Diabetes Self-management Behaviors Research Articles

Study protocol for family model diabetes self-management education with Marshallese participants in faith-based organizations

BackgroundCulturally-appropriate family models of diabetes self-management education and support (DSMES) using community health workers (CHWs) have been shown to help address barriers to improving type 2 diabetes mellitus (T2DM) self-management for racial/ethnic minority communities; however, there is limited DSMES research among Marshallese and other Pacific Islanders. Using a community-based participatory research approach, we engaged community stakeholders to co-design a study to implement a culturally adapted family model DSMES (F-DSMES) intervention in faith-based organizations (FBOs) (i.e., churches). MethodsUsing a cluster-randomized controlled trial design, we will assess the effectiveness of the F-DSMES intervention for Marshallese patients with T2DM in Arkansas and Oklahoma. Twenty-four FBOs (with 12 primary participants per FBO) will be randomized to one of two study arms: the intervention arm or the wait-list control arm. Primary participants must have at least one family member willing to attend education sessions and data collection events. The F-DSMES intervention consists of ten h of diabetes education delivered by CHWs over eight to ten weeks. Data will be collected from the intervention arm at pre-intervention (baseline), immediate post-intervention (12 weeks), and three months post-intervention. The wait-list control arm will complete a second pre-intervention data collection before receiving the intervention. The primary study outcome will be glycemic control, as measured by HbA1c. Secondary measures include glucose, weight, body mass index, blood pressure, diabetes self-management behaviors, and diabetes management self-efficacy. ConclusionThe knowledge gained from this research will inform future DSMES and other health promotion interventions conducted with Marshallese and other Pacific Islander communities.

Cognitive Function and Self-Management Behaviors in Older Adults With Type 2 Diabetes.

Type 2 diabetes (T2D) is strongly associated with cognitive impairment. Decreased cognitive function could affect daily self-management behaviors critical for people with T2D. Executive function is significant for daily self-management, and decreased subjective cognitive function could be an early indicator of poor daily self-management. However, little is known about whether executive or subjective cognitive function affects daily self-management behaviors in older adults. We investigated the effect of executive function or subjective cognitive function on daily self-management behaviors (diet, glucose management, physical activity, and physician contact) in older adults with T2D. We used a cross-sectional, observational design with convenience sampling of 84 adults aged ≥60 years with T2D. Telephone-administered cognitive function tests measured participants' overall cognitive and executive function levels. Subjective cognitive function, diabetes self-management, and covariates, including demographic information (age, gender, race/ethnicity, and level of education), body mass index, depressive symptoms, and diabetes duration, were assessed using online surveys. Data were analyzed using bivariate correlation and backward stepwise regression. The mean age of the sample was 68.46 ± 5.41 years. Participants were predominantly female and White, and the majority had normal cognitive function. Controlling for demographics, body mass index, depressive symptoms, and diabetes duration, a decrease in executive function indicated by a greater number of errors made during the telephone-administered Oral Trail Making Test Part B relative to the sample was associated with poorer adherence to physician contact behaviors. Subjective cognitive function was not associated with any self-management behaviors. A reduction in executive function was associated with poorer adherence to physician contact behaviors in older adults with T2D and normal cognitive function; lack of adherence to physician contact behaviors could be an early indicator of declining cognitive function. Difficulties or changes in routine diabetes self-management behaviors should be closely monitored in older adults. Cognitive assessment should be followed when needed.

Roles of Serious Game in Diabetes Patient Education

Background Diabetes affects many people across the world. Diabetes education plays a critical role in helping people with diabetes to perform diabetes self-management at home. Intervention We explored whether serious games can be used as a supplementary tool for diabetes education. Two online video games- the “Diabetic Dog” game and “Carb Counting with Lenny the Lion” game, were used for the study. Methods Fourteen patients with Type II diabetes were recruited from the Norman Diabetes Center by personal invitations. After initial training, the patients played the games a minimum of four times per week during the two-week study duration. Pre- and post-assessments of patients' diabetes knowledge and self-efficacy in diabetes self-management behaviors were performed using questionnaires, and an interview was conducted at the end to gauge the effectiveness of the game intervention. Results The results from the questionnaires show a general trend of improvement in patient diabetes knowledge and self-efficacy in diabetes self-management. A general trend of improvements in patients’ self-efficacy in controlling blood sugar level, handling abnormal blood sugar levels, taking insulin, and complying with a diabetes diet was observed. The interview results showed that the patients reinforced their diabetes knowledge and became more aware of their own lifestyles by playing diabetes educational games. They perceived the games as fun and easy to play. They also provided suggestions for the game design for diabetes education. Conclusion The study showed that serious game intervention had good potential to be a useful supplement to clinic-based diabetes education in improving patient diabetes knowledge and increasing patient self-efficacy in diabetes self-management behavior.

