Diabetes Self-management Skills Research Articles

Diabetes self-management skills in patients considering Ramadan fasting: Sfax pre-Ramadan education workshops experience

Diabetes self-management skills in patients considering Ramadan fasting: Sfax pre-Ramadan education workshops experience

Walking the mile - Fostering diabetes self-management and psychosocial skills among pharmacy students through a hybrid advanced diabetes certificate elective course

Background: Pharmacy school curricula contain required course content in diabetes management. However, patient-care skills like effective communication, lifestyle counselling, and the provision of healthy coping strategies require additional training opportunities that are not typically afforded in the required diabetes curriculum. Methods: A 2-credit hour elective course was created to provide third-year pharmacy students with first-hand experience in diabetes self-management and the psychosocial aspects of diabetes care. The course includes the certificate training programme "The Pharmacist and Patient-Centered Diabetes Care" offered by the American Pharmacists Association (APhA). Results: 110 pharmacy students completed four-course cohorts. Average capstone assessment scores were 92% for the patient case and 88.3% for hands-on diabetes management skills. 99.1% of students successfully obtained the APhA certificate with an average final assessment score of 85%. Students demonstrated an understanding of the psychosocial and behavioural aspects of diabetes care through simulation and case-based activities. Conclusion: The course had a positive impact on pharmacy students' proficiency in diabetes care and self-management skills, as evidenced by their performance within the APhA certificate programme. Through simulation activities, students gained firsthand experience and demonstrated an understanding of the psychosocial aspects of diabetes care.

Effect of variables of sociodemographic on disease management skills on individuals with type 1 and type 2 diabetes receiving insulin therapy

Introduction: Self-care and self-management skills are at the forefront of disease management skills in individuals with Type 1 and Type 2 diabetes. An individual with diabetes who defines his/her self-care well will have increased his/her disease management skills as well as self-management skills to the desired level. The aim of this study is to evaluate the self-management skills of individuals with Type 1 and Type 2 diabetes receiving insulin therapy according to their sociodemographic characteristics. Method: The research is a prospective analytical study. Within the scope of the study, 913 individuals with Type 1 and Type 2 diabetes who applied to the diabetes polyclinic of a university hospital in Izmir in a month were included. The researchers collected the data through face-to-face interviews into Diabetes Patient Diagnosis Form and Diabetes Self-Management Skill Form. Results: In study 99.8% of the patients received diabetes education at least once and 60.8% of the individuals had never experienced hypoglycemia. When the diabetes self-management skills and self-insulin making skills of individuals with diabetes are examined; A statistically significant difference was found between the diagnostic variable categories in the sub-dimensions of medical nutrition therapy, exercise and treatment management, awareness of chronic complications, and diabetic outpatient care behaviors. It was determined that there was a significant difference between the education styles of individuals with diabetes, the frequency of blood sugar control and the frequency of hypoglycemia, and the sub-dimensions of diabetes self-management skills and the ability to make insulin on their own (p<0.001). Conclusion: Diabetes education given to individuals with diabetes contributes to their development of self-management skills. Multiple factors can affect individuals' self-management skills. As the number of educations, type of education, treatment methods, and education level of individuals with diabetes increase, their self-management skills and self-insulin making skills increase. If type 1 and type 2 diabetes patients can be followed closely and their training needs, diversity and application methods can be corrected, disease management will improve. Complications that may develop due to insulin application errors can be prevented.

Diabetes Care at Summer Camps.

Attending summer camp can be a rewarding experience for children with type 1 diabetes and an opportunity for them to build their confidence and diabetes self-management skills. Diabetes camps are built to cater to the medical needs of children with diabetes. With proper communication, education, and resources, traditional summer camps can provide the same benefits.

A Diabetes Education App for People Living With Type 2 Diabetes: Co-Design Study.

