Diabetes Fatalism Research Articles

186-OR: Longitudinal Effect of Diabetes Fatalism on Clinical Outcomes and QOL in AA with Type 2 Diabetes Mellitus

186-OR: Longitudinal Effect of Diabetes Fatalism on Clinical Outcomes and QOL in AA with Type 2 Diabetes Mellitus

The Association between Religiosity and HbA1c Level in Patients

Glycemic control poses a challenge in the management of type 2 diabetes mellitus (T2DM). Religiosity can influence a patient’s coping strategies with the disease. However, the relationship between patient religiosity and glycemic control has not been thoroughly explored. In this systematic review, we assessed the relationship between religiosity and glycemic control in patients with T2DM. Using PubMed and Google Scholar, we included articles published in English from 2011 onwards that quantitatively examined religiosity and its relationship with glycemic control based on the glycated hemoglobin (HbA1c) levels. Four studies from four different countries were included, employing varying measurement tools to assess religiosity. The HbA1c level was significantly related to the Diabetes Fatalism Index (p<0.05) and with general gratitude and gratitude to God, as assessed using the Multidimensional Measurement of Religiousness. Religiosity may alleviate stress-related diseases and enhance diabetes care. One study showed a relationship between the HbA1c levels and the Beliefs and Values score amongst Muslims only. Two studies reported a significant correlation between religiosity and HbA1c levels. Reducing fatalistic beliefs and improving gratitude to God could be a viable strategy for helping patients manage T2DM. Further studies are needed to promote such an approach in T2DM management.

720-P: Material Needs Security and Mental Health Outcomes in Adults with Type 2 Diabetes in Lebanon

Despite their documented significance in type 2 diabetes (T2DM) management, social determinants of health (SDOHs) including material needs security and mental health outcomes (herein referred to as depression and diabetes fatalism) are understudied in the Middle East and North Africa (MENA) region. This study aims to assess the relation between material needs security and mental health outcomes in Lebanese adults with T2DM. Subjects with T2DM (N=299) were recruited from primary health care centers in Lebanon; sociodemographic, material need variables, depression measured by Patient Health Questionnaire (PHQ-9) and Diabetes Fatalism measured by Diabetes Fatalism Scale (DFS) were used. Depression and diabetes fatalism were used as outcome variables. Most of the participants were men, married and with lower educational levels. Multivariate analyses revealed that having material needs security was associated with diabetes fatalism (β=-0.63(-1.13; -0.12)), and depression (β=-0.46(-0.78; -0.13)) after controlling for all relevant confounding variables. Results from the fully adjusted logistic regression model showed that material needs security (OR: 0.82; 95% CI: 0.69; p<0.001). Our study highlights the importance of material needs security on mental health outcomes for adults with T2DM in the MENA region. Clinicians are encouraged to assess impact of material needs on mental health outcomes. Further research is needed to understand potential pathways/mechanisms and options for effective interventions and policy making. Disclosure O.Sukkarieh: None. M.Bassil: None. L.E.Egede: None.

Validity and reliability study of Diabetes Fatalism Scale inTurkish patients with type 2 diabetes

Background. Turkey is one of the countries with the highest prevalence of diabetes in Europe, with about one in every seven adults diagnosed with diabetes mellitus. By 2035, Turkey will have the highest number of people with type 2 diabetes in Europe, at almost 12 million. Mortality rates have increased with the increasing prevalence of type 2 diabetes, especially in the younger population, such that half of the deaths come from those under sixty. The beliefs and mental state of patients with chronic illnesses like diabetes can affect disease outcomes and the patients’ self-management. Self-care and diabetes medications are important components in improving the disease outcome, though many studies have shown that these activities can be negatively related to fatalism about the disease state. The aim of this study was to investigate the reliability and validity of the Turkish version of the Diabetes Fatalism Scale (DFS), which was developed by Dr. Leonard Egede. Materials and methods. This was a methodological study. The scales were administered to a total of 139 patients with type 2 diabetes. The content and construct validity of the scale were assessed. The construct validity was evaluated using confirmatory factor analysis, and the reliability was assessed in terms of internal consistency. Results. In terms of the population tested, 54.7% of the participants were men, 73.4% were married, 54% had one additional disease other than diabetes, 18% were high school graduates, the mean age was 50.20±16.82 years, the average duration of diabetes was 19.31±14.25 years, and mean glycated hemoglobin level was 7.06±0.65%. It was found that the Kaiser-Meyer-Olkin (KMO) measure of sampling-size adequacy was 0.770, indicating an adequate size, and the chi-square value was 1078.402. When the fifth item was excluded from the study and the analysis was repeated, the KMO coefficient was 0.802 and the chi-square value was 1020.244, p=0.000. The Cronbach’s alpha value reached 0.806, indicating a good internal consistency. The Cronbach’s alpha values of the other subscales also seemed to be at a very good level. Conclusions. Our study showed that the DFS is a valid and reliable scale for the Turkish society. DFS-T is a suitable scale for health professionals to use to assess diabetes fatalism in adults with diabetes in Turkey.