How has the COVID-19 Pandemic Affected Diabetes Self-Management in People With Diabetes? - A One-Year Follow-Up Study.

In Denmark, the COVID-19 pandemic resulted in two lockdowns, one from March to May 2020 and another from December 2020 to April 2021, which had severe impact on everyday life. The aim of this study was to explore changes in diabetes self-management behaviors during the pandemic and to examine how specific population characteristics were associated with changes in diabetes management. In a cohort study from March 2020 to April 2021, two online questionnaires were collected from a total of 760 people with diabetes. Descriptive statistics were used to assess the proportion of participants experiencing improvements, deterioration, and status quo in diabetes self-management during the pandemic. Using logistic regressions, baseline characteristics were explored as potential predictors of change. Approximately half of the participants reported that they experienced lower physical activity in April 2021 compared to before the pandemic, approximately one fifth reported diabetes self-management to be more difficult than prior to the pandemic, and one fifth reported eating more unhealthily than before the pandemic. Some participants reported higher frequency of high blood glucose levels (28%), low blood glucose levels (13%) and more frequent blood glucose variability (33%) compared to before. Easier diabetes self-management was reported by relatively few participants, however, 15% reported eating more healthily, and 20% reported being more physically active. We were largely unable to identify predictors of change in exercise activities. The few baseline characteristics identified as predictors of difficulties in diabetes self-management and adverse blood glucose levels due to the pandemic were sub-optimal psychological health, including high diabetes distress levels. Findings indicate that many people with diabetes changed diabetes self-management behaviors during the pandemic, mostly in a negative direction. Particularly high diabetes distress levels in the beginning of the pandemic was a predictor of both positive and negative change in diabetes self-management, indicating that people with high diabetes distress levels could potentially benefit from increased support in diabetes care during a period of crisis.

The effects of a nurse-led integrative medicine-based structured education program on self-management behaviors among individuals with newly diagnosed type 2 diabetes: a randomized controlled trial

BackgroundInternational guidelines advocate providing prompt structured education to individuals with diabetes at diagnosis. However, among the few eligible structured education programs, heterogeneous intervention regimens and inconsistent findings were reported. Eligible programs for Chinese individuals with diabetes are lacking. This study aimed to investigate the effects of a nurse-led integrative medicine-based structured education program on self-management behaviors, glycemic control and self-efficacy among individuals with newly diagnosed type 2 diabetes.MethodsEmploying a randomized controlled trial, 128 individuals with type 2 diabetes diagnosed in the preceding three to nine months were recruited from four university-affiliated tertiary hospitals in Xi’an City, Northwest China, and randomly allocated to the intervention or control groups after baseline assessments. Participants in the intervention group received a 4-week nurse-led integrative medicine-based structured education program, which is theoretically based on the Health Belief Model and Self-Efficacy Theory, in line with updated diabetes management guidelines, and informed by relevant systematic reviews. Participants in the control group received routine care. Self-management behaviors and self-efficacy were measured with the Summary of Diabetes Self-Care Activities and the Diabetes Management Self-Efficacy Scale at baseline, immediate post-intervention and 12 weeks following the intervention while Glycated Hemoglobin A was measured at baseline and the 12th-week follow-up. The intervention effects were estimated using the generalized estimating equation models.ResultsParticipants in the intervention group exhibited significantly better self-management performance in specific diet regarding intake of fruits and vegetables at both follow-ups (β = 1.02, p = 0.011 and β = 0.98, p = 0.016, respectively), specific diet regarding intake of high-fat foods at the immediate post-intervention follow-up (β = 0.83, p = 0.023), blood glucose monitoring at the 12th-week follow-up (β = 0.64, p = 0.004), foot care at both follow-ups (β = 1.80, p < 0.001 and β = 2.02, p < 0.001, respectively), and medication management at both follow-ups (β = 0.83, p = 0.005 and β = 0.95, p = 0.003, respectively). The intervention also introduced significant improvements in Glycated Hemoglobin A (β = − 0.32%, p < 0.001), and self-efficacy at both follow-ups (β = 8.73, p < 0.001 and β = 9.71, p < 0.001, respectively).ConclusionsThe nurse-led integrative medicine-based structured education program could produce beneficial effects on multiple diabetes self-management behaviors, glycemic control and self-efficacy.Trial registrationThis study was retrospectively registered in the ClinicalTrials.gov. on 25/08/2017; registration number: NCT03261895.

