Diabetes Self-care Research Articles

1217-P: Willingness to Deintensify in Patients with Type 2 Diabetes—The Diabetes and Aging Study

Background: The ADA recommends treatment de-intensification be considered in older patients with poor health, on complex regimens, or experiencing side effects. We examined factors associated with older patients’ willingness to de-intensify treatment. Methods: Cross-sectional analysis of Diabetes Preferences and Self-Care Survey responses and EHR data in adults with type 2 diabetes from Kaiser Permanente Northern California. We calculated proportions of patients who responded to the survey question “I would be willing to take less medication for my diabetes” as willing, neutral, or unwilling. Willingness was contrasted across demographic, clinical, and health status factors. Results: Analysis included 1,337 adults prescribed glucose-lowering medications (age 74.2 ± 6.0 years, 44% women, 54.4% non-Hispanic white). The proportions of willing, neutral, and unwilling to de-intensify treatment were 51.2%, 27.3%, and 21.5%, respectively. Willingness to de-intensify varied by age (p<0.001) with 54.2% of younger adults (age 65-74) willing to de-intensify compared to 38.5% of older adults (age 85+). Willingness varied by duration of diabetes (p<0.001) with 61.0% of adults with diabetes for 0-4 years willing to de-intensify compared to 44.2% of adults with diabetes for longer duration (>15 years). Willingness among those with good, intermediate, or poor health status (as defined by the ADA) was 54.2% vs. 47.5% vs. 55.1%, respectively. Individuals with an A1c greater than 9% were more willing to de-intensify treatment compared to individuals with A1c of 7%-9%, or <7%, (57% vs 51% vs 50%, p<0.001). Willingness to de-intensify decreased as number of medications increased (p<0.001) and little difference was noted in willingness among patients by insulin use or hypoglycemia history. Discussion: Patterns of patient willingness to de-intensify treatment are misaligned with clinical guideline recommendations and highlight the influence of patient experience living with diabetes over time. Disclosure S.Haider: None. M.M.Parker: Research Support; Dexcom, Inc. E.Huang: Advisory Panel; Twin Health, Stock/Shareholder; AbbVie Inc., Cardinal Health, Amgen Inc. R.W.Grant: None. H.H.Moffet: Research Support; Dexcom, Inc. N.Laiteerapong: None. J.Liu: None. K.J.Lipska: Other Relationship; UpToDate. A.J.Karter: None. Funding National Institute on Aging (5R01AG063391)

1043-P: Uncovering Root Causes Contributing to Persistent Gaps in Glycemic Control and Effective Weight Management in Patients with Type 2 Diabetes and Obesity

This QI initiative in 2 large US-based community health systems assessed root causes hindering A1C control and weight management in people with T2D and obesity through health care provider (HCP) surveys (n = 29), baseline EMR audits (n = 100), team-based audit-feedback (AF) sessions, and patient-provider collaborative education sessions. Lack of treatment access and delayed treatment intensification were identified as factors contributing to inadequate A1C control. In the survey, 48% of HCPs reported providing treatment access support as a top barrier. Missed opportunities to escalate care were revealed through gaps in key care measures for patients not on target to achieve their A1C goal, including reevaluating current diabetes medication (77% HCPs reported routinely performing) and referring patients to a diabetes care and education specialist (49%). Following the AF intervention, the percentage of HCPs who plan to consider therapy escalation within 3 months increased from 38% to 80%. Following collaborative education, the percentage of patients who reported understanding the importance of achieving their A1C goal increased from 47% to 71% and 81% committed to taking a more active role in their diabetes management and self-care. Gaps were uncovered in weight management counseling, support, and shared decision-making (SDM). Asking patients about treatment goals was documented in 57% of charts. Reporting weight loss goal discussion every 3 months were 60% of HCPs and 33% of patients. Following AF sessions, the percentage of HCPs who plan to prioritize SDM as a top 2 goal increased from 21% to 53% and HCPs committed to updating patient materials to support more productive conversations about individual health goals. Key factors hindering attainment of A1C and weight management goals revealed through this study include gaps in treatment access, treatment intensification, SDM, and weight management counseling, support. Disclosure E.Zyborowicz: None. C.Heggen: None. M.A.Rodriguez: None. J.D.Carter: None. J.P.Frias: Advisory Panel; Becton, Dickinson and Company, Pfizer Inc., Sanofi, Consultant; Akero Therapeutics, Inc., 89bio, Inc., Aimmune, Boehringer Ingelheim Inc., Eli Lilly and Company, Carmot Therapeutics, Inc., Echosens, Merck & Co., Inc., Metacrine, Inc., Novo Nordisk, Pfizer Inc., Sanofi, Employee; Ionis Pharmaceuticals, Research Support; Akero Therapeutics, Inc., 89bio, Inc., Altimmune, Axcella Health Inc., Boehringer Ingelheim Inc., Eli Lilly and Company, Intercept Pharmaceuticals, Inc., Carmot Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Metacrine, Inc., Novo Nordisk, Oramed Pharmaceuticals, Novartis, Pfizer Inc., Sanofi, Speaker's Bureau; Eli Lilly and Company, Sanofi. Funding Eli Lilly and Company (A-31209)

