear Model was used in statistical analysis. Results: The mean age of respondents was 56.4 ± 8.8 and 56.9 ± 7.1 years old, 59.5%, and 76.5% had good family support, and 70.3% and 50% of respondents had not received diabetes education for the control and intervention groups, respectively. The average pretest self-empowerment score was 27.03 ± 3.73 and 27.59 ± 3.53 (diff. 0.56; 95%CI -1.16; 2.29), and the post-test score was 27.43 ± 4.13 and 32.76 ± 4.38 (diff. 5.33; 95%CI 3.32; 7.35) for the control and intervention groups, respectively. Online peer-group improve self-empowerment significantly in the intervention group. Conclusion: Smartphone-based online peer-group can improve self-empowerment in patients with T2DM.

Glycemic excursion minimization in the management of type 2 diabetes: a novel intervention tested in a randomized clinical trial

IntroductionThis study of adults with type 2 diabetes employed a non-inferiority hypothesis to investigate whether an innovative lifestyle focused on minimizing postnutrient blood glucose (BG) excursions (glycemic excursion minimization (GEM))...

Psychosocial factors predict type 2 diabetes mastery

Abstract Background Psychosocial aspects of chronic diseases such as Type 2 diabetes (T2D) and cardiovascular disease (CVD) are increasingly recognised as impacting effective self-management. Until now, little was known regarding the moderating effects of empowerment and depression on the relationship between diabetes-specific distress and mastery. Purpose To evaluate the potential mediating role of diabetes empowerment and depression on the relationship between diabetes-specific distress and mastery. Methods Sample comprised 131 participants diagnosed with T2D, mean [SD] age 62.3 [8.8]; 59.5% male. Mean time since diagnosis was 10.4 years. Assessments included: emotional distress (Problem Areas in Diabetes Scale; PAID); depression and anxiety (Hospital Anxiety and Depression Scale; HADS); mastery (Pearlin Mastery Scale); and empowerment (Diabetes Empowerment Scale – Short Form; DES-SF). Data were examined using SPSS: PROCESS a logistic regression-based path analytical framework for multiple mediator models. Results Regression coefficients for the model identified distress (b=−0.249, t(5,112)=−3.71, p&amp;lt;0.001), empowerment (b=0.280, t(5,112)=3.02, p&amp;lt;0.001) and depression (b=−0.980, t(5,112)=−5.73, p&amp;lt;0.001) were all statistically significant predictors of mastery. The PROCESS model assessed ΔR2 as a result of the interaction between distress and depression, which indicated a significant increase (ΔR2=0.08) in variance explained due to the inclusion of both moderators: F(2,112)=16.88, p&amp;lt;0.001, ΔR2=0.14. Also identified were interaction effect sizes: at low levels of empowerment, increasing depression led to increasing levels of distress predicting overall levels of mastery. This held true at moderate and high levels of empowerment; increasing levels of depression led to increasing distress predicting mastery. Conclusions These findings elucidate the impact of empowerment and depression on the association between distress and mastery in a diabetes cohort. The evidence suggests that the psychosocial interventions likely to have greatest impact on mastery are those that target key moderators such as empowerment and depression. Funding Acknowledgement Type of funding source: None

Assessment of the complexity of drug therapy and psychosocial and behavioral aspects in people living with type 2 diabetes mellitus.

Background Type 2 diabetes mellitus is a public health problem worldwide. The complexity of drug therapy and behavioral aspects are important factors in its management. Objective To characterize the complexity of drug therapy, attitudes, empowerment and self-care in people with type 2 diabetes mellitus. Methods Observational descriptive study involving people with type 2 diabetes mellitus recruited in eight public primary care settings in Brazil, 2018. We used validated instruments to determine the complexity of drug therapy employing the Medication Regimen Complexity Index, and to describe the behavioral aspects, encompassing Diabetes Attitudes Questionnaires, Diabetes Empowerment Scale-Short Form and Diabetes Mellitus Care Self-Management. Results The 119 participants showed median age of 64years (Quartile 1 57.0; Quartile 3 71.0) with predominance of women (68.1%). We found high percentages of participants with low scores on attitudes (87.9%) and self-care (84.8%) questionnaires, but with high scores on empowerment questionnaire (81.8%) in groups with high complexity of drug therapy. Conclusion High complexity of drug therapy concentrated low scores for attitudes and self-care, even though presenting elevated empowerment scores. Further studies are needed to investigate the effect of these aspects on the behavior of people with type 2 diabetes mellitus on drug therapies of high complexity.

