Diabetes Mellitus Self-management Research Articles

'No matter what time of day': The value of joining Facebook groups supporting women's self-management of gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) affects a significant and growing proportion of pregnant women each year. The condition entails additional monitoring, self-management and healthcare use during pregnancy, and some women also join GDM support groups on Facebook. Little is known about the practices inside these groups, but examining them may elucidate support needs, women's experience of healthcare and improve overall outcomes. The aims of this study were to explore motivations for joining GDM Facebook groups and the perceived value and benefits of such spaces. A cross-sectional design using a web-based survey collected data from two peer-led GDM Facebook groups; relevant quantitative and qualitative data were extracted from open and closed questions, and analysed using descriptive statistics and content analysis. A total of 340 women responded to the survey, with 306 (90%) tendering their motivations to join a GDM Facebook group. Their answers were classified into six categories: peer support; information and practical advice; lived experiences; community; a safe place to ask questions and being recommended. The most commonly reported benefits of membership were 'reading about food ideas' and 'finding helpful information and tips'. Respondents reported finding their group strongly sympathetic, sincere, compassionate, heart-felt, tolerant, sensitive, warm and supportive. GDM Facebook groups are valuable for informational and emotional support, and the sharing and perusal of lived experiences; another key benefit for women is feeling belonging to a community. GDM Facebook groups provide women with access to more tailored and readily available support, filling gaps not addressed by healthcare providers. This study was led by a person with lived experience of GDM, and the survey was pilot tested with women who had also experienced GDM, which contributed to its development.

Knowledge and Diabetes Self-Management Practices Among Type-2 Diabetes Mellitus Patients in Tomohon

Type 2 Diabetes Mellitus (T2DM) is a chronic disease that requires careful management and adequate knowledge from the patients. This study seeks to explore the relationship between knowledge levels and self-management in patients with type 2 diabetes mellitus. It utilized a descriptive analytical approach within a cross-sectional study framework, where data were collected using the Diabetes Knowledge Questionnaire-24 (DKQ-24) questionnaire which was used to assess the variable of knowledge level about DM. For the variable of self-management of diabetes mellitus, was measured with Diabetes Self-Management Questionnaire-Revised (DSMQ-R) questionnaire. Samples were sixty T2DM patients in the city of Tomohon. The study findings indicated a significant relationship between the level of knowledge and diabetes self-management among patients with type 2 diabetes mellitus in Tomohon, with a p-value of 0.029 (p<0.05). Most patients have a fair to poor understanding of Diabetes Mellitus self-management. These findings highlight the importance of ongoing education and more focused interventions to improve knowledge and control of diabetes in T2DM patients. In conclusion, this study indicates the need for greater efforts from the healthcare sector to enhance understanding and management of diabetes in T2DM patients through a holistic approach, including more intensive education, psychosocial support, and accessible and affordable healthcare services.

PERAWATAN KOMUNITAS AGREGAT USIA DEWASA DENGAN DIABETES MELITUS MENGGUNAKAN INTERVENSI DIABETES SELF-MANAGEMENT EDUCATION (DSME)

Diabetes mellitus requires long-term treatment, can cause complications that can be life-threatening and affect the lives of diabetes mellitus patients. Self-management actions include glucose management, diet control, physical activity, and the use of health care can minimize complications. Lack of knowledge can make self-management ineffective. This case study aims to apply a community nursing care through the implemention of Diabetes Self-Management Education (DSME) in adult population using flip sheets and leaflets. A community nursing assessment conducted on nine patients and a nursing diagnosis of the ineffective health self-management was established based on the assessment data. The nursing care plan was prepared and focused on health education about self-management of diabetes mellitus using flip sheets and leaflets. Before and after the implementation of nursing, tests were carried out using the Diabetes Self-Management Questionnaire (DSMQ). The evaluation results showed significant changes in self-management after the intervention (100% of respondents were in a good category). The average percentage increase in self-management status is 48.55%. The conclusion was that counseling for the aggregate of adults with diabetes mellitus positively influenced self-management status. It is recommended for community nurses to provide health education in the community, especially for adults with diabetes mellitus.

