Diabetes Empowerment Research Articles

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.

Factors Associated with Diabetes Control in Predominately African American and Hispanic Population with Newly Diagnosed Type 2 Diabetes.

This study characterizes factors affecting glycemic control in a predominately African American and Hispanic population with newly diagnosed type 2 diabetes (T2DM). Retrospective longitudinal cohort study of 1638 patients with newly diagnosed T2DM to determine factors associated with improved HbA1c (ΔHbA1c ≤ - 0.5%) and achieving target HbA1c < 7%. At baseline, mean age 51.7 ± 11.5years, males 52.9%, mean BMI 33.9 ± 7.8kg/m2, median HbA1c 9.9 (7.6-12.1)%. At study end, median follow-up duration 27 (13-54)months, median HbA1c 7.0 (6.2-8.7)%, 69.6% with improved HbA1c, 48.3% achieved target HbA1c < 7%, 88.4% monitored blood glucose, 40.1% used insulin, and 72.4% reported not missing medications. In multivariate analysis, improved HbA1c significantly correlated with glucose monitoring (OR = 2.65), higher initial HbA1c (OR = 1.85), and medication adherence (OR = 1.66) and inversely correlated with insulin use (OR = 0.38) and follow-up duration (OR = 0.99). Achieving HbA1c < 7% significantly correlated with glucose monitoring (OR = 2.14), medication adherence (OR = 1.88), more provider visits (OR = 1.04), and older age (OR = 1.03). It inversely correlated with insulin use (OR = 0.47), initial HbA1c (OR = 0.93), and follow-up duration (OR = 0.98). In those with newly diagnosed T2DM, achieving better glycemic control was mainly related to patient self-management behaviors and inversely related to insulin use. Emphasis on patients' diabetes education and empowerment are critical to improved glycemic control.

647-P: Short-Term Continuous Glucose Monitoring Use in Adolescents with Type 1 Diabetes Enhances Empowerment

Background: Studies in adults with type 1 diabetes (T1D) show Continuous Glucose Monitoring (CGM) significantly lowers HbA1c however, the benefit of CGM use in adolescents has been elusive. We asked if short-term CGM use would have an effect on adolescents with poorly controlled T1D. Methods: In a randomized open label study we recruited 12 CGM naïve subjects with T1D, with an HbA1c &amp;gt;8% and ages 13-18 years. Visit 1 (V1) entailed consent, survey completion (Stage of Change (SOC), Diabetes Empowerment Scale (DES-SF), Pediatric Quality of Life (PedsQL), diabetes knowledge) and randomization to treatment (T), CGM Dexcom G4 for 1 week, or control (C). Both groups received daily diabetes care communication for the 1 week between V1 and Visit 2 (V2). Visit 3 (V3) was 1 month later and Visit 4 (V4) was at 3 months. Surveys were completed at all visits and HbA1c at V1 and V4. Results: Subjects (n=12) had an average age of 15.5 years and consisted of six Hispanic and five males. There were no significant (NS) differences between subject characteristics in the C (n=3) and T (n=9) groups. Compared to V1, there were NS changes in SOC and average number of boluses or blood glucoses (BGs) between the groups. The change in DES-SF from V1 to V4 was significant (p=0.04) for the T compared to the C. The decrease in HbA1c between V1 and V4 (-1.5%) in the T vs. an increase in the C (.4%) was NS (p=0.10) but clinically meaningful. Although NS, there was an increase in average BGs/day (+1.7) and a decrease in 7 day average BG (-81mg/dl) for T vs. the C (+0.1 BGs and -28mg/dl) from V1 to V2. Conclusions: Research on CGM use or its emotional effects in adolescents with poorly controlled T1D is limited. This study demonstrated a significant impact on diabetes empowerment with short-term use of CGM. Although NS, this was associated with an increased number of BG checks and a decreased average BG during CGM use plus a decreased HbA1c at 3 months. Use of more advanced CGM systems may hold promise for adolescents with T1D through greater empowerment. Disclosure J. Ilkowitz: None. M. Raisingani: None. F. Wu: None. Y. Chen: None. J. Gerson: None. M. Gallagher: None. B. Franklin: None.

