Improve Diabetes Self-management Research Articles

Use of Financial Incentives to Promote Adolescent Type 1 Diabetes Self-management: A Pilot Randomized Controlled Trial.

To evaluate whether financial incentives lead to improvement in self-management behaviors and glycemia in adolescents with type 1 diabetes (T1D). Adolescents (12- to 18-year-olds) with T1D selected incentivized self-management behavior and clinical outcome goals in a 3-treatment (gain frame, loss frame, no incentives) crossover randomized controlled trial. Participants could earn up to $180 in each 12-week incentive treatment arm. Compared with a mean 41% behavioral goal attainment within the nonfinancial incentives arm, mean behavioral goal attainment under gain and loss frames was 50% (P < 0.01) and 45% (P < 0.01), respectively. Mean time in range (TIR) in gain frame and loss frame arms was higher 43% (P < 0.01) and 42% (P < 0.01), respectively, compared with when not receiving financial incentives (38%). There was no difference in A1C among the three arms. Financial incentives can improve diabetes self-management behaviors and TIR in adolescents with T1D in the short-term.

Feasibility and acceptability of a tailored health coaching intervention to improve type 2 diabetes self-management in Saudi Arabia: a mixed-methods randomised feasibility trial

BackgroundAround one-third of the population of Saudi Arabia have been diagnosed with type 2 diabetes, a condition often requiring lifestyle changes. Personalised health coaching, a strategy developed to assist individuals...

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

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

Diabetes Basic Training Program: Empowering Veterans for Wellness.

Diabetes impacts 1 in 4 patients in the Veterans Health Administration and is associated with serious negative health consequences in addition to high health care system utilization and cost. The Cincinnati Veterans Affairs Medical Center developed Diabetes Basic Training, a 9-week intervention that blends medical consultation with group support and training in self-management strategies for enhancing patient motivation and empowerment. Diabetes Basic Training combined 3 monthly shared medical appointments and 6 Diabetes Self-Management Program sessions led in part by trained peers with diabetes. Diabetes Self-Management Program sessions focus on educating patients on diabetes and self-management tools and encourage active practice in building self-management skills and confidence. During shared medical appointments, a clinical psychologist or psychology postdoctoral fellow skilled in motivational interviewing facilitated the group to enhance patient motivation and empowerment for improved diabetes self-management. This novel program combined 2 types of group appointments to provide veterans with access to health care professionals and education on diabetes self-management. Preliminary results suggest the need for larger studies and that these programs may be beneficial in a veteran population.

Electronic Interactive Games for Glycemic Control in Individuals With Diabetes: Systematic Review and Meta-Analysis.

Several electronic interventions have been used to improve glycemic control in patients with diabetes. Electronic interactive games specific to physical activity are available, but it is unclear if these are effective at improving glycemic control in patients with diabetes. This study aimed to determine the effects of electronic game-based interventions on glycemic control in patients with diabetes. Relevant studies that were published before April 1, 2023, were searched from 5 databases: PubMed, Embase, Web of Science, Scopus, and Cochrane Library. Eligibility criteria included prospective studies examining the relationship between electronic games with physical activities or diet education and glycemic control as the outcome. The risk of bias was assessed using the Cochrane risk-of-bias tool. All analyses were conducted using RevMan5.4.1. Depending on the heterogeneity across studies, the pooled effects were calculated using fixed-effects or random-effects models. Participants from 9 studies were included and assessed. Glycated hemoglobin (HbA1c) and fasting blood glucose improved in the intervention group, although the analysis revealed no significant reduction in HbA1c (-0.09%, 95% CI -0.29% to 0.10%) or fasting blood glucose (-0.94 mg/dL, 95% CI -9.34 to 7.46 mg/dL). However, the physical activity of individuals in the intervention group was significantly higher than that of those in the control group (standardized mean difference=0.84, 95% CI 0.30 to 1.38; P=.002). Other outcomes, such as weight and blood lipids, exhibited no significant improvement (all P>.05). Electronic games had a good impact on participants' physical activity and offered an advantage in glycemic control without reaching statistical significance. Electronic games are convenient for reminders and education. Low-intensity exercise games may not be considered a better adjuvant intervention to improve diabetes self-management care.

Healthcare coaching program for youth with type 1 diabetes in South Korea: a pilot study.