Development of Nurse-led Self-Management Education Instruments for Type 2 Diabetes Mellitus Patients

Purpose: The purpose of this study is to develop and outline the Nurse-Led Diabetes Mellitus Self-Management Education (Nu-DiMENTION) program, aimed at improving knowledge and behavior change among type 2 diabetes mellitus (DM) patients. Given the challenges faced by these patients in managing their disease effectively, including risks of complications such as diabetic foot ulcers, retinopathy, and ketoacidosis, there is a pressing need for tailored self-management education programs. The study seeks to address this need by creating a web-based nurse-led educational intervention that has demonstrated efficacy in increasing patient knowledge and promoting positive behavior change. Methods: The research adopts a research and development (R&D) approach to outline the development process of Nu-DiMENTION. Drawing upon theory, existing research evidence, international guidelines, and qualitative data from target users, the study identifies determinants of self-management and defines the content to be included in the program. The development process involves multiple stages, including evaluating existing educational instruments, conducting focus groups with relevant stakeholders (e.g., healthcare professionals and type 2 DM patients), and assessing item validity through expert evaluation. Results and discussion: The initial evaluation of 19 diabetes mellitus educational instruments revealed inadequacies in terms of goals, targets, content, methods, media, time, and evaluation. Subsequent focus groups involving healthcare professionals and type 2 DM patients provided valuable insights into strategic issues and innovation plans for the Nu-DiMENTION program. The assessment of item validity conducted by diabetes mellitus education experts confirmed the validity and reliability of the developed instruments, with a Cronbach's alpha value of 0.834 indicating good internal consistency. Implications of the research: The development of Nu-DiMENTION holds significant implications for improving the self-management capabilities of type 2 DM patients and reducing the risk of diabetes-related complications. By providing accessible, web-based nurse-led education, the program has the potential to empower patients with the knowledge and skills necessary to effectively manage their condition. Moreover, the rigorous development process, including expert validation, ensures the quality and reliability of the program, enhancing its suitability for implementation in clinical settings. Originality/value: This study contributes to the literature by outlining the development process and subject matter of Nu-DiMENTION, a novel web-based nurse-led self-management education program for type 2 DM patients. By synthesizing theory, existing evidence, and stakeholder insights, the program offers a comprehensive approach to addressing the educational needs of this patient population. Furthermore, the emphasis on item validity assessment ensures the program's reliability and effectiveness, adding to its value as a practical intervention for improving diabetes self-management. Overall, Nu-DiMENTION represents an innovative and valuable contribution to diabetes care and patient education.

Behind the Curtain: Patients' Perceptions, Treatment Expectations and Behavior in Type 2 Diabetes Mellitus Self-management

Objectives: The objectives of this qualitative study were to understand patients' diabetes perceptions and treatment experiences, and to explore the most common behavioral aspects related to Type 2 Diabetes Mellitus (T2DM) self-management. Methods: We included 50 insulin-treated T2DM patients in the study. The semi-structured interview texts were analyzed using thematic analysis. The interview questions were organized around 3 major groups of questions focusing on the history of the disease, the current treatment regimen, and the ecological context of the treatment. Results: According to the results of our qualitative analysis, the emotional correlates dominated a significant proportion of responses of insulin-treated T2DM patients. Moreover, we stated that exploring and understanding diabetes-specific coping strategies, attitudes to insulin therapy, patients' treatment satisfaction and openness to new insulin delivery technologies are essential for providing professional support in diabetes treatment. Conclusion: The therapeutic behavior of insulin- treated T2DM patients is determined by the patients' emotional engagement with diabetes and treatment, and the effectiveness of the given diabetes-specific methods for coping with treatment-related difficulties.