Type 2 diabetes (T2D) is a growing global health concern, including in Singapore. Diabetes education programs have been shown to be effective in improving health outcomes and diabetes self-management skills. Mobile health apps have emerged as useful tools for diabetes education; however, their use and acceptance by the target population remain inconsistent. Therefore, end-user participation in the design and development of a mobile health app is crucial for designing an acceptable app that can improve outcomes for populations with a chronic disease. The objective of this study was to apply an end-user participatory approach to co-design a diabetes education app prototype for people living with T2D by exploring their perceptions, acceptance, and usability of an app prototype, as well as their diabetes experience and perspectives on digital diabetes education. A total of 8 people with T2D, who were recruited from diabetes management Facebook groups, participated in 4 web-based surveys via Qualtrics and 2 structured interviews via Zoom (Zoom Video Communications, Inc) between August 20, 2021, and January 28, 2022. Descriptive statistics and thematic analyses of the discussion and iterative feedback on the app prototype were used to assess the participants' perceptions of living with T2D, attitudes toward digital diabetes education, and acceptance of the prototype. Analyses of the surveys and interview data revealed 3 themes: challenges of living with T2D; validation, acceptability, and usability of the diabetes education app prototype; and perspectives on digital diabetes education. In the first theme, participants highlighted the importance of solitary accountability, translating knowledge into practice, and developing pragmatic self-consciousness. The second theme indicated that the diabetes education app prototype was acceptable, with information and appearance being key; revealed ambivalent and polarized opinions toward the chatbot; and confirmed potential impact of the app on diabetes self-management skills and practice. The third theme comprised the necessity of using a variety of information-seeking strategies and recommendations for desired content and app qualities, including accessibility, adaptability, autonomy, evidence-based design and content, gamification, guidance, integration, personalization, and up-to-date content. The findings were used to reiterate the app design. Despite a small sample size, the study demonstrated the feasibility of engaging and empowering people living with T2D to consider digital therapeutics for diabetes self-management skills and practice. Participants gave rather positive feedback on the design and content of the app prototype, with some recommendations for improvements. The findings suggest that incorporating end-user feedback into app design can lead to the creation of feasible and acceptable tools for diabetes education, potentially improving outcomes for populations with a chronic disease. Further research is needed to test the impact of the refined diabetes education app prototype on diabetes self-management skills and practice and quality of life.

Management of type 2 diabetes: Self-management education and clinical findings

Abstract Aim: The purpose of this study is to determine the effects of the self-management education provided to patients with type 2 diabetes under the leadership of a nurse on the perceptions of self-management and clinical findings of patients. Materials and Methods: The sampling of the research comprises 281 patients who received a diagnosis of type 2 diabetes and whose treatment is being conducted. The self-management perceptions, body mass index, preprandial blood glucoses, and glycolyzed hemoglobin levels of the patients were measured before and after the intervention and 3 months later. Results: It was determined as a result of the comparison of the scores before and after the nursing education provided to the patients that the patients’ self-management perception scale scores increased significantly and that the body mass index, preprandial blood glucose, and glycolyzed hemoglobin levels reduced significantly (P < 0.01). Conclusions: It is determined in research that the self-management education provided to patients with type 2 diabetes under the leadership of a nurse had a meaningful impact on the diabetes self-management skills and clinical findings of the patients. Practice Implications: It was determined that the average diabetes self-management education scores increased significantly when comparing before and after the self-management provided to patients and that the body mass index, preprandial blood glucose, and glycolyzed hemoglobin levels decreased at a statistically meaningful level.

549-P: Assessing Feasibility of a Diabetes Mellitus Program Using Behavioral Economics to Optimize Outreach and Self-Management Support with Technology—The DM-BOOST Project