536-P: Psycho-behavioral and Clinical Characteristics in Koreans with Type 2 Diabetes With or Without Perceived Hypoglycemia

Objective: To compare characteristics in Koreans with type 2 diabetes (T2D) with or without perceived hypoglycemia. Methods: A cross-sectional, correlational design was used. Participants 20 years or older (N=177, men= 113 [63.8%]) were recruited from a university-affiliated diabetes clinic in Korea. Groups were divided by perceived hypoglycemia or not based on the Control Problem Scale. Socio-demographics (e.g., sex, age, years with T2D), psycho-behavioral factors including diabetes self-care activity (Summary of Diabetes Self-Care Activities Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), health-related quality of life (QoL; SF-12) and diabetes-related clinical factors (HbA1C, random glucose, blood pressure and lipids) were assessed. Body mass index [BMI], skeletal muscle mass [SMM], total body water (TBW), body fat mass [BFM], and fat free mass [FFM] were assessed by a body composition analyzer (InBody970, Korea). Statistical analyses were performed using SPSS (version 26.0) to compare group differences. Findings: One-third (n=67, 37.9%) perceived hypoglycemia in the past month (mean age [yr]= 59.1±12.7 vs. 62.1±12.8 and 35 participants experienced severe hypoglycemic reactions (e.g., passing out, needing help) during the past year. The hypoglycemia group reported a lower SF-12 score (88.5±14.1 vs. 96.1±15.2, p=.001), especially mental health functioning (T-score: 47.0±10.2 vs. 51.9±11.6, p=.005) and poor sleep quality needing professional counseling (n=43 [64.2%] vs. n=56 [50.9%]). Frequent monitoring of blood glucose and feet was performed while no differences for diet and exercise. The hypoglycemia group showed lower BMI (p=.018) and trend for lower SMM (p=.078), TBW (p=.086), BFM (p=.086) and FFM (p=.084). Conclusions: Perceived hypoglycemia is associated with psycho-behavioral and clinical factors. Further investigation is warranted to examine risks for hypoglycemia related to muscle and body mass decline. Disclosure E.Cha: None. Y.Shin: None. K.Joung: None. H.Kim: None. H.Kim: None. M.S.Faulkner: None. Funding National Research Foundation of Korea (HNU X-Corps)

543-P: A Peer-Led Diabetes Self-Management Education (DSME) and Support (DSMS) Intervention for Black Men with Type 2 Diabetes—Results of a Three-Month Pilot Randomized Clinical Control Trial