Perception and Educational Needs in the Self-Management Type 2 Diabetes Mellitus Patients: A Phenomenological Study Based on Local Wisdom

Lack of knowledge, misperceptions, and the absence of a diabetes management culture pose challenges to providing social support, particularly within families. This is a qualitative phenomenological study aimed at identifying factors contributing to self-management, unearthing the influence of a patrilineal culture, and uncovering the educational needs for local wisdom-based diabetes mellitus self-management in type 2 patients. Data were collected through in-depth interviews and analyzed thematically. The study population consisted of type 2 diabetes mellitus patients living within patrilineal families. The sample size was 10 female individuals aged between 40 and 60 years. The duration of type 2 DM ranged from 6 to 15 years. Four themes emerged from the research: (1) Insufficiency in self-management, (2) Beliefs and perceptions about type 2 diabetes mellitus, (3) The influence of patrilineal families on self-management, and (4) The need for the development of educational programs for self-management type 2 DM management rooted in local culture. According to the results, people with Type 2 Diabetes Mellitus may not be capable of managing their health. Though there are many different opinions and views regarding Type 2 DM, there are frequently gaps in our knowledge. The management of diabetes is greatly impacted by patrilineal family systems. Participants express a significant need for educational programs that are culturally sensitive and improve their ability to control their diabetes.

Baseline Perceptions of Women With Gestational Diabetes Mellitus and Health Care Professionals About Digital Gestational Diabetes Mellitus Self-Management Health Care Technologies: Interview Study Among Patients and Health Care Professionals.

Gestational diabetes mellitus (GDM) is a significant medical complication of pregnancy that requires close monitoring by a multidisciplinary health care team. The growing sophistication of mobile health (mHealth) technology could play a significant supporting role for women with GDM and health professionals (HPs) regarding GDM management. This study included 2 phases. The aim of phase 1 was to explore the perceptions of HPs and women with GDM regarding the use of mHealth for GDM self-management and to identify their needs from these technologies. The aim of phase 2 was to explore the perceptions of women with GDM about their experiences with a state-of-the-art app for managing GDM that was offered to them during the COVID-19 lockdown. This phase aimed to understand the impact that COVID-19 has had on women's perceptions about using technology to manage their GDM. By combining both phases, the overall aim was to establish how perceptions about GDM self-management technology have changed owing to the pandemic restrictions and experience of using such technology. In total, 26 semistructured interviews were conducted in 2 phases. In phase 1, overall, 62% (16/26) of the participants, including 44% (7/16) of HPs, 50% (8/16) of women with GDM, and 6% (1/16) of women in the postpartum period with GDM history participated in the interviews. In phase 2, overall, 38% (10/26) of women with GDM participated in the interviews. NVivo (QSR International) was used to extract qualitative data, which were subjected to thematic analysis. Phase 1 identified 3 themes from the interviews with women with GDM: fitting with women's lifestyle constraints, technology's design not meeting women's needs, and optimizing the technology's design to meet women's needs. Overall, 3 themes were derived from the interviews with HPs: optimizing the technology's design to improve the quality of care, technology to support women's independence, and limitations in the care system and facilities. Analysis of phase-2 interviews identified 2 further themes: enhancing the information and functionalities and optimizing the interface design. In both phases, participants emphasized a simple and user-friendly interface design as the predominant positive influence on their use of technology for GDM management. The combined findings underlined similar points. Poor usability, data visualization limitations, lack of personalization, limited information, and lack of communication facilities were the prime issues of current GDM self-management mHealth technology that need to be addressed. The analysis also revealed how women with GDM should play a vital role in gathering the requirements for GDM self-management technology; some needs were identified from in-depth discussion with women with GDM that would be missed without their involvement.

Description of Self Management of Type 2 Diabetes Mellitus Patients in the Samadua Health Center Working Area, South Aceh Regency

Diabetes mellitus is one of the threats to human health. Diabetes mellitus causes various complications. These complications can be minimized if the patient has the ability and knowledge to manage diabetes (self-management diabetes mellitus). Self-management of diabetes mellitus in this case includes glucose management, dietary control, physical activity, and health care. Objective: to determine the description of self-management in patients with diabetes mellitus in the Samadua Health Center working area, South Aceh Regency. Methods: This research is a quantitative study that uses descriptive methods. The number of samples in this study was 112, using the purposive sampling technique. Data collection instruments were used using the Diabetes Mellitus Management Questionnaire (DMSQ), with a total of 16 question items. Results: The description of self-management of type 2 DM patients in the Samadua Health Center working area is in the good category. Conclusions and Suggestions: The picture of self-management of DM respondents based on the total score of each of the five components is in the good category. More than half of the respondents have a good diet, most have good physical exercise, more respondents do foot care, the majority of respondents have good diabetes medication-taking behavior, and more respondents regularly monitor blood sugar.