Introduction: The DM-BOOST intervention was developed to enhance engagement with diabetes self-management training (DSMT). Participants received peer-written text message tips with nudges to reply with personal preferences. They then completed a video call with the DM-BOOST team to confirm patient portal access, review key functions, and set a diabetes behavior goal. This was later followed by receipt of a patient portal message with their goal, which they commit to sending to the DSMT provider they are scheduled to meet with. Methods: Adults with poorly controlled type 2 diabetes (HbA1c ≥ 8) received mailed invitations and a recruitment phone call. Participants (n=60) were randomized (1:1) to usual care or DM-BOOST. All participants received assistance obtaining a DSMT referral and scheduling a DSMT appointment. The primary outcome of interest was the DSMT appointment no-show/cancellation rate. Results: Enrolled participants (n=60) were 60.0% female with a mean age of 45.5 years (SD = 8.3). The average HbA1c at enrollment was 10.1% (SD = 1.8). All intervention participants (30/30) had a DSMT appointment scheduled compared to 86.7% of comparison participants (26/30). Intervention group participants had fewer DSMT no-shows/cancellations (3/30, 10%) compared to comparison group participants (10/26, 35%) (p = 0.01). Conclusions/Discussion: Technology-based interventions guided by behavioral economics can increase initial engagement with DSMT. Several system-level barriers, including challenges in obtaining referrals and scheduling appointments, were identified. Secondary outcomes, including patient-reported changes in diabetes self-efficacy, self-management skills, and treatment satisfaction are being evaluated. Future research efforts include cultural adaption of DM-BOOST for Spanish-speaking patients and rigorous implementation evaluation. Disclosure D.J.Amante: None. L.L.Shenette: None. G.Puerto: None. S.Lemon: None. D.M.Harlan: Advisory Panel; Novartis, Vertex Pharmaceuticals Incorporated, Diabeloop SA, Other Relationship; Stability Health, Wolters Kluwer Health. B.S.Gerber: Other Relationship; Abbott. Funding National Center for Advancing Translational Sciences (KL2TR001455); National Institute for Diabetes and Digestive and Kidney Diseases (1K01DK131318)

The psychometric properties of the Diabetes Self-Efficacy Scale in Saudis with type 2 diabetes.

To assess the psychometric properties of the Arabic version of the Diabetes Self-Efficacy Scale (A-DSES). This study used a cross-sectional design. This study recruited 154 Saudi adults with type 2 diabetes at two primary healthcare centres in Riyadh, Saudi Arabia. Its instruments were the Diabetes Self-Efficacy Scale and the Diabetes Self-Management Questionnaire. The psychometric properties of the A-DSES were assessed for reliability, including internal consistency and validity using exploratory factor analysis, confirmatory factor analysis and criterion validity. The item-total correlation coefficients were >0.30 for all items, ranging from 0.46 to 0.70. The Cronbach's alpha for internal consistency was 0.86. One factor was extracted from the exploratory factor analysis (self-efficacy for diabetes self-management), and the one-factor model showed an acceptable fit to the data in the confirmatory factor analysis. Diabetes self-efficacy levels were positively correlated with diabetes self-management skills (r = 0.40, p < 0.001), indicating criterion validity. The results indicate that the A-DSES is a reliable and valid instrument for assessing self-efficacy related to diabetes self-management. The A-DSES could be used in clinical practice and research to provide a reference for assessing self-efficacy levels in areas of diabetes self-management. Participants were not involved in the design, conduct, reporting or dissemination plans of this research.

Artificial Intelligence Aided Continuous Glucose Monitoring and its Effectiveness in the Management of Type 2 Diabetes; A Narrative Review

This literature review offers a thorough summary of current research on continuous glucose monitoring (CGM) for the treatment of diabetes. Continuous glucose monitoring is a non-invasive technique proven efficient in enhancing diabetes management by reducing HbA1C and achieving better sugar control. Patients who use CGM for managing their diabetes have also experienced decreased fear of hypoglycemia and improved diabetes self-management skills, increasing their confidence to control their blood sugars efficiently. Although data management is challenging, CGM systems offer helpful insights into glucose levels for the management of diabetes. The review covers various CGM-related topics, including accuracy, efficacy, patient outcomes, technological advancements, patient challenges, limitations, and future research recommendations referring to the literature published in the past on the topic. The review also discusses optical signalling, biosensors, and other technologies used in glucose-sensing technology for continuous monitoring.

Feasibility and acceptability of an online guided self-determination program to improve diabetes self-management in young adults.

Evaluate the feasibility and acceptability of an online guided self-determination (GSD) program to improve diabetes self-management skills among young adults with type 1 diabetes (YAD). An online program comprising seven structured interactive conversations was designed. A pre- and post- interventional study used a sequential, two-phase multiple method design. Phase one comprised a training program for diabetes educators (DEs). In Phase two YAD participated in program and completed pre- and post-surveys assessing motivation to self-manage, perceived competence in diabetes and communication with DEs. Both YAD and DEs provided a program evaluation. The online GSD program was acceptable, feasible and effective in improving autonomous motivation in self-management and communication with DEs. Easy access and program flexibility were highly appreciated by both participant groups and perceived to assist YAD to stay motivated. The program had a significant impact on the diabetes self-management of YAD and was a feasible and acceptable way to engage and communicate with DEs. The GSD platform contributes to age appropriate and person-centred diabetes self-management. It can potentially reach geographically distanced populations, or with social circumstances or other barriers impeding in-person service provision.

