Diabetes Self-management Activities Research Articles

Validation of the Arabic version of the diabetes self-management questionnaire in patients with type 2 diabetes mellitus: a cross-sectional study

BackgroundThe number of instruments available for measuring diabetes self-management activities in Arabic countries has been limited to date. To our knowledge, no multidimensional instrument suitable for measuring diabetes self-management is currently available in Arabic. This study assessed the validation of the Arabic version of the Diabetes Self-Management Questionnaire (A-DSMQ) in patients with type 2 diabetes mellitus (T2DM).MethodsThis cross-sectional study was conducted from May to August 2022 at primary healthcare centers within the Riyadh region of Saudi Arabia. Four steps were followed during the translation and adaptation of the DSMQ: forward translation, consulting an expert panel, backward translation, and pilot testing on the target population. The data were collected using a convenience sample of 154 patients with T2DM. Cronbach’s α coefficient, criterion validity, and known-group validity were determined.ResultsCronbach’s α coefficient for internal consistency was 0.76. The A-DMSQ “sum scale” scores were negatively correlated with glycosylated hemoglobin (HbA1c) levels (Pearson’s r = − 0.48, p < 0.01) and body mass indices (r = − 0.29, p < 0.01) and positively correlated with Self-Rated Health Scale scores (r = 0.41, p < 0.01). Mean A-DSMQ “sum scale” scores differed significantly among groups with adequate, partially adequate, and inadequate glycemic control (F = 23.193, p < 0.001).ConclusionsThese results indicate that the A-DSMQ is a reliable and valid tool for measuring diabetes self-management in patients with T2DM. The A-DSMQ can be used by researchers and healthcare providers interested in assessing diabetes self-management in this population. Healthcare providers should remain alert for suboptimal diabetes self-management, which may lead to significant economic costs in emergency and healthcare utilization.

Diabetes Distress Among Patients Undergoing Surgery for Diabetic Retinopathy and Associated Factors: A Cross-Sectional Survey.

Diabetes distress (DD) is a negative emotion related to diabetes management and a predictor of depression; it affects diabetic retinopathy (DR) patients' quality of life and disease outcomes. The prevalence of DD was higher in patients undergoing surgery for DR. However, few studies have been conducted on DD in DR surgery patients. The present study aims to investigate the status of DD in DR surgery patients and identify factors associated with DD. Using a convenience sampling method, 210 DR surgery patients who were admitted to 2 tertiary-level hospitals in Wenzhou City (Zhejiang Province) and Zhengzhou City (Henan Province) from February to June 2023 were selected as research subjects. A questionnaire collecting demographic and disease-related information, the Diabetes Distress Scale, the Summary of Diabetes Self-Management Activities, the Family Care Index Scale, and the Social Support Rating Scale were used to collect data. Statistical analyses included descriptive statistics, t tests, ANOVAs, Pearson's correlation analyses and stepwise multiple linear regression. This study is reported according to the STROBE guidelines. In total, 156 out of 210 (74.29%) DR surgery patients experienced DD, with an average score of 2.13±0.63. The results of the stepwise multiple regression analysis showed that residential location, employment status, self-management level, family support, and social support were significantly associated with DD. These variables accounted for 30.6% of the total variation in DD. DR surgery patients exhibit moderate levels of distress. Health care professionals should pay attention to DD in DR surgery patients and develop targeted interventions to improve the self-management ability of these patients, increase their family support and social support to reduce their DD levels.

Barriers to Diabetes Self-Management in Grenada During the Covid-19 Pandemic: A Qualitative Study

During the COVID-19 lockdown, several countries implemented restrictions that affected how persons with diabetes managed their condition. While several studies exploring diabetes self-management during the pandemic was conducted, none was done in Grenada or the Caribbean region. Therefore, the aim of this study was to identify the barriers to diabetes self-management during the COVID-19 lockdown in Grenada. The study was a descriptive qualitative study with a phenomenological approach. Semi-structured interviews were conducted with 13 participants with type 2 diabetes in Grenada over two months. Two overarching themes emerged, reflecting external and internal barriers to diabetes self-management activities. The results indicated that these personal and environmental barriers significantly affected adherence across the five self-management behaviors. The findings may be used to develop a multidisciplinary approach to improve self-management skills and attitudes and promote appropriate diabetes disaster planning for a future pandemic. Addressing those barriers to diabetes self-management will improve health outcomes and quality of life.