This pilot study aimed to assess the feasibility, preliminary efficacy, and effects of a mobile app healthcare coaching program developed based on self-regulation theory among youths with type 1 diabetes. A mixed-method design was utilized. Participants were randomly assigned into intervention (n=23, 12-week coaching program) or control groups (n=16, usual care). Pre- and post-intervention assessments included self-efficacy, diabetes management behavior, and health outcomes (quality of life, depression, and HbA1c). Quantitative data were analyzed with SPSS/WIN ver. 26.0. The narrative information from the participants in the healthcare coaching program underwent content analyzed. The intervention group had significantly lower depression scores (t=2.57, p=.014) than the control group. No significant differences were observed in self-efficacy, diabetes management behavior, and health outcomes between the two groups. The average frequency of health behavior monitoring per week among the participants was 1.86±1.60. The qualitative findings indicated that participants perceived improved diabetes self-management with the intervention; however, challenges during vacations, dietary control difficulties, and a lack of disease awareness were identified. The healthcare coaching program improved psychological aspects for youth with type 1 diabetes. Further research is needed to develop and implement mobile app interventions aimed at enhancing compliance with diabetes management in pediatric and adolescent populations.

A Formative Evaluation of Diabetes Self-Management Education and Support Within the Virtual Medical Center.

The Diabetes Self-Management Education and Support (DSMES) program provides education and medical monitoring of diabetes to Veterans through the Virtual Medical Center (VMC). Qualitative interviews were conducted with 15 key stakeholders (4-DSMES VMC trainers, 5-clinical faculty, and 6-Veterans) from across Ohio urban and rural populations for up to 1h about their experiences using the program and suggestions for improvement. All the Veterans interviewed were able to access care within the DSMES VMC and reported a positive experience using the program, and improved diabetes self-management. Other stakeholders suggested more administrative and technical support for the DSMES VMC to increase awareness for VA staff and Veterans of the program to improve recruitment, and to shift to a web-based platform that is more easily accessible by clicking a link to reduce technical issues with downloading the program. These findings can inform future implementation efforts using technology to increase access to care allowing better health education for Veterans.

Social support via Internet communication technology for diabetes self-management: a scoping review.

The global prevalence of diabetes has been increasing over the past 30 years, leading to a rise in complications; diabetes is the leading cause of amputations, blindness, and kidney failure in developed countries. Diabetes self-management is challenging due to the complex lifestyle changes required. Social support from family and friends plays a crucial role in overcoming barriers to healthy behavior choices. Integrating Internet and communication technologies with social support interventions has the potential to improve diabetes self-management. A scoping review was conducted by searching PubMed, Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Association for Computing Machinery (ACM) Digital Library databases for studies combining diabetes, Internet and communication technologies, and social support interventions. Inclusion criteria focused on adult patients with diabetes and primarily Internet and communication technologies-based strategies to initiate and enhance social support. Data abstraction included study population, design, outcomes, social support domains emphasized, support relationship intervention strategy, and Internet and communication technologies modality. The review identified 39 articles and 33 unique studies representing 27 unique interventions utilizing peer web forums, interactive voice recordings, messaging-based interventions (including Short Message Service and instant messaging), and email as Internet and communication technologies modalities. Various outcomes were reported, including improvements in perception of social support, psychosocial well-being, behavior changes, and clinical outcomes. Existing support relationships may be more effective in promoting behavior change and clinical outcomes compared to developing new relationships. Studies that explicitly measured patients' perception of support consistently showed improvements in psycho-social, behavioral, and clinical outcomes. This scoping review highlights the pivotal role of social support in diabetes self-management. By integrating Internet and communication technologies into interventions, diverse modalities such as web forums and text messaging have shown promise in enhancing patients' perception of support and improving psychosocial well-being, behavior changes, and clinical outcomes. The emphasis on leveraging existing support relationships, rather than establishing new ones, underscores the effectiveness of personalized, patient-centered approaches. These findings provide essential insights for healthcare strategies, emphasizing the need to harness technology and existing social networks to empower individuals in managing diabetes effectively.

Randomised controlled trial on the effect of social support on disease control, mental health and health-related quality of life in people with diabetes from Côte d’Ivoire: the SoDDiCo study protocol

IntroductionDiabetes mellitus (DM) and its severe complications contribute significantly to disability and, hence, burden of disease. Poor mental health, a frequent DM consequence, may hinder successful diabetes control in low-income...

