Diabetes Self-management Outcomes Research Articles

The Effect of Family Caregiver Empowerment Model Intervention on Fear of Hypoglycemia in People with Type-2 Diabetes Mellitus

Background: Fear of hypoglycemia is a common psychological issue in people with type-2 diabetes mellitus (T2DM). Families play a crucial role in diabetes self-management, but many need a better understanding of their responsibilities. This gap can lead to increased disease management burdens, contributing to psychological problems like fear of hypoglycemia, which worsens blood glucose control. The Family Caregiver Empowerment Model (FCEM) is an intervention that can empower families in their caregiving roles for T2DM management.Purpose: The study aimed to analyze the effect of the FCEM intervention on the fear of hypoglycemia in people with T2DM.Methods: The study used a randomized control group pretest-posttest design. The sample consisted of family members serving as family caregivers. A total of 85 respondents were randomly assigned to either the intervention group (41 respondents) or the control group (44 respondents). FCEM was conducted once per week for ten weeks. Fear of hypoglycemia was measured using the Indonesian version of the Fear of Hypoglycemia Scale questionnaire. The data were analyzed using the Wilcoxon signed rank test and independent t-test.Results: The results showed significant differences in fear of hypoglycemia between the pre-test and post-test in the intervention group (p=0.001) and the control group (p=0.001). However, there was a significant difference in the decrease in fear of hypoglycemia between the treatment and control groups (t=-7.087; p=0.001 < α = 0.05). It suggests that FCEM intervention can significantly reduce the fear of hypoglycemia in patients with T2DM.Conclusion: FCEM intervention can reduce the fear of hypoglycemia in people with T2DM by increasing family support and caregivers' ability to manage T2DM. Nurses can use FCEM intervention in the management of T2DM so that it can improve diabetes self-management outcomes.

Racial and Ethnic Disparities in Patient Experience and Diabetes Self-Management Among Nonpregnant Women of Childbearing Age With Diabetes in the United States: A Scoping Review, 1990 to 2020

ObjectiveThis scoping review aimed to identify any empirical literature describing racial and ethnic disparities in patient experience and diabetes self-management among nonpregnant women (aged 18–49 years) of childbearing age with diabetes in the United States. MethodsThis scoping review followed the Arksey and O'Malley methodological framework. We used a comprehensive search strategy to identify articles published from 1990 to 2021 in PubMed, CINAHL, EMBASE, Web of Science, the Cochrane Library, and Proquest Digital Dissertation and Theses. Two independent reviewers used Covidence, a web-based review management software, to screen articles by title and abstract, and then by full-text articles based on inclusion and exclusion criteria. A third reviewer arbitrated any disagreements. ResultsOf the original 6,115 peer-reviewed studies identified, eight fit the eligibility criteria. In research on nonpregnant women of childbearing age in the United States, four studies investigated racial and ethnic disparities in patient experience, and seven of the eight eligible studies investigated racial and ethnic disparities in diabetes self-management outcomes. No eligible studies examining racial and ethnic variations in the association between patient experience and diabetes self-management were found. ConclusionsThis scoping review identified limited available studies examining racial and ethnic disparities in patient experience and diabetes self-management among nonpregnant women of childbearing age in the United States. Future studies should examine these relationships to fill the gap in research. These findings are relevant as the prevalence of diabetes is increasing worldwide and racially/ethnically minoritized women are disproportionately affected.

Experiences of Filipino Americans with Type 2 Diabetes during COVID-19: A Qualitative Study.

Little is known about the experiences of Filipino Americans with type 2 diabetes regarding their self-management during the early phase of the COVID-19 pandemic. We conducted a qualitative research study using semistructured interviews. In total, 19 interviews were recorded, transcribed, and analyzed by 4 independent coders. We situated our understanding of these results using three concepts from an indigenous Filipino knowledge system called Sikolohiyang Pilipino: Kapwa (shared identity), Bahala Na (determination), and Pakikibaka (spaces of resistance). The following three main themes emerged: (1) stressors of the pandemic, (2) coping behaviors (with two subthemes: emotional and lifestyle-focused responses), and (3) diabetes self-management outcomes. Participants experienced stresses, anxiety, and loneliness during the pandemic magnified by the complexities of self-management. Although many admitted the pandemic brought challenges, including burnout, they coped by using existing resources-support from family, friends, the use of technology, and various emotional coping mechanisms. Many said that they made few diabetes self-management changes.