DIMAS (Diabetes Management Support) Application: Mobile-Phone Based Intervention to Support Diabetes Self-Management Activities

Introduction: The self-management process in Diabetes Mellitus (DM) is essential to improve glycemic control. Currently, COVID-19 leading to a significant limitation in services and accessibility, especially regular support for diabetes patients. The utilization of DIMAS Mobile App is expected to be a support system to overcome these problems. This application has three menus such as health education containing information about diabetes, nutrition, medication, exercise, stress management, and foot care; self-care monitoring containing medication reminders, blood sugar and exercise records; and consultation with nurses. This study aimed to determine the effect of DIMAS (Diabetes Management Support) application on Diabetes Self-Management activities. Methods: Using an experimental study with One Group Pre-Posttest Design, the self-management activities were measured among 24 respondents after four weeks of intervention. The intervention was carried out with the DIMAS app and WhatsApp communication. Using the Summary of Diabetes Self-Care Activity (SDSCA) questionnaire, the data were analysed with one paired sample t-test using SPSS 22. Results: Statistically significant changes were observed between pre and post-intervention measures: DSM activities with SDSCA (p=0,000) and the level of knowledge (p=0,000). The results showed that the biggest change in self-care activity was foot care and exercise with the increase of scoring was 2.4 and 0.8 respectively. Respondents stated that the application was useful for reminding them to take medication and communicating with nurses. Conclusion: The application makes it easier for patients to keep connected with nurses despite being constrained by distance and provides practical benefits in nursing services at home.

Self-Management of Diabetes and Associated Factors among Patients Seeking Chronic Care in Tshwane, South Africa: A Facility-Based Study.

The burden of diabetes continues to increase in South Africa and a significant number of diabetes patients present at public primary healthcare facilities with uncontrolled glucose. We conducted a facility-based cross-sectional study to determine the diabetes self-management practices and associated factors among out-patients in Tshwane, South Africa. An adapted validated questionnaire was used to collect data on sociodemography, diabetes knowledge, and summaries of diabetes self-management activities measured in the previous seven days, and over the last eight weeks. Data were analysed using STATA 17. A final sample of 402 diabetes out-patients was obtained (mean age: 43 ± 12 years) and over half of them were living in poor households. The mean total diabetes self-management of score was 41.5 ± 8.2, with a range of 21 to 71. Almost two thirds of patients had average self-management of diabetes, and 55% had average diabetes knowledge. Twenty-two percent of patients had uncontrolled glucose, hypertension (24%) was the common comorbidity, and diabetic neuropathy (22%) was the most common complication. Sex [male: AOR = 0.55, 95% CI: 0.34-0.90], race [Coloured: AOR = 2.84, 95% CI: 1.69-4.77 and White: AOR = 3.84, 95% CI: 1.46-10.1], marital status [divorced: AOR = 3.41, 95% CI: 1.13-10.29], social support [average: AOR = 2.51, 95% CI: 1.05-6.00 and good: AOR = 4.49, 95% CI: 1.61-7.57], body mass index [obesity: AOR = 0.31, 95% CI: 0.10-0.95], diabetes knowledge [average: AOR = 0.58, 95% CI: 0.33-0.10 and good: AOR = 1.86, 95% CI: 0.71-4.91], and uncontrolled glucose [AOR = 2.97, 95% CI: 1.47-5.98] were factors independently predictive of diabetes self-management. This study emphasizes that the self-management of diabetes was mostly on average among patients and was associated with the aforementioned factors. Innovative approaches are perhaps needed to make diabetes education more effective. Face-to-face sessions delivered generally during clinic visits should be better tailored to the individual circumstances of diabetes patients. Considerations should be given to the options of leveraging information technology to ensure the continuity of diabetes education beyond clinic visits. Additional effort is also needed to meet the self-care needs of all patients.

Application of Artificial Intelligence in Assessing the Self-Management Practices of Patients with Type 2 Diabetes.

