Diabetes In Rural Communities Research Articles

Factors associated with hypertension and diabetes in rural communities in the Asante Akim North Municipality of Ghana

Background Hypertension and diabetes are leading non-communicable diseases that have driven an epidemic of cardiovascular diseases globally. Understanding the factors associated with the occurrence of hypertension and diabetes, particularly in rural settings, is crucial for designing interventions to improve awareness, detection, and control. This study assessed factors associated with hypertension and diabetes in Asante Akim North Municipality, a rural community in Ghana. Methods This cross-sectional study involved 2,576 participants. Data were collected using a structured questionnaire covering sociodemographic, blood pressure measurements, anthropometric measurements, biochemical parameters, and modifiable risk factors for hypertension and diabetes. Descriptive statistics of the outcomes were performed. The factors associated with hypertension or diabetes were assessed using a multivariate logistic regression model. Results The study found that participants' mean age was 35 years (SD) with a slight female preponderance of 53.88%. Age, marital status, educational status, and occupation positively predicted the occurrence of hypertension. The prevalences of hypertension and diabetes were found to be 30.9% and 17.7%, respectively. Community members above 18 years of age had increased odds of developing hypertension [18–44 years (aOR=1.99, CI=1.06–3.71, p <0.05), 45–64 years (aOR=6.12, CI=3.15–11.9, p <0.001), and >64 years (aOR=14.55, CI=7.17–29.53, p <0.001)]. Community members who were fishing/farming (aOR=0.45, CI=0.26–0.76, p <0.01) and being student/apprentices (aOR=0.11, CI=0.02–0.56) were at reduced odds of developing diabetes. Participants who consumed snacks (aOR=0.64, CI=0.41–0.99, p <0.05) during working hours had reduced odds of developing diabetes. Conclusions The study concluded that commonly known risk factors (dietary behaviour, alcohol intake, tobacco use, and physical activities) were not associated with hypertension or diabetes. Sociodemographic characteristics and poor health screening practices were the main predictors of hypertension and diabetes in rural areas. Urgent steps to improve health education and population-level screening are pivotal for controlling hypertension and diabetes.

Informal caregiving among people supporting a person with type 2 diabetes in rural communities of Northern Vietnam: A cross-sectional study of caregiver burdens.

The prevalence of type 2 diabetes mellitus (T2DM) in Vietnam has doubled from 3% to 6% over the last decades, with potential consequences for persons with diabetes and their caregivers. This study aimed to assess caregiver burdens and factors associated with caregiver burden. A cross-sectional study was conducted in 2019, using data from 1,241 informal caregivers (ICGs). Caregiver burden was scored from 0-32 using 8 questions from the Zarit Burden Interview (ZBI). Quantile regression analysis was used to identify factors associated with caregiver burden. The median score of the ZBI was 7.0 (Q1-Q3: 2.0-10.0), indicating that the burden among caregiver of persons with T2DM is not high. Quantile regression showed that the higher the monthly income, the lower the burden among caregivers (50% quantile and 75% quantile of burden: -0.004). Lower educational level (25%Q: 4.0, 50%Q; 3.0, 75%Q: 2.16), being a farmer (25%Q: 2.0) and providing care to other people besides the person with T2DM (25%Q: 2.0, 50%Q; 2.54, 75%Q: 1.66) were associated with higher burden on caregivers. The study found that caregivers facing additional life stressors, such as low income or other caregiving responsibilities, reported higher levels of burden. These findings could inform the development of interventions targeted at supporting informal caregivers in rural areas in low- and middle-income countries.

MHealth Self-Monitoring Model for Medicine Adherence of Patients With Diabetes in Resource-Limited Countries: Structural Equation Modeling Approach.