Stories for change protocol: A randomized controlled trial of a digital storytelling intervention for Hispanic/Latino individuals with type 2 diabetes

BackgroundHispanic/Latino adults are disproportionately impacted by type 2 diabetes mellitus (T2D). The Stories for Change (S4C) Diabetes digital storytelling intervention promotes T2D self-management among Hispanic/Latino people. We describe the S4C protocol and participant baseline characteristics. MethodsStudy eligibility criteria: Hispanic or Latino, age 18–70 years, ≥1 office visit within a year at a participating clinic, T2D diagnosis for ≥6 months, HbA1c ≥ 8%, and intention to continue care at the recruitment clinic. We used a two-group, parallel randomized controlled trial design and an intervention derived through a community-based participatory research approach. All participants received usual diabetes care and two cards describing how to engage healthcare teams and access diabetes-related resources. At baseline, the intervention group additionally viewed the 12-min, intervention video (four stories about diabetes self-management). To encourage subsequent video viewing, participants received five monthly text messages. The messages prompted them to self-rate their motivation and self-efficacy for T2D management. The control group received no additional intervention. Bilingual (English/Spanish) staff collected data at baseline, six weeks, three months, and six months including biometric measurements and a survey on diabetes self-management outcomes, theory-based measures, and the number of video views. We reviewed the number of diabetes-related appointments attended using electronic medical record data. ResultsParticipants (n = 451; 70% women, mean age = 53 years) had an average HbA1C ≥9%. Intervention participants reported identifying with the storytellers and engaging with the stories. ConclusionWe present a digital storytelling intervention protocol that provides a template for future health promotion interventions prioritizing health disparity populations.ClinicalTrial.gov#NCT03766438

A New Taxonomy for Technology-Enabled Diabetes Self-Management Interventions: Results of an Umbrella Review.

A 2017 umbrella review defined the technology-enabled self-management (TES) feedback loop associated with a significant reduction in A1C. The purpose of this 2021 review was to develop a taxonomy of intervention attributes in technology-enabled interventions; review recent, high-quality systematic reviews and meta-analyses to determine if the TES framework was described and if elements contribute to improved diabetes outcomes; and to identify gaps in the literature. We identified key technology attributes needed to describe the active ingredients of TES interventions. We searched multiple databases for English language reviews published between April 2017 and April 2020, focused on PwD (population) receiving diabetes care and education (intervention) using technology-enabled self-management (comparator) in a randomized controlled trial, that impact glycemic, behavioral/psychosocial, and other diabetes self-management outcomes. AMSTAR-2 guidelines were used to assess 50 studies for methodological quality including risk of bias. The TES Taxonomy was developed to standardize the description of technology-enabled interventions; and ensure research uses the taxonomy for replication and evaluation. Of the 26 included reviews, most evaluated smartphones, mobile applications, texting, internet, and telehealth. Twenty-one meta-analyses with the TES feedback loop significantly lowered A1C. Technology-enabled diabetes self-management interventions continue to be associated with improved clinical outcomes. The ongoing rapid adoption and engagement of technology makes it important to focus on uniform measures for behavioral/psychosocial outcomes to highlight healthy coping. Using the TES Taxonomy as a standard approach to describe technology-enabled interventions will support understanding of the impact technology has on diabetes outcomes.

Effectiveness of Mobile App-Based Interventions to Support Diabetes Self-Management: A Systematic Review

Introduction: Diabetes is a major health problem worldwide due to its rapidly growing prevalence and high disease burden. Nowadays, the evolution of mobile technology provides a large number of health-related mobile applications (apps) mainly focusing on the self-management of diabetes. The aim of this paper is to systematically review the effectiveness of mobile app-based self-management interventions on clinical and/or psychological outcomes in patients with type 1 and type 2 diabetes.Methods: A systematic search of four databases (Scopus, Medline, CINAHL, and Proquest) was conducted using the terms "diabetes" AND "self-management" AND "mobile applications" OR "mobile based" OR “smartphone”. Studies published in English from 2016 to 2020 were considered. Only randomized controlled trials (RCTs) for patients with type 1 and type 2 diabetes that reported any of the study outcomes were included. Using our search strategies, we identified 4339 articles. After removing duplicate studies, a total of 12 articles met the inclusion and exclusion criteria included in the review.Results: The majority measured self-monitoring of blood glucose monitoring frequency, glycated hemoglobin (HbA1c) and/or psychological or cognitive outcomes. The most positive findings were associated with mobile app-based health interventions as a behavioral outcome, with some benefits found for clinical and/or psychological diabetes self-management outcomes for patients with type 1 and type 2 diabetes mellitus.Conclusion: Therefore, more research with larger and longer studies to develop the ideal mobile-app based self-management tool for diabetes is needed.

