Diabetes Self-care Research Articles

Serial mediation roles of empowerment and self-care activities connecting health literacy, quality of life, and glycemic control in people with type 2 diabetes.

Health literacy, empowerment, and self-care activities are likely the crucial concepts affecting the quality of life and glycemic control in people with type 2 diabetes (T2D). However, evidence demonstrating the mechanisms underlying these concepts is scarce. The aim of this study was to test the serial mediation roles of empowerment and self-care activities on the relationships between health literacy and quality of life and between health literacy and hemoglobin A1c (HbA1c) in people with T2D. A cross-sectional study was conducted among 319 people with T2D in Guangzhou, China, from July 2019 to January 2020. Data were collected using the Health Literacy Scale, the Diabetes Empowerment Scale-Short Form, the Summary of Diabetes Self-Care Activities Measure, and the Adjusted Diabetes-Specific Quality of Life Scale. RStudio 4.2.1 was used for serial mediation analysis. The dimension of communicative health literacy accounted for the most total variance (β = 0.810, p < .001) in the construct of health literacy. The serial multiple mediation of empowerment and self-care activities in the associations between health literacy and quality of life (β = -.046, p = .019) and between health literacy and HbA1c (β = -.045, p = .005) were statistically significant. This study emphasized the vital role of communicative health literacy when improving health literacy in people with T2D. Diabetes care and education specialists could implement empowerment approaches and flexible self-care strategies to improve the quality of life and glycemic control in people with T2D. Enhancing health literacy was suggested as a favorable strategy for promoting empowerment and self-care activities in people with T2D.

Associated factors with the self-care of people with diabetes mellitus in the COVID-19 pandemic

Objective: to analyze the factors associated with self-care in people with diabetes during the COVID-19 pandemic. Methods: cross-sectional analytical and exploratory online study with 70 participants, using the Summary Diabetes Self-Care Activities Questionnaire. The clinical and sociodemographic profile was portrayed with a descriptive analysis. Fisher's exact test, the Chi-square test and Poisson regression with robust variance were used to determine the association between the variables. Results: after regression, the items Physical Activity, Use of Medication and General Diet from the Summary Diabetes Self-Care Activities Questionnaire showed, respectively, a significant association with the variables Physical Exercise (p&lt;0.001), Occupation (p=0.005) and Age (p=0.01). Conclusion: the physical exercise, medication use and general diet items on the self-care questionnaire were related to the variables of age, occupation, and physical exercise, respectively. Contributions to practice: health services should intensify the investigation of factors associated with the difficulties of people with diabetes, to offer a better quality of life and adequate health promotion for this population.

Association between self-care and complications among patients with type 2 diabetes mellitus: A cross-sectional study

Abstract Background: Self-care is essential for diabetes patients to keep control of the disease and avoid complications. Self-care can help minimize these complications. Objectives: The study endeavored to examine type 2-diabtic patients’ knowledge regarding self-care management and to determine the association between self-care management and the disease complications. Materials and Methods: This study was a quantitative research of cross-sectional design on a sample of 151 patients who visited the endocrine and diabetes center in Al-Dewaynia Teaching Hospital, Iraq. Data were collected by demographic questionnaire and the Diabetes Self-Care Scale (DSCS). Results: The results showed that there was a significant association between the diabetes self-care management and both diabetic foot and neuropathy (0.002 and 0.005), respectively, whereas it was no association between the diabetes self-care management with retinopathy, cardiovascular problems, nephropathy, and hepatic problems at any significant level. Conclusion: The study revealed that individuals’ adherence to self-care management of type 2 diabetes is very poor. Enhancing patients’ and community’s regarding changing the lifestyle is essential.

Qualitative study exploring the perspectives of emerging adults with type 1 diabetes after transfer to adult care from a paediatric diabetes centre in Montreal, Canada

IntroductionAmong youth living with type 1 diabetes (T1D), the increasing demands to diabetes self-care and medical follow-up during the transition from paediatric to adult care has been associated with greater...