Prioritizing the Prevention of Diabetic Foot Disease: We Each Have a Role to Play.

Individuals living with diabetes mellitus (DM) are at an increased risk for multiple serious health complications including diabetic foot disease (DFD). Daily, DFD contributes to increased morbidity, mortality, increased hospitalization, limb amputation, and reduced quality of life. Prevention of DFD is a foundational component of diabetes management. The purpose of this study was to explore how individuals manage the care required to protect their feet from DM related foot complications. This qualitative descriptive study utilized semi structured interviews to explore the perspectives of 23 participants on preventing foot care complications associated with DM. All data were analyzed using reflexive thematic analysis. Participants were challenged to consistently make health choices that were congruent with recommended DM self-management for the prevention of DFD. In addition, participants intuited multiple mixed messages from healthcare providers and workplaces that appeared to diminish their individual responsibility to self-manage their DM. Findings were organized under two main themes: a) Ineffective coping: Distancing self from disease b) Vacillating responsibility: Multiple mixed messages. Nurses are in a unique position to provide the education and support needed to assist individuals in carrying out the many recommended self-care strategies to reduce the risk of DFD. Contextually, nurses must encourage consistent messaging among health care providers and workplaces to prioritize the health needs of individuals living with diabetes and to support the challenging work these individuals must navigate every day. It will take a concerted effort to reinforce the message that diabetes care is a priority for everyone.

Structured educational app in improving self-care management in diabetes mellitus patients: systematic review

Self-care management is a process that does not only develop over time but evolves along with the experience of the type of illness. Successful self-management of diabetes mellitus depends on self-care motivation and self-awareness, specifically designed to control symptoms and avoid complications. This systematic review uses telehealth intervention and smartphone-based applications for diabetes mellitus patients with randomized control trial, qualitative, and cross-sectional studies obtained from six databases. This review included inclusion and exclusion criteria established using population, intervention, comparison, outcomes and study (PICOS) framework, and then data were extracted, reviewed, and assessed using the Joanna Briggs Institute (JBI) tool. Seventeen selected articles that met the inclusion and exclusion criteria passed the selection through the selection process shown in the flow chart, which all research results show an impact on self-care management. The use of technology especially the applications, is very influential and effective in increasing knowledge and self-care management of diabetes mellitus patients. Besides that, it can also save operational costs in providing interventions for people with diabetes mellitus, but further research is needed to look at the sustainability of structured educational applications on health outcomes.

The effectiveness of mobile application for monitoring diabetes mellitus and hypertension in the adult and elderly population: systematic review and meta-analysis

ContextArterial Hypertension (AH) and Diabetes Mellitus (DM) are diseases that are getting worse all over the world. Linked to this advance, is the growing digital health market with numerous mobile health applications, which aim to help patients and professionals in the proper management of chronic diseases. The aim of this study was to analyze, through a systematic review and meta-analysis, the effectiveness of using mobile health applications in monitoring AH and/or DM in the adult and elderly population.MethodsThe systematic review and meta-analysis was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Metanalyses guidelines and involved searching five databases – Medline/PubMed, Embase, CINAHL, Virtual Library in Health and Cochrane Library. The review included randomized and cohort clinical trials testing the effects of the intervention on changing biochemical parameters and clinical efficacy in people treated for AH and/or DM. The quality of the selected studies was assessed based on the evaluation criteria of the Joanna Briggs Institute tool. The random effects meta-analysis method was used to explain effect distribution between studies, by Stata® software (version 11.0) and publication bias was examined by visual inspection of graphs and Egger test.ResultsWe included 26 studies in the systematic review and 17 in the meta-analysis. These studies were published between 2014 to 2022 in 14 countries. Were reported improvement in knowledge and self-management of AH and DM, social motivation with treatment and behavioral change, reduction in glycated hemoglobin values, fasting glucose and blood pressure, improvement in adherence to drug treatment, among others. The result of the meta-analysis showed that there is evidence that the use of mobile applications can help reduce glycated hemoglobin by 0.39% compared to the usual care group.ConclusionsMonitoring and self-monitoring of behaviors and health care related to AH and DM in adults and the elderly through mobile applications, has clinically significant effectiveness in reducing glycated hemoglobin levels. Future studies should provide more evidence and recommendations for best practices and development of digital health interventions.Trial registrationPROSPERO. International Prospective Registry of Systematic Reviews. CRD42022361928.