The Effect of Diabetes Management Shared Care Clinic on Glycated Hemoglobin A1c Compliance and Self-Management Abilities in Patients with Type 2 Diabetes Mellitus.

We aim to evaluate the impact of diabetes management shared care clinic (DMSCC) on glycated hemoglobin A1c (HbA1c) compliance and self-management abilities in patients with type 2 diabetes mellitus (T2DM). This study was a prospective cohort study of patients with T2DM participating in the DMSCC. At baseline and after management, the HbA1c levels were measured, the HbA1c compliance rate were calculated, and the Summary of Diabetes Self-Care Activities-6 (SDSCA-6), Diabetes Empowerment Scale-DAWN Short Form (DES-DSF), and Problem Areas in Diabetes Scale-Five-item Short Form (PAID-5) were completed. These pre- and post-management data were compared. A total of 124 eligible patients were enrolled. After the diabetes management of DMSCC, the average HbA1c decreased and the HbA1c compliance rate increased significantly (P < 0.01). SDSCA-6 showed significant improvement in physical activity, glycemic monitoring, smoking (P < 0.01), and taking medication (P < 0.05). DES-DSF suggested a greater willingness to try to effectively treat diabetes (P < 0.05). PAID-5 indicated significant improvement in diabetes-related emotional distress. DMSCC can help patients with T2DM reduce HbA1c, increase HbA1c compliance, improve diabetes self-management behaviors, empowerment, and diabetes-related emotional distress and serve as an effective exploration and practice of diabetes self-management education and support.

Diabetes Cam: An Objective Methodology to Study Diabetes Self-Management

Introduction: The prevalence of Type 2 Diabetes Mellitus (T2DM) is rapidly increasing throughout the world. T2DM is primarily a self-managed disease yet clinical studies indicate that a large proportion of adults with T2DM struggle to self-manage their diabetes. This puts them at high risk of developing diabetes-related complications. This paper presents Diabetes Cam, a new methodology to objectively study T2DM self-management and identify its barriers and facilitators. Methods: Thirty adults with diabetes of i-taukei descent from the four medical divisions throughout Fiji wore a camera for four days that automatically recorded images every 7 seconds. They also participated in in-depth photo-elicitation interviews to explore their experiences and perceptions of T2DM self-management. Data was collected between October 2021 and May 2022, and the analysis was done in August 2023. Results: Approximately 11,500 images per participant were generated providing rich data. The method is ethical, legal, and acceptable for adults with T2DM, their families, and the wider community. The images can be readily coded for food availability and consumption, physical activity, transportation, medication use, and foot care. Photo-elicitation enabled further information on what was occurring within the images and about participants’ perspectives on diabetes self-management. Conclusions: The Diabetes Cam methodology enabled automated, objective observation of participants’ T2DM self-management and their perspectives on self-management. It provides unique insights into diabetes self-management and ways to improve diabetes self-management. It provides valuable data to develop strategies to enhance diabetes self-management for people living with diabetes, their families, the wider community, health professionals, and policymakers.

Uptake of diabetes follow-up checks by minority community groups: a rapid review of the evidence for the CYMELL study

BackgroundType 2 diabetes is a public health priority for the UK. A growing body of evidence has indicated ethnic and socioeconomic disparities in rates of diabetes prevalence and complications. Attendance at diabetes follow-up checks is key to ensuring complications are identified and managed at an early stage. The aim of this rapid review was to identify and summarise evidence of ways to improve diabetes management in ethnic minority groups. MethodsIn this rapid review, we searched PubMed, PsycInfo, and CINAHL for studies published in English between Jan 1, 2000, and Jan 31, 2023. Studies were included if the population was from ethnic minority groups and if the intervention was community-based and aimed to improve diabetes self-care. The comparisons were persuasion and behaviour change, and the outcomes were improved diabetes self-management including, glycaemic control, attending eye tests, kidney, and foot screening follow-up checks. This study is registered with PROSPERO 2023, CRD42023399283. FindingsNine studies were included, from Mexico (n=1), USA (n=7), and UK (n=1). Most studies reported on community engagement (n=8), and one focussed on peer support and diabetes self-management. Peer support and diabetes self-management education were found to significantly improve diabetes control in a Mayan community (n=29) in Mexico (p<0·0001) and in the Korean American (n=105), African American (n=107), and Latino American (n=56) communities in the USA. Another study showed that women from the Pakistani community in England also benefitted from a culturally appropriate and socially supportive environment when learning about diabetes self-management. Diabetic eye screening rates could be increased through education but not through incentive payments. InterpretationCulturally competent health-care policies and programmes have been shown to increase diabetes self-management including uptake of diabetes screening for people with diabetes from ethnic minority communities to avoid potential harmful and life limiting conditions. A strength of this review is that robust, recent, and relevant papers regarding self-management of diabetes were included. The main limitations were that none of the nine studies included any cost analyses, and only one UK-based study was included, indicating that further research is required to fill the evidence gap. FundingResearch for Patient and Public Benefit (RfPPB), Health and Care Research Wales.