The use of Artificial intelligence in healthcare has evolved substantially in recent years. In medical diagnosis, Artificial intelligence algorithms are used to forecast or diagnose a variety of life-threatening illnesses, including breast cancer, diabetes, heart disease, etc. The main objective of this study is to assess self-management practices among patients with type 2 diabetes in rural areas of Pakistan using Artificial intelligence and machine learning algorithms. Of particular note is the assessment of the factors associated with poor self-management activities, such as non-adhering to medications, poor eating habits, lack of physical activities, and poor glycemic control (HbA1c %). The sample of 200 participants was purposefully recruited from the medical clinics in rural areas of Pakistan. The artificial neural network algorithm and logistic regression classification algorithms were used to assess diabetes self-management activities. The diabetes dataset was split 80:20 between training and testing; 80% (160) instances were used for training purposes and 20% (40) instances were used for testing purposes, while the algorithms' overall performance was measured using a confusion matrix. The current study found that self-management efforts and glycemic control were poor among diabetes patients in rural areas of Pakistan. The logistic regression model performance was evaluated based on the confusion matrix. The accuracy of the training set was 98%, while the test set's accuracy was 97.5%; each set had a recall rate of 79% and 75%, respectively. The output of the confusion matrix showed that only 11 out of 200 patients were correctly assessed/classified as meeting diabetes self-management targets based on the values of HbA1c < 7%. We added a wide range of neurons (32 to 128) in the hidden layers to train the artificial neural network models. The results showed that the model with three hidden layers and Adam's optimisation function achieved 98% accuracy on the validation set. This study has assessed the factors associated with poor self-management activities among patients with type 2 diabetes in rural areas of Pakistan. The use of a wide range of neurons in the hidden layers to train the artificial neural network models improved outcomes, confirming the model's effectiveness and efficiency in assessing diabetes self-management activities from the required data attributes.

Factors predicted quality of life of people with type 2 diabetes in western Ethiopia.

Multiple factors predict the quality of life of adults with diabetes. However, the relationships of demographics, self-management practice, and support status with the quality of life of people with diabetes are unknown. Therefore, the study aimed to assess factors related with the quality of life of adults with type 2 diabetes in western Ethiopia. A hospital-based cross-sectional study involving adults with type 2 diabetes was conducted in western Ethiopia from June 02, 2020, to August 31, 2020. Convenience sampling technique was used in selecting subjects. The translated and psychometrically tested summary of diabetes self-management activities (expanded), diabetes quality of life, and diabetes care profile support scales were used in measuring self-management practice, quality of life, and support status, respectively. Data were collected via face-to-face interviews. Factors related with quality of life were examined through bivariate analysis and multivariable linear regression. In all statistical tests, P value <0.05 and confidence level that excluded zero were considered statistically significant. A total of 417 adults with type 2 diabetes participated in the study. In a multivariable linear regression, seven factors including age, male, homemakers, those separated/divorced, number of years since diabetes diagnosis, self-management practice and support needed were related with quality of life. Male patients (β = 2.786, 95% CI = 1.285 to 4.287, p < 0.001), homemakers (β = 0.366, 95% CI = 0.056; 0.677, p = 0.021), self-management practice (β = 4.528, 95% CI = 3.851 to 5.205, p < 0.001) and those who needed support from their families or peers (β = 1.623, 95% CI = 0.458; 2.788, p = 0.006) were related positively with quality of life whereas those who separated or divorced (β = -1.698, 95% CI = -3.371 to -0.025, p = 0.047), older age (β = -0.195, 95% CI = -0.269 to -0.121, p < 0.001) and those who lived with diabetes for a longer duration (β = -2.206, 95% CI = -4.151 to -0.261, p = 0.026) were related negatively with quality of life. Quality of life of people with type 2 diabetes living in western Ethiopia was predicted positively by being male, homemakers, having self-management practice, and support needed, whereas negatively influenced by old age, separation or divorce, and long diabetes life. Thus, encouraging self-management practice, and continuous family or friend support are necessary to enhance quality of life of people with type 2 diabetes. Further study should employ random sampling techniques and involve participants from multiple study settings to increase representativeness of the samples.

Psychometric validation of the hindi version of summary of diabetes self-care activities (H-SDSCA) amongst pregnant women with gestational diabetes mellitus, in Lucknow.

The English version of the Summary of Diabetes Self-Care Activities (SDSCA) measure is the most often used self-reporting instrument assessing diabetes self-management. This study was aimed at translating English SDSCA into the Hindi version and validating and evaluating its psychometric properties. The Hindi version of SDSCA was developed based on the guidelines provided by the World Health Organization (2008) for translation and adaptation of tool. Following steps were adopted: (1) Cultural and linguistic validation, (2) content validity testing, (3) construct validity testing, and (4) internal validity testing. Sixty women diagnosed with GDM were selected for the purpose of this study. The tool showed promising and satisfactory results. Of mention are the results related to Cronbach's alpha (0.82). The exploratory factor analysis showed three factors that fit the data satisfactorily. This study provided evidence for the reliability and validity of the Hindi Summary of Diabetes Self-Care Activities instrument, which may be used in the future to assess diabetes self-management activities among the pregnant women diagnosed with gestational diabetes mellitus among Hindi-speaking population.