Division of Type 1 Diabetes Responsibility in Latinx and Non-Latinx White Mother-Adolescent Dyads.

Incidence rates of type 1 diabetes are increasing faster in Latinx youth than other ethnic groups, yet this population remains understudied. The current study (1) tested differences in division of diabetes-related responsibility (adolescent alone, mother alone, and shared) across Latinx and non-Latinx White families (N = 118 mother-adolescent dyads, 56 = Latinx dyads, Mage=13.24 years), and (2) examined associations between diabetes responsibility and adolescent health (HbA1c, diabetes self-management behaviors, and depressive symptoms). Latina mothers reported more shared and less adolescent responsibility than non-Latinx White mothers, but there were no ethnic differences in adolescent reports of responsibility. Independent of demographic and illness-related characteristics, mother- and adolescent-reports of shared responsibility were associated with higher self-management behaviors, while individual responsibility (adolescent or mother alone) was generally associated with lower self-management behaviors. Shared responsibility associations with higher mother-reported self-management behaviors occurred among Latinx families, but not non-Latinx White families. Shared and individual responsibility were not associated with HbA1c or depressive symptoms. The findings suggest the importance of shared responsibility for diabetes management in adolescence, particularly in Latinx families.

Nexus between constructs of social cognitive theory model and diabetes self-management among Ghanaian diabetic patients: A mediation modelling approach.

The promotion of Diabetes Self-Management (DSM) practices, education, and support is vital to improving the care and wellbeing of diabetic patients. Identifying factors that affect DSM behaviours may be useful to promote healthy living among these patients. The study assessed the determinants of DSM practices among Type 2 diabetes mellitus (T2DM) patients using a model-based social cognitive theory (SCT). This cross-sectional study comprised 420 (T2DM) patients who visited the Diabetic Clinic of the Komfo Anokye Teaching Hospital (KATH), Kumasi-Ghana. Data was collected using self-structured questionnaires to obtain socio-demographic characteristics, T2DM-related knowledge, DSM practices, SCT constructs; beliefs in treatment effectiveness, level of self-efficacy, perceived family support, and healthcare provider-patient communication. Path analysis was used to determine direct and indirect effects of T2DM-related knowledge, perceived family support, and healthcare provider service on DSM practices with level of self-efficacy mediating the relationships, and beliefs in treatment effectiveness as moderators. The mean age of the participants was 53.1(SD = 11.4) years and the average disease duration of T2DM was 10 years. Most of the participants (65.5%) had high (>6.1mmol/L) fasting blood glucose (FBG) with an average of 6.93(SD = 2.41). The path analysis model revealed that age (p = 0.176), gender (p = 0.901), and duration of T2DM (p = 0.119) did not confound the relationships between the SCT constructs and DSM specified in the model. A significant direct positive effect of family and friends' support (Critical ratio (CR) = 5.279, p < 0.001) on DSM was observed. Self-efficacy was a significant mediator in this relationship (CR = 4.833, p < 0.001). There were significant conditional indirect effects (CIE) for knowledge of T2DM and family and friends' support at medium and high levels of belief in treatment effectiveness (p < 0.05) via level of self-efficacy on DSM practices. However, no evidence of moderated-mediation was observed for the exogenous variables on DSM. Diabetes-related knowledge of T2DM, family and friends' support, level of self-efficacy, and belief in treatment effectiveness are crucial in DSM practices among Ghanaian T2DM patients. It is incumbent to consider these factors when designing interventions to improve DSM adherence.