Black men are disproportionately impacted by Type 2 diabetes (T2D) and are more likely to die from diabetes complications than non-Hispanic White men. To address the unique challenges this group faces in diabetes self-management, we implemented a 3-month peer-led and empowerment-based DSME/S intervention in metro-Detroit. Twenty-five Black men ≥55 years of age with self-reported T2D were recruited and randomized to either the intervention group (n=12) − 10 hours of DSME and 9 hours of DSMS, or to an enhanced usual care (EUC) group (n=13) − 10 hours of DSME. Peer leaders (n=3), trained by certified diabetes care and education specialists (CDCES) who used training materials related to Black men with diabetes, led the sessions (mean age: 59.7 years; 100% Black, male, and with at least some college education). Changes in A1C levels, diabetes self-care activities, and diabetes distress levels were assessed at baseline and post-intervention. In the intervention group, the mean A1C at baseline was 7.73%, SD 2.16, and at follow-up, 7.06%, SD 1.39. The EUC group experienced a 0.13% decrease in A1C levels (p = 0.68). Within the intervention group, differences in average diet and blood-glucose testing scores, both measured using the Summary of Diabetes Self-Care Activities (SDSCA) measure, from baseline were statistically significant [(p = 0.03, mean change: 1.32, SD 1.71) and (p < 0.05, mean change: 0.50, SD 0.74), respectively]; EUC group general diet scores were: p = 0.08, mean change: 1.77. Diabetes distress scores among those who attended 1-6 sessions, ≤ 50%, (n=4): p = 0.92, mean change: −0.75, SD 14.06. Of those who attended 7-12 sessions, > 50%, (n=7), the decrease in score was statistically significant: p = 0.003, mean change: −5.71, SD 3.20. Implementing a peer-led DSMS program for Black men was feasible, adopted, and led to positive changes in outcomes. Scaling up the program is warranted to measure sustainability. Disclosure A.Ewen: None. K.A.Kloss: None. R.Nwankwo: None. M.M.Funnell: None. G.Piatt: None. J.M.Hawkins: None. Funding National Institute on Aging (2P30AG024824–16); Blue Cross Blue Shield Foundation of Michigan (003063.MG)

645-P: Experiences of Managing Comorbid Obstructive Sleep Apnea and Type 2 Diabetes among Veterans

Obstructive sleep apnea (OSA) is highly prevalent in patients with type 2 diabetes (T2DM), more so in veterans compared to non-veterans. Positive airway pressure (PAP) is the recommended first-line treatment for OSA. However, adherence to both PAP and to diabetes management regimens can be challenging to older adults. This study describes older veterans’ experiences managing comorbid OSA and T2DM, and the types of support they receive from family and friends. Methods: We conducted a postal survey of 900 randomly selected veterans (aged ≥50 years with medical diagnoses of OSA and T2DM) from one VA healthcare system. Questions included the Diabetes Patient Behavior Checklist and perceived benefits of and assistance with PAP use. Results: Of the 145 respondents (97% men, 51% White, 21% Black, mean age 72 years), 43% received help for diabetes from family or a friend, including preparing healthy food (91%), providing encouragement for diabetes self-care (89%), and eating at the same time (89%). Almost two thirds of the respondents were current PAP users. Among the respondents, 27% received help using PAP from a household member, including putting on the mask (68%), filling the water reservoir (59%), and cleaning the device (59%). Current PAP users had significantly lower levels of hemoglobin A1c than nonusers (6.7 ± 1.1 vs. 7.3± 1.6 %, respectively, p=0.008). Current PAP users also reported significantly higher perceived benefits of PAP use on improving sleep quality, sleep apnea, diabetes, and general health than nonusers. Married or non-White respondents thought it would be more helpful for a family member or friend to receive education on treatment of both OSA and T2DM. Conclusion: Future studies should investigate feasible strategies for addressing adherence to PAP use as part of diabetes self-management to improve glycemic control and overall health outcomes among patients with T2DM and comorbid OSA. Family support and social/demographic factors should be considered. Disclosure Y.Song: None. S.E.Choi: None. A.Papazyan: None. P.M.Macey: None. C.Alessi: None. C.H.Fung: None. J.Martin: None. Funding National Institutes of Health (K23AG055668); University of California, Los Angeles Clinical and Translational Science Institute School of Nursing

59-LB: Patient-to-Peer Education—An Unconventional Prescription for Teens with Type 1 Diabetes

Introduction: Type 1 diabetes (T1D) is a chronic condition affecting nearly 200,000 youths in the US with increasing incidence. There is often decreased adherence to therapy in adolescents because of challenges in managing T1D combined with social and metabolic changes. Therefore, addressing the individual and social factors affecting treatment is essential in teens with T1D. To date, scant research exists on how to improve patient’s self-care in the context of their relationships to peers without T1D. Objectives: We aimed to test feasibility of a brief socio-educational intervention designed to improve patient perceived social support, diabetes self-care behaviors, and glycemic levels among teens with T1D. Methods: A medical student encouraged participants to 1) develop a SMART goal for improving self-care of T1D, 2) recruit peers without T1D to help achieve the goal, and 3) educate peers on the goal’s importance to their health. Participants were surveyed prior to goalsetting and 3-4 months post-intervention to assess social support, self-care, self-efficacy, and intervention acceptability; measures of glycemia were also gathered from the EMR. Thematic analysis of participant goals and plans with peers was performed. Results: All 13 participants who attended an info meeting consented to join the study; 8 completed study surveys. On average, there was a 0.9% decrease in HbA1c among the small cohort. Survey results reflect participants were satisfied with the intervention and were more interested in working with others to care for their T1D. Thematic analysis revealed teens primarily wanted assistance, reminders, and encouragement from peers for completing their T1D self-care goals. Conclusions: This intervention is a potentially low cost and feasible tool that may improve teens with T1Ds’ perceived social support, diabetes knowledge, treatment adherence, and overall health. More research into the effects of encouraging positive patient-peer interactions is warranted. Disclosure R. Pack: None. L. N. Aronson: None. N. V. Vyas: None. J. Pierce: None.