The COVID-19 pandemic has led to serious challenges and emphasized the importance of using technology for health care operational transformation. Consequently, the need for technological innovations has increased, thus empowering patients with chronic conditions to tighten their adherence to medical prescriptions. This study aimed to develop a model for a mobile health (mHealth) self-monitoring system for patients with diabetes in rural communities within resource-limited countries. The developed model could be based on the implementation of a system for the self-monitoring of patients with diabetes to increase medical adherence. This study followed a quantitative approach, in which data were collected from health care providers using a questionnaire with close-ended questions. Data were collected from district hospitals in 3 South African provinces that were selected based on the prevalence rates of diabetes and the number of patients with diabetes treated. The collected data were analyzed using smart partial least squares to validate the model and test the suggested hypotheses. Using variance-based structural equation modeling that leverages smart partial least squares, the analysis indicated that environmental factors significantly influence all the independent constructs that inform patients' change of behavior toward the use of mHealth for self-monitoring of medication adherence. Technology characteristics such as effort expectancy, self-efficacy, and performance expectancy were equally significant; hence, their hypotheses were accepted. In contrast, the contributions of culture and social aspects were found to be insignificant, and their hypotheses were rejected. In addition, an analysis was conducted to determine the interaction effects of the moderating variables on the independent constructs. The results indicated that with the exception of cultural and social influences, there were significant interacting effects on other independent constructs influencing mHealth use for self-monitoring. On the basis of the findings of this study, we conclude that behavioral changes are essential for the self-monitoring of chronic diseases. Therefore, it is important to enhance those effects that stimulate the behavior to change toward the use of mHealth for self-monitoring. Motivational aspects were also found to be highly significant as they triggered changes in behavior. The developed model can be used to extend the research on the self-monitoring of patients with chronic conditions. Moreover, the model will be used as a basic architecture for the implementation of fully fledged systems for self-monitoring of patients with diabetes.

THU254 VICTOR-Pilot Study Of A Virtual Dietary Intervention To Improve Diabetes And Cardiovascular Risk In Rural Communities - Primary Results

Abstract Disclosure: C.C. Low Wang: Research Investigator; Self; Dexcom, Virta Health. R.O. Estacio: None. S. Coronel-Mockler: None. N. Flattery: None. A. McKenzie: Employee; Self; Virta Health. Stock Owner; Self; Virta Health. D. Harrison: Employee; Self; Virta Health. Stock Owner; Self; Virta Health. M.P. Bonaca: Consulting Fee; Self; Audentes. Research Investigator; Self; Abbott Laboratories, Agios Pharmaceuticals, Alexion Pharmaceuticals, Inc., Alnylam, Amgen Inc, Angionetics, Anthos Therapeutics, ARCA Biopharma Inc, Array, AstraZeneca, Atentiv, Better Therapeutics, Bayer, Inc., Bristol-Myers Squibb, Cardiol Therapeutics, CellResearch Corp, CSL Behring, Eidos Therapeutics, EP Trading Company, Esperion Therapeutics, EveryWell, Faraday Pharmaceuticals, Fortress Biotech, HeartFlow, Insmed, Jansen Pharmaceuticals, Lexicon Pharmaceuticals, Inc., Kowa Research, Merck & Co., Moderna, Novo Nordisk, Pfizer, Inc., PhaseBio, PPD Development, Prothena Biosciences, Regeneron Pharmaceuticals, Regio Biosciences, Sanifit Therapeutics, Sanofi, Stealth Biotherapeutics, Wraser, Cambrian Biopharma, Cook Regentech, EPG Communications, Epizon Pharma, Exicon Consulting, Medtronic, Silence Therapeutics, VarmX. Stock Owner; Self; Pfizer, Inc., Medtronic. Introduction: Individuals in rural communities face challenges accessing healthcare. Innovative strategies combining local Community Health Workers (CHW) and virtual digital solutions may be beneficial for improving type 2 diabetes (T2D) care and cardiovascular (CV) risk. Hypothesis: A virtually delivered digitally based intervention will improve glycemic control in individuals with diabetes in rural communities. Methods: The Virta Intervention in CommuniTies in cOloRado (VICTOR)-Pilot Study is designed to examine whether referral to the Virta Intervention (VINT) while integrated into the CHW program Colorado Heart Healthy Solutions (CHHS), a health education program designed to improve cardiovascular risk factors, is feasible, acceptable, and improves hemoglobin A1c (HbA1c). VINT is a low-carbohydrate approach to T2D treatment which is delivered through a continuous remote care platform via a smartphone application; patients receive care from a dedicated Health Coach and Medical Provider to boost efficacy and ensure safety. Adults with T2D age 18-79 yr in rural Colorado enrolled in CHHS and taking one or more antihyperglycemic medications for at least 3 months, with BMI >25 kg/m2, and HbA1c >7.5% were randomized to VINT + CHHS vs CHHS alone. The primary outcome is change in HbA1c from baseline to 3 months. Secondary outcomes include change in body weight, number of diabetes medications, and patient-reported outcomes. The Intervention arm undergoes VINT + CHHS for 6 months, then CHHS alone for 3 months. The Control arm starts with CHHS alone for 3 months, then VINT + CHHS for 3 months, and finally CHHS alone for 3 months. Both groups are assessed at baseline (0), 3, 6 and 9 months. Enrollment for the trial is complete, and the study is ongoing. Results: A total of 48 individuals are enrolled from 2 rural Colorado communities, 25 in the Intervention arm and 23 in the Control arm. Of these, 65% are female, mean age 59.4 years (range 36-77, SD 10.1), 92% white, 4% Hispanic, mean body mass index (BMI) 34.3 kg/m2 (range 25-62, SD 7.0), mean HbA1c 9.0% (range 7.5-14.1%, SD 1.3), mean weight 216.6 lb (range 148-364, SD 46.9), median number of diabetes medications: 2, with 36% of participants on insulin. The primary outcome of change in HbA1c from baseline to 3 months will be assessed in March 2023 and available for reporting at the 2023 Endocrine Society meeting. Conclusion: The VICTOR-Pilot study is evaluating the effect on HbA1c, medication burden, feasibility, and acceptability of a virtual digital dietary intervention to improve glycemic control and risk factor management in patients with type 2 diabetes living in rural communities. The trial has fully enrolled, and the primary end point as well as other key secondary endpoints will be reported. Presentation: Thursday, June 15, 2023