Barriers and enablers to sustaining self-management behaviours after attending a self-management support intervention for type 2 diabetes: a protocol for a systematic review and qualitative evidence synthesis

Background: Attendance at self-management support interventions is associated with improved outcomes for people with type 2 diabetes. However, initial improvements are often not sustained beyond one year, which may be a result of difficulties in sustaining positive changes made to self-management behaviours. The aim of this systematic review is to synthesise qualitative research on the barriers and enablers to sustaining self-management behaviours following attendance at a self-management support intervention for type 2 diabetes. Methods: The review will use the “best fit” framework synthesis method to develop a new conceptual model of sustained behaviour change in type 2 diabetes. MEDLINE (Ovid), EMBASE (Elsevier), CINAHL (EBSCO), PsycINFO (Ovid), SCOPUS, ProQuest Dissertations and Theses, WorldCat and Open Grey will be searched to identify primary qualitative studies. A parallel search will be conducted in Google Scholar to identify relevant theories for the development of an a priori framework to synthesise findings across studies. Methodological limitations of included studies will be assessed using an adapted version of the Critical Appraisal Skills Programme tool for Qualitative Studies. A sensitivity analysis will be conducted to examine the impact of studies with methodological limitations on synthesis findings. Confidence in the synthesis findings will be assessed using the GRADE-CERQual tool. Screening, data extraction, methodological limitation assessment, synthesis and GRADE-CERQual assessment will be conducted by one author with a second author independently verifying a randomly selected 20% sample. Discussion: This review will develop a new model of sustained behaviour change in type 2 diabetes self-management. The findings can be used to inform the development of new interventions or revision of existing interventions to better support sustained engagement in type 2 diabetes self-management behaviours.

A smartphone application of diabetes coaching intervention to prevent the onset of complications and to improve diabetes self-management: A randomized control trial

Background and aimDiabetes mellitus (DM) has been a worldwide public health problem during the last two decades. To examine the effect of a smartphone application of diabetes coaching intervention on improving self-management behaviors and preventing onset diabetes complications. MethodsA randomized control trial, two groups, pre-test, and post-test design with a non-equivalent control group was conducted. The intervention group received a 12-week smartphone application of diabetes coaching intervention to improve diabetes self-management behaviors and to prevent onset diabetes complications. While the control group received the usual care from the community health centers. The smartphone application consisted of narrative App-based coaching, a printed user guide, mindfulness-based coaching; skill-based coaching, and a small App-interaction. ResultsAfter implementation, the self-management behaviors among the experimental group were improved than the control group in terms of dietary control, physical exercise, blood glucose monitoring, medication adherence, and screening of complications. The clinical outcomes were also significantly improved among the experimental group and to the control group. ConclusionsA smartphone application-based diabetes coaching intervention was feasible to apply as a nationwide program to promote diabetes self-management (DSM) during the covid-19 pandemic

Barriers and enablers to sustaining self-management behaviours after attending a self-management support intervention for type 2 diabetes: a protocol for a systematic review and qualitative evidence synthesis

Background: Attendance at self-management support interventions is associated with improved outcomes for people with type 2 diabetes. However, initial improvements are often not sustained beyond one year, which may be a result of difficulties in sustaining positive changes made to self-management behaviours. The aim of this systematic review is to synthesise qualitative research on the barriers and enablers to sustaining self-management behaviours following attendance at a self-management support intervention for type 2 diabetes. Methods: The review will use the "best fit" framework synthesis method to develop a new conceptual model of sustained behaviour change in type 2 diabetes. MEDLINE (Ovid), EMBASE (Elsevier), CINAHL (EBSCO), PsycINFO (Ovid), SCOPUS, ProQuest Dissertations and Theses, WorldCat and Open Grey will be searched to identify primary qualitative studies. A parallel search will be conducted in Google Scholar to identify relevant theories for the development of an a priori framework to synthesise findings across studies. Methodological limitations of included studies will be assessed using an adapted version of the Critical Appraisal Skills Programme tool for Qualitative Studies. A sensitivity analysis will be conducted to examine the impact of studies with methodological limitations on synthesis findings. Confidence in the synthesis findings will be assessed using the GRADE-CERQual tool. Screening, data extraction, methodological limitation assessment, synthesis and GRADE-CERQual assessment will be conducted by one author with a second author independently verifying a randomly selected 20% sample. Discussion: This review will develop a new model of sustained behaviour change in type 2 diabetes self-management. The findings can be used to inform the development of new interventions or revision of existing interventions to better support sustained engagement in type 2 diabetes self-management behaviours.