Dominican Adolescents’ Preferences for Content, Design, and Functionality of a Mobile Application for Type 1 Diabetes Mellitus Self-management

ObjectiveThe purpose of this interdisciplinary study was to determine Dominican adolescents’ preferences for the content, functionality (i.e. food’s glycemic index list, and amount of insulin based on foods’ carbohydrate count), and design of a culturally and linguistically relevant mobile application (app) for type 1 diabetes mellitus (T1DM) self-management. The app would facilitate T1DM self-management education and support by addressing providers’ challenges in monitoring patients’ disease progression and promoting patient adherence to recommended lifestyle changes. Findings inform an app development process that considers the linguistic and cultural values, norms, and structures of people with T1DM and their providers in the Dominican Republic. MethodsPhone interviews were conducted with 23 adolescents (14 to 18 years of age), using a semistructured questionnaire. The research team conducted the data analysis using NVivo through a deductive and inductive approach. ResultsThe findings suggest that, regardless of the context, adolescents with T1DM desire similar features and functionalities in a self-management app. Overall, participants preferred an app with a graphic format that has accessible information, a straightforward design, and instructional videos. Participants also desired that an app provide information and reminders about proper eating and insulin administration timing and be a vehicle to access a social network to foster mutual support and encouragement. ConclusionsOur study highlights adolescents’ perspectives on components for inclusion in an app for T1DM self-management. Participants' recommendations for the app’s potential usability, contents, and design features will be used to guide the development of a new app to promote engagement and foster better health outcomes.

Pengetahuan dan Self -Management dengan Pencegahan Komplikasi Diabetes Melitus

Background: The number of people with diabetes mellitus in the world reached 425 million aged 20-79 years in 2017. The high number of people with diabetes mellitus is caused by a low level of knowledge and awareness in early detection of diabetes mellitus which is not good. Based on data from the top 10 diseases at Mergangsan Health Center on October 2021, it shows that diabetes mellitus is included in the top 10 diseases in 3rd place, namely Type 2 Diabetes Mellitus Non-Insulin-Dependent as many as 894 people .Methods: This study used quantitative methods. The research samples were 80 people with diabetes mellitus without complications of diabetes mellitus. The data collection technique used purposive sampling. The instrument used for data collection was the DKQ (Diabetes Knowledge Questionnaire) and DSMQ (Diabetes Self Management Questionnaire) questionnaires. Analysis of data processing using Chi Square Test and the research design is cross sectional.Results: Based on the results of the Chi-Square test, the knowledge variable with the degree of error used = 0.05 and n = 80, it can be assessed with a significant p-value of 0.025. The results showed that the p value of 0.05 means that Ha was accepted and Ho was rejected, which means that there was a correlation between the knowledge variable and the prevention of diabetes mellitus complications and the diabetes mellitus self-management variable, with a significant p-value of 0.000. These results indicated that a p-value of 0.05 means Ha was accepted and Ho was rejected, which means that there was a correlation between the self-management variable and the prevention of complications of diabetes mellitus.Conclusion: There is a significant correlation between knowledge and self-management of diabetes mellitus with the prevention of complications of diabetes mellitus at Mergangsan Health Center, Yogyakarta City.