Peer Support Self-Management Intervention for Individuals With Type 2 Diabetes in Rural Primary Care Settings: Protocol for a Mixed Methods Study.

The increasing prevalence of diabetes is placing important demands on the Chinese health care system. Providing self-management programs to the fast-growing number of people with diabetes presents an urgent need in rural primary care settings in China. Peer support has demonstrated effectiveness in improving self-management for individuals with diabetes in urban communities in China. A priority then becomes developing and evaluating a peer support program in primary care settings in rural communities of China and determining whether it is feasible and acceptable. The aims of this study are (1) to evaluate the feasibility and acceptability of a peer support approach to type 2 diabetes self-management in rural primary care settings; (2) to identify enabler and facilitator factors likely to influence the peer support implementation; (3) to provide primary data and evidence for developing a version of the program suitable for a randomized controlled trial in rural primary care settings. Three townships will be sampled from 3 different counties of Anhui province as the study setting. Participants will be recruited based on these counties' local primary care health record system. The peer supporters will be recruited from among the participants. The peer support program will be led by peer supporters who have completed 12 hours of training. It will be guided by primary care providers. The program will include biweekly meetings over 3 months with varied peer support contacts between meetings to encourage the implementation of diabetes self-management. Mixed methods will be used for evaluation. Qualitative methods will be used to collect information from health care system professionals, individuals with diabetes, and peer supporters. Quantitative methods will be used to collect baseline data and data at the end of the 3-month intervention regarding psychosocial factors and self-management practices. The results will include (1) quantitative baseline data that will characterize type 2 diabetes self-management practices of individuals with diabetes; (2) qualitative data that will identify enablers of and barriers to self-management practices for individuals with type 2 diabetes in rural communities; (3) both qualitative and quantitative evaluation data, after the 3-month intervention, to demonstrate the feasibility and acceptability of the peer support approach for individuals with type 2 diabetes. Our findings will inform the design of a tailored intervention program to improve self-management among individuals with type 2 diabetes in rural primary care settings. If we find that the peer support approach is feasible and acceptable, we will develop a larger randomized controlled trial to evaluate effectiveness in multiple rural settings in the province. PRR1-10.2196/47822.