Positive Psychology Interventions for Improving Self-management Behaviors in Patients with Type 1 and Type 2 Diabetes: a Narrative Review of Current Evidence.

Interests have been emerging in using positive psychology interventions (PPIs) to improve diabetes self-management (DSM) behaviors (e.g., blood glucose monitoring, physical activity). To explore the impact of those interventions on DSM behaviors, we summarized the evidence of PPIs on self-management behaviors among both type 1 diabetes (T1D) and type 2 diabetes (T2D) patients between 2012 and 2022. Among the eight studies identified, different study designs and types of PPIs were apparent. Typical PPIs (e.g., activities enhancing positive affect/gratitude/self-affirmation/optimism) were usually applied to T1D patients (N = 5); PPIs were usually combined with motivational interviewing for T2D patients (N = 3). Contrary to expectations, PPIs did not consistently demonstrate positive effects on self-management behaviors' change regardless of the types of diabetes patients, compared to the control groups. Improvements in diabetes patients' self-management behaviors from PPIs are still unclear. Future studies should more rigorously evaluate and identify the active ingredients of PPIs for behavioral changes among diabetes patients.

Diabetes knowledge predicts HbA1c levels of people with type 2 diabetes mellitus in rural China: a ten-month follow-up study

Improving diabetes self-management (DSM) is facing real-world challenges among people with type 2 diabetes mellitus (T2DM) who have a low education level in resource-limited areas. This study aimed to investigate whether diabetes knowledge could predict glycemic levels in people with T2DM in rural China. This analytical cross-sectional study recruited 321 people with T2DM from eight villages by purposive sampling at baseline. After 10 months, 206 patients completed the follow-up survey and HbA1c tests, with a response rate of 64.17% (206/321). Multiple regression analysis was employed to explore the correlation between diabetes knowledge and HbA1c levels. The patient's diabetes knowledge was significantly negatively correlated with HbA1c levels before and after controlling for covariates in both hierarchical multiple regression and multiple logistic regression (p < 0.01). In addition, other influencing factors, including sex, age, marital status, employment status, income, and HbA1c levels at baseline, were also identified. Diabetes knowledge could predict HbA1c levels significantly among patients with low education levels in rural China. Therefore, interventions on improving diabetes knowledge need to be strengthened for patients in rural China so that they can improve their health outcomes and reduce the disease burden.

Impact of Fatigue and Its Influencing Factors on Diabetes Self-Management in Adults With Type 2 Diabetes: A Structural Equation Modeling Analysis.

The purposes of this study were to (1) examine the relationships between fatigue, its influencing factors, and diabetes self-management and (2) test the mediation effects of fatigue on the link between the influencing factors and diabetes self-management in adults with type 2 diabetes. This cross-sectional, correlational study was guided by the theory of unpleasant symptoms. Data were collected using structured questionnaires. Fatigue was measured by the Fatigue Symptom Inventory and the Multidimensional Fatigue Inventory. Diabetes self-management was measured by the Summary of Diabetes Self-Care Activities. From March to July 2021, a convenience sample of 150 participants was recruited from 2 diabetes outpatient clinics of a regional hospital in Taiwan. Data were analyzed using structural equation modeling. A more recent diagnosis of diabetes, more depressive symptoms, and lower sleep quality were related to higher fatigue. Higher fatigue correlated with less performance in diabetes self-management. Fatigue mediated the relationship between depressive symptoms, sleep quality, and diabetes self-management. Fatigue had a mediating effect on the link between psychological influencing factors and diabetes self-management. Future development of fatigue interventions integrating depressive symptoms and sleep management will likely increase the performance of diabetes self-management and improve the health outcomes in adults with type 2 diabetes. The study tested the theory of unpleasant symptoms using empirical data and will assist in building theory-guided fatigue interventions to improve diabetes self-management in people with type 2 diabetes.