A Structural Equation Modeling Analysis to Explore Diabetes Self-Care Factors in a Rural Sample.

Diabetes is a public health problem that requires management to avoid health sequelae. Little is known about the determinants that influence diabetes self-care activities among rural populations. The purpose of this analysis was to explore the relationships among diabetes self-care activities, diabetes knowledge, perceived diabetes self-management, diabetes fatalism, and social support among an underserved rural group in the southern United States. A diabetes health promotion program was tested during a cluster randomized trial that tested a disease risk reduction program among adults living with prediabetes and diabetes. A structural equation model was fit to test psychosocial factors that influence diabetes self-care activities using the Information–Motivation–Behavioral Skills Model of Diabetes Self-Care (IMB-DSC) to guide the study. Perceived diabetes self-management significantly predicted self-care behaviors, and there was also a correlation between perceived diabetes self-management and diabetes fatalism. Perceived diabetes self-management influenced diabetes self-care activities in this rural sample and had an association with diabetes fatalism. The findings of this study can facilitate clinical care and community programs targeting diabetes and advance health equity among underserved rural groups.

Validity and reliability study of diabetes fatalism scale inturkish patients with type 2 diabetes Corrigendum: International Journal of Endocrinology (Ukraine) 2022;18(8):440-445. doi: 10.22141/2224-0721.18.8.2022.1223

Background. Turkey is one of the them that has the highest prevalence in Europe, with about one in every seven adults diagnosed diabetes mellitus. By 2035, Turkey will have the highest number of people with type 2 diabetes in Europe, at almost 12 million. Mortality rates have increased with the increasing prevalence of type2 diabetes, especially in the younger population, such that half of the deaths come from those under sixty. The beliefs and mental state of patients with chronic illnesses like diabetes can affect disease outcomes and the patients’ self-management. Self-care and diabetes medications are important components in improving the disease outcome, though many studies have shown that these activities can be negatively related to fatalism about the disease state. The aim of this study was to investigate the reliability and validity of the Turkish version of the Diabetes Fatalism Scale (DFS), which was developed by Egede. Materials and methods. This was a methodological study. The scales were administered to a total of 139 patients with type 2 diabetes. The content and construct validity of the scale were assessed. The construct validity was evaluated using confirmatory factor analysis (CFA), and the reliability was assessed in terms of internal consistency. Results. In terms of the population tested, 54.7% of the participants were men, 73.4% were married, 54% had another disease, 18% were high school graduates, the average age was 50.20±16.82 years, the average duration of diabetes was 19.31±14.25, and mean glycated hemoglobin (HbA1c) level was 7.06±0.65%. It was found that the Kaiser-Meyer-Olkin (KMO) measure of sampling-size adequacy was 0.770, indicating an adequate size, and the chi-square value was 1078.402. When the fifth item was excluded from the study and the analysis was repeated, the KMO coefficient was 0.802 and the chi-square value was 1020.244, p=0.000. The Cronbach’s alpha value reached 0.806, indicating a good internal consistency. The Cronbach’s alpha values of the other subscales also seemed to be at a very good level. Conclusions. Our study showed that the DFS is a valid and reliable scale for the Turkish society. DFS-T is a suitable scale for health professionals to use to assess the fatalism of diabetic patients in Turkey.

Factors Associated with Diabetes Outcomes among Rural African Americans.

Diabetes is a major public health threat and contributory risk factor for cardiovascular disease, especially among underserved populations living in the rural, southern states. In these areas, African Americans have the highest rates of both diabetes and cardiovascular disease, but not much is known about the psychosocial factors that influence diabetes outcomes. This study examined bivariate correlations among diabetes knowledge, diabetes self-care activities, perceived diabetes self-management, diabetes fatalism, and social support. The data were collected during a cluster randomized trial involving rural African American participants living with diabetes and prediabetes in a rural, southeastern area. The findings of this analysis point to associations among social support, diabetes fatalism, diabetes self-care activities, and perceived diabetes self-management. Diabetes knowledge was not significantly correlated with any of these factors or their subscales.