The effect of web based type 2 diabetes education on diabetes self management.

This study is a control group intervention study to determine the effect of web-based education on diabetes self-management in individuals with type 2 diabetes. The study was conducted in the Training and Research Hospital Diabetes Education Unit of Hitit University. The study was completed with 75 people (intervention 38, control 37). The data were obtained in the web site through patient identification form, self-management perception scale in diabetes, diabetes attitude, self-care scale and HbA1c, HDL, LDL values were followed by providing training and counseling. The values followed were viewed at the third and sixth months. Written permission was obtained from ethics committee and participants. The data of the study were evaluated with number, percentage, mean, pearson chi-square, independent t-test, repetitive analysis and variance analysis. Statistically significant decrease in HbA1c and LDL values, diabetes self-management scale, diabetes attitude scale and self-care scale scores were found to be significantly different between the intervention and control groups. Web-based education and follow-up studies are effective in decreasing HbA1c values in increasing diabetes self-management skills of individuals with type 2 diabetes. It is recommended to use as a complementary tool in health care services for type 2 diabetes management.

Diabetes Mellituslu Bireylerde Diyabet Komplikasyon Risk Algısının ve Diyabet Öz Yönetim Becerilerinin İncelenmesi

Aim: It was aimed to examine the complication risk perception and diabetes self-management skills of individuals with diabetes.&#x0D; Material and Methods: The data of the descriptive and relational study were collected using google forms. The sample consists of 153&#x0D; diabetic individuals. Data were collected with the recognition form, Diabetes Mellitus-Risk Perception Scale, and Diabetes Self-Management&#x0D; Skills Scale. Number, percentage, mean, standard deviation and median were used as descriptive statistical methods in the evaluation of&#x0D; the data. The distribution of the data was evaluated with the Kolmogorov-Smirnov and Shapiro-Wilk test. Mann-Whitney U test, Kruskal-&#x0D; Wallis test and Spearman correlation analysis were used to evaluate non-parametric data.&#x0D; Results: The mean age of the sample was 49.96 years, 51% were female, 24.8% were illiterate, 5.2% had postgraduate education, 45.1%&#x0D; had poor income, 60.1% had Type 2 diabetes and 36.6% had the highest It has few complications. 87.6% of individuals with diabetes&#x0D; were worried about the development of complications, their self-management scores were found to be higher than those of the nonconcerned&#x0D; group, and a statistically significant difference was found (p

Influence of Literacy, Self-Efficacy, and Social Support on Diabetes-Related Outcomes Following Hospital Discharge.

ObjectiveTo evaluate the relationship between health literacy, social support, and self-efficacy as predictors of change in A1c and readmission among hospitalized patients with type 2 diabetes (T2D).MethodsThis is a secondary analysis of patients with T2D (A1c >8.5%) enrolled in a randomized trial in which health literacy (Newest Vital Sign), social support (Multidimensional Scale of Perceived Social Support), and empowerment (Diabetes Empowerment Scale-Short Form) was assessed at baseline. Multivariable models evaluated whether these concepts were associated with A1c reduction at 12 weeks (absolute change, % with >1% reduction, % reaching individualized target) and readmission (14 and 30 days).ResultsA1c (N=108) decreased >1% in 60%, while individualized A1c target was achieved in 31%. After adjustment for baseline A1c and potential confounders, health literacy was associated with significant reduction in A1c (Estimate −0.21, 95% CI −0.40, −0.01, p=0.041) and >1% decrease in A1c (OR 1.37, 95% CI 1.08, 1.73, p=0.009). However, higher social support was associated with greater adjusted odds of reaching the individualized A1c target (OR 1.63, 95% CI 1.04, 2.55, p=0.32). Both higher empowerment (OR 0.23, 95% CI 0.08, 0.64, p=0.005) and social support (OR 0.57, 95% CI 0.36, 0.91, p=0.018) were associated with fewer readmissions by 14 days, but not 30 days.ConclusionThe study indicates that health literacy and social support may be important predictors of A1c reduction post-discharge among hospitalized patients with T2D. Social support and diabetes self-management skills should be addressed and early follow-up may be critical for avoiding readmissions.Clinical TrialNCT03455985.