1178-P: Multicomponent Integrated Care Program Benefits on Cardiovascular Risk Factors for Adults with Diabetes and High Cardiovascular Risk: The DIABEMPIC Program

Cardiovascular disease (CVD) is a major cause of death/disability in people with diabetes, this impact could be even 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 persons with type 2 diabetes (PwT2D) implemented in a public primary care specialized diabetes clinic in Mexico City/Iztapalapa. DIABEMPIC is a 5-months empowerment-based program with the following components: interdisciplinary case management team, diabetes self-management education and support, individual/group sessions, shared medical appointments, patient-centered approach, audit and feedback, and guaranteed supply of medications. We evaluated the effect of the intervention on the improvement in diabetes care goals using a ’before and after’ design in participants with a high CV risk. Results: total PwT2D were 610, of which 375 (61.1%) had high CV risk (10-year risk of cardiovascular disease ≥10% with Globorisk lab score). The mean (SD) age of this subgroup was 59.3 (9.4) years, 66% female, 56% had elementary or less education, 73% had medium-low or lower socioeconomic status. Mean diabetes duration was 13 (8) years, 21.8% with current smoking status, 61% with hypertension diagnosis. After the intervention systolic and diastolic blood pressure (-12, -4 mmHg respectively), A1c (-2.4%), triglycerides (-40 mg/dl), and non-HDL cholesterol (-36 mg/dl) decreased significantly (p&amp;lt;0.0001). Conclusions: We found a high prevalence of high risk for CVD in primary care. This quality of care initiative had a valuable effect on CV-related diabetes care goals in a real-world setting. MIC strategies may play an important role to mitigate CVD burden in high-risk populations. We suggest further replications of this intervention. Disclosure R. Silva-Tinoco: Speaker’s Bureau; Self; Novo Nordisk Inc. E.C. Cuatecontzi: None. V. delaTorre-Saldaña: None. E.B. Guzman: None. D. Cabrera-Gerardo: None. D. Prada: None. A. Villa-Cortés: None. E. León-García: None. A. Segovia-Velazquillo: None. C. Zarate: None. M. Romero-Ibarguengoitia: None. A. Gonzalez-Cantu: None.

637-P: Factors Related to Recruitment and Retention of Patients into Diabetes Group Visits

Background: Diabetes is a chronic disease requiring medical treatment and self-management. Group visits (GVs) are one way to deliver care and provide self-management education to patients with diabetes. While studies have examined the impact of GVs on clinical outcomes, no study to date has examined factors related to recruitment and retention of patients in diabetes GVs. Methods: We examined the association between patient characteristics and GV attendance of 83 patients enrolled in a GV intervention in six Midwestern FQHCs in an ongoing cluster randomized trial. Patients with uncontrolled type 2 diabetes (A1C &amp;gt;8%) who were seen in clinic in the past year were eligible. Linear mixed models were used to evaluate associations between retention of patients and race, language, comorbidities burden, diabetes empowerment score, diabetes distress score, diabetes social support, and duration of diagnosis. A Chi-squared analysis was performed to compare enrolled and unenrolled patients and test for association with patient recruitment method. Results: Of 280 eligible patients reached by FQHCs, 44% (24/55) of patients contacted in person were recruited into the study, compared to 25% (56/225) of those contacted by telephone and/or mail (P=0.006). In the multivariate analysis, patients with more GV attendance were associated with higher diabetes empowerment score (P=0.03) and likely heavier comorbidities burden (P=0.08). Conclusion: In-person recruitment for group visits was more effective than recruitment by telephone or mail. Patients with more comorbidities and those who felt less empowered to manage their diabetes at baseline were most motivated to attend GVs, suggesting that patients with multiple chronic conditions who need more support in disease management may be most interested in receiving care in a group setting. This finding may be especially important for FQHC providers taking care of underserved populations who face greater barriers to self-management in traditional care settings. Disclosure A.G. Naik: None. E.M. Staab: None. J. Li: None. W. Wan: None. C.T. Schaefer: None. A. Campbell: None. M.T. Quinn: None. A.A. Baig: None. Funding Office of Minority Health (1 CPIMP171145-01-00)

1317-P: Improving Access and Communication through Telehealth for Pediatric Type 1 Diabetes