Diabetes self-care activities among patients with type 2 diabetes: A systematic review and meta-analysis

Diabetes self-care activities among patients with type 2 diabetes: A systematic review and meta-analysis

Reliability and validity of the Diabetic foot self-care questionnaire in Turkish patients

AimThis study was conducted to examine the psychometric, properties of the Turkish version of the Diabetic, Foot Self-Care, Questionnaire. MethodsThis was a descriptive– methodological study conducted on 193 diabetes patients. Data were collected, using Descriptive, Information Form and Diabetic Foot Self-Care Questionnaire. Data were analyzed using exploratory factor analysis, item-total score correlation, Cronbach's alpha, and test-retest analysis. ResultsThe Diabetic, Foot Self-Care, Questionnaire consists of 16 items and three sub-dimensions. The three sub-dimensions recorded a variance of 58.137%. The total Cronbach's alpha coefficient of the Turkish version of the Diabetic, Foot Self-Care, Questionnaire was 0.87, and Cronbach's alpha values of its sub-dimensions were 0.71 and 0.88. The two-month test-retest credibility interpreted with intra-class correlation was 0.97. ConclusionsIt has been shown that the questionnaire is a valid and reliable tool for assessing foot self-care behavior in diabetic patients.

A Nurse-Led Telehealth Program for Diabetes Foot Care: Feasibility and Usability Study.

Diabetes mellitus can lead to severe and debilitating foot complications, such as infections, ulcerations, and amputations. Despite substantial progress in diabetes care, foot disease remains a major challenge in managing this chronic condition that causes serious health complications worldwide. The primary aim of this study was to examine the feasibility and usability of a telehealth program focused on preventive diabetes foot care. A secondary aim was to descriptively measure self-reported changes in diabetes knowledge, self-care, and foot care behaviors before and after participating in the program. The study used a single-arm, pre-post design in 2 large family medical practice clinics in Texas. Participants met individually with the nurse practitioner once a month for 3 months using synchronous telehealth videoconferencing. Each participant received diabetes foot education guided by the Integrated Theory of Health Behavior Change. Feasibility was measured with rates of enrollment and program and assessment completion. Usability was measured with the Telehealth Usability Questionnaire. Diabetes knowledge, self-care, and foot care behaviors were measured with validated survey instruments at baseline, 1.5 months, and 3 months. Of 50 eligible individuals, 39 (78%) enrolled; 34 of 39 (87%) completed the first videoconference and 29 of 39 (74%) completed the second and third videoconferences. Of the 39 who consented, 37 (95%) completed the baseline assessment; 50% (17/34) of those who attended the first videoconference completed the assessment at 1.5 months, and 100% (29/29) of those who attended the subsequent videoconferences completed the final assessment. Overall, participants reported a positive attitude toward the use of telehealth, with a mean Telehealth Usability Questionnaire score of 6.24 (SD 0.98) on a 7-point scale. Diabetes knowledge increased by a mean of 15.82 (SD 16.69) points of 100 (P<.001) from baseline to 3 months. The values for the Summary of Diabetes Self-Care Activities measure demonstrated better self-care, with participants performing foot care on average 1.74 (SD 2.04) more days per week (P<.001), adhering to healthy eating habits on average 1.57 (SD 2.12) more days per week (P<.001), and being physically active on average 1.24 (SD 2.21) more days per week (P=.005). Participants also reported an improvement in the frequency of foot self-examinations and general foot care behaviors. The mean scores for foot care increased by a mean of 7.65 (SD 7.04) points (scale of 7 to 35) from baseline to 3 months postintervention (P<.001). This study demonstrates that a nurse-led telehealth educational program centered on diabetes foot care is feasible, acceptable, and has the potential to improve diabetes knowledge and self-care, which are precursors to preventing debilitating foot complications.