PSUN164 Feasibility of a telehealth-delivered diabetes foot care educational program

Abstract Background Diabetes-related nerve damage, foot ulcerations, and amputations occur as consequences of type 2 diabetes mellitus that is prevalent worldwide. Aims The study aims to investigate the preliminary effects and the feasibility of a telehealth educational program in patients with type 2 diabetes. Methods We conducted a single-arm, pre-mid-post measure study in two primary care practices in Texas. A total of 29 participants who met eligibility criteria (type 2 diabetes, Internet access, and English speaking) met with the research team once a month for 3 months via Zoom. The intervention involved telehealth visits with a board-certified family nurse practitioner/nurse educator for diabetes foot care and counseling, diabetes education, and discussion of self-management behaviors. Diabetes foot care behaviors, knowledge, and self-management activities were measured at baseline, 1.5 months, and 3 months. Results Initially, the mean score of the Diabetes Foot Self-Care Behavior Scale (DFSBS) was 17.75. The mean score of DFSBS increased to 21.59 at 1.5 months and rose to 25.46 at 3 months, indicating an improved frequency of foot care behaviors. Knowledge of diabetes was 70.48% correct at baseline and increased to 75.92% at 1.5 months and 83.89% at 3 months. At 1.5 months, the mean scores of the Summary of Diabetes Self-Care Activities improved by 0.4 days/week (d/w) for general diet, 0.29 d/w for exercise, 0.21 d/w for blood glucose testing, and 0.69 d/w for foot care. At 3 months, these values increased by 1.4 d/w for general diet, 1.13 d/w for exercise, 2.02 d/w for blood glucose testing, and 1.71 d/w for foot care compared with baseline. Of those enrolled, 87.18% completed the first telehealth visit, while 74.36% completed the second and third telehealth visits. Overall, 74.36% completed all three telehealth visits. Conclusions In two large primary care practices in Texas, a telehealth educational program that was centered on diabetes foot self-care management led to an improvement in self-care behaviors and knowledge for patients with type 2 diabetes. Clinical Implications: The promising results from this pilot study demonstrated the feasibility of a telehealth-delivered diabetes foot care educational program for patients with type 2 diabetes. Innovative strategies such as incorporating telehealth visits with in-person examinations may improve diabetes monitoring and prevent diabetes-related foot complications. Further research is needed to determine the long-term effects of a multi-disciplinary and personalized telehealth approach for monitoring diabetes foot care and self-management behaviors. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Exploring the Perspective of Diabetes, Diabetes Self-Management, and Quality of Life Among Older Adults With Type 2 Diabetes: A Qualitative Study Before and During the COVID-19 Pandemic.

The purpose of the study was to explore the perspective and impact of diabetes, diabetes self-management, and quality of life (QoL) among older adults with Type 2 diabetes (T2DM) before and during the COVID-19 pandemic to better inform T2DM self-management interventions. A qualitative descriptive approach with focus group discussions (n = 5 sessions with 5-6 older adults per session) and in-depth interviews (n = 15) was conducted with community-dwelling older adults with T2DM. Five themes emerged. The definition of diabetes carries negative connotations, QoL is defined in terms of biopsychosocial health, diabetes self-management refers to the ability to adhere to medical advice and lifestyle changes, the QoL of older adults is differentially affected by COVID-19 measures, and important aspects of diabetes self-management activities are impacted by COVID-19 measures. Understanding older adults' perspectives on diabetes, diabetes self-management, and QoL provided insights into the facilitators and barriers to diabetes self-management practices before and during the COVID-19 pandemic. Findings inform the need for greater bottom-up initiatives and the need for a multipronged approach that considers the intra- and interpersonal and current policy factors to encourage diabetes self-management behaviors, especially during the COVID-19 era.