The effectiveness of planned teaching programme on knowledge regarding self-management of diabetes mellitus among patient with diabetes mellitus

The effectiveness of planned teaching programme on knowledge regarding self-management of diabetes mellitus among patient with diabetes mellitus

Mindfulness eating based on spiritual interventions on diet compliance and blood sugar levels in type 2 DM patients

Introduction: Diet is one component of diabetes mellitus (DM) self-management for controlling blood sugar levels. Several obstacles in the implementation of the diet program have the potential for non-compliance, so that blood sugar levels tend to increase. Mindfulness eating based on spiritual intervention is one of the interventions that is expected to form adaptive eating behavior control to achieve dietary compliance and controlled blood sugar levels. The purpose of this study was to analyze the effect of mindfulness eating based on spiritual intervention on dietary compliance and blood sugar levels in patients with type 2 diabetes. Methods: The study's quasi-experimental, untreated control group design included dependent pre- and post-test samples. The population used was all patients with type 2 diabetes. The sample was taken using a simple random sampling technique with determination according to inclusion and exclusion criteria. The independent variables in this study were mindfulness eating based on spiritual intervention, while the dependent variables were dietary compliance and blood sugar levels. A glucometer and the Personal Diabetes Questionnaire (PDQ) were the tools employed in this investigation. The t-test was used as the statistical test. Results: There were a total of 50 samples that were divided between the control group and the intervention group. The results of the statistical test showed that mindfulness eating based on spiritual intervention had a statistically significant effect on dietary compliance (p < 0.001) and blood glucose levels (p < 0.001) compared to the control group. Conclusion: The value of diet adherence is greatly increased by mindfulness eating practices based on spiritual intervention, and mean blood glucose levels are significantly reduced at the conclusion of the study. Exercises in mindfulness eating that are based on spiritual intervention can be popularized as a way to deal with dietary issues and blood sugar regulation.

The Correlation of Knowledge and Duration of Illness Towards Self Management With Diabetes Mellitus Patients in the Pan-demic Era of COVID-19

(1) Background: Diabetes mellitus (DM) is a chronic disease that, if not treated trigger various disease, and also cause the severity of COVID-19 infection. People with DM need proper knowledge and management to improve the quality of life of patients during a pandemic and the treatment process will take a lifetime. The purpose of this study is to determine the relationship between knowledge and duration of illness on diabetes mellitus self-management; (2) Methods: The study's design is a correlational study with a cross-sectional approach, with a total sample of 138 respondents who were taken by convenience sampling technique. Data was collected using the diabetes knowledge questionnaire (DKQ-24), the COVID-19 knowledge questionnaire, and the diabetes self-management questionnaire (DSMQ); (3) Results: The Chi-Square statistical test analysis revealed a p-value of 0.00 relationship between knowledge and self-management; (4) Conclusions: There is a relationship between knowledge of diabetes mellitus and COVID-19 on self-management of diabetes mellitus, and there is no relationship between duration of illness and diabetes mellitus self-management during the COVID-19 pandemic.

Perceived barriers to the effective management of diabetes mellitus among the Wakhi people: A qualitative study

One of the effective strategies used to maintain the glucose level and prevent complications associated with diabetes is self-management. It is the responsibility of the diabetic person to manage their chronic condition. The management includes monitoring blood glucose levels, taking diabetic medicine timely, following a diabetic diet plan, and focusing on physical activities to keep the blood glucose level regular. These practices are necessary for the self-management of the disease; however, due to various barriers, patients cannot manage their disease. This study used a qualitative exploratory design to explore the perceived barriers to managing diabetes among the diabetic people of the Wakhi population in District Hunza. In-depth interviews were conducted with 16 participants to gain insight into the perception regarding barriers that impede diabetes mellitus self-management. The interviews were recorded and transcribed. The content analysis method was used to analyze the data. The analysis revealed four main themes, including Socio-demographic and cultural barriers, personal barriers, healthcare system-related, and diet-related barriers. Each core theme had sub-themes. The critical barrier to the management of diabetes included diet-related barriers and healthcare system issues, and social engagement in rural settings. The findings of this study may help healthcare providers educate their patients about self-management practices, design and develop interventions to educate the patients, and conduct awareness sessions by involving dietitians to educate the patients about culturally and socially suitable diet plans. The identified barriers in the study may help guide the concerned authorities for patient-specific self-care interventions.