The Effect of Flipped Learning Method on Self-care of Patients with Type 2 Diabetes

Background: One of the reasons for the lack of success and desired treatment results in diabetic patients is their lack of participation in treatment. Diabetes self-care education is a key factor in the prevention and treatment of diabetes, which is effective in improving the patient’s quality of life (QoL) and cost reduction. Objectives: This study aimed to determine the effect of the flipped learning method on the self-care of patients with type-2 diabetes referred to the Diabetes Clinic of Bu-Ali Hospital in Zahedan. Methods: A semi-experimental study was conducted on 114 diabetic patients. The participants were randomly divided into intervention and control groups, and a pre-test was administered. The self-care of diabetes index (SCODI), 40 items, was completed before and after the intervention by the research samples. The flipped learning program was conducted as an intervention in five sessions for patients in the intervention group, and a post-test was administered two months after the completion of the educational intervention. The obtained data were analyzed by SPSS 26. The significance level was considered less than 0.05. Results: Two months after the flipped learning intervention, the findings showed more positive changes in the flipped learning method in increasing the patients’ self-care in the intervention group (P &gt; 0.001). The mean score of self-care and its variations mean was significantly higher in the intervention group in the post-test than in the control group (P = 0.001). Conclusions: Implementing flipped learning positively affects increasing self-care in diabetic patients. It seems that the implementation of such programs can play an effective role in the treatment and prevention of type-2 diabetes complications.

RWD115 Assessing the Association of Various Characteristics with Perceived Level of Confidence Managing Diabetes Among United States Adults with Diabetes

Patient confidence in diabetes management is critical to initiating and maintaining diabetes self-care behaviors. However, various characteristics may be associated with a patients’ level of confidence in managing diabetes. This study assesses the association of various characteristics with perceived level of confidence in managing diabetes among United States (US) adults with diabetes.

The relationship between self-care, spiritual well-being and coping strategies in patients with type 2 diabetes mellitus.

Diabetes is one of the most common diseases in the world. The most important underlying cause of death in diabetic patients is the lack of self-care and management. However, there is little known about the influence of coping strategies and spiritual well-being (SWB) on self-care in diabetic patients. This study aimed to investigate the relationship between self-care activities with coping strategies and spiritual well-being (SWB) in patients with type 2 diabetes mellitus (T2DM). In this descriptive-analytical study, we selected 236 patients with T2DM referred to the diabetes hospital clinics in the southwest of Iran. Inclusion criteria were patients diagnosed with T2DM, with the age group ranging 20-80 years, literate, not suffering from severe and debilitating complications of diabetes and lacking acute psychological illness. Exclusion criteria included refusing to complete questionnaires and cognitive or emotional impairment. Instruments include the demographic questionnaire, Summary of Diabetes Self-Care Activities, Lazarus and Folkman's Coping Strategies Questionnaire and the Spiritual Well-Being Scale (SWBS; developed by Paloutzian and Ellison). To examine the relationship between variables, the Pearson correlation and multiple stepwise regression analysis were used. The findings of this study on 236 patients with T2DM (53.25 ± 10.91) including 76 (32.2%) males and 160 (67.8%) females showed the majority of participants were female, the age group was between 41 and 60 years (68.22%), had a Diploma (63.98%), were insured (63.55%) and had a moderate economic situation (55.93%). There was a direct and significant correlation between self-care activities and coping strategies (r = 0.163, p < 0.05), and only a problem-focused coping strategy was considered as a predictor variable of self-care (p < 0.01). There was a direct and significant correlation between self-care and SWB (r = 0.385, p < 0.01). The results of this study showed that there is a significant relationship between self-care and the problem-focused dimension of coping strategies and SWB in patients with T2DM.