Association of Diabetes Management Self-efficacy with Adherence to Medication, Glycemic Control, and Disease Outcomes Among Type 2 Diabetes Patients

Background: Diabetes management self-efficacy (DMSE) positively affects diabetes self-care behaviors and can lead to better glycemic control and improved disease outcomes in diabetes patients. Objectives: This study aimed to evaluate DMSE level and its relationship with medication adherence, glycemic control, and diabetes complications among type 2 diabetes (T2D) patients. Methods: A cross-sectional study was carried out from November 2019 to January 2020 on T2D patients who attended the Diabetes Center of the Kerman University of Medical Sciences. Data were collected using two validated questionnaires including the diabetes management self-efficacy scale (DMSES) to evaluate DMSE level and the eight-item Morisky medication adherence scale (MMAS) to assess adherence to medication. The SPSS statistical software version 22 was employed for data analysis. Results: Of 440 T2D patients entering the study, 72% were female with a mean (SD) age of 59.60 (10.48). The mean (SD) DMSE score of the respondents was 5.76 (1.87). A significant negative correlation was observed between DMSE with HbA1c (r = -0.289, P &lt; 0.0001) and also with FBS (r = -0.229, P &lt; 0.0001), but there was a significant positive correlation between DMSE and adherence to medication (r = 0.208, P &lt; 0.0001). FBS level (β = -0.252, P &lt; 0.0001), number of visits by specialty or subspecialty physicians (β = -0.139, P = 0.002), medication adherence score (β = 0.165, P &lt; 0.0001), neuropathy (β = 0.142, P = 0.002), marital status β = 0.125, P = 0.004), household income (β = -0.126, P = 0.004), and blood glucose checks at home (β = 0.109, P = 0.013) were considered predictors of DMSE score. Conclusions: Diabetes management self-efficacy is considered suboptimal among T2D patients. Patients with higher DMSE have better adherence to medication, better blood glucose control, lower risk of neuropathy, and fewer visits by specialty and subspecialty physicians.

Prevalence of Self-care Practices among Type 2 Diabetes Mellitus Patients and its Effect on Glycemic Control: A Cross-sectional Study in Secondary and Tertiary Health-care Centers in Lucknow.

Globally, prevalence of diabetes is 10.5%, and in 2019, approximately 463 million adults were living with diabetes by 2045; this will increase to 700 million (10.9%). India is a diabetic capital of world, prevalence of diabetes in India is 8.3%. This study aimed to assess self-care practices (SCPs) among type 2 diabetes mellitus (T2DM) patients, its predictors, and effect of SCP on glycemic control. A cross-sectional hospital-based study was conducted among 300 known T2DM patients in the age group of 18-60 years attending noncommunicable diseases clinic at Secondary and Tertiary Care Hospitals of Lucknow, Uttar Pradesh, selected using two-stage purposive sampling method. Data were collected using a predesigned and pretested semi-structured questionnaire. Data were collected from consenting respondents on the sociodemographic profile (about their residence, gender, marital status, type of family, educational status, family income, employment status, etc.). SCP was assessed using Summary of Diabetes Self-Care Activities. Data were analyzed using SPSS. Among 300 patients with a mean age 50 ± 8.9 years, the prevalence of good SCPs was 37%. Out of 189 T2DM patients with poor SCPs, 66.4% had uncontrolled blood sugar level (285.4 ± 67 mg/dL). Out of 73 T2DM patients with poor SCPs, 65.7% had uncontrolled glycated hemoglobin level (8.4% ± 2%), and this was statistically significant. The practice of self-care was found to be suboptimal among patients with T2DM in the study.