Mobile health application based intervention for improvement of quality of life among newly diagnosed type 2 diabetes patients

Background. Diabetes and its complications arebecoming a major threat to public health. Quality of life among diabetes patients is not optimum. Objective. To know the usefulness of the mobile health application for improvement of QoL and diabetes selfmanagement activities of the type 2 diabetes patients. Methods. The present study was conducted in a tertiary care hospital for 2 years from October 2016 to October 2018. In this study, 66 newly diagnosed type 2 diabetes patients, educated, techno-friendly smart phone users, aged between 18–60 years, were included. They were allocated to intervention and control group by block randomization method. Intervention group was allotted to use the android application and control group was allotted to use the website. The data were imported and analyzed by SPSS v 20. Results. Overall quality of life and general health was 70.26 ± 16.51; for physical health it was 59.52 ± 7.15, for psychological it was 63.38 ± 9.2, for social relations it was 74.87 ± 13.98 and for environment it was 71.87 ± ± 8.38. The score of overall quality of life was increased in both control and intervention group during follow-ups. It was found that there was significant improvement in glucose management, dietary control, physical activity, health care use and sum score. Wilk’s lambda was significant for HbA1c both in control and intervention group. Conclusions. Mobile-based applications with focusing on diabetes self-management education may support to reduce the complications of diabetes and improve the QoL of diabetes patients.

Randomized trial of a patient empowerment and cognitive training program for older people with diabetes mellitus and cognitive impairment.

To evaluate the effectiveness of a combined patient empowerment program (PEP) and cognitive training (CT) program on improving glycemic control among older subjects with diabetes and cognitive impairment. A prospective single blinded, randomized controlled study was carried out in 139 older patients with diabetes aged ≥65 years with memory complaints and recent glycosylated hemoglobin level of 7-9%. They were randomly assigned to either undergo once-weekly PEP combined with CT for 10 weeks (intervention group, N = 73) or receive no intervention (control group, N = 66). All participants were followed up at months 4 and 12 to examine the immediate and long-term effects on glycemic control, cognition, mood and compliance to drug and diabetes self-management. The intervention did not significantly reduce glycosylated hemoglobin. The intervention group showed significant progressive improvement in memory over 1 year and executive function improved significantly at month 12. There was no significant change in diabetes self-management activities with the intervention. Combination of PEP and CT did not improve glycemic control or self-care activities in older patients with diabetes and memory complaints but was effective in improving cognitive function in the longer term. Geriatr Gerontol Int 2020; 20: 1164-1170.

Improving Diabetes Management in Emerging Adulthood: An Intervention Development Study Using the Multiphase Optimization Strategy.

BackgroundPoor diabetes self-management in emerging adulthood (age 18-25 years) is associated with poorer diabetes health and diabetes complications. Emerging adults’ focus on individuation and independence underlies their poor diabetes outcomes, offering a lever for behavior change. Self-determination theory (SDT) suggests that interventions leveraging emerging adults’ innate developmental need for autonomy may offer a route to improving diabetes outcomes by increasing feelings of responsibility for and control over diabetes self-management activities.ObjectiveThis research project will use the multiphase optimization strategy to test the efficacy of three autonomy-supportive intervention components to elicit a clinically significant improvement in metabolic control, assessed by a 0.5% improvement in hemoglobin A1c (HbA1c), among older adolescents and emerging adults (16-25 years) with poorly controlled type 1 diabetes (T1D; HbA1c≥9.0%).MethodsA question prompt list (QPL) is a tool to empower patients to assume a more active role during medical visits by asking questions and stating concerns. The motivation enhancement system (MES) is a brief counseling intervention that uses motivational interviewing communication strategies to build intrinsic motivation and self-efficacy for self-management. Text message reminders to complete diabetes care tasks may increase self-efficacy for diabetes self-management. After refining these intervention components for emerging adults, we will conduct a component selection experiment using an eight-arm full factorial design: 2 (QPL yes or no)×2 (MES yes or no)×2 (Text yes or no). Participants will complete 3 study visits: baseline, treatment end at 2 months, and a follow-up at 6 months. The primary outcome is metabolic control, which will be measured via HbA1c. Secondary outcomes include diabetes management and diabetes clinic attendance. SDT constructs of intrinsic motivation, self-efficacy, and the quality of the patient-provider relationship (ie, relatedness) are hypothesized mediators. Depression symptoms and emerging adults’ gender are hypothesized moderators. We will use the mixed-effects linear model for the analysis of variance of a factorial design to analyze continuous longitudinal experimental data; the generalized linear model will be used with categorical outcomes (eg, treatment attendance). The experiment was powered to detect the main effects of the intervention on the primary outcome.ResultsA total of 20 participants have enrolled and completed a qualitative interview after reviewing one or more intervention components. Analysis of interview data are underway, with a report of these results anticipated in the fall of 2020. The clinical trial will be launched in the fall 2020, with participants enrolled through May 2023 and data collection continuing through November 2023.ConclusionsAt the end of this experiment, we will have empirical evidence to support a large-scale, multisite effectiveness trial of an intervention package that has been optimized for older adolescents and emerging adults with poorly controlled T1D.Trial RegistrationClinicalTrials.gov NCT04066959; https://clinicaltrials.gov/ct2/show/NCT04066959International Registered Report Identifier (IRRID)DERR1-10.2196/20191