The Turkish Adaptation of the Diabetes Fatalism Scale: A Validity and Reliability Study.

Background and Objective: This study was carried out as a validity and reliability study of the Turkish version of the Diabetes Fatalism Scale (DFS) and to investigate its psychometric properties in the Turkish society with type 2 diabetes patients. Methods: Exploratory factor analysis was conducted to assess the scale's factor structure. Confirmatory factor analysis (CFA) was performed to validate the "best fit" model. Results: The explanatory factor analysis and CFA results confirmed the three-factor structure of the scale. The Cronbach's α, item-total correlation and test-retest analyses showed high reliability. Conclusion: The results showed that DFS is a valid and reliable tool for evaluating fatalism in diabetic patients from a Turkish population.

Fatalism, Social Support and Self-Management Perceptions among Rural African Americans Living with Diabetes and Pre-Diabetes.

Diabetes is a public health problem and a major risk factor for cardiovascular disease, the leading cause of death in the United States. Diabetes is prevalent among underserved rural populations. The purposes of this study were to perform secondary analyses of existing clinical trial data to determine whether a diabetes health promotion and disease risk reduction intervention had an effect on diabetes fatalism, social support, and perceived diabetes self-management and to provide precise estimates of the mean levels of these variables in an understudied population. Data were collected during a cluster randomized trial implemented among African American participants (n = 146) in a rural, southern area and analyzed using a linear mixed model. The results indicated that the intervention had no significant effect on perceived diabetes management (p = 0.8), diabetes fatalism (p = 0.3), or social support (p = 0.4). However, the estimates showed that, in the population, diabetes fatalism levels were moderate (95% CI = (27.6, 31.3)), and levels of social support (CI = (4.0, 4.4)) and perceived diabetes self-management (CI = (27.7, 29.3)) were high. These findings suggest that diabetes fatalism, social support, and self-management perceptions influence diabetes self-care and rural health outcomes and should be addressed in diabetes interventions.

Living with diabetes and disadvantage: A qualitative, geographical case study

The aim of the study was to elucidate the experiences of people living with diabetes, residing in an urban diabetogenic area. Community-level social and environmental factors have a role to play in the development of type 2 diabetes mellitus. Socio-economic deprivation; high obesity rates; high access to fast foods; and, multiculturalism contributes to higher rates of diabetes in some geographical areas. However, there is a lack of research examining people's experiences of living with diabetes in diabetogenic areas. The word diabetogenic implies that the phenomenon of interest contributes to the development of diabetes. Qualitative, geographical case study approach. A convenience sample of 17 people living with diabetes in a diabetogenic, low-socioeconomic urban area participated in face-to-face, semi-structured interviews. Interviews were audio-recorded, transcribed and analysed thematically. This paper adheres to the COREQ guidelines. Four main themes were identified: 1. Diabetes fatalism: Inevitability and inertia; 2. Living with Inequity: Literacy and intersectionality; 3. Impersonal services: Intimidating and overwhelming; and, 4. Education in the community: Access and anecdotes. This study has highlighted the need to develop local solutions for local problems. In this geographical area, solutions need to address generally lower health literacy, how the community would prefer to receive diabetes education and the issue of diabetes fatalism. Findings from this study have highlighted a need to re-examine how diabetes education is delivered in communities that are already experiencing multiple disadvantages. There are research and practice connotations for how fatalism is positioned for people at high risk of developing diabetes.

Diabetes in Appalachia: providers' perspectives.