Person-centred, occupation-based intervention program supported with problem-solving therapy for type 2 diabetes: a randomized controlled trial

BackgroundIndividuals with diabetes mellitus have difficulty solving problems in meaningful occupations and have similar difficulties with self-care regimens. We examined the effects of an occupation-based intervention supported with problem-solving therapy in individuals with type 2 diabetes mellitus on participation in and satisfaction with meaningful occupations, diabetes-related psychosocial self-efficacy, preferred coping strategies and individual well-being.MethodsThis study was planned as a single-blind, randomised controlled study with a 3-month follow-up involving 67 adults with type 2 diabetes. The Canadian Occupational Performance Measure, Diabetes Empowerment Scale, Brief COPE and five-item World Health Organisation Well-Being Index were used. This programme included evaluations, diabetes education, and problem-solving therapy. The intervention was conducted for 6 weeks, and each weekly session lasted approximately 60 min. Differences between groups were analysed using the Mann-Whitney U test, and the Friedman test was used to calculate group-time interaction differences (i.e., baseline, after 6 weeks and after 3 months).ResultsAll participants identified the most significant occupational performance problems in self-care as personal care. Significant improvement was reported in the intervention group compared to the control group regarding participation in meaningful occupation, satisfaction with performance, psychosocial self-efficacy, and well-being results (p < 0.001) after the programme and 3 months of follow-up. Participant use of effective coping strategies, active coping and acceptance strategies, and self-efficacy, as revealed by the results, suggested improvement in favour of the intervention group (p < 0.05).ConclusionsOccupation-based problem-solving therapy encourages participation in meaningful occupations and improves psychosocial self-efficacy, effective coping styles, and well-being in patients with type 2 diabetes mellitus. Problem-solving therapies that incorporate individuals’ priorities via meaningful occupation can be used to lead to a meaningful and quality life for individuals with type 2 diabetes mellitus.Trial registrationClinicalTrials.gov Identifier: NCT03783598. Retrospectively Registered. First Posted-December 21, 2018, Last Update Posted-February 18, 2020.

Adaptation of Diabetic Empowerment Scale-Short Form to Older Individuals and to Turkish Language: Validity and Reliability Study.

The empowerment of old people is important in order for them to gain control over their own lives and to raise their quality of life. The purpose of this study was to adapt the Diabetes Empowerment Scale-Short Form (DES-SF) to old people and to the Turkish language, and to determine its validity and reliability. This methodological type study was conducted between 1 January and 30 March 2017 with 106 old people fitting the criteria of acceptance in the study who attended the geriatrics clinic of a university hospital. In determining validity, language equivalence, content, and predictive validity were used, while reliability was tested with temporal invariance, Cronbach's alpha coefficient, and item total correlation. We examined its reliability and validity via item analyses, content validity (expert panel), confirmatory factor analyses, and construct validity (exploratory factor analyses). The Cronbach's alpha of the scale was 0.883. The scale items were grouped under a single factor in accordance with the original. Confirmatory and exploratory factor analysis showed good fit signs. After conducting validity and reliability testing on the adaptation of the Diabetic Empowerment Scale-Short Form to old people and the Turkish language, it is was concluded that it is a reliable scale to determine the empowerment levels of old people. Based on the statistical analyses applied to evaluate the validity and reliability of the scale obtained by adapting the DES-SF to old people, it was inferred that it is an instrument with high validity and reliability. The scale is a short and practical instrument to evaluate the empowerment levels of old people. The new name of the scale is the elderly empowerment scale.

A Resilience Intervention for Adults with Type 2 Diabetes: Proof-of-Concept in Community Health Centers.

Given the psychological stress associated with managing type 2 diabetes (T2D), resilience-promoting interventions may particularly benefit populations experiencing high levels of stress (e.g., racial/ethnic minority and lower-income individuals). Federally qualified Community Health Centers (CHCs) primarily serve these patients and are therefore ideal settings for resilience-promoting T2D programs. This proof-of-concept study tested the Resilience-Based Diabetes Self-Management Education (RB-DSME) intervention within a CHC. Thirty-five patients with T2D (M age = 51years, 71% female, 60% Hispanic, 69% annual household income < $20,000) at two clinics within the CHC completed the RB-DSME, consisting of eight bi-weekly classes and two monthly support groups. In this treatment-only design, resilience resources, self-management behaviors, and physical and mental health outcomes were measured at baseline and 6months. Attendance (M = 7.66/10) and program satisfaction (M = 6.79/7) were high. Participants improved adaption to stress (d = .67), adaptive coping (d = .60), diabetes empowerment (d = .57), and finding positive meaning (d = .85). Large increases in self-management behaviors (d = 1.38) and number of steps (d = 1.11) were also observed. Participants lowered A1C from baseline (M = 8.79%) to 6months (M = 8.11%; d = .50), along with diabetes distress (d = 1.31), depressive symptoms (d = .80), and general perceived stress (d = .55). This study demonstrated the ability of the RB-DSME to improve resilience resources, self-management behaviors, and health outcomes among racial/ethnic minority and lower-income patients with T2D at clinics within a CHC. A larger, randomized trial should more rigorously test the RB-DSME in this clinical setting.