School-aged children with type 1 diabetes benefit more from a coping skills training program than adolescents in China: 12-month outcomes of a randomized clinical trial.

Managing type 1 diabetes can be challenging, especially for youth, so there is a need for effective interventions to help youth live with diabetes. To determine the efficacy of a coping skills training (CST) program for Chinese youth with type 1 diabetes and to explore whether the efficacy of the program was different for school-aged children than for adolescents with type 1 diabetes. A total of 100 youth with type 1 diabetes aged 8 to 20 years were randomly placed in either an intervention group (CST + standard care [SC]) or a control group (SC). Data were collected at baseline, 6-month, and 12-month follow-ups on primary outcomes of perceived stress, coping, and self-efficacy and secondary outcomes of diabetes self-management, quality of life, and glycated hemoglobin A1c (HbA1c). A generalized estimating equation analysis for repeated measures was used to determine the program effects and differential effects by age group. The CST program had no significant effect on primary or secondary outcomes over 12 months. However, there was a significant increase in positive coping (P < .001), self-efficacy (P = .017), diabetes problem-solving and goals of diabetes self-management (P = .007, P = .001), and quality of life (P = .016) of school-aged children in the intervention group compared with the control group. There were no significant differences in primary or secondary outcomes between the intervention group and the control group (P > .05). The CST program was effective for school-aged children, improving psychosocial and diabetes self-management outcomes. Further research is needed to develop programs that improve outcomes in adolescents with type 1 diabetes.

Impact of technology-based interventions for children and young people with type 1 diabetes on key diabetes self-management behaviours and prerequisites: a systematic review

BackgroundThe role of technology in the self-management of type 1 diabetes mellitus (T1DM) among children and young people is not well understood. Interventions should aim to improve key diabetes self-management behaviours (self-management of blood glucose, insulin administration, physical activity and dietary behaviours) and prerequisites (psychological outcomes and HbA1c) highlighted in the UK guidelines of the National Institute for Health and Care Excellence (NICE) for management of T1DM. The purpose was to identify evidence to assess the effectiveness of technological tools in promoting aspects of these guidelines amongst children and young people.MethodsA systematic review of English language articles was conducted using the following databases: Web of Science, PubMed, Scopus, NUSearch, SAGE Journals, SpringerLink, Google Scholar, Science Direct, Sport Discus, Embase, Psychinfo and Cochrane Trials. Search terms included paediatric, type one diabetes, technology, intervention and various synonyms. Included studies examined interventions which supplemented usual care with a health care strategy primarily delivered through a technology-based medium (e.g. mobile phone, website, activity monitor) with the aim of engaging children and young people with T1DM directly in their diabetes healthcare. Studies did not need to include a comparator condition and could be randomised, non-randomised or cohort studies but not single-case studies.ResultsOf 30 included studies (21 RCTs), the majority measured self-monitoring of blood glucose monitoring (SMBG) frequency, clinical indicators of diabetes self-management (e.g. HbA1c) and/or psychological or cognitive outcomes. The most positive findings were associated with technology-based health interventions targeting SMBG as a behavioural outcome, with some benefits found for clinical and/or psychological diabetes self-management outcomes. Technological interventions were well accepted by children and young people. For the majority of included outcomes, clinical relevance was deemed to be little or none.ConclusionsMore research is required to assess which elements of interventions are most likely to produce beneficial behavioural outcomes. To produce clinically relevant outcomes, interventions may need to be delivered for at least 1 year and should consider targeting individuals with poorly managed diabetes. It is not possible to determine the impact of technology-based interventions on insulin administration, dietary habits and/or physical activity behaviour due to lack of evidence.

Extension‐Delivered Diabetes Program for Rural‐residing Latinos Improves Diabetes Self‐management, Self‐efficacy and Knowledge