Southeastern Appalachian Ohio has more than double the national average of diabetes and a critical shortage of healthcare providers. Paradoxically, there is limited research focused on primary care providers' experiences treating people with diabetes in this region. This study explored providers' perceived barriers to and facilitators for treating patients with diabetes in southeastern Appalachian Ohio. We conducted in-depth interviews with healthcare providers who treat people with diabetes in rural southeastern Ohio. Interviews were transcribed, coded, and analyzed via content and thematic analyses using NVivo 12 software (QSR International, Chadstone, VIC, Australia). Qualitative analysis revealed four themes: (1) patients' diabetes fatalism and helplessness: providers recounted story after story of patients believing that their diabetes was inevitable and that they were helpless to prevent or delay diabetes complications. (2) Comorbid psychosocial issues: providers described high rates of depression, anxiety, incest, abuse, and post-traumatic stress disorder among people with diabetes in this region. (3) Inter-connected social determinants interfering with diabetes care: providers identified major barriers including lack of access to providers, lack of access to transportation, food insecurity, housing insecurity, and financial insecurity. (4) Providers' cultural understanding and recommendations: providers emphasized the importance of understanding of the values central to Appalachian culture and gave culturally attuned clinical suggestions for how to use these values when working with this population. Evidence-based interventions tailored to Appalachian culture and training designed to increase the cultural competency and cultural humility of primary care providers may be effective approaches to reduce barriers to diabetes care in Appalachian Ohio.

Differential Impact of Food Insecurity, Distress, and Stress on Self-care Behaviors and Glycemic Control Using Path Analysis.

The aim of this study was to investigate the direct and indirect pathways through which food insecurity influences glycemic control and self-care behaviors. Using data collected from 615 adults with type 2 diabetes, we investigated pathways between food insecurity and diabetes outcomes using path analysis. We included measures of perceived stress, diabetes distress, diabetes fatalism, and depression as psychosocial factors in the pathway. Self-care behaviors included general diet, specific diet, exercise, blood sugar testing, foot care, and medication adherence. Analyses were conducted using Stata v14, to include both direct and indirect effects, with standardized estimates to allow comparison of paths. Food insecurity was directly associated with stress (r = 0.43, p < 0.001), depression (r = 0.34, p < 0.001), fatalism (r = 0.09, p = 0.03), and distress (r = 0.36, p < 0.001). The type of stress, however, was differentially associated with outcomes, with distress associated with HbA1c (r = 0.25, p < 0.001), general and specific diet (r = - 0.28 and - 0.17, respectively, p = 0.001), and medication adherence (r = - 0.26, p < 0.001), while stress was associated with specific diet (r = - 0.14, p = 0.005) and medication adherence (r = - 0.15, p < 0.001) and depression was associated with exercise (r = - 0.06, p = 0.007). Food insecurity was indirectly associated with HbA1c (r = 0.08, p = 0.001), and four self-care behaviors (general diet, specific diet, exercise, and medication adherence). Food insecurity influences self-care behaviors indirectly via multiple psychosocial factors, and glycemic control indirectly through diabetes distress, supporting the hypothesis that stress is an important mechanism. Programs to improve access to resources and manage psychosocial concerns should be combined with food-based programs for food insecure populations with diabetes.

815-P: Eating Behaviors, Personality Traits, and Diabetes Fatalism: Predictors of HbA1c in Type 2 Diabetes

The effect of eating behavior and personality on glycemic outcomes in type 2 diabetes (T2DM) has received little attention. Diabetes fatalism has furthermore been associated with uncontrolled glycemia. The aim of the present study is to explore the interrelationship of these constructs, which might uncover new insights for diabetes management. A total of 333 Lebanese patients (Age: 59 ± 13 years, 50.2% M) with T2DM were recruited. Eating behaviours (Dutch Eating Behaviour Questionnaire), personality traits (NEO Five-Factor Inventory-3), and diabetes related fatalistic attitudes (Diabetes Fatalism Scale) were assessed. Regression analyses showed that neuroticism, restrained eating, and external eating predicted A1C. Total diabetes fatalism and its ‘despair’ subscale also predicted HbA1C. Multiple regression analysis showed that neuroticism, restrained eating, and fatalism subscale ‘despair’ predicted HbA1C levels and explained 5.4% of the variance (F(3,302) = 5.77, p = .001). A moderated moderation was run and revealed that the effect of conscientiousness on restrained eating was moderated by powerlessness (fatalism subscale) and neuroticism. At low neuroticism levels and with any powerlessness levels, conscientiousness did not exert a significant effect on restrained eating. However, at high levels of neuroticism with low or moderate levels of powerlessness, conscientiousness exerted significant effect on restrained eating (low powerlessness: B = .07, t = 4.39, p &amp;lt; .001; medium powerlessness: B = .04, t = 3.24, p &amp;lt; .01). On the other hand, when powerlessness was high, conscientiousness did not exert a significant effect on restrained eating. In summary, the impact of conscientiousness on restrained eating, which in turn predicts HbA1C levels, is moderated by the belief of powerlessness and neuroticism in T2DM. These factors should be taken into account in the clinical practice. Further exploring similar constructs in T2DM to improve the quality of health care is warranted. Disclosure N. Farran: None. O.A. Sukkarieh-Haraty: None. D. Al Bakhour: None. M. Bassil: None.