Perspectives of Persons With Type 2 Diabetes Toward Diabetes Self-Management: A Qualitative Study

Background. The global increase in type 2 diabetes (T2D) poses a significant public health challenge worldwide. Due to the chronic and complex nature of the disease, management does not depend on pharmacotherapy alone; rather, a comprehensive medical and self-management plan is required. Diabetes Self-Management Education programs should address diabetes-specific behaviors and be grounded in patients' perceptions of their disease and its consequences. Aim. The study aims to understand perceptions of diabetes self-management (DSM) among persons of different nationalities with T2D living in Qatar. Method. A phenomenological qualitative study was implemented using four focus group interviews using Triandis Interpersonal Behavior Model to understand factors influencing DSM perceptions and behaviors. Therefore, deductive content analysis was used, also inductive content analysis used to find new emerging themes. Twenty-nine participants with T2D of 12 different nationalities were recruited. Results. Content analyses revealed that participants were mainly motivated to manage their diabetes by fear of future health complications-and the resulting impact on their families-triggered by witnessing these complications on other family members and friends. Factors that influenced DSM included cultural factors such as food content and holidays' customs, weather conditions, psychological distress, and social factors such as lack of family support. Furthermore, access to healthy food, number of working hours and time, and cost of DSM supplies were found to be among the barriers to DSM. Conclusion. Understanding and considering patients' perspectives is a core component of culturally competent and evidence-based DSM programs, and it should be considered in any DSM program.

Patients' and Nurses' Perceptions of Diabetes Self-Management in Oman: A Qualitative Study.

Patient-centered care enhances diabetes self-management; however, the primary care nurse’s role in promoting diabetes self-management within a patient-centered care model is unexplored. This study investigated the perceptions of Omani patients with type-2 diabetes and their clinic nurses on the nurses’ role in promoting diabetes self-management within a patient-centered care approach. The thematic analysis of the data from individual interviews with patients (n = 24) revealed two themes: patients experienced “missteps on an unclear path” and “nurses doing their best.” Patients struggled to identify treatment goals and faltered in their attempts to adopt diabetes self-management behaviors. The nurses’ role was perceived as task-oriented. Nurse narratives (n = 21) revealed that very few nurses were aware of the patient-centered care philosophy. A theme emerged of nurses “needing a new perspective” to transition their care delivery to align with the patient-centered care model. Nurses expected patients to comply with their instructions and missed opportunities for assessment, engagement, and collaborative problem-solving during patient encounters. The shift from a physician-based medical model to a patient-centered primary care delivery system may necessitate that nurses engage more effectively with patients, collaborate on an individual treatment plan, and motivate them to adopt self-management behaviors.

605-P: Self-Management Behaviors Mediate the Relationship between Diabetes Burden in Caregivers and A1C