Cultural Beliefs About Diabetes-Related Social Exclusion and Diabetes Distress Impact Self-Care Behaviors and HbA1c Among Patients with Type 2 Diabetes

BackgroundType 2 diabetes mellitus (T2DM) disproportionally impacts Latin Americans (Latinos) in the U.S. compared to non-Latino Whites, as reflected by an increased risk for disease complications and higher mortality rates. Guided by an Integrative Model of Culture, Psychological Processes, and Health Behavior, the purpose of the present study was to examine the role of cultural beliefs and diabetes distress as determinants of self-care behaviors and HbA1c among Latino patients with T2DM.MethodsParticipants included 109 Latino patients with T2DM recruited from a diabetes treatment center located in a region of Southern California with high diabetes mortality rates. Structural equation modeling was employed to examine the extent to which cultural beliefs about diabetes-related social exclusion and diabetes distress impact self-care behaviors and self-reported HbA1c.ResultsConsistent with the study hypotheses, cultural beliefs about diabetes-related social exclusion predicted diabetes distress, which in turn predicted poor diabetes self-care.ConclusionsFindings suggest an important need for intervention efforts that address both cultural and psychological factors in order to improve diabetes self-care behaviors and associated disease outcomes among Latino patients with T2DM. Future research could benefit from investigating protective aspects of culture that could help counter the negative implications of cultural beliefs about social exclusion and diabetes distress associated with poor self-care.

Knowledge and Self-Care Practices on Diabetic Foot among Diabetic Patients in Public Hospitals of Lahore, Pakistan - A Descriptive Study

Background: The purpose of this study is to examine the degree of knowledge and practise of diabetic foot self-care among people with diabetes mellitus, as well as to determine the variables that influence the level of knowledge and practise in a public hospitals of Lahore, Pakistan. It is also beneficial for raising awareness about foot-care in diabetic patients. Methodology: A descriptive cross-sectional research was done in outpatient diabetes clinics on 153 adult patients with diabetes. Participants were given self-administered questionnaires about their knowledge and practise of diabetic foot self-care. Their responses were used to determine their scores. A total score of &gt;60% was assessed as good and &lt;40% as poor. SPSS was used for analyzing data frequency and percentages. Results: Amongst 153 patients majority of patients 85(55.5%) had poor knowledge about diabetic foot care, 48(31.3%) had average knowledge, and 20(13.2%) had good knowledge about foot care. About 79(51.6%) participants had poor practices regarding diabetic foot care, 49(32%) had satisfactory practices, and 25(16.4%) had good practices of diabetic foot care. Patients with college level education had good level of knowledge about foot care. Knowledge of participants and self-care practices is significantly associated with age and education of participants. Practical Implication: Knowledge and self-care practices of foot care were associated with age and education level of participants. Health-care professionals should concentrate on filling knowledge gaps in foot care, promoting good foot hygiene habits, and enticing patients to take part in diabetes education initiatives. Conclusion: The results of study concluded that majority of participants had poor knowledge and self-care practices about foot care. Keywords: Knowledge; Diabetic Foot; Diabetes Mellitus; Self-Care Practices

Psychometric Properties of General Self-Efficacy (GSE) Scale Korean Version for Older Korean Immigrants with Diabetes: A Cross-Sectional Study in the United States.

Patients with diabetes must have self-efficacy to perform necessary self-care tasks. Self-efficacy has been considered as one of the primary motivators on diabetes self-care; therefore, it is essential for health care professionals to assess the self-efficacy of patients with diabetes to provide optimal care. Despite older Korean immigrants having greater difficulty in diabetes management, research on self-efficacy for them is lacking. This study aims to examine the psychometric property of the General Self-Efficacy scale Korean version for older Korean immigrants with diabetes in the United States. In this cross-sectional, methodological study, data were collected using convenience sampling. Cronbach's alpha, exploratory factor analysis, and confirmatory factor analysis were employed to examine the psychometric properties. Cronbach's alpha for the entire GSE scale Korean version is 0.81. The initial Eigenvalues show two factors, coping and confidence; however, the confirmatory factor analysis showed reasonable goodness of fit to the data (χ2(35) = 86.24, p < 0.01), χ2/df ratio = 2.46, AGFI = 0.87, GFI = 0.91, IFI = 0.90, ECVI = 0.74, CFI = 0.89, and RMSEA = 0.093 in the one-factor model. The General Self-Efficacy scale Korean version demonstrated acceptable reliability and validity. It can be used to investigate self-efficacy and to devise culturally tailored diabetes interventions.

Diabetes self-management and its related factors among Chinese young adults with type 2 diabetes mellitus.