Unmet needs for informal care among people with type 2 diabetes in rural communities in Vietnam

ObjectivesThe objective of this study was to identify determinants associated with unmet needs for informal support among people with type-2 diabetes in rural communities of Vietnam in order to inform development of effective interventions aimed at bridging the gap between community members and resource constrained health systems. Study designA cross-sectional survey was conducted from December 2018 to February 2019 in a rural area of northern Vietnam. MethodsFrom 2 districts in northern Vietnam, 806 people with type-2 diabetes participated in a survey to assess who were their most important informal caregivers (ICGs) and to measure the association between demographic and socio-economic predictors and unmet needs of informal support of relevance for diabetes self-care using bivariate and multivariate analyses. ResultsThe spouse was reported as the most important ICG (62.9%) followed by a daughter or son (28.4%). 32.0% reported at least one type of unmet need for informal support. The most commonly reported unmet needs of informal care were: transport to health facilities and company when seeking formal care (20.5%), financial support related to costs of diabetes self-management (18.5%), and reminders to engage in physical exercise (14.5%). People living alone reported the highest odds ratio (OR) for unmet need of informal care (OR = 4.41; CI95%: 2.19–8.88), followed by those being poor (OR = 3.79; CI95%: 1.25–11.52) and those being unemployed (OR = 2.85; CI95%: 1.61–5.05). ConclusionsAlmost one-third of people with type-2 diabetes reported at least one type of unmet need for informal care. These findings provide a basis for development of new modalities for strengthening support provided by ICGs in rural communities in Vietnam and in other low- and middle-income countries.

Cost-effectiveness of community diabetes screening: Application of Akaike information criterion in rural communities of Nigeria.

BackgroundThe prevalence of diabetes mellitus (DM) is increasing globally, and this requires several approaches to screening. There are reports of alternative indices for prediction of DM, besides fasting blood glucose (FBG) level. This study, investigated the ability of combination of biochemical and anthropometric parameters and orodental disease indicators (ODIs) to generate models for DM prediction, using Akaike information criterion (AIC) to substantiate health economics of diabetes screening.MethodsFour hundred and thirty-three subjects were enrolled in the study in Ndokwa communities, Delta State, Nigeria, and their glycaemic status was determined, using the CardioChek analyser® and previous data from the Prediabetes and Cardiovascular Complications Study were also used. The cost of screening for diabetes (NGN 300 = $0.72) in a not-for-profit organization/hospital was used as basis to calculate the health economics of number of individuals with DM in 1,000 participants. Data on the subjects' anthropometric, biochemical and ODI parameters were used to generate different models, using R statistical software (version 4.0.0). The different models were evaluated for their AIC values. Lowest AIC was considered as best model. Microsoft Excel software (version 2020) was used in preliminary analysis.ResultThe cost of identifying <2 new subjects with hyperglycemia, in 1,000 people was ≥NGN 300,000 ($ 716). A total of 4,125 models were generated. AIC modeling indicates FBG test as the best model (AIC = 4), and the least being combination of random blood sugar + waist circumference + hip circumference (AIC ≈ 34). Models containing ODI parameters had AIC values >34, hence considered as not recommendable.ConclusionThe cost of general screening for diabetes in rural communities may appear high and burdensome in terms of health economics. However, the use of prediction models involving AIC is of value in terms of cost-benefit and cost-effectiveness to the healthcare consumers, which favors health economics.

Challenges Experienced by Families With a Child With Diabetes in Rural Communities: An Opportunity for OT

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. In rural communities, children with Type 1 diabetes can struggle to get care matching current diabetes guidelines, potentially resulting in increased health complications. focus-group findings indicated that families may experience dramatic family and lifestyle changes after diagnosis and lack of access to specialized care but that isolation improved resourcefulness in health management, and technology improved health management and flexibility. Primary Author and Speaker: Vanessa Jewell Additional Authors and Speakers: Benjamin Feiten Contributing Authors: Emily Knezevich, Amy Abbott, Kameran Ulferts, and Shelby Hoffmann

Nurse practitioner scope of practice and the prevention of foot complications in rural diabetes patients.