Type 1 Diabetes (T1D) treatment involves engaging in multiple complex and burdensome self-management behaviors daily. The purpose of this study was to examine the relationship between diabetes burden, self-management behaviors, and A1C. Caregivers of 77 adolescents with T1D (age=14.9±1.9 years, A1C=9.8±1.6%, T1D duration=6.8±3.5 years, 45.5% male) participating in a RCT that provided integrated behavioral intervention to improve A1C completed a short version of Problem Areas in Diabetes-Parent Revised (PAID-PR) at the baseline visit prior to beginning intervention. The Immediate Burden subscale of PAID-PR was used to assess diabetes burden. Objective self-management behaviors were calculated using data downloaded from adolescents’ T1D devices. As caregiver burden increased, so did the frequency of self-management behaviors of carbohydrate entries per day (r=0.365, p&amp;lt;0.01) and insulin boluses per day (r=0.273, p&amp;lt;0.05) , but not blood glucose readings. Caregiver burden increased as A1C decreased (r=-0.224, p&amp;lt;0.05) . There was a significant indirect effect of diabetes burden on A1C through the self-management behaviors for carbohydrate entries per day (b=-0.023, 95% bias-corrected and accelerated bootstrap (BCa) CI [-0.056, -0.002] and insulin boluses per day (b=-0.016, 95% BCa CI [-0.041, 0.001]) . Higher T1D self-management is associated with lower A1C, but this may come with a cost- greater feelings of burden due to T1D management. Family interventions to promote teamwork and assist caregivers and adolescents to appropriately distribute responsibility for T1D management may allow for continued high engagement while reducing burden. Disclosure H.K.O'donnell: None. A.C.Himelhoch: None. T.B.Vigers: None. G.T.Alonso: None. S.Majidi: None. L.Pyle: None. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. R.Wadwa: Advisory Panel; Dompé, Consultant; Beta Bionics, Inc., Other Relationship; Tandem Diabetes Care, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Tandem Diabetes Care, Inc. K.A.Driscoll: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK113363)

49-LB: Use of Financial Incentives to Promote Adolescent Type 1 Diabetes Self-Management—A Pilot Randomized Controlled Trial

Background: Providing individuals with immediate, consistent inducements for health behaviors that do not provide proximal tangible benefits may promote adherence to diabetes self-management behaviors. Objective: To evaluate whether financial incentives lead to improvement in glycemic control and self-management behaviors in adolescents with type 1 diabetes. Methods: We conducted a randomized controlled crossover study with 12-18 year olds with type 1 diabetes. Adolescents self-selected target self-management behaviors (e.g., increase continuous glucose monitor [CGM] sensor wear time) and outcome goals (e.g., improve time in range [TIR]) and could earn up to $180 in each 3-month intervention cycle. Adolescents cycled through 3 study arms every 3 months: gain-framed payment where adolescents earned money for meeting behavioral goals, loss-framed payment where adolescents lost a portion of a weekly payment for not meeting behavioral goals, and usual care. Adolescents earned or lost $1.75 per day in the financial incentives arms, and a $2.75 weekly bonus for meeting their outcome-based goal. Goals were modeled against study arms with generalized linear mixed models to account for the longitudinal nature of the crossover design. Results: Out of 39 participants (mean age 16.1 years, 54% male, mean baseline HbA1c 9.42%, 38% insulin pump use, 95% CGM use) , 34 completed the trial. Mean HbA1c aggregated over all interventions was lower compared to baseline at 9.07% (p=0.13) and there was no difference in HbA1c among the 3 arms. Compared to the mean TIR for those under usual care of 39%, mean TIR under gain- and loss-frames were 45% (p&amp;lt;0.01) and 43% (p&amp;lt;0.01) , respectively. Compared to a mean 41% behavioral goal attainment within usual care, mean behavioral goal attainment under gain- and loss-frames were 50% (p&amp;lt;0.01) and 45% (p&amp;lt;0.01) , respectively. Conclusions: Financial incentives can improve adolescent self-management behaviors and time in range in the short term and merits further longitudinal study to evaluate the effects on glycemic control and health care utilization. Disclosure F. Malik: n/a. T. Chen: None. M. Manzueta: None. J. Yi-frazier: None. C. Pihoker: None. J. L. Leblanc: None. S. K. Shah: None. D. Wright: None. Funding American Diabetes Association (1-18-ICTS-100)

35-LB: Classification in Koreans with Oral Antidiabetic Agents by Diabetes Education and Psychological Support Needs Using Q Methodology