Mobile Health Intervention in Patients With Type 2 Diabetes

Clinical pharmacists and health coaches using mobile health (mHealth) tools, such as telehealth and text messaging, may improve blood glucose levels in African American and Latinx populations with type 2 diabetes. To determine whether clinical pharmacists and health coaches using mHealth tools can improve hemoglobin A1c (HbA1c) levels. This randomized clinical trial included 221 African American or Latinx patients with type 2 diabetes and elevated HbA1c (≥8%) from an academic medical center in Chicago. Adult patients aged 21 to 75 years were enrolled and randomized from March 23, 2017, through January 8, 2020. Patients randomized to the intervention group received mHealth diabetes support for 1 year followed by monitored usual diabetes care during a second year (follow-up duration, 24 months). Those randomized to the waiting list control group received usual diabetes care for 1 year followed by the mHealth diabetes intervention during a second year. The mHealth diabetes intervention included remote support (eg, review of glucose levels and medication intensification) from clinical pharmacists via a video telehealth platform. Health coach activities (eg, addressing barriers to medication use and assisting pharmacists in medication reconciliation and telehealth) occurred in person at participant homes and via phone calls and text messaging. Usual diabetes care comprised routine health care from patients' primary care physicians, including medication reconciliation and adjustment. Outcomes included HbA1c (primary outcome), blood pressure, cholesterol, body mass index, health-related quality of life, diabetes distress, diabetes self-efficacy, depressive symptoms, social support, medication-taking behavior, and diabetes self-care measured every 6 months. Among the 221 participants (mean [SD] age, 55.2 [9.5] years; 154 women [69.7%], 148 African American adults [67.0%], and 73 Latinx adults [33.0%]), the baseline mean (SD) HbA1c level was 9.23% (1.53%). Over the initial 12 months, HbA1c improved by a mean of -0.79 percentage points in the intervention group compared with -0.24 percentage points in the waiting list control group (treatment effect, -0.62; 95% CI, -1.04 to -0.19; P = .005). Over the subsequent 12 months, a significant change in HbA1c was observed in the waiting list control group after they received the same intervention (mean change, -0.57 percentage points; P = .002), while the intervention group maintained benefit (mean change, 0.17 percentage points; P = .35). No between-group differences were found in adjusted models for secondary outcomes. In this randomized clinical trial, HbA1c levels improved among African American and Latinx adults with type 2 diabetes. These findings suggest that a clinical pharmacist and health coach-delivered mobile health intervention can improve blood glucose levels in African American and Latinx populations and may help reduce racial and ethnic disparities. ClinicalTrials.gov Identifier: NCT02990299.

MHealth Intervention for Vietnamese Living With Diabetes: Protocol for a Stepped Wedge Pilot Study.

Evidence indicates participation in a diabetes self-management education and support program improves self-care behaviors and hemoglobin A1c. Language and cultural differences may be barriers to program participation resulting in ineffective self-management, but these factors can be addressed with appropriate interventions. Given the high health care costs associated with diabetes complications, we developed a multicomponent, culturally tailored Self-Management Mobile Health Intervention for US Vietnamese With Diabetes (SMart-D). This study aims to evaluate the SMart-D intervention's feasibility, acceptability, and effectiveness with intentions to scale up the intervention in the future. This mixed methods study incorporates the Reach, Effectiveness, Adoption, Implementation, Maintenance framework to evaluate the intervention. This stepped wedge randomized controlled pilot study will be conducted over 2 years in collaboration with primary care clinics. Eligible participants are patients with type 2 diabetes who are receiving health care from participating clinics. Clinics will be randomly assigned to an implementation date and will begin with patients enrolling in the control period while receiving standard care, then cross over to the intervention period where patients receive standard care plus the SMart-D intervention for over 12 weeks. Focus groups or interviews will be conducted with clinicians and patients after study completion. Qualitative data will be analyzed using NVivo. Outcomes on self-care behavior changes will be measured with the Summary of Diabetes Self-Care Activities scale and clinical changes will be measured using laboratory tests. A generalized linear mixed-effect model will be used to compute time effect, clustering effect, and the interaction of the control and intervention periods using SAS (version 9.4; SAS Institute). We hypothesize that (1) at least 50% (n=5) of eligible clinics and 50% (n=40) of eligible patients who are invited will participate, and at least 70% (n=56) of patients will complete the program, and (2) patients who receive the intervention will have improved self-care behaviors and clinical test results with at least 75% (n=60) of the patients maintaining improved outcomes at follow-up visits compared with baseline, and participants will verbalize that the intervention is feasible and acceptable. As of August 2023, we enrolled 10 clinics and 60 patients. Baseline data results will be available by the end of 2023 and outcome data will be published in 2025. This is the first Vietnamese diabetes self-management education and support intervention that leverages mobile health technology to address the barriers of language and culture differences through collaboration with primary care clinics. This study will provide a better understanding of the implementation process, demonstrate the potential effectiveness of the intervention, accelerate the pace of moving evidence-based interventions to practice among the US Vietnamese population, and potentially provide a replicable implementation model that can be culturally adapted to other non-English speaking ethnic minorities. DERR1-10.2196/48585.