Assessing student pharmacists' confidence and knowledge of basic diabetes self-management skills

IntroductionThe significance of diabetes self-management and recent advances in diabetes medications call for healthcare professionals' preparedness in educating patients. This study assessed correlations between student pharmacists' confidence and knowledge of diabetes self-management skills. MethodsAn online questionnaire was administered to third-year student pharmacists at one United States college of pharmacy. Students indicated their level of agreement (strongly disagree, disagree, agree, strongly agree) with nine confidence items and identified the correct multiple-choice response for nine knowledge items. Correlations between confidence and knowledge scores were assessed using simple linear regression, logistic regression, and Spearman rank (Rho) test. ResultsForty-five students completed the questionnaire. The majority agreed/strongly agreed that they were confident in their knowledge for eight of the nine confidence items. The majority correctly answered six of the nine knowledge items. No associations were identified between confidence and knowledge scores in the linear regression (beta scaled = 0.25) or Spearman's correlation test (r = 0.294). In the logistic regression model, confidence and knowledge scores were associated positively for three domains: glucose meter use (odds ratio [OR] = 4.88), glucagon-like peptide-1 receptor agonist use (OR = 4.23) and hyperglycemia treatment (OR = 3.33); confidence and knowledge scores were associated negatively with one domain: insulin syringe administration (OR = 0.41). ConclusionsThis study found no overall association between confidence and knowledge scores in third-year student pharmacists' basic diabetes self-management skills, although there were significant associations with four specific domains. Student pharmacists may require additional training to improve their diabetes self-management skills.

A multi-center pediatric to adult care transition intervention program to improve clinic visit adherence and clinical outcomes among adolescents and emerging adults with type 1 diabetes mellitus [PATHWAY]: Protocol for a randomized controlled trial

ObjectiveThis multi-center randomized controlled trial aims to evaluate the effectiveness of a context-specific transition intervention program to improve clinic visit adherence and clinical outcomes among emerging adults with type 1 diabetes mellitus (T1DM) in Delhi, India. MethodsWe will recruit patients with T1DM of duration ≥1 year and age 15–19.5 years from the participating pediatric sites. After a baseline assessment and a “basic introductory session”, which apprises participants about the concept of transition, study participants (proposed sample size =156) will be randomly allocated into an intervention and control arm. Participants in the intervention arm will receive a structured transition program delivered over 15 months. On the other hand, control arm participants will continue to receive usual care from the pediatric site till the time of transfer to the adult site. The study assessments will be done at baseline, at the time of transfer, and at 1 and 2 years following the transfer. The primary outcome is the difference in clinic attendance rate between intervention and control arms at the end of 1 year post-transfer. The secondary outcomes include the difference in clinic attendance rate at the end of 2 years, the difference in proportion of participants with a minimum of 4 visits in the first follow-up year, and process indicators such as diabetes knowledge and self-management skills, diabetes treatment satisfaction, overall quality of life, diabetes-related distress, hospitalization for acute complications and screening for chronic diabetes complications, and HbA1c. ConclusionThis study will provide important new evidence about a potential strategy to improve clinical care among adolescents and emerging adults with T1DM in lower resource contexts during the vulnerable phase of transition from pediatric to adult healthcare.The trial is registered on the Clinical Trials Registry of India (http://ctri.nic.in) under the CTRI registration number CTRI/2020/10/028379.

505-P: Fasting in Ramadan during the Peak of COVID-Pandemic: DAFNE Graduates Experience