User Retention and Engagement With a Mobile App Intervention to Support Self-Management in Australians With Type 1 or Type 2 Diabetes (My Care Hub): Mixed Methods Study.

BackgroundMobile health apps are commonly used to support diabetes self-management (DSM). However, there is limited research assessing whether such apps are able to meet the basic requirements of retaining and engaging users.ObjectiveThis study aimed to evaluate participants’ retention and engagement with My Care Hub, a mobile app for DSM.MethodsThe study employed an explanatory mixed methods design. Participants were people with type 1 or type 2 diabetes who used the health app intervention for 3 weeks. Retention was measured by completion of the postintervention survey. Engagement was measured using system log indices and interviews. Retention and system log indices were presented using descriptive statistics. Transcripts were analyzed using content analysis to develop themes interpreted according to the behavioral intervention technology theory.ResultsOf the 50 individuals enrolled, 42 (84%) adhered to the study protocol. System usage data showed multiple and frequent interactions with the app by most of the enrolled participants (42/50, 84%). Two-thirds of participants who inputted data during the first week returned to use the app after week 1 (36/42, 85%) and week 2 (30/42, 71%) of installation. Most daily used features were tracking of blood glucose (BG; 28/42, 68%) and accessing educational information (6/42, 13%). The interview results revealed the app’s potential as a behavior change intervention tool, particularly because it eased participants’ self-care efforts and improved their engagement with DSM activities such as BG monitoring, physical exercise, and healthy eating. Participants suggested additional functionalities such as extended access to historical analytic data, automated data transmission from the BG meter, and periodic update of meals and corresponding nutrients to further enhance engagement with the app.ConclusionsThe findings of this short-term intervention study suggested acceptable levels of participant retention and engagement with My Care Hub, indicating that it may be a promising tool for extending DSM support and education beyond the confines of a physical clinic.

Efficacy and Acceptability of My Care Hub Mobile App to Support Self-Management in Australians with Type 1 or Type 2 Diabetes.

The aim of this study was to evaluate the preliminary efficacy and user acceptance of My Care Hub (MCH) mobile app—developed to provide evidenced-based support and education on diabetes self-management (DSM). Using a mixed-methods design, the efficacy and acceptability of MCH were measured among people with type 1 or type 2 diabetes after three weeks of intervention. The primary outcome measure was level of involvement with DSM, while the mediating factors were skills and self-efficacy for DSM. Telephone interviews were conducted to elucidate information on perceptions of the app’s impact on participants’ DSM and interest in future use. Statistically significant improvements were observed between pre- and post-intervention measures: DSM activities (4.55 ± 1.14 vs. 5.35 ± 0.84; p = 0.001); skills (7.10 ± 1.99 vs. 7.90 ± 1.67; p = 0.04); and self-efficacy (7.33 ±1.83 vs. 8.07 ± 1.54; p = 0.03). Multivariate analysis showed that self-efficacy had the strongest, though not significant influence on DSM. Interview findings revealed that the app reinforced knowledge and provided motivation to participate in DSM activities. The study suggested a positive impact of MCH on DSM and acceptability by patients. To confirm these promising results, further large scale and long-term studies are required.

Application of structural equation modeling in assessing the self-management activities of patients with type 2 diabetes.