Results of a Culturally Tailored Multidisciplinary Intervention on Diabetes Self-Care and Glycemic Outcome in Lebanese Patients with Type 2 Diabetes

Background: Enhancing diabetes self-care is known to improve glycemic control of patients with type 2 diabetes mellitus (T2DM). According to American Diabetes Association guidelines, a multidisciplinary and culturally appropriate intervention is needed for optimal diabetes self-care and glycemic outcomes. There is no published study that evaluated an educational intervention targeting diabetes self-care and glycemic outcomes in Lebanese patients with T2DM. Aim: The aim of this pilot-study was to test the effect of culturally-tailored educational program targeting diabetes self-care on glycemic control of Lebanese patients with T2DM, of low socioeconomic status. Methods: A sample of 27 adults (Age: 61±10 years, 59% males, A1C: 8.98±1.38%) diagnosed with T2DM for at least one year was recruited from two dispensaries in Beirut. Participants received culturally-tailored, multidisciplinary educational sessions based on the Information-Motivation-Behavioral model and on American Diabetes Association’s National Standards for Diabetes Self-Management Education and Support. Summary of Diabetes Self-Care Activities (SDSCA), Social Support Scale (SS), Diabetes Fatalism Scale (DFS), and Diabetes Knowledge Test (DKT), as well as blood samples (HbA1c, Fasting Plasma Glucose) were collected at baseline and three months post-intervention. Results: Results revealed improvements in various diabetes self-care activities (Diet and Self-Monitoring Blood Glucose) after 3 months, which was reflected in a significant decrease in glycaemia (A1C: -0.6%; Fasting Plasma Glucose: -35 mg/dl; p&amp;lt;0.05). Conclusion: This is the first intervention study showing the effectiveness of a culturally-tailored, multidisciplinary education program in improving glycemic control and diabetes self-care behavior of Lebanese patients with T2DM. It sets the stage for larger scale implementation with more representative sample. Disclosure O. Sukkarieh-Haraty: None. M. Bassil: None. L.E. Egede: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Novo Nordisk Inc..

Psychometric properties of the Arabic version of the 12-item diabetes fatalism scale.

BackgroundThere are widespread fatalistic beliefs in Arab countries, especially among individuals with diabetes. However, there is no tool to assess diabetes fatalism in this population. This study describes the processes used to create an Arabic version of the Diabetes Fatalism Scale (DFS) and examine its psychometric properties.MethodsA descriptive correlational design was used with a convenience sample of Lebanese adults (N = 274) with type 2 diabetes recruited from a major hospital in Beirut, Lebanon and by snowball sampling. The 12- item Diabetes Fatalism Scale- Arabic (12-item DFS-Ar) was back-translated from the original version, pilot tested on 22 adults with type 2 diabetes and then administered to 274 patients to assess the validity and reliability of the scale. Confirmatory factor analysis (CFA) was used to test the hypothesized factor structure. Cronbach’s alpha was used to test for reliability.ResultsCFA supported the existence of the three factor hypothesis of the original DFS scale. The five items measuring “emotional distress” loaded under Factor 1, the four items measuring “spiritual coping” loaded under factor 2 and the last three items measuring “perceived self-efficacy” of the original scale loaded under Factor 3 (p <0.001 for all three subscales). Goodness of fit indices confirmed adequateness of the CFA model (CFI = 0.97, TLI = 0.96, RMSEA = 0.067 and pclose = 0.05). The 12-item DFS-Ar showed good reliability (Cronbach’s alpha of 0.86) and significantly predicted HbA1c (β = 0.20, p < 0.01). After adjusting for the demographic characteristics and the number of diabetes comorbid conditions, the 12-item DFS-Ar score was independently associated with HbA1c in a multivariable model (β = 0.16, p < 0.05).ConclusionsThe 12-item DFS-Ar demonstrated good psychometric properties that are comparable to the original scale. It is a valid and reliable measure of diabetes fatalism. Further testing with larger and non-Lebanese Arabic population is needed.