Objective: To classify diabetes attitude, wishes and needs affecting diabetes self-management behaviors in persons with type 2 diabetes (T2D) taking oral medication. Methods: Q-methodology, a mixed method of inquiry with bottom up-logic, was used to identify psychological phenotypes. Data using 33 Q-samples collected from 51 Q-Korean sorters (35men; 16 women) were analyzed by factor analysis using varimax orthogonal rotation (PQ Method Program, Version 2.35) . The Summary of Diabetes Self-Care Activity measure and A1C in the past 6 months were included to obtain comprehensive understanding for managing diabetes. Findings: A total of 34% variance was explained by 4 factors: Factor 1 (n=18) : moderate management with low confidence (age=60.0±12.2; A1C=7.06±1.98) , Factor 2 (n=15) : good management with high confidence (age= 68.3±9.7; A1C=6.60±0.59) , Factor 3 (n=6) : good management, necessitating assurance from trustful others including health care providers and logistic support (age=65.8±8.4; A1C=6.53±0.86) , Factor 4 (n=12) : poor management with low confidence and behavioral skills to be improved (age= 56.4±14.1; A1C= 7.53 ±1.14) . Conclusions: Psychosocial screening affecting diabetes self-management behaviors needs to be regularly assessed to provide precision health in T2D education and support. Since those in a younger age were associated with poor diabetes management, further investigation is warranted to identify life stage care needs for T2D education and support. Disclosure E. Cha: None. M. Shin: None. H. Jang: None. K. Joung: None. H. Kim: None. M. S. Faulkner: None. Funding Korea Research Foundation (NRF-2019R1A2C1087199)

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.

Pharmacists’ perceived role in supporting diabetes education and self-management in Ireland: a qualitative study

Background: Support for people with diabetes is necessary for optimal self-management. Structured diabetes education programmes fulfil this need, but attendance rates are consistently low. The role of pharmacists has expanded but the profession remains underutilised in chronic disease management. The objective of this study is to explore pharmacists’ perceived role in the support of diabetes education and self-management behaviours. Methods: A qualitative study using semi-structured interviews of community pharmacists in Ireland was conducted. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. Results: Ten pharmacists were interviewed. The four themes identified illustrate the juxtaposition of pharmacists’ potential in diabetes care with the realities of current pharmaceutical practice. One theme outlined the relationship between the person with diabetes and the pharmacist, ‘Patient or customer: the nature of the pharmacist relationship’. Two themes described the pharmacists’ role in supporting diabetes education and self-management, ‘Beyond medication: pharmacists’ current and potential role in diabetes management’ and ‘Need for diabetes education’. The final theme highlighted the barriers to a more engaged role in patient care, ‘Barriers: “all the stuff that gets in the way”’. Conclusion: The relationship between pharmacists and people with diabetes could facilitate pharmacists in supporting diabetes self-management. However, variability across pharmacists’ level of involvement and consistent resource barriers were noted. Pharmacists were poorly informed about structured diabetes education programmes. Further research is needed to explore this variability but there may be potential to enhance the pharmacist role in promoting attendance at structured diabetes education programmes.

Exploring the Discursive Emphasis on Patients and Coaches Who Participated in Technology-Assisted Diabetes Self-management Education: Clinical Implementation Study of Health360x

BackgroundA critical unmet need for underserved patients with diabetes is regular access to sufficient support for diabetes self-management. Although advances in digital technologies have made way for eHealth applications that provide a scalable path for tailored interventions for self-management of chronic conditions, health and digital literacy has remained an obstacle to leveraging these technologies for effective diabetes self-management education. Studies have shown that the availability of coaches helps to maintain engagement in internet-based studies and improves self-efficacy for behavior change. However, little is known about the substances involved in these interactions.ObjectiveThis study aims to compare the content of conversations between patient–coach pairs that achieved their self-management goals and those that did not. The context is a clinical implementation study of diabetes self-management behavior change using Health360x within the practices of the Morehouse Choice Accountable Care Organization in the Atlanta metro area. Health360x is a coach-assisted consumer health information technology designed to support self-management skills acquisition and behavior among underserved, high-risk patients with diabetes.MethodsWe provide a novel analysis of the discursive emphasis on patients and coaches. We examined transcripts of visits using a structural topic model to estimate topic content and prevalence as a function of patient and coach characteristics. We compared topics between patient–coach pairs that achieved diabetes-related self-management goals and those who did not. We also estimated a regression in which utterances are the units, the dependent variable is the proportion of an utterance that is about a given topic, and the independent variables are speaker types and explored other themes.ResultsTranscripts from 50 patients who were recruited and consented, starting in February 2015, were analyzed. A total of 44 topics were estimated for patient–coach pairs that achieved their intended health goals and 50 topics for those who did not. Analysis of the structural topic model results indicated that coaches in patient–coach pairs that were able to achieve self-management goals provided more contextual feedback and probed into patients’ experience with technology and trust in consumer information technologies. We also found that discussions around problem areas and stress, support (βCoach=.015; P<.001), initial visits (βCoach=.02; P<.001), problems with technology (βCoach=.01; P<.001), health eating goals (βCoach=.01; P=.04), diabetes knowledge (βCoach=.02; P<.001), managing blood sugar (βCoach=.03; P<.001), and using Health360x (βCoach=.003; P=.03) were dominated by coaches.ConclusionsCoach-facilitated, technology-based diabetes self-management education can help underserved patients with diabetes. Our use of topic modeling in this application sheds light on the actual dynamics in conversations between patients and coaches. Knowledge of the key elements for successful coach–patient interactions based on the analysis of transcripts could be applied to understanding everyday patient–provider encounters, given the recent paradigm shift around the use of telehealth.