ObjectiveThis study aimed at assessing the self-management activities of type 2 diabetes patients using Structural Equation Modeling (SEM) which measures and analyzes the correlations between observed and latent variables. This statistical modeling technique explored the linear causal relationships among the variables and accounted for the measurement errors.MethodsA sample of 200 patients was recruited from the middle-aged population of rural areas of Pakistan to explore the self-management activities of type 2 diabetes patients using the validated version of the Urdu Summary of Diabetes Self-care Activities (U-SDSCA) instrument. The structural modeling equations of self-management of diabetes were developed and used to analyze the variation in glycemic control (HbA1c).ResultsThe validated version of U-SDSCA instrument showed acceptable psychometric properties throughout a consecutive reliability and validity evaluation including: split-half reliability coefficient 0.90, test-retest reliability (r = 0.918, P ≤ .001), intra-class coefficient (0.912) and Cronbach’s alpha (0.79). The results of the analysis were statistically significant (α = 0.05, P-value < .001), and showed that the model was very well fitted with the data, satisfying all the parameters of the model related to confirmatory factor analysis with chi-squared = 48.9, CFI = 0.94, TLI = 0.95, RMSEA = 0.065, SPMR = 0.068. The model was further improved once the items related to special diet were removed from the analysis, chi-squared value (30.895), model fit indices (CFI = 0.98, TLI = 0.989, RMSEA = 0.045, SPMR = 0.048). A negative correlation was observed between diabetes self-management and the variable HbA1c (r = –0.47; P < .001).ConclusionsThe Urdu Summary of Diabetes Self-Care Activities (U-SDSCA) instrument was used for the patients of type 2 diabetes to assess their diabetes self-management activities. The structural equation models of self-management showed a very good fit to the data and provided excellent results which may be used in future for clinical assessments of patients with suboptimal diabetes outcomes or research on factors affecting the associations between self-management activities and glycemic control

The Summary of an Urdu Version of Diabetes Self-Care Activities Measure: Psychometric Evaluation and Validation.

Objective: The English version of the Summary of Diabetes Self-Care Activities (SDSCA) measure is the most frequently used self-reporting instrument assessing diabetes self-management. This study is aimed at translating English SDSCA into the Urdu version and validating and evaluating its psychometric properties. Methods: The Urdu version of SDSCA was developed based on the guidelines provided by the World Health Organization for translation and adaptation of instruments. The panel of experts examined the content validity, reliability, and internal consistency of the instrument. The translation process from the English version to the Urdu version revealed excellent results at all the stages. Results: The instrument showed promising and acceptable results. Of particular mention are the results related to split-half reliability coefficient 0.90, test-retest reliability (r = 0.918, P < .001), intraclass coefficient (0.912), and Cronbach’s alpha (.79). The factor analysis (exploratory and confirmatory) was not performed in this study due to the small sample size (n = 30) as the objective was to validate the Urdu version of the SDSCA instrument. Conclusions: This study provided evidence for the reliability and validity of the Urdu Summary of Diabetes Self-Care Activities (U-SDSCA) instrument, which may be used in the future for the patients of diabetes in order to assess type 2 diabetes self-management activities in the rural area of Pakistan and other Urdu-speaking countries.

854-P: Personality, Self-Management Behaviors, and Glycemic Control among Japanese Patients with Type 2 Diabetes Mellitus (T2DM)

Diabetes self-management is an essential part of diabetes care. Although several personality traits were reportedly associated with self-management behaviors or glycemic control in Western countries, clinical evidence of such an association is still sparse, especially among Asian patients with diabetes. Thus, we aimed to clarify the associations among personality, self-management behaviors, and glycemic control in Japanese patients with T2DM. Analyzed were 510 Japanese patients with T2DM (62.2 ± 11.2 y; 57% men) with available information on personality (assessed by NEO Five-Factor Inventory), diabetes self-management activities (assessed by the Japanese version of Summary of Diabetes Self-Care Activities), body mass index (BMI), and HbA1c. Coefficient of correlation indicated that those with high scores for neuroticism, as well as low scores for conscientiousness, had lower levels of diet (neuroticism r = -0.14, P&amp;lt;0.05; conscientiousness r = 0.14, P&amp;lt;0.001) and physical activity (neuroticism r = -0.13, P&amp;lt;0.05; conscientiousness r = 0.15, P&amp;lt;0.001) self-management than those without such scores. There was no significant trend in medication adherence according to personality traits. Structural equation modeling showed that HbA1c was negatively associated with conscientiousness (standardized path coefficients = -0.024, P&amp;lt;0.05). Conscientiousness was significantly associated with higher self-management scores on diet and physical activity and was directly and indirectly (via BMI) related to HbA1c levels. Our results showed that Japanese patients with high conscientiousness levels had better glycemic control via favorable adherence to diet and physical activity but not medication adherence than those with lower conscientiousness levels. Evaluation of personality traits could identify patients likely to exhibit good/poor diabetes self-management care. This might be helpful in providing effective and efficient patient education. Disclosure S.Y. Morikawa: None. K. Fujihara: None. M. Hatta: None. Y. Takeda: None. D. Ishii: None. J. Yachida: None. C. Horikawa: None. M. Kato: None. H. Maegawa: Research Support; Self; Antares Pharma, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Merck Sharp &amp; Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.