Diabetic foot ulcers afflict a quarter of type-2 diabetes mellitus patients and are associated with higher mortality rates among people with diabetes. Routine primary and preventive care is essential to both prevent and treat foot ulcers before they can contribute to further adverse outcomes. One approach for expanding this care to people with diabetes in rural communities is increasing the practice authority of nurse practitioners. This study examines whether the presence of nurse practitioner practice authority is associated with fewer foot ulcer complications in rural populations as measured through the incidence of foot debridement-a common procedure for addressing severe diabetic foot ulcers. This study uses medical claims to estimate the incidence of foot debridement for US counties. A multivariable linear regression was performed to examine the association between nurse practitioner practice authority and the county incidence of foot debridement after adjusting for measures of local health care workforce and sociodemographics. Nurse practitioner practice authority was associated with 219.4 fewer foot debridements per 10,000 enrollees (P < .001) in rural counties. Rural health clinics (P < .03) and skilled nursing facilities (P < .03) were also associated with fewer rural debridements. The number of nurse practitioners (P < .69) and primary care physicians (P < .69) per enrollee were not significant. No measure of health care workforce was associated with the incidence of foot debridement in urban counties. Expanding nurse practitioner practice authority may be an effective solution for preventing complications from diabetic foot ulcers in rural communities.

Prevalence and risk factors associated with diabetes in Meru County, Kenya: a cross-sectional study

Diabetes has emerged as a leading global health problem associated with severe morbidity, mortality, and health-system costs. This is attributed to population growth, aging, urbanization, physical inactivity, and obesity. The increased prevalence of diabetes particularly in rural settings creates a public health challenge for prevention and treatment. However, there is currently a dearth of data supporting planning and implementation of programs for prevention and management of diabetes in rural communities. The objective of this study was to estimate the prevalence of diabetes and its associated risk factors among a rural population in Meru County, Kenya. A descriptive cross-sectional study was conducted in Imenti South, rural areas in Meru County between September and November 2019. Data from 435 respondents comprising 263 (60.5%) females and 172 (39.5%) males were analyzed. Prevalence ratios were calculated using Poisson regression models with robust variance to explore factors associated with the prevalence of diabetes. The prevalence of diabetes was higher among women (16.35%, 95% CI: 12.3–21.4) compared to that among men (13.95%, 95% CI: 9.5–20) and significantly increases with advancing age, BMI, previous diagnosis of hypertension, and high cholesterol. Our findings showed an overall diabetes prevalence of 15.4% (95% CI: 12.3–19.1) in the study area. Age, hypertension, BMI, physical inactivity, alcohol consumption, and tobacco use were significantly associated with a higher risk of diabetes. Preventive intervention strategies should aim to address the modifiable correlates so as to reduce the burden of diabetes in rural communities in Kenya.

Progression to Abnormal Glucose Tolerance and Its Related Risk Factors Among Women with Prior Gestational Diabetes in Rural Communities of China.

BackgroundThe purpose of this study was to describe the status of abnormal glucose tolerance with a longer duration after delivery among women with prior gestational diabetes mellitus (GDM) in a rural community of China, and to explore the influence of socio-demographic factors, GDM-related factors (family history of diabetes, number of children, receipt of treatment for GDM), psychosocial factors (perceived stress, self-efficacy, and social support), lifestyle behaviors (physical activity, sedentary activity, fruit or vegetables intake), and obesity indicators (body mass index and waist circumferences) on abnormal glucose tolerance.Patients and MethodsA cross-sectional descriptive survey was conducted among women with prior GDM in two county-level hospitals in Western and Eastern Hunan, China from November 2017 to June 2018. Under the guidance of life course theory, data were collected using self-report measures of socio-demographic and GDM-related factors as well as psychosocial factors (perceived stress, self-efficacy, and social support) and postpartum lifestyle behaviors (physical activity, sedentary activity, and fruit and vegetable intake). Additionally, a 75-g oral glucose tolerance test was conducted, and weight, height, and waist circumference were measured on site.ResultsA total of 425 women were included in this study, with an average postpartum duration of 18.04 months. Of these women, 20.9% had abnormal glucose tolerance (AGT). A multivariate analysis indicated that the proportion of abnormal glucose tolerance increased with increased age (OR = 2.13; 1.27–3.57, p=0.004), ethnic minority (OR: 1.62, 95% CI: 0.96–2.72, p=0.069), lower educational levels (OR:0.58, 95% CI: 0.33–1.02, p=0.057), receipt of treatment for GDM during pregnancy (OR =1.93; 1.11–3.37, p=0.020) and larger waist circumference (OR = 1.08; 1.05–1.12, p=0.000).ConclusionMore than one-fifth of the women with GDM in rural China had progression to AGT. More postpartum programs aimed at reducing waist circumference are warranted to delay or prevent progression to type 2 diabetes mellitus for rural Chinese women with prior GDM.