The role of social support on self-management of gestational diabetes mellitus

The role of social support on self-management of gestational diabetes mellitus

A Mobile Application to Improve Diabetes Self-Management Using Rapid Prototyping: Iterative Co-Design Approach in Asian Settings.

Diabetes is a global public health issue, causing burden on healthcare system and increasing risk of mortality. Mobile applications (apps) can be a promising approach to facilitate diabetes self-management. An increasingly utilized approach to facilitate engagement with mobile health (mHealth) technology is to involve potential users in the creation of the technology. The aim of this study was to use co-design for type 2 diabetes mellitus (T2DM) self-management mHealth development. Three rounds of iterative rapid prototyping panel sessions were conducted with a total of 9 T2DM participants in an Asian setting between Oct 2020 and April 2021. The participants were recruited through convenience sampling. For each round, feedback was gathered through qualitative interviews, and the feedback was used as a reference by the development team to develop and test a more refined version of the app in the next round. Transcribed semi-structured interview data was analyzed thematically using an inductive approach. Participants' ages ranged from 40 to 69 years. Data saturation was reached, with no new themes emerging from the data. During the sessions, the participants expressed a variety of concerns and feedback on T2DM self-management using EMPOWER app and raised suggestions on the features of ideal T2DM self-management app. Important features include 1) reminders and notifications for medications, 2) Bluetooth integration with glucometers and blood pressure machines to minimize manual entry, 3) enlarged local food database including information on sugar content and recommendations for healthier options, 4) one touch for logging of routine medications and favorite foods, 5) export function for data sharing with physicians. Overall inputs concerned aspects such as user-friendliness of the app, customization possibilities, and educational content for the features in the mobile app. In this study, we explored users' opinions on a T2DM self-management mobile app using co-design approach. This study adds to the growing body of literature on co-designing behavioral mHealth interventions and can potentially guide researchers in mobile app design for other chronic conditions.

Effect of Pharmacist-Led Interventions on Medication Adherence and Glycemic Control in Type 2 Diabetic Patients: A Study from the Chinese Population.

Medication adherence plays an important role in glycemic control in type 2 diabetes mellitus (T2DM) self-management. To analyze the factors influencing medication adherence in T2DM patients and the effect of pharmacist-led interventions, we conducted a study in Beijing, China. T2DM patients with hypoglycemic drugs for at least 6 months were enrolled. A pharmacist-led survey was conducted followed by individualized interventions for those non-adherent patients monthly within 3 months. FPG, HbA1c, and 2hPG were measured as the comprehensive glycemic control. Medication adherence was determined according to the patient's self-reported compliance with prescribed medication during the last 3 months. A total of 763 T2DM patients were included. The average age was 63.26±11.89 years, with 363 males. After pharmacist intervention, the patients with good adherence increased from 34.21% to 39.06%, while poor adherence decreased from 32.5% to 24.5% (p < 0.001). The average adherence score was a significant increase (p < 0.001) from 27.846±4.185 to 29.831±7.065. Furthermore, our study demonstrated that pharmacist-led interventions significantly increased glycemic control (FPG from 42.33% to 53.60%, p < 0.001; 2hPG from 41.68% to 48.75%, p = 0.005; HbA1c from 24.12% to 29.23%, p = 0.024). The results found that body mass index (OR 0.643, 95% CI 0.437-0.945), use of medications empirically (occasionally (OR=3.066, 95% CI 2.069-4.543); often (OR=2.984, 95% CI 1.107-8.044)), following the doctor's advice to visit (OR 2.129, 95% CI 1.079-4.202) and lifestyle compliance (OR 2.835, 95% CI 1.094-7.346) were the independent risk factors of non-adherence (p < 0.05), the area under the ROC curve was 0.716. Self-reported medication adherence and glycemic control in T2DM patients were poor which can be improved by pharmacist-led interventions. Interventions should focus on empirical medication behavior, non-adherence to lifestyle, and failure to follow the doctor's advice. The recall bias with self-reported results needs further objective data to verify.