Telehealth may positively impact diabetes self-management by increasing contact between patients and providers. Our diabetes team developed a telehealth intervention to provide insulin adjustments and establish diabetes goals. Eligible youth had T1D, Medicaid insurance, and A1c 9-12%. Participants set goals at quarterly visits. Monthly, participants communicated glucose data with the healthcare team through EMR portal or via phone calls. Youth &amp;gt;10 years completed Diabetes Distress Scale (scores 1-6; higher=greater distress) and Diabetes Empowerment Scale (scores 1-5; higher=greater self-efficacy) at baseline, 6 mo, and 12 mo, while caregivers completed Diabetes Distress Scale for Parents (scores 1-5; higher=greater distress). Satisfaction surveys done at 3 and 12 mo (scores 1-5; higher=greater satisfaction). Baseline and 3 mo data presented. Youth (N=32, 56% male, 53% AA), aged 5-22 (12.4±3.9), with T1D for 5.1±3.5 years had baseline mean A1c 10.7±1.5%; 19% CSII and 34% CGM. At baseline, participants endorsed low levels of diabetes distress (mean score 1.9±0.9 youth and 2.1±0.6 parents). Youth endorsed high diabetes self-efficacy at baseline (mean score 4.2±0.6). There was no difference between mean A1c at baseline and 3 months (10.7% to 10.9%, N=26). Baseline A1c did not correlate with age, T1D duration, diabetes distress or empowerment for youth but correlated negatively with parental frustration [“I am the only one who takes responsibility for helping my teen manage diabetes” (r=-0.458; p=0.048) and “my teen ignores my suggestions about diabetes” (r=-0.842; p&amp;lt;0.009)]. Participants reported high satisfaction with the intervention (mean score 4.3±0.49). Correlation between A1c and parental frustration suggests need to improve communication between T1D teens and caretakers and enhance mental health support. Although A1c did not decline short term, families reported high satisfaction. Further research needs to assess the long-term impact of telehealth interventions. Disclosure L.E. Rasbach: None. M. Freemark: None. V. Purrington: None. M. Griffis: None. A. Annas: None. L.C. Page: None. R. Hall: None. R. Benjamin: None. Funding Duke University School of Medicine (3993054)

Role of social and other determinants of health in the effect of a multicomponent integrated care strategy on type 2 diabetes mellitus

BackgroundAlthough important advances in treatment strategies have been developed in type 2 diabetes mellitus (T2DM), large gaps exist in achieving glycemic control and preventing complications, particularly in low-and middle-income countries, which suggests a potential effect of social determinants of health (SDH, i.e., education level and socioeconomic status). However, few studies have determined the role of SDH and other determinants of health (ODH, i.e., diabetes knowledge and self-care scores) in achieving T2DM goals during effective multidisciplinary interventions. We aimed to examine a multicomponent integrated care (MIC) program on diabetes care goals and determine the effect of SDH and ODH on T2DM patients.MethodsA before-and-after design (a pretest, a 5-month intervention, and a follow-up) was used in a T2DM population from Mexico City. The SDH included education level and socioeconomic status; the ODH included diabetes knowledge, self-care scores, and deltas (i.e., differences between baseline and follow-up scores). The triple-target goal (glycated hemoglobin, blood pressure, and LDL-cholesterol) was established as a measurement of T2DM goals.ResultsThe DIABEMPIC (DIABetes EMPowerment and Improvement of Care) intervention (n = 498) reduced the glycated hemoglobin levels (mean reduction 2.65%, standard deviation [SD]: 2.02%) and cardiometabolic parameters; it also improved health-related quality of life. From 1.81% at baseline, 25.9% of participants (p-value< 0.001) achieved the triple-target goal. We found a significant association between education level (p-value = 0.010), diabetes knowledge at baseline (p-value = 0.004), and self-care scores at baseline (p-value = 0.033) in the delta (change between baseline and follow-up assessments) of HbA1c levels. Improvements (increase) in diabetes knowledge (p-value = 0.006) and self-care scores (p-value = 0.002) were also associated with greater reductions in HbA1c.ConclusionsMIC strategies in urban primary care settings contribute to control of T2DM. SDH, such as education level, and ODH (diabetes knowledge and self-care scores at baseline) play a key role in improving glycemic control in these settings.

Patient Empowerment Using Electronic Telemonitoring With Telephone Support in the Transition to Insulin Therapy in Adults With Type 2 Diabetes: Observational, Pre-Post, Mixed Methods Study.