Identifying Information, Motivation &amp; Behavioral Factors and Its’ Relation to Diabetes Self-Care: A Qualitative Study among People with T2DM

Background: Self-care in diabetes management is not a one-size-fits-all approach. It requires individualization based on factors such as age, lifestyle, social support, and overall health. Objective: This study aimed to qualitatively explore psychosocial aspects such as information, motivation &amp; behavioral factors concerning diabetes self-care among people with type 2 Diabetes Mellitus (T2DM). Method: Purposive sampling was used to select patients with Type 2 Diabetes Mellitus from government health facilities in Klang, Selangor. They participated in an In-Depth Interview (IDI) session, which included a semi-structured guide questionnaire. All data were analyzed thematically. Results: A total of 21 IDIs consisting of nine females and twelve males T2DM patients were conducted with an average age of 56 years. The qualitative analysis identified three major themes: Information, Motivation, and Behavior. Conclusions: It is crucial to understand individual needs, capabilities, and the factors that affect type 2 diabetes patients' capacity to perform these self-care behaviors. Recommendation: Psychosocial aspects should be embedded in diabetes care settings to delay or prevent the progression of complications associated with Diabetes

Preliminary efficacy of an acceptance-based diabetes education (ACT-DE) programme for people with type 2 diabetes on diabetes distress and self-care behaviours: A pilot randomised controlled trial

BackgroundDiabetes distress is often characterised by aversive feelings about diabetes and avoidance of diabetes self-care, leading to suboptimal blood glucose control, diabetes complications and depression. Evidence from a recent review has indicated the potential efficacy of acceptance-based diabetic self-management programmes for improving blood glucose levels and mental health outcomes by fostering psychological flexibility. MethodsWe conducted a two-arm and assessor-blinded pilot randomised controlled trial (RCT) with 48 participants aged 18–64 with type 2 diabetes and moderate distress levels, in which we compared a 6-week acceptance and commitment therapy and diabetes education (ACT-DE) programme intervention with diabetes education. Diabetes distress (the primary outcome), self-care behaviour, self-efficacy in diabetes management, and psychological inflexibility were measured at baseline and post-intervention. Focus group interviews were conducted to explore the intervention group's perceptions of the benefits and limitations of the intervention. ResultsResults of ANCOVA test showed that the intervention group exhibited significantly greater decrease in diabetes distress (effect size [Cohen's d] = 0.65), and increase in exercise frequency (d = 1.16), and foot-care frequency (d = 0.59) than the diabetes education group. The qualitative feedback of the intervention group revealed that the learnt ACT skills can be effectively applied in self-care and highlighted the utility of some of the intervention's therapeutic components, primarily mindfulness practices, metaphors, and interactive diabetes education. The intervention was well-accepted, with an 87.5% completion rate, but caution is needed due to a low recruitment rate (28.1%) during COVID-19 pandemic peak. ConclusionThis pilot study confirmed that ACT-DE programme is an acceptable intervention for people with type 2 diabetes. It demonstrated preliminary efficacy with medium-to-large effect sizes in alleviating the participants’ diabetes distress and improving their self-care. Recruitment strategies can be improved to enhance the feasibility. Moreover, a full-scale RCT with longer-term follow-up is warranted to examine the intervention effects on diabetes distress, blood glucose control and other health outcomes.

The Japanese version of Problem Areas in Diabetes Scale: a clinical and research tool to assess emotional functioning among people with diabetes.