Rural‐residing Latinos are at high diabetes risk due to limited access to healthcare services, high rates of overweight and obesity, and acculturation. Culturally‐sensitive diabetes self‐management education programs are needed to reduce the risk and severity of Type 2 diabetes among rural‐residing Latinos. Improvements in diabetes‐related self‐efficacy and knowledge can lead to improved diabetes self‐management outcomes. Latinos Living Well (LLW) was created using the Social Marketing Theory (SMT) and the Health Belief Model (HBM). SMT ensured the content was audience‐centered and culturally‐relevant. HBM constructs were addressed through facilitative discussion, cooking practicums, and hands‐on activities. LLW is made up of four two‐hour classes with culturally‐relevant food and physical activity examples, were taught in Spanish, and delivered through Cooperative Extension. This study evaluated the impact of LLW on diabetes self‐management practices, diabetes self‐efficacy, and diabetes knowledge. A convenience sample of rural‐residing Latino adults age 18+ in a Midwest state (n=120) were recruited, regardless of diabetes status, through collaborations with established community groups serving Latinos, radio commercials and print media, and word of mouth; 76 completed the program (63.3% completion rate). Participants completed a Spanish questionnaire comprised of validated tools, sociodemographic questions, and questions regarding diabetes status at the start of Class 1 (PRE) and the end of Class 4 (POST). Descriptive statistics analyzed sociodemographic data while paired‐samples t‐tests examined changes in diabetes self‐management, diabetes self‐efficacy and diabetes knowledge from PRE to POST. The majority were females (n=73; 97.3%), between the ages of 30 and 49 years (n=34; 51.6%), who were first generation immigrants (n=63; 87.5%). Two‐thirds (n=49; 65.3%) reported some history of a diabetes diagnosis. Significant increases were detected for diabetes self‐management practices (p&lt;0.006), diabetes self‐efficacy (p&lt;0.0001), and diabetes knowledge (p&lt;0.004). These results suggest LLW is effective in improving diabetes self‐management practices, diabetes self‐efficacy, and diabetes knowledge outcomes among rural‐residing Latinos.Support or Funding InformationThis research was funded by the United States Department of Agriculture, National Institute of Food and Agriculture Rural Health and Safety Education Grant, #2014‐46100‐22349

Implementing Group Visits: Are They Effective to Improve Diabetes Self-Management Outcomes?

Diabetes is a prevalent patient condition seen in primary care settings. One of the challenges of managing patients with diabetes is the complexity of treatment regimens and the need to have patients self-manage their chronic condition. This article describes the development of a group visit study for patients in an academic health center. The group visits occurred over 32 months with a total of 197 visits representing 51 patients. Improvements were noted in self-management skills, adherence to diabetes metrics, and high satisfaction. Sustainability was an issue because of the complexity of reimbursement and dependence on referrals.

Family Inclusion in Diabetes Education: A Nationwide Survey of Diabetes Educators

The purpose of this study was to investigate perceptions about family inclusion and support in diabetes self-management education. Surveys were mailed to certified diabetes educators (CDEs) in all 50 states and the District of Columbia, with a return of 225 surveys. Descriptive and inferential statistics (eg, t test, analysis of variance, correlation, and chi-square) were used as appropriate. Levels of importance placed on family involvement in diabetes education were significantly related to the emphasis placed on family during CDEs' formal or preprofessional education. CDEs' formal exposure to family theory influenced perceptions of their knowledge about family and the frequency that family support was emphasized in self-management activities but was unrelated to perceptions of their skillfulness in educating family members. Diabetes educators' personal values of family support were significantly related to how frequently family members were asked to participate in formal diabetes education classes. CDEs perceived that they were meeting individuals' self-management needs significantly better than those of families. Regional differences did not appear to be a factor in how CDEs incorporated family in diabetes education. Diabetes educators without formal exposure to family theory may be overestimating how much they emphasize family support in diabetes education. Increasing formal education about the importance of family involvement in self-management behaviors could positively affect individual diabetes self-management outcomes.

Computer-assisted intervention improves patient-centered diabetes care by increasing autonomy support.

To determine if a patient-centered, computer-assisted diabetes care intervention increased perceived autonomy support, perceived competence (from self-determination theory), and if these constructs mediated the effect of the intervention on ADA/NCQA recommended diabetes care outcomes. A randomized controlled trial of 866 adult type 2 diabetes patients in heterogeneous primary care settings in Colorado. Perceived autonomy support, perceived competence, patient satisfaction, glycemic control (HbA1c), ratio of total to HDL cholesterol, diabetes distress, and depressive symptoms. The computer-assisted intervention increased patient perception of autonomy support relative to a computer-based control condition ( p = .05). Change in perceived competence partially mediated the effects of increased autonomy support on the change in lipids, diabetes distress, and depressive symptoms. The construct of autonomy support was found to be separate from that of patient satisfaction. A patient-centered, computer-assisted intervention was effective in improving diabetes self-management outcomes, in part, because it increased patients' perception that their autonomy was supported which changed perceived competence. These findings support the self-determination model for health behavior change and the chronic care model and support the further study of the use of these technologies to motivate patients to improve their health outcomes.