BackgroundInitiation of insulin therapy for the management of type 2 diabetes can be an unwelcome and distressful development for patients. Current evidence suggests that telemonitoring can help improve glycemic control in type 2 diabetes and can support empowerment to self-manage diabetes. This telemonitoring intervention was underpinned by an empowerment approach.ObjectiveThis study aimed to evaluate the clinical effectiveness and feasibility and the patients’ and health care providers’ experiences of a 12-week telemonitoring intervention with telephone support for patients commencing insulin therapy. This paper focuses on the impact on patient empowerment.MethodsAn observational, pre-post, multimethod, and triangulation design was employed to study a 12-week automated electronic telemonitoring intervention with telephone support from a diabetes clinical nurse specialist (CNS). Forty patients were recruited from the clinic as they were about to commence insulin therapy. In the quantitative arm, biometric data (hemoglobin A1c [HbA1c] and weight) and psychosocial data (diabetes empowerment scale [DES] scores and diabetes distress scale [DDS] scores) were gathered by the research team at baseline (T1), the end of the intervention (T2), and 3 months postintervention (T3). Data on hospital admission and general practitioner (GP) visits were collected for the duration of the study. In the qualitative arm, separate focus group interviews were conducted with the CNS team supporting the intervention (n=2) and patients (n=16).ResultsOf 39 patients who completed the intervention, 23 (59%) were male. The mean age of the sample was 62.4 years (range 37-80 years). The mean HbA1c (mmol/mol) decreased significantly between T1 and T2 (mean difference [MD] −17.13; P<.001) and T1 and T3 (MD −18.16; P<.001), with no significant impact on weight. In the focus groups, patients reported an increased awareness to self-manage diabetes and feelings of safety and comfort. There were 13% (5/39) of patients who had hypoglycemia on two or more occasions. A significant increase in the mean DES score occurred between T1 and T2 (MD 0.62; P=.001) and T1 and T3 (MD 0.72; P<.001). The mean DDS score decreased between T1 and T2 (MD −0.64; P=.002) and T1 and T3 (MD −0.6; P=.002). The mean patient satisfaction with the intervention was above 4 out of possible 5 on all items on the Telemedicine Satisfaction and Usefulness Questionnaire. We observed a reduction in diabetes clinic attendances and GP visits. A significant increase in workload was reported by the CNS team.ConclusionsThis intervention had an empowering effect for patients in the self-management of type 2 diabetes and has the potential to meet the need for safer and more effective care in insulin initiation in the community setting. We observed a significant increase in workload for health care staff. Telemonitoring needs to be streamlined with health care delivery and accompanied by adequate support services.

Diabetes-Specific Self-Compassion: A New Measure for Parents of Youth With Type 1 Diabetes.

Given the high daily demands of managing type 1 diabetes (T1D), parents of youth with T1D can experience high levels of emotional distress, burden, and self-criticism, with implications for parent and child well-being and parent self-efficacy for managing diabetes. Diabetes-specific self-compassion (SC), or being kind to oneself when facing challenges related to managing diabetes, may serve as protective for parents. This study aimed to create and assess the psychometric properties of a new tool, the diabetes-specific Self-Compassion Scale (SCS-Dp), to assess diabetes-specific SC in parents of youth with T1D. We adapted a parent diabetes-specific SC measure; surveyed parents (N = 198; parent: 88% female; 95% non-Hispanic White; M age = 44 ± 8.9; child: 46% female; M age = 13 ± 3.4, range 2-18 years; 83% insulin pump users; 40% continuous glucose monitor (CGM) users; HbA1c from clinic data available for 76 participants: M HbA1c = 8.1 ± 1.3%) and conducted confirmatory factor analysis, and reliability and construct validity analyses. Validity measures included diabetes distress, diabetes empowerment, diabetes numeracy, and HbA1c. A bifactor structure provided the best fit, with one general factor and two wording-related group factors (positively and negatively worded items). The final 19-item SCS-Dp demonstrated excellent internal consistency (α =.94; range of item-total correlations: .52-.81) and good construct validity. As predicted, greater SC was associated with lower distress (r = -.68, p < .001) and greater empowerment (r = .43, p < .001) and was not associated with diabetes numeracy (p = .61). Diabetes-specific Self-Compassion Scale was not associated with HbA1c (p = .28). Results provide initial evidence of good reliability and validity of the SCS-Dp to assess diabetes-specific SC in parents.