Diabetes fatalism and its emotional distress subscale are independent predictors of glycemic control among Lebanese patients with type 2 diabetes

ABSTRACTBackground: Achieving and sustaining optimal glycemic control in type 2 diabetes (T2DM) is difficult because of socio-cultural and psychosocial factors including diabetes fatalism. Diabetes fatalism is ‘a complex psychological cycle characterized by perceptions of despair, hopelessness, and powerlessness’.Purpose: The purpose of this paper is to explore whether diabetes fatalism and other psychosocial and socio-cultural variables are correlates of glycemic control in Lebanese population with T2DM.Methods: A convenience sample of 280 adult participants with T2DM were recruited from a major hospital in greater Beirut-Lebanon area and from the community. Diabetes fatalism was assessed using the Arabic version of 12-item Diabetes Fatalism Scale. Multiple linear regression models were used to assess the relationship between HbA1c and psychosocial and socio-cultural characteristics including diabetes fatalism. Four models were run to examine the independent association between HbA1c and diabetes fatalism and to identify which of the 3 subscales (emotional distress, spiritual coping and perceived self-efficacy) were associated with HbA1c.Results: The mean age of the participants was 58.24(SD = 13.48) and the majority were females (53.76%), while 32.73% of the sample had diabetes for more than 10 years. Fully adjusted multiple linear regression models showed that higher scores on diabetes fatalism and the emotional distress subscale (P = 0.018) were significantly associated with higher HbA1c values. In addition, having diabetes for more than 11 years (P = 0.05) and a higher number of diabetes complications (P < 0.001) were associated with higher HbA1c levels. However, advanced age (P = 0.055), female gender (P = 0.003), and diabetes education (P = 0.011) were significantly associated with lower HbA1c levels.Conclusion: This is the first study in the Arab region that identifies diabetes fatalism as an independent predictor of glycemic control among Lebanese. Future studies should further investigate this construct to guide interventions that can address it for better diabetes outcomes.

Predictors of Diabetes Fatalism Among Arabs: A Cross-Sectional Study of Lebanese Adults with Type 2 Diabetes

Fatalism is a grounded cultural belief that is common among Arabs and is known to hinder self-care in chronic diseases including diabetes (Nabolsi and Carson in Scand J Caring Sci 25(4):716-724, 2011). The purpose of this study is to identify predictors of diabetes fatalism in this population. Data on 280 Lebanese patients with type 2 diabetes (mean age 58.24±13.48years; mean HbA1c 7.90±1.90%; 53.76% females) recruited from one hospital in greater Beirut, Lebanon, and from the community using snowballing technique were examined. Multiple linear regression was used to assess the independent association between diabetes fatalism and demographic and patient characteristics. Age (β=-.14, 95% CI -.27, -.002), BMI (β=.35, 95% CI .15; .54), level of education (β=-3.98, 95% CI -7.64; -.32) and number of diabetes problems (β=-5.03, 95% CI -9.89; -.18) were significantly associated with diabetes fatalism in the regression model. The combination of demographic and patient characteristics accounted for 14.5% of the variance in diabetes fatalism scores' change. Patients with type 2 diabetes who exhibited more fatalistic attitudes were younger, of lower education levels, had higher BMI and had fewer diabetes comorbidities. Such findings are crucial for healthcare practitioners to identify fatalistic patients and to tailor culturally appropriate strategies in diabetes management. Further studies are warranted to explore other potential determinants of diabetes fatalism with larger sample and non-Lebanese Arabic population.

Abstract TP190: The Effectiveness of a Person-centered Empowerment-based Self-management Intervention in Reducing Risk of Stroke Among Male Patients With Poorly Controlled Type 2 Diabetes: A Mixed-method Study