To explore the status quo of self-management among young adults with type 2 diabetes mellitus (T2DM) and the determinants of self-management under the guidance of social cognitive theory. A cross-sectional study. In total, 227 young adults (18-44 years old) with T2DM at two hospitals in Beijing completed the questionnaires. The Summary of Diabetes Self-care Activities (SDSCA) was used, along with additional questionnaires about diabetes self-efficacy, attitude, diabetes distress, diabetes knowledge, coping styles and social support. Univariate analysis and multiple linear regression were used to explore the related factors of self-management among the young patients. The scores for the SDSCA in diet, exercise, blood-glucose testing, foot care and medication taking were (4.16 ± 1.51), (3.46 ± 2.50), (2.28 ± 2.24), (1.08 ± 1.84) and (6.09 ± 1.88), respectively. Stepwise multiple linear regression showed that fasting blood-glucose value was significantly associated with self-management behaviours of diet, exercise, blood-glucose testing and medication taking. Self-efficacy was significantly associated with self-management behaviours of diet, exercise and foot care. Diabetes distress, diabetes-related social activity, confrontation, education, duration of T2DM, treatment modalities and diabetes knowledge were associated with the one or two dimensions of SDSCA in the young adults with T2DM.

Effect of nurse-led intervention on knowledge and preventive behavior of diabetic pregnant women regarding COVID-19 associated mucromycosis infection in mid-delta region of Egypt

BackgroundBlack fungus (mycoses) is an opportunistic invasive infection that predominantly occurred among immunosuppressed persons. It has been recently detected in COVID-19 patients. The pregnant diabetic woman is susceptible to such infections and needs recognition for protection. This study aimed to evaluate the effect of the nurse-led intervention on the knowledge and preventive practice of diabetic pregnant women regarding fungal mycosis during the COVID-19 pandemic.MethodThis quasi-experimental study was conducted at maternal health care centers in Shebin El-Kom, Menoufia Governorate, Egypt. The study recruited 73 diabetic pregnant women through a systematic random sampling of pregnant women attending the maternity clinic during the period of the study. A structured interview questionnaire was used to measure their knowledge regarding Mucormycosis and COVID-19 manifestations. The preventive practices were assessed through an observational checklist of hygienic practice, insulin administration, and blood glucose monitoring for the prevention of Mucormycosis infection.ResultsThe study revealed a statistically significant increment in the participants’ knowledge, preventive practice, personal hygiene, and diabetes self-care scores (9.56 ± 1.75 ,3.6 ± 1.18, 3.18 ± 1.29 post-intervention) comparable to (6.19 ± 1.66, 1.97 ± 1.35, 0.89 ± 1.38 pre-intervention) respectively. There was a significant improvement in the overall COVID-19 protective score against Mucormycosis (from 2.66 ± 1.74 to 4.53 ± 1.43).ConclusionNursing educational sessions had a positive effect on pregnant women’s awareness and preventive behavior. Hence, it is recommended to integrate nurse-led intervention targeting the preventive practice against COVID-19-associated Mucormycosis infection (CAM) as routine services for diabetic pregnant women during antenatal care.

Educational Interventions on Diabetic Foot Self-Care: A Study Protocol for a Pragmatic Randomized Controlled Trial

ABSTRACT Diabetic foot is one of the most serious complications of diabetes and foot ulcer recurrence has been associated with poor foot care. Educational programs may work as a vehicle for promoting knowledge and adequate foot self-care behaviors, reducing potential ulcerative complications in the diabetic foot, and promoting a better quality of life. This study protocol will analyze the impact of two different educational strategies – an instructive video (Experimental Group 1) compared to a foot care leaflet with real-time guided reading (Experimental Group 2) and standard care (Control Group) – on adherence and knowledge about diabetic foot care and patients’ perception of their foot health. This study is a Pragmatic Randomized Controlled Trial of a non-pharmacological treatment. Participants need to have a diabetic foot diagnosis and attend a Diabetic Foot Multidisciplinary Consultation at two hospitals from the North of Portugal. Participants will be assessed at the first appointment of the diabetic foot consultation (T0), two weeks after (T1), and three months later, at follow-up (T2). Primary outcomes will be adherence and knowledge about diabetic foot care and general foot health. Secondary outcomes will be illness representations regarding diabetic foot. The results of this study will inform educational interventions to decrease diabetic foot ulcers, amputation rates, and the costs associated with both, contributing to foot care adherence and improve patient’s quality of life.