Culture, Social Support, and Diabetes Empowerment Among American Indian Adults Living With Type 2 Diabetes.

OBJECTIVE | Type 2 diabetes represents a major health disparity for many American Indian/Alaska Native (AIAN) communities, in which prevalence rates are more than double that of the general U.S. population. Diabetes is a major indicator for other comorbidities, including the leading cause of death for AIANs (i.e., cardiovascular disease). This study investigated associations between protective factors (social support and cultural factors) and self-reported empowerment to manage illness. DESIGN AND METHODS | Participants were drawn from a random sample of tribal clinic records. Data included results from computer-assisted personal interviews with 192 American Indian adults with a diagnosis of type 2 diabetes living on or near a reservation. Community Research Councils, developed at each of the five partnering Anishinaabe reservations, oversaw protocols and procedures in this community-based participatory research collaboration. RESULTS | Multiple ordinary least squares regression models determined that general social support and diabetes-specific social support are positively related to diabetes empowerment. These associations persisted when both social support measures were added to the model, indicating independent effects of different types of social support. Cultural identity and cultural practices were positively related to diabetes empowerment in bivariate analyses; however, both measures dropped from statistical significance after accounting for all other covariates. An interaction term revealed a moderation effect through which cultural identity amplified the positive relationship between social support and diabetes empowerment. CONCLUSION | Results moderately support policy and risk-reduction efforts aiming at expanding social support networks into multiple domains and reinforcing cultural identity and cultural practices.

Nurse Coaching and Mobile Health Compared With Usual Care to Improve Diabetes Self-Efficacy for Persons With Type 2 Diabetes: Randomized Controlled Trial

BackgroundType 2 diabetes is a growing public health problem amenable to prevention and health promotion. As healthy behaviors have an impact on disease outcomes, approaches to support and sustain diabetes self-management are vital.ObjectiveThis study aimed to evaluate the effectiveness of a nurse coaching program using motivational interviewing paired with mobile health (mHealth) technology on diabetes self-efficacy and self-management for persons with type 2 diabetes.MethodsThis randomized controlled trial compared usual care with an intervention that entailed nurse health coaching and mHealth technology to track patient-generated health data and integrate these data into an electronic health record. The inclusion criteria were as follows: (1) enrolled at 1 of 3 primary care clinics, (2) aged 18 years or above, (3) living with type 2 diabetes, and (4) English-speaking. We collected outcome measures at baseline, 3 months, and 9 months. The primary outcome was diabetes self-efficacy; secondary outcomes were depressive symptoms, perceived stress, physical functioning, and emotional distress and anxiety. Linear regression mixed modeling estimated the population trends and individual differences in change.ResultsWe enrolled 319 participants; 287 participants completed the study (155 control and 132 intervention). The participants in the intervention group had significant improvements in diabetes self-efficacy (Diabetes Empowerment Scale, 0.34; 95% CI –0.15,0.53; P<.01) and a decrease in depressive symptoms compared with usual care at 3 months (Patient Health Questionnaire-9; 0.89; 95% CI 0.01-1.77; P=.05), with no differences in the other outcomes. The differences in self-efficacy and depression scores between the 2 arms at 9 months were not sustained. The participants in the intervention group demonstrated a significant increase in physical activity (from 23,770 steps per week to 39,167 steps per week at 3 months and 32,601 per week at 9 months).ConclusionsWe demonstrated the short-term effectiveness of this intervention; however, by 9 months, although physical activity remained above the baseline, the improvements in self-efficacy were not sustained. Further research should evaluate the minimum dose of coaching required to continue progress after active intervention and the potential of technology to provide effective ongoing automated reinforcement for behavior change.Trial RegistrationClinicalTrials.gov NCT02672176; https://clinicaltrials.gov/ct2/show/NCT02672176

Psychometric properties of the Malay version of the Diabetes Empowerment Scale among Hospital Serdang type 2 diabetes mellitus patients using exploratory factor analysis