686-P: Temporal Association of Adherence to Diabetes Self-Management and Glycemic Control from Adolescence to Adulthood in a Longitudinal Cohort of Women with Type 1 Diabetes (T1D)

Adherence to recommended diabetes self-management (DSM) is essential for glycemic control. Little is known regarding the association between DSM adherence and glycemic control as adolescents transition to adulthood. This secondary analysis examined the association of DSM adherence and glycemic control in adolescence and its temporal association with DSM adherence and glycemic control reported as adults in women with T1D. Data from female adolescents who participated in a preconception counseling intervention trial were linked with data collected in adulthood via a retrospective survey. DSM adherence was assessed regarding following a diet plan, checking blood sugar, taking insulin, exercising regularly, and keeping appointments and summed as a score ranging 5 to 25, where higher scores suggest greater DSM adherence. Glycemic control was measured via self-report (scaled as 1=poor to 4=excellent) and finger stick A1c. Of the 30 T1D women followed (100% Caucasian, Age [M±SD]: 25.8±2.4 years, Age at T1D diagnosis: 8.6±4.8 years), as teens most reported being adherent to the five DSM activities on average "most of the time" (20.4±2.4), being in good to excellent control (n=20, 66.7%; 2.8±0.7), and having a mean A1c of 7.5±0.7%, with moderate correlations between DSM adherence and self-reported glycemic control (r=.50, p&amp;lt;.001) and A1c (r=-.41, p=.005). As adults, mean DSM adherence improved (23.1±3.3, p=.001), while no significant changes were found for either self-reported glycemic control (2.7±0.8, p=.476) or A1c (7.2±1.0, p=.342). DSM adherence in adolescence was not associated with DSM adherence in adulthood (r=.21, p=.276), yet moderate associations were found for self-reported glycemic control (r=.51, p=.004) and A1c (r=.59, p=.044). These findings suggest DSM adherence may improve as adolescent females transition to adulthood and is related to glycemic control both in adolescence and adulthood. Disclosure S.M. Sereika: None. A.F. Fischl: None. D. Charron-Prochownik: None. Funding American Diabetes Association (1-11-CT-10, 7-02-CR-06 to D.C-P.)

The Impact of Shift Work on Diabetes Self-Management Activities.

Once a person is diagnosed with diabetes, aggressive management is imperative to minimize poor glycemic control devastating outcomes. However, for some patients reaching optimum blood glucose levels is challenging due to the complexity of diabetes care. To achieve good blood glucose control, patients affected by diabetes must engage in self-care activities that include routine blood glucose check, dietary control, physical activity, medication regimen, and routine medical provider visits. Diabetes-associated self-care activities aimed to reach good blood glucose control can be hindered by multiple factors including shift work. To evaluate self-management activities of individuals affected by diabetes who are employed as shift workers. This study also informs primary care nurse practitioners of the challenges shift workers face in managing their disease. This was a cross-sectional descriptive study. Participants were individuals affected by type II diabetes from a single primary care practice (N = 86); 45 were individuals working on the dayshift and 41 worked on the evening/night shift. Each participant completed the diabetes self-management questionnaire and author-developed demographic/supplemental questionnaire. There were no differences in self-reported diabetes management activities (i.e., physical activity, glucose management, and healthcare use) between the two groups. Thirty-nine percent of participants working shifts reported worse sleep patterns compared to their dayshift counterparts (X 2[1, N = 85] = 8.73, p = .003). Evening/night shift workers also reported more symptoms such as leg pain, fungal infection, numbness of the feet and legs, dizziness, and vision changes (X 2[1, N = 79] = 43.037, p < .001). A better understanding of the impact that shift work has on diabetes care may help healthcare providers formulate meaningful treatment plans to meet the needs of evening/night shift diabetic workers. The use of a patient-centered medical home is one strategy.