Introduction: The overall incidence of stroke was higher in men than women. Type 2 diabetes is found to be a risk factor for stroke. Previous prospective studies showed each 1% increase in HbA1c would be associated with 12% increase in the risk of developing a stroke. Identifying effective strategies to optimize the glycemic control of male patients with poorly controlled type 2 diabetes would be valuable for reducing the risk of stroke. This mixed-method study aims to examine how male patients with poorly controlled type 2 diabetes responded to a person-centered empowerment-based self-management intervention. Methods: Phase I study was based on a sub-group analysis of 179 male subjects with poorly controlled type 2 diabetes [with Glycated hemoglobin (HbA1c) ≥7.5%] who received a six-week empowerment-based self-management intervention (n= 93) or attentional control (n= 86), respectively. The primary outcome was HbA1c level from baseline to three-month post-intervention. Phase II study was an in-depth individual interview with the purpose to reveal how facilitating factors or barriers become apparent in the implementation of self-management practice. Integration of quantitative and qualitative data was performed to disclose a comprehensive picture of intervention effect and mechanism. Results: The pre-post HbA1c change for male subjects in the intervention group was 1.01%, which indicated a clinical significant reduction in the risk of developing stroke. At three-month post-intervention, male participants in the intervention group showed significant improvement in glycemic control (8.99% vs. 9.68%, between-group difference: 0.69±2.64, p= 0.045). Content analysis revealed that setting personally meaningful goals, making a personalized action plan, and reflecting and solution-finding were facilitating factors perceived by male subjects with poorly controlled type 2 diabetes. Two categories for barriers to optimal glycemic control were identified, including collective culture and diabetes fatalism. Conclusions: Person-centered empowerment-based intervention could facilitate male subjects with poorly controlled type 2 diabetes to actively engage in self-management activities for stroke prevention.

Pathways for the relationship between diabetes distress, depression, fatalism and glycemic control in adults with type 2 diabetes

BackgroundThe aim of this study was to examine the mechanism by which depressive symptoms, diabetes distress, and diabetes fatalism together influence diabetes outcomes using structured equation modeling. Methods615 adults with type 2 diabetes were recruited from two primary care clinics in the southeastern United States. Psychosocial factors found to be associated with diabetes outcomes were measured using validated questionnaires. Structured equation modeling (SEM) was used to investigate the relationship between diabetes fatalism, depressive symptoms, diabetes distress, self-care and glycemic control. ResultsThe final model (chi2(903)=24,088.91, p<0.0001, R2=0.93, RMSEA=0.05 and CFI=0.90) showed that higher diabetes distress was directly significantly related to a decreased self-care (r=−0.69, p<0.001) and increased HbA1c (r=0.69, p<0.001). There was no significant direct association between depressive symptoms or fatalism, and glycemic control or self-care. There was, however, an indirect association between increased depressive symptoms and increased fatalism, explained through the direct association with diabetes distress in that higher depressive symptoms (0.76, p<0.001) and higher fatalism (0.11, p<0.001) were significantly associated with higher diabetes distress. ConclusionDiabetes distress serves as a pathway through which depressive symptoms and fatalism impact both glycemic control and self-care. In addition, pathways between diabetes distress and both self-care behaviors and glycemic control in patients with type 2 diabetes remained separate, suggesting the need to address both psychological and behavioral factors in standard diabetes care, rather than focusing on psychological care primarily through support for self-management and treatment of depression.

Lifestyle, Diet, Self-care, and Diabetes Fatalism of Diabetic Patients with and without Diabetic Foot

This study was to determine diabetes fatalism of diabetic patients with and without diabetic foot and its association with lifestyle, diet, and self-care. Methods: The subjects were diabetic patients with (male/female 48/21) and without diabetic foot (male/female 33/26). We administered the questionnaires which were designed to determine diabetes fatalism, lifestyle, diet, and self-care. Diabetes fatalism was determined by Diabetes fatalism scale (DFS), which consisted of total 12 items in three subscales namely, emotional stress, religiou·spiritual coping, and perceived selfefficacy. Results: The patients with diabetic foot had undesirable diets more frequently (1.37 and 0.91 days/week respectively) and their desirable diets (2.74 and 3.61 days/week respectively) and foot care (4.61 and 5.53 days/week respectively) were less frequent than those without diabetic foot (p < 0.05). An item analysis of the 12 DFS items revealed a Chronbach`` α of 0.614 and 0.869, respectively in diabetic patients with and without diabetic foot. Perceived self-efficacy related DFS of subjects without diabetic foot was positively associated with smoking (r = 0.350, p < 0.01), undesirable diet (r = 0.295, p < 0.05), and drinking (r = 0.257, p < 0.05), while its negative association with exercise (r = -0.224, p < 0.088) and foot care (r = -0.247, p < 0.059) did not reach to statistical significance. Conclusions: This work was the first study reporting the potential usefulness of DFS, especially perceived self-efficacy related subscale as a predictor of lifestyle, diet and self-care on the Korean diabetic patients, at least those without severe diabetic foot to screen those who should be the first target for diabetes education. Korean J Community Nutr 19(3): 241~249, 2014