The effectiveness of an education intervention based on self-care model on diabetes self-management behaviors and glycemic control

IntroductionThe needs of diabetic patients are not only limited to adequate glycemic control but also correspond with preventing complications and increasing their awareness to participate in self-management. The study aimed to analyze the effectiveness of an education intervention based on self-care model to Diabetes self-management behaviour (DSM behaviour). MethodsThe study was conducted from January to August 2021 at diabetic clinics of Thika level 5 hospital (TL5H) and Kiambu level 5 hospital (KL5H). The study employed a pre-test post-test non-equivalent quasi-experimental study design. There were 96 adolescents with Type 1 Diabetes Mellitus (T1DM) obtained by stratified random sampling technique, and assigned into experimental (48 respondents) and control group (48 respondents). Diabetes self-management behaviours were evaluated in the first and seventh month using The Summary of Diabetes Self Care Activities (SDSCA) questionnaire. Paired sample T-Test and Independent T-test was used to analyze data. ResultsPaired sample T-test statistical revealed a significant difference in increasing level of DSM Behaviour and decreasing HbA1c (p < 0.05) before and after the intervention; Independent T-test discovered a significant difference on DSM Behaviour and HbA1c (p < 0.05) between the intervention and control group at post-intervention. ConclusionsEducation intervention based on self-care model is an effective program that can improve DSM Behaviour and HbA1c level. In addition, the education intervention based on self-care model needs to be implemented continuously to prevent complications and improve self-care and HbA1c level for diabetic patients.

The Effects of Snack Control Education and Telephone Coaching on Self-Management, Social Support, Self-Efficacy, and Blood Glucose in Diabetes Patients

Dietary therapy for diabetes is the most basic way to manage blood glucose. Currently, the nutritional intake rate of diabetic patients in Korea is beyond the recommended rate of the Korean Diabetes Association, showing large amounts of carbohydrates in foods consumed as snacks with an additional focus on sugar. Thus, it is necessary to support healthy dietary habits through snack control. This study is a random assignment experimental study with a total of 56 participants; 28 participants were in the control group, while the remaining 28 patients had type 2 diabetes and had visited Kyung Hee University Hospital. The experimental group with snack control education and telephone coaching exhibited a higher self-management score (t = –9.494, &lt;i&gt;P&lt;/i&gt; &lt; 0.001), perceived social support score (t = 7.201, &lt;i&gt;P&lt;/i&gt; &lt; 0.001), and self-efficacy score (t = 7.185, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) than the control group. Additionally, the experimental group showed lower levels of glycosylated hemoglobin and average blood glucose compared to the control group (t = –4.820, &lt;i&gt;P&lt;/i&gt; &lt; 0.001). Thus, snack control education and telephone coaching are effective in improving diabetes self-management behavior, perceived social support, self-efficacy, and reducing glycosylated hemoglobin and average blood glucose. These results confirm the usefulness of snack education materials, and I suggest snack control education as a means of arbitration to improve the self-care of diabetics.