Types and sources of social support among adults living with type 2 diabetes in rural communities in the Dominican Republic

ABSTRACTType 2 diabetes management hinges on various determinants, including the role of interpersonal relationships in self-management behaviours. The aim of this study was to explore the types and sources of social support received by adults in the diabetes diagnosis and self-management processes. We conducted qualitative interviews with 28 men and women at two rural clinics in the Dominican Republic and used a combination of narrative and thematic analytic techniques to identify key sources and types of social support in their diabetes experiences. Participants described three stages in their diabetes experience: diagnosis, programme-enrolment, and long-term management. During diabetes diagnosis, most participants described receiving no support. At the programme-enrolment stage, friends and neighbours frequently provided informational or instrumental support to get to the clinic. In long-term management, cohabiting partners provided the most support, which was often assistance with their diet. Our findings highlight he need to assess and leverage distinct types and sources of social support at different stages of the diabetes experience.

Promotion of a healthy lifestyle in individuals with type 2 diabetes mellitus in rural communities

Objective: To determine the lifestyle of individuals with type 2 diabetes mellitus (DM2) in rural communities. Materials and methods: A sample population of 126 subjects with DM2 were evaluated to determine their body mass index (BMI), glycosylated hemoglobin (GH) and a two-phase questionnaire was applied to determine changes in their lifestyle before and after the study. Results: Initial and final BMI was 26.67 and 26.36 respectively, and GH was 7.74 and 7.33 respectively without a significant difference. The survey showed that 69.3% of the population has a low self-esteem as consequence of their status of life; 56.5% do not go with their physician; 30.2% do not have interest in their health status; 39% do not know about their diseases; 34% do not practice any type of exercise; 56.6% is not or just some times are interested to get a good nutrition, and only 16.2% are conscious of doing exercise frequently. Conclusions: Cultural factors, sociodemographic status, and knowledge about health, have an impact in the lifestyle of this DM2 population. Is necessary to develop programs to improve health and lifestyle in patients with diabetes in rural communities.

Peer Support Training Improved the Glycemic Control, Insulin Management, and Diabetic Behaviors of Patients with Type 2 Diabetes in Rural Communities of Central China: A Randomized Controlled Trial.

BackgroundThe efficacy of peer support in Chinese diabetes patients is still uncertain. The purpose of this study was to observe the effects of a peer support program on the outcomes of patients with type 2 diabetes who received community-based insulin therapy in rural communities of central China.Material/MethodsTwo hundred and eight eligible patients with type 2 diabetes were randomly assigned into the traditional training group (control group, n=111) and peer support intervention group (peer group, n=97) between June 2013 and January 2014 in 2 rural communities of Jingzhou area, China. Both groups received 3-month traditional training, followed by another 4-month traditional training or peer support training, respectively. At baseline and 7 months after treatment, the blood glycemic level was evaluated by biochemical detection. Capacities of self-management and knowledge related to insulin usage were assessed by questionnaire survey.ResultsNinety-seven and ninety patients completed this study in the control group and peer group, respectively. There was no significant difference in age, gender, diabetes duration, insulin usage time, and complications between the 2 groups at baseline (P>0.05). Compared with the control group, peer group patients achieved a more significant decrease in blood glycosylated hemoglobin levels (P<0.05), increase in knowledge related to insulin usage, and increase of diabetes self-management ability (P<0.05).ConclusionsPeer support intervention effectively improves outcomes of patients with type 2 diabetes in rural communities of central China.