BackgroundThis study was initiated to examine the psychometric components of the Diabetes Empowerment Scale (DES) by translating and validating the scale into the Malay language (DES-M) which is the main language spoken in Malaysia. This study can determine the level of empowerment among diabetic patients towards diabetes management. In addition, the reliability and validity of the DES-M was also demonstrated.MethodsA total of 151 patients with type 2 diabetes mellitus were recruited (between June 2016 and October 2016) to complete sets of questionnaires, which were DES-M, the Malay versions of the Diabetes Quality of Life (DQOL) for Adults and Summary of Diabetes Self Care Activities Questionnaire (SDSCA). Confirmatory and Exploratory factor analysis (CFA and EFA) were carried out to determine the factor structures of the DES-M.ResultsThere were 100 males and 51 females with ages ranging from 19 to 81 years old (55 ± 13) included in this study. The instrument displayed good internal consistency (Cronbach’s α =0.920) and the respective coefficients ranged from 0.65–0.84. Discriminant validity showed adequate correlations ranged from 0.257–0.744. Concurrent validity with SDSCA (Pearson’s correlation = 0.313, p = 0.012). Predictive validity with DQOL (B = 0.27, p = 0.016). CFA indicated that four factor model of the DES-M has good fit to the data.ConclusionThis study indicates that the DES-M has a good internal consistency and validity. Therefore, it is a valid and reliable instrument for assessing empowerment score among patients with diabetes in Malaysia.Trial registrationNMRR-16-805-30503 (IIR).

The Empowerment among Type 2 Diabetes Mellitus Patients

Context: TYPE 2 DIABETES MELLITUS is one of the most serious health concerns and policy agendas around the world. Diabetes is strongly associated with the patients’ unhealthy lifestyle and behavioural patterns and socio-economic changes. New model of thinking is required to recognize whether the patients are in control of and responsible for the daily self-management of Type 2 Diabetes Mellitus. A descriptive study was conducted for a period of 4 weeks in 2018 in AIMS hospital. Objective is to assess the level empowerment among Type 2 Diabetes Mellitus, to find the association between Diabetes Empowerment Scale and selected variable. Method Data were collected by using Diabetes Empowerment Scale(DES). Collected data was analysed by using IBS SPSS software version 20. Methodology: A quantitative research approach with convenience sampling technique was used for study the setting of the study was the sample size of Type 2 Diabetes Mellitus patient selected. A semistructured questionnaire used to assess demographic data and diabetes empowerment scale used to assess empowerment among type 2 Diabetic Patient. Result: A sample size of 150 was available for analysis, ranging from 20 years to above with 43% of the subjects belongs to the age group above 65 years and majority are females. Using, diabetes empowerment scale, each domains of ‘managing the psychosocial aspects of diabetes, assessing dissatisfaction and readiness to change and setting and achieving diabetes goal were measured and scored for each patient. The Data analysis revealed a statistical significance in age. Conclusion: Using the empowerment approach, healthcare professional would help patients make informed decision in accordance with their particular circumstance.

Participation in the Diabetes Empowerment Group Program Research Project: Patient Partners’ Perspectives

In 2014, the multidisciplinary, patient-centred Diabetes Empowerment Group Program (DEGP) (1) was piloted at a family medicine clinic in Montreal, Québec. The DEGP was initially developed by a family physician (F.H.-E.) and a nurse clinician (J.R.). The aim was to help empower people living with diabetes by improving their quality of life, motivation and sense of control. Between 2016 and 2018, a research project was conducted to assess the feasibility of implementing the DEGP at different health institutions across Québec, in collaboration with researchers from the McGill Department of Family Medicine.

Impact of a Culturally Tailored Diabetes Education and Empowerment Program in a Mexican American Population Along the US/Mexico Border: A Pragmatic Study.

BackgroundThe study purpose was to deliver a diabetes education program under real world conditions and evaluate its effect on diabetes-related clinical, self-management and psychosocial outcomes among Mexican Americans residing along the US/Mexico border.MethodsA pragmatic study was conducted among adult patients with diabetes in three primary care clinics located along the US/Mexico border. A bilingual culturally tailored diabetes education program incorporating hands-on participatory techniques was delivered in 4 - 8 weekly group sessions. Clinical, self-management and psychosocial outcomes were evaluated pre- and post-intervention with surveys and medical record review.ResultsA total of 209 participants were enrolled; mean age was 58.9 years (range 23 - 94, standard deviation: 11.2); 68.4% were female; 91.1% were Hispanic. Significant improvements were observed in glycated hemoglobin (-1.1%, P < 0.001, n = 79), total cholesterol (-17.2 mg/dL, P = 0.041, n = 63), glucose self-monitoring (+1.3 times a week, P = 0.021, n = 115), exercise less than once a week (-18.2%, P < 0.001, n = 129), nutritional behavior (+2.23, P < 0.001, n = 115), knowledge (+1. 83, P < 0.001, n = 141) and diabetes-related emotional distress (-7.32, P = 0.002, n = 111). Benefits were observed with attendance rates as low as 50%.ConclusionA clinic-based culturally competent diabetes education/self-management program resulted in significant improvements in outcomes among Hispanic participants. Experimentally tested culturally appropriate interventions adapted for real world situations can benefit Mexican American diabetic patients even when attendance is imperfect.