Are diabetes self-management interventions delivered in the psychiatric inpatient setting effective? A protocol for a systematic review

IntroductionDiabetes is a major risk factor for cardiovascular disease, which is the most significant contributor to increased mortality due to natural causes in those with severe mental illness (SMI). Self-management...

Effect of Health Literacy Intervention on Glycemic Control and Renal Function Among Thai Older Adults at Risk of Type 2 Diabetes Mellitus.

Diabetes patients with low health literacy often have poor health and clinical outcomes. The study aimed to assess the effectiveness of a health literacy intervention on glycemic control and renal function among Thai older adults at risk of type 2 diabetes mellitus (T2DM). A quasi-experimental study was carried out in rural areas of Phayao Province in northern Thailand. The participants were older adults with T2DM who recorded blood glucose levels ranging from 140 to 180 mg/dL and who were not receiving prescribed medication. The intervention lasted 12 weeks, and data were collected at three points: baseline, post-intervention, and at 3 months' follow-up. The study outcomes included the measurement of fasting blood sugar (FBS), hemoglobin A1C (HbA1c), and glomerular filtration rate (eGFR) levels after the intervention. A linear mixed model and generalized estimating equations model were used to assess the intervention effect for continuous and binary outcomes, respectively. From baseline to post-intervention, FBS and HbA1c decreased more in the intervention group than in the control group by 8.2 mg/dL (p < 0.001) and 0.1% (p = 0.029), respectively, whereas eGFR increased by 8.0 mL/min/1.73m2 (p < 0.001). The absolute effect of the intervention at follow-up was -9.8 units for FBS, -0.4 units for HbA1c, and 14.0 units for eGFR. Abnormal HbA1c level (≥6.5%) of the intervention group was reported as 70.3% at baseline, 31.3% at post-intervention, and 9.4% at follow-up. Compared to baseline levels, the T2DM patients who received the intervention were 0.31 times less likely to have abnormal HbA1c levels than the control subjects at follow-up (p = 0.003) who received no intervention. Our findings suggest that this intervention may potentially improve diabetes self-management and prevention behaviors, thereby reducing the diabetes burden in rural communities in northern Thailand.

Interprofessional Education in Diabetes Care—Findings from an Integrated Review

Diabetes is a leading non-communicable disease with a huge and predictably increasing burden on individuals, societies and governments. Interprofessional education (IPE) aims to enhance healthcare providers’ competence and patient care by providing well-organised, coordinated interprofessional care (IPC) within teams of healthcare professionals of different disciplines. Interprofessional practices are crucial in diabetes care. However, evidence on the effect of diabetes-specific IPE on diabetes outcomes is limited. This study aims to survey and report recent findings on the impact of interprofessional approaches on the outcomes of diabetes management. A systematic search of PubMed and Google Scholar from 2008 was adopted to identify relevant studies. After screening for relevance, the studies used in this review were thematically analysed, and two main categories of the findings were isolated: the impact of IPE and IPC on enhanced care provision and on improved diabetes self-management. The results indicate that healthcare professionals and students and people with diabetes benefit from IPE/IPC to improve diabetes outcomes and quality of care. However, improving diabetes care is achieved when inhibitors are addressed to incorporate IPE in health professions curricula and to support IPC in clinical settings.

Twenty-first century management of diabetes with shared telemedicine appointments

This commentary article discusses the benefits of utilizing telemedicine to conduct shared medical appointments for people with type 1 diabetes and type 2 diabetes. We conducted a literature review of articles about shared medical appointments or group medical visits in people with diabetes with associated clinical data. We identified 43 articles. Models of this approach to care have demonstrated positive outcomes in adults and children with type 1 diabetes. Shared telemedicine appointments also have the potential to improve diabetes self-management, reduce the treatment burden, and improve psychosocial outcomes in adults with type 2 diabetes. Ten key recommendations for implementation are presented to guide the development of shared telemedicine appointments for diabetes. These recommendations can improve care for diabetes.

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.