Peer support for patients with type 2 diabetes in rural communities of China: protocol for a cluster randomized controlled trial.

BackgroundThe prevalence of diabetes has been growing rapidly in developing countries. This causes devastating economic burdens and increases demands on the health care system. Therefore, there is an urgent need to find a cost-effective and multi-faceted approach for diabetes care. Peer support models provide a potentially low-cost, flexible means which complements the current existing health care services. In this way, trained peer leaders can become qualified extensions to a formal healthcare system, capable of assisting education delivery and bolstering the efforts of professional staff. As such, creating a cultural specific peer support program and determining whether it is acceptable and cost-effective in rural communities of China is crucial. This study aims to implement and evaluate biophysical and psychosocial outcomes of peer support program for people with type 2 diabetes in rural communities, and to explore the program’s feasibility and sustainability in China.Methods/DesignThis study is a cluster randomised controlled trial. All consenting patients will be randomised by community staff members to receive either peer support or the control care. The data collection and analysis including social demographics, health status, psychosocial status, economic status and biomedical measures will be collected at baseline, 6 months, and 12 months. The primary indicator measured is the change in HbA1c, whereas secondary indicators include biophysical, psychosocial functioning and other lifestyle factors. Finally, economic evaluations will determine whether the program is cost effective.DiscussionThis protocol is a cluster randomized, controlled trial of group-based peer support for people with type 2 diabetes in the community settings of rural China. Results from this trial may provide evidence to the effectiveness of peer support; furthermore, they will provide valuable information concerning the acceptability and feasibility of a new approach to improve diabetes self-management among resource-constrained settings.Trial registrationClinicalTrials.gov Identifier: NCT02119572, April 18, 2014.

Effectiveness of using group visit model to support diabetes patient self-management in rural communities of Shanghai: a randomized controlled trial

BackgroundDiabetes has become a major public health problem in China. Support of patient self-management is a key component of effective diabetes care and improved patient outcomes. A series of peer-led community-based disease-specific self-management programs including diabetes have been widely disseminated in urban communities of Shanghai since 1999. However, the strategy of using trained lay leaders to support patient self-management faces challenges in rural communities in Shanghai. This study developed a Chinese diabetes group visit program as an alternative approach to support patient self-management and examined its effectiveness on self-management behaviors, self-efficacy and health status for patients with type 2 diabetes in rural communities of Shanghai.Methods208 patients with type 2 diabetes aged 35–80 years were randomly assigned to the intervention group (n=119) of 12 monthly group visit sessions or to a control group (n=89) of usual care. The trial was undertaken in two rural communities in Shanghai, China. Randomization and allocation to study group were carried out by using a random number table. Analysis of covariance was used to compare changes in the 17 self-management behavior, self-efficacy and health status related variables in two groups at 12 months’ follow-up based on 176 patients (n=98; n=78).ResultsCompared with controls, the intervention patients, on average, increased their duration of aerobic exercise by more than 40 minutes per week (p=0.001); had significant increase of 0.71 in mean score on self-efficacy to manage diabetes (p=0.02); and had significant improvements in measures of illness intrusiveness and systolic blood pressure. The intervention patients attended an average of 10.1 of the 12 program sessions with 75.6% of them attended 10 and more sessions.ConclusionThe Chinese diabetes group visit model is a feasible, acceptable and effective alternative for supporting diabetes patient self-management in Chinese rural communities. The model requires larger studies to determine its effect on blood glucose control and health care utilization.Trial registrationISRCTN87909028