Efektifitas Pemberdayaan Keluarga Terhadap Kontrol Metabolik Pada Pasien Diabetes Mellitus Tipe 2

Background : Family empowerment plays an important role in the management of diabetes mellitus experienced by family members. Because of the chronic nature of this disease, people with diabetes mellitus need long-term assistance to improve self-care and delay chronic complications from diabetes mellitus through glycemic control. Aim : To conduct a systematic review and assess the effectiveness of family empowerment for metabolic control in patients with type 2 diabetes mellitus. Method : Systematic reviews are carried out using electronic databases in article searches such as PubMed, ScienceDirect, ProQuest, Google Scholar. Results: After reviewing five articles it was found that family-based intervention or by empowering families in the care of patients with diabetes mellitus played a role in decreasing HbA1c as an indicator in glycemic control. And the most widely used instruments are the scale of self-care and diabetes activity (SDSCA), the diabetes empowerment scale (DES) and the diabetes knowledge questionnaire (DKQ). Conclusion : From the review of the article reviewed it can be concluded that families must be involved in the care of people with diabetes mellitus, diabetes education given only to individuals with type 2 diabetes limits the impact on patients, therefore empowering families will provide a large role in the management of chronic diseases that emphasize context where this disease occurs including the family's physical environment, education, and the personal needs of patients and family members. Helps develop healthy family behavior and shows self-management of diabetic patients, especially in health care programs, especially those who are able to promote various forms of social support, glycemic control and to strengthen ties between family members.Keywords : Family empowerment, metabolic control, type 2 diabetes mellitus.

The association between self-efficacy and self-management behaviors among Chinese patients with type 2 diabetes.

BackgroundSelf-management is the cornerstone of diabetes care, however, despite the numerous recommendations available for self-management, type-2 diabetes mellitus (T2DM) patients’ performance is suboptimal in China. This study aimed to explore the association between self-efficacy and self-management behaviors among Chinese T2DM patients, which might provide evidence to inform effective self-management interventions for these patients.MethodsA cross-sectional survey was conducted using a multi-stage stratified randomized sampling in Shandong Province, China. The Diabetes Empowerment Scale-Short Form (DES-SF) was used to measure patients’ self-efficacy to manage diabetes. Latent class analysis (LCA) was used to explore the observed classes of self-management behaviors (dietary control, physical exercise, regular medication and self-monitoring of blood glucose). A two-class solution for self-management behaviors was tested to be the fittest based on LCA; we labelled active and inactive self-management groups. Univariate and multivariate logistic regression analysis were used to examine the associations between self-efficacy and self-management behaviors.ResultsA total of 2166 T2DM patients were included in the analysis. The mean DES-SF score was 31.9 (standard deviation: 5.2). The estimated proportions of T2DM in the active and inactive groups were 54.8% and 45.2%, respectively. The multivariate logistic regression showed that higher DES-SF score was significantly associated with higher possibility of active self-management behaviors (odds ratio = 1.06; 95% confidence interval: 1.04–1.08).ConclusionsSelf-efficacy in managing diabetes is associated with self-management behaviors among Chinese T2DM patients. To improve self-management behaviors, multiple strategies should be conducted to improve patients’ self-efficacy.