Analysis of diabetes attitudes, wishes and needs in Switzerland, the Swiss DAWN2™ Study

Swiss DAWN2™ aimed to evaluate the difficulties and unmet needs of individuals with diabetes and stakeholders, based on the assessments of diabetes care and self-management: the individual burden of disease, the perception of the quality of medical care, and the treatment satisfaction of individuals with diabetes living in the Canton of Bern. The results of the Swiss cohort were analysed and compared with the global DAWN2™ results. 239 adult individuals with diabetes were enrolled in a cross-sectional study at the Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism at the University Hospital of Bern between 2015 and 2017. The participants completed validated online questionnaires regarding health-related quality of life (EQ-5D-3L) and emotional distress (PAID-5), diabetes self-care activities (SDSCA-6), treatment satisfaction (PACIC-DSF), and health-related wellbeing (WHO-5). Eligibility criteria were as follows: participants were aged >18 years, had a diagnosis of diabetes type 1 or 2 since at least 12 months and gave written informed for the participation in the present study. When compared globally, the Swiss cohort reported a higher quality of life (77.28 ± 16.73 vs. 69.3 ± 17.9 EQ-5D-3L score, p <0.001) and lower emotional distress (22.28 ± 20.94 vs. 35.2 ± 24.2 PAID-5 score, p = 0.027). Higher frequencies of self-measurement of blood glucose (6.43 ± 1.68 vs. 3.4 ± 2.8 SDSCA-6 score, p <0.001) and physical activity (4.40 ± 2.04 vs. 3.8 ± 2.7 SDSCA-6 score, p = 0.05) were reported. PACIC-DSF revealed higher satisfaction concerning organisational aspects of patient care (60.3 ± 1.51 vs. 47.3 ± 24.3, p<0.001) and higher health-related well-being as compared to the global score (71.38 ± 23.31 vs. 58 ± 13.8 WHO-5 Well-Being Index, p <0.001). HbA1c >7% correlated to emotional distress (PAID-5, 26.08 ± 23.37 vs. 18.80 ± 17.49, p = 0.024), unfavourable eating habits (4.28 ± 2.22 vs. 4.99 ± 2.15, p = 0.034) and decreased physical activity (3.95 ± 2.16 vs. 4.72 ± 1.92, p = 0.014). Sleeping problems were most commonly reported (35.6%). In total, 28.8% of respondents completed diabetes-related educational programs. In global comparison, Swiss DAWN2™ showed a lower burden of disease and yet a higher level of treatment satisfaction in patients who were treated in Switzerland. Further studies are required to assess the quality of diabetes treatment and unmet needs in patients treated outside of a tertiary care center.

Associations of Diabetes-related and Health-related Quality of Life With Glycemic Levels in Adolescents With Type 1 Diabetes Preparing to Transition to Adult Care

ObjectivesAs adolescents with type 1 diabetes (T1D) progress to adulthood, they assume responsibility for diabetes self-management while dealing with competing life demands, decreasing parental support, and the transfer to adult care. Lower perceived quality of life (QOL) may hamper diabetes management, which is associated with suboptimal glycemic levels. Our objective was to determine associations of diabetes- and health-related QOL with glycemic management (glycated hemoglobin [A1C]) in adolescents with T1D before their transfer to adult care. MethodsWe conducted a cross-sectional analysis of baseline data from the Group Education Trial to Improve Transition (GET-IT- T1D) in adolescents with T1D (16 to 17 years of age). Participants completed validated questionnaires measuring diabetes-related QOL (PedsQL 3.2 Diabetes Module) and health-related QOL (PedsQL 4.0 Generic Core Scales). Associations of QOL Total and subscale scores with A1C were assessed using linear regression models adjusted for sex, diabetes duration, socioeconomic status, insulin pump use, and mental health comorbidity. ResultsOne hundred fifty-three adolescents with T1D were included (mean age, 16.5 [standard deviation, 0.3] years). Diabetes-related QOL Total scores (adjusted β=−0.04; 95% confidence interval [CI], −0.05 to −0.02) as well as subscale scores for Diabetes Symptoms (adjusted β=−0.02; 95% CI, −0.04 to −0.00) and Diabetes Management (adjusted β=−0.04; 95% CI, −0.05 to −0.02) were inversely associated with A1C. Health-related QOL Total scores were not associated with A1C, but Psychosocial Health subscale scores were (adjusted β=−0.01; 95% CI, −0.03 to −0.00). ConclusionOur results suggest that strategies focussing on diabetes-related QOL and psychosocial health may help prepare adolescents for the increasing responsibility of diabetes self-care.