Telephone Coaching to Improve Diabetes Self-Management for Rural Residents

L ow-cost methods are desperately needed for improving diabetes management for people with diabetes in rural communities. With this understanding, the research team designed a project that used student pharmacists as coaches. High rates of diabetes and its complications in many rural communities point to these sites as diabetes hot spots.1 In Washington State's diabetes hot-spot communities, 17% of people > 45 years of age have diabetes on average, compared to 8.6% of people ≥ 45 years of age statewide. In one remote rural community, 40% of the population has diabetes. People in diabetes hot-spot communities also have higher rates of hospitalizations for severe diabetes complications. Controlling diabetes to reduce the incidence of its complications rests largely on individual patients and requires vigorous self-management of the disease.2 Unfortunately, without sustained support, few people achieve their goals or master the tasks that will allow them to live healthfully and reduce their risk of costly complications.3 Telephone follow-up for education and support has been shown to be a cost-effective method for improving healthy lifestyle behaviors in a variety of conditions, including diabetes.4-7 This project tested the use of brief telephone coaching sessions to improve the health of rural residents with diabetes by helping them achieve diabetes self-management goals for regular medical care and adherence to medication, diet, and physical activity regimens. Specifically, the research intent was to determine whether: 1. Participants would be better able to implement self-management tasks and reduce their risk of diabetes complications compared to a historical control group not receiving coaching, 2. Faculty and staff at the Washington State University (WSU) Extension and College of Pharmacy would be able to develop a telephone-coaching program to support additional lifestyle modifications after diabetes education to augment health care in rural areas, and 3. Telephone coaches would be …

Improving Diabetes Care in Rural Communities: An Overview of Current Initiatives and a Call for Renewed Efforts

Diabetes is a crucial health issue that affects 180 million people worldwide, including 23.6 million people residing in the United States.1,2 Each year, diabetes is responsible for ~ 5% of all deaths globally (10-15% in the United States), and its prevalence is steadily increasing.1,2 According to the International Diabetes Federation, the number of people living with diabetes is projected to reach 380 million by 2025.3 Because of its widespread prevalence and potentially debilitating impact, diabetes has become an international and national priority area of health concern.2,4 Although the importance of addressing diabetes is well recognized, translating clinical, evidence-based management interventions for practical implementation has proven difficult, particularly for rural communities.5,6 Individuals living in rural communities often encounter difficulties obtaining appropriate health care because of distance from health clinics, financial limitations, cultural barriers, mistrust, communication issues, and high rates of health illiteracy. In this overview, we will discuss the prevalence and severity of diabetes in rural areas, as well as some of the barriers to health access and disease management that have led to observed disparities between rural and urban areas. We will then describe strategies currently being implemented to improve diabetes care in rural areas, including some of our own experiences and efforts in rural Alabama. Although a number of health disparities exist between rural and urban areas, including injury-related deaths, heart disease rates, and cancer rates, diabetes ranks as one of the most significant health concerns.4 Compared to urban areas, rural areas experience an ~ 17% higher diabetes prevalence rate.7 In fact, the impact of diabetes in rural communities has earned it prominence as a top-three priority area in Rural Healthy People 2010. 8 Despite the high prevalence of diabetes in rural communities, there …

Health-related quality of life deficits associated with varying degrees of disease severity in type 2 diabetes

BackgroundDiabetes is a chronic medical condition accompanied by a considerable health-related quality of life (HRQL) burden. The purpose of this analysis was to use generic measures of HRQL to describe HRQL deficits associated with varying degrees of severity of type 2 diabetes.MethodsThe RAND-12 physical and mental health composites (PHC and MHC, respectively) and Health Utilities Index Mark 3 (HUI3) were self-completed by 372 subjects enrolled in a prospective, controlled study of an intervention to improve care for individuals with type 2 diabetes in rural communities. Analysis of covariance was used to assess differences in HRQL according to disease severity and control of blood glucose. Disease severity was defined in terms of treatment intensity, emergency room visits and absenteeism from work specifically attributable to diabetes. To control for potential confounding, the analysis was adjusted for important sociodemographic and clinical characteristics.ResultsThe PHC and MHC were significantly lower for individuals treated with insulin as compared to diet alone (PHC: 41.01 vs 45.11, MHC: 43.23 vs 47.00, p < 0.05). Individuals treated with insulin had lower scores on the vision, emotion and pain attributes of the HUI3 than individuals managed with oral medication or diet. The PHC, MHC, pain attribute and overall score on the HUI3 captured substantial decrements in HRQL associated with absenteeism from work due to diabetes, while the burden associated with emergency room utilization for diabetes was seen in the PHC and HUI3 pain attribute.ConclusionsWe concluded that generic measures of HRQL captured deficits associated with more severe disease in type 2 diabetes.