ENGAGEMENT AND EFFECTIVENESS OF USING MOBILE APP FOR DIABETES SELF-MANAGEMENT AMONG OLDER ADULTS

Mobile health applications (app) have shown to be beneficial for chronic disease management. However, few studies assessed older adults’ engagement in tracking self-management activities with app functions and effectiveness on improving their diabetes outcomes. This study investigated tracking patterns of each app function (blood sugar, blood pressure, diet, exercise, medication adherence etc.) in a graphic-based aging-friendly diabetes self-management app (IMTOP app) and associated the patterns with changes in HbA1c, self-care behavior, diabetes empowerment, and health promotion. The sample included 334 community-dwelling older adults with type 2 diabetes in Taiwan (mean age 64.57 ± 6.64 years) participated in the IMTOP training course that designed to motivate and train older adults with diabetes to use mobile tablets and apps. We performed trajectory analyses using SAS TRAJ procedure to identify distinct classes of individuals following similar longitudinal patterns on absence or presence of weekly app use for each individual app function. The relationships between the app engagement class memberships and 4- and 8-month diabetes health outcomes were assessed using an econometric regression analysis approach. The results showed the degree of app engagement on any single function was significantly and positively correlated with diabetes self-care scale scores (all p < .05). Only the engagement on the blood sugar function had statistically significant association with HbA1c improvements (p < .05). The app use was not associated with diabetes empowerment or health promotion. The study findings suggest any app function engagement significantly improved older adults’ overall self-management but blood sugar tracking is critical to improve HbA1c.

Changes in diabetes distress among people with type 2 diabetes during a risk screening programme for diabetic kidney disease – Longitudinal observations of the PRIORITY study

AimsTo investigate levels and changes in diabetes distress over the course of the PRIORITY (Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In people with TYpe 2 diabetes and normoalbuminuria) randomised controlled trial of screening for diabetic kidney disease (DKD) risk among people with type 2 diabetes (T2D) at a specialist diabetes clinic in Denmark. MethodsOf 436 trial participants with T2D, 216 were invited to complete the 17-item diabetes distress scale at the time of screening (T1, n = 180), immediately after receiving the screening results at 6–8 weeks (T2, n = 169), and at 12 months follow up (T3, n = 107). Linear mixed models were used to explore changes in diabetes distress. ResultsNo significant changes in diabetes distress were observed between the time of screening, receiving results, and at 12 months. Changes in diabetes distress were not influenced by diabetes empowerment, sense of coherence, or perceived support for diabetes self-management. ConclusionsIn contrast to previous studies demonstrating that screening programmes can have negative psychological consequences, our findings indicate that participating in this screening programme for DKD does not influence emotional burden or physician-related distress among people with T2D.

Diabetes empowerment scores among type 2 diabetes mellitus patients and its correlated factors: A cross-sectional study in a primary care setting in Malaysia.

BACKGROUNDThere are limited studies on diabetes empowerment among type 2 diabetes patients, particularly in the primary care setting.AIMTo assess the diabetes empowerment scores and its correlated factors among type 2 diabetes patients in a primary care clinic in Malaysia.METHODSThis is a cross sectional study involving 322 patients with type 2 diabetes mellitus (DM) followed up in a primary care clinic. Systematic sampling method was used for patient recruitment. The Diabetes Empowerment Scale (DES) questionnaire was used to measure patient empowerment. It consists of three domains: (1) Managing the psychosocial aspect of diabetes (9 items); (2) Assessing dissatisfaction and readiness to change (9 items); and (3) Setting and achieving diabetes goal (10 items). A score was considered high if it ranged from 100 to 140. Data analysis was performed using SPSS version 25 and multiple linear regressions was used to identify the predictors of total diabetes empowerment scores.RESULTSThe median age of the study population was 55 years old. 56% were male and the mean duration of diabetes was 4 years. The total median score of the DES was 110 [interquartile range (IQR) = 10]. The median scores of the three subscales were 40 with (IQR = 4) for “Managing the psychosocial aspect of diabetes”; 36 with (IQR = 3) for “Assessing dissatisfaction and readiness to change”; and 34 with (IQR = 5) for “Setting and achieving diabetes goal”. According to multiple linear regressions, factors that had significant correlation with higher empowerment scores among type 2 diabetes patients included an above secondary education level (P < 0.001), diabetes education exposure (P = 0.003), lack of ischemic heart disease (P = 0.017), and lower glycated hemoglobin (HbA1c) levels (P < 0.001).CONCLUSIONDiabetes empowerment scores were high among type 2 diabetes patients in this study population. Predictors for high empowerment scores included above secondary education level, diabetes education exposure, lack of ischemic heart disease status and lower HbA1c.