Background: The lockdown due to the COVID-pandemic in April 2020 led to the suspension of face-to-face diabetes care and education. In this period, management of diabetes emergency was a challenge because it needed rapid recognition, diagnosis and treatment. Despite adverse situations, many DAFNE graduates had chosen to fast during Ramadan. This was supported virtually to DAFNE graduates through intermittently scanned continuous glucose monitoring (isCGM) . Aims: This study aimed to compare the isCGM glucose metrics of people with T1D who fasted during Ramadan. Methods: Baseline and fasting period isCGM data were collected. The primary outcome measures HbA1c, time in range [ (TIR) 3.9- mmol/L], time below range [ (TBR) &amp;lt;3.9 mmol/L], coefficient of variation (CV) , and self-reported adverse events. Results: A total of 35 people with T1D fasted with a median of 20 days. Mean HbA1c was 7.5 (0.93) % and 7.4 (0.91) % before and after fasting periods, respectively. No significant change in TIR (pre 61.1 ± 17.9% vs. during 61.9 ± 14.9%) and TAR (pre 32.1 ± 19.0% vs. during 33.1 ± 15.6%) were found. However, TBR (pre 6.8 ± 5.4% vs. during 5.0 ± 4.6%) was significantly decreased (p= 0.045) . The CV (-2.3%) and low glucose events (-5.0) also decreased during the fasting period (p≤ 0.010) . No episodes of severe hypoglycemia, DKA, or hospitalization occurred during the fasting period. Conclusions: DAFNE graduates can fast safely without the fear of hypoglycemia, and safe metrics of glycemia using diabetes self-management skills, including disaster situations like the COVID-pandemic. Disclosure M.Irshad: None. E.S.Alozairi: None. A.K.Elsamad: None. A.Abdullah: None. M.Azizieh: None. J.Alkandari: None. A.Varghese: None. S.Murad: None. E.Taghadom: None. A.Megahed: None.

526-P: e-Health Literacy Rates and Applicability of a Patient-Facing Mobile App Intervention in a Predominantly African-American and Latinx Cohort with Type 2 Diabetes

Introduction: Racial and ethnic minorities have a higher burden of type 2 diabetes in part due to limited access to health-promoting resources and self-management tools. We developed and implemented a patient-centric mobile application, DiabetesXcel, to provide guideline-based education (via animated videos) and adherence support via goal setting and tailored push notifications. Methods: Patients provided verbal or e-consent via REDCap generated e-mail links virtually (in-light of COVID-19) and completed baseline sociodemographic and e-health literacy (EHL) surveys (eHEALs) ; and DQoL (Diabetes quality of life) , DSMQ (Diabetes Self-Management Questionnaire) and DKQ-24 (Diabetes Knowledge Questionnaire) . Participants were guided on downloading the app and its functionality was explained in detail. Laboratory data were obtained by chart review from the Epic EHR. Results: Of the 50 patients, mean age was 46.9 (± 9.2) years, 70% were female, and 82% identified as Blacks and Hispanics. Overall, the cohort, with an average 13.1 ± 8.3 years since diagnosis, had high prevalence of complications (60%) , and poor glycemic control (HbA1C &amp;gt; 7.5, 58%) . At baseline, scores of satisfaction (22.6 ± 6.9) , worry (10.9 ± 8.4) , impact (15.5 ± 5.2) and total DQoL scores (48.9 ± 15.6) indicated low quality of life (QoL) . DSMQ (21.8 ± 6.9) and DKQ (18.4 ± 3) were low across patients with and without complications (p= 0.5 and 0.8, respectively) . Interestingly, 88% had moderate-good EHL scores. Conclusion: Most patients in our cohort demonstrated good e-health literacy scores. We expect that our mobile health application will promote diabetes education and self-management skills in our underserved minority community and favorably impact clinical outcomes. We eventually plan to disseminate the app and promote its uptake across marginalized populations on the national level. Disclosure S.Kaur: None. L.Mahali: None. E.Cosar: None. S.Jariwala: None. Funding New York Regional Center for Diabetes Translation Research

"Peer Support" intervention to improve glycemic control in type 2 diabetes mellitus: A literature review

Hyperglycemia is one of the complications of Type 2 Diabetes Mellitus (T2DM). Continuation of this situation in T2DM will lead to more serious complications such as morbidity and death. There are improvements and advances in the management of T2DM at present, but they are accompanied by an increase in medical costs. To solve these problems, an organized approach is needed to control hyperglycemia through peer support interventions which are considered to be able to reduce treatment costs. Peer support may take advantage of the ability of diabetes patients to support each other in managing their daily lives, which is very useful as a step to promote the type of daily behavioral efforts needed to prevent disease progression. This study aimed to identify the effect of peer support intervention in improving glycemic control in patients with T2DM. This study was a literature review using seven databases including PubMed, ScienceDirect, ProQuest, Clinical Key, Cochrane, Ebsco, and DOAJ. Inclusion criteria were: articles published in the last 10 years, in full text and in English version. Five studies were reviewed that met the inclusion criteria. The results of this review showed the effectiveness of peer support in improving glycemic control in diabetes patients. Peer support significantly lowered HbA1c and also led to a significant reduction in fasting blood sugar. Peer support may reduce glycosylated blood hemoglobin levels, increase knowledge regarding insulin use and increase diabetes self-management skills, especially in patients who do not have literacy skills. In conclusion, peer support can be used as a non-pharmacological therapy to improve glycemic control in patients with T2DM.

Efficacy and Safety of a Decision Support Intervention for Basal Insulin Self-Titration Assisted by the Nurse in Outpatients with T2DM: A Randomized Controlled Trial.

ObjectiveThe main aim of this study was to evaluate a combined fasting blood glucose based dosage self-titration setting and decision supported telephone coaching intervention on glycemic control and diabetes self-management skills, compared to the conventional care.MethodsA 12-week, single-blinded, randomized controlled trial was conducted on adults with type 2 diabetes (T2DM) primarily treated with basal insulin. After randomization, the intervention group (IG, n = 426) received a basal insulin self-titration decision support intervention administered by the Diabetes Specialty Nurses while the control group (CG, n = 423) received conventional care for 12 weeks, both included five telephone interviews. The primary efficacy endpoint was the effect of intervention on glycemic control, measured as the change in glycated hemoglobin (HbA1c) from baseline to Week 12 (after intervention) compared to the control group. Other endpoints included comparisons of the effects of intervention on fasting plasma glucose (FPG), postprandial plasma glucose (PPG), body weight, Michigan diabetes knowledge test (MDKT), diabetes empowerment scale-short Form (DES-DSF), and summary of diabetes self-care activities (SDSCA). Changes in the primary and secondary outcomes were compared using the t-test for continuous variables with a normal distribution and χ2-test for categorical variables.ResultsThe IG showed more improvements on mean HbA1c, compared to the CG (−2.8% vs −1.8%), so did the FPG, PPG, MDKT, DES-DSF and SDSCA (all P<0.01) after the 12-week follow up. Though the final mean insulin dose in the IG was higher than the CG at the end of the study (0.32 U/kg vs 0.28 U/kg), the changes of body weight were similar between the two groups (0.46kg vs 0.40kg, P=0.246), and the proportion of patients with hypoglycemia events during the whole trial were similar (20.65% vs 17.73%, P=0.279).ConclusionDecision supporting of basal insulin glargine self-titration assisted by Diabetes Specialty Nurses is effective and safe in patients with T2DM. Decision supported telephone coaching intervention offers ongoing encouragement, guidance, and determination of relevant sources of decisional conflict, facilitating adjusting the insulin dose.

A national survey of transition from pediatric to adult healthcare providers for adolescents and young adults with type 1 diabetes: perspectives of pediatric endocrinologists in Korea

Purpose Transition from pediatric to adult healthcare for adolescents and young adults with type 1 diabetes (T1D) increases the risk for poor outcomes. This study aimed to describe the circumstances and clinical practice patterns associated with this transition of care based on a nationwide survey of pediatric endocrinologists in Korea.Methods An electronic survey regarding the healthcare transition of T1D patients was administered to 143 pediatric endocrinologists registered in the Korean Society of Pediatric Endocrinology.Results The response rate was 50.2% (n=72). Among responders, 58.3% (n=42) were females, and 70.8% (n=51) worked in academic medical centers. The main reasons for transfer to adult care were request from a patient or family (69.6%) and age ≥18 years (42.0%). Impediments to transition were a long-lasting therapeutic relationship (72.9%) and lack of adult specialists in T1D care (62.9%). Communication between pediatric and adult endocrinologists was via nonstructured patient summary (68.6%) and telephone or email (27.1%). Responders reported that successful transition requires development of transition protocols (79.2%) and a multidisciplinary team approach for transition care (52.8%).Conclusions Transition care of T1D patients is a challenge to pediatric endocrinologists in Korea. Development of transition care protocols for healthcare providers and improvement of diabetes self-management skills for patients are needed.