The purpose of this study was to develop the Japanese version of the Problem Areas in Diabetes (PAID) scale, a measure of emotional adjustment to diabetes that has been translated into Japanese by our group. A total of 418 Japanese people with diabetes attending our outpatient clinic participated (n = 65 type 1 and n = 353 type 2). We assessed the internal reliability of the PAID, examined correlations of the PAID with conceptually related psychosocial constructs, evaluated mean differences in the PAID between diabetes treatment groups, and examined correlations of the PAID with diabetes self-care behaviours and selected treatment outcomes. Results showed that the PAID had excellent reliability (Cronbach alpha = 0.934). The PAID correlated significantly with the Diabetes Treatment Satisfaction Questionnaire (r = -0.593, p < 0.0001) and the positive wellbeing (r = -0.396, p < 0.0001), negative wellbeing (r = -0.640, p < 0.0001) and energy (r = -0.444, p < 0.0001) subscales of the Wellbeing Questionnaire. Adherence to diet was negatively correlated with PAID score (r = -0.263, p < 0.0001). The frequency of recent hypoglycemia and number of chronic complications (retinopathy, nephropathy and neuropathy) were positively correlated with PAID scores. PAID was weakly correlated with HbA1c (r = 0.13, p = 0.01). In conclusion, the Japanese version of the PAID demonstrated good internal reliability and evidence of concurrent and discriminant validity. The PAID measures the impact of diabetes, diabetes treatment and treatment outcomes on the emotions of people with diabetes. The results provide encouraging evidence for the clinical utility of the PAID in Japanese people with diabetes.

Visualizing holistic person-specific dynamic systems: a case example with self-efficacy and self-care behavior in emerging adults with type 1 diabetes

Common ways to test associations between two repeatedly measured constructs have two primary limitations. Studies often report the average effects and ignore the heterogeneity. Independently interpreted autoregression and cross-lagged coefficients (i.e. local effects) may not match the holistic dynamic patterns (i.e. considering all coefficients simultaneously). Our paper aims to address the limitations by introducing vector plots to visualize holistic person-specific dynamic patterns. We utilized a case example of 14-day daily diary data of diabetes self-efficacy and self-care from 200 emerging adults with type 1 diabetes. A dynamic structural equation model was used to generate person-specific coefficients. Vector plots and eigenvalues were generated to visualize person-specific holistic patterns. We found heterogeneity in both local and holistic dynamic patterns. Most participants (N = 178) had mismatching local and holistic patterns. Our study provided important evidence that failing to capture person-specific holistic dynamic patterns might result in incomplete interpretations of dynamic associations.

The relationship between diabetes self-care management and blood glucose level among type 2 diabetes mellitus patients

There are still many patients with diabetes mellitus (DM) with uncontrolled blood sugar levels. Self-care was needed to control blood glucose levels. The aim of this study was to analyze the relationship between diabetes self-care management and blood sugar levels in type 2 DM (T2DM) patients. This study was used a correlational design. Data was collected from the Internal Medicine Polyclinic of William Booth Hospital Surabaya. The dependent variable was blood glucose and the independent variable was diabetes self-care management. The 99 respondents were selected using the purposive sampling technique. The inclusion criteria were patients with T2DM, the ages between 45-and 64 age years old. We used the summary of diabetes self-care activities to assess self-care management and blood sugar level was measured using a capillary blood glucose test. Chi-square was used to calculate the relationship between diabetes self-care management and blood glucose level. This study showed that most of the respondents with good diabetes self-care management had good blood sugar levels and there was a significant relationship between diabetes self-care management and blood sugar levels among T2DM patients (p&amp;lt;0.05). Increasing diabetes self-care management among T2DM patients was required to control blood glucose levels.

Foot self-care practices among diabetic patients attending a teaching hospital in Tamil Nadu, India.

Diabetes is a common non-communicable disease in the world. Diabetic foot ulcer is a common complication of diabetes mellitus. Awareness and practice of foot self-care play a major role in the prevention of complications due to diabetic neuropathy. Descriptive cross-sectional study was conducted among diabetic patients from Sep 2022 to Feb 2023. A semi-structured questionnaire containing four parts including socio-demographic including clinical details, questions related to knowledge and practice of foot self-care, and clinical examination was used. Ten grams monofilament and 128 Hz tuning fork were used to assess the sensation of the foot. A total of 211 patients were included. The average age was found to be 58.4 ± 10.0 years and the majority were females (64.0%). The mean percentage score of knowledge on diabetes and foot self-care was found to be 59.6 ± 27.5 and 55.1 ± 11.9, respectively. Participants with low knowledge scores and those who do not engage in regular physical activity had significant poor foot care practices. The majority (54.5%) of the participants had at least one of the clinical problems related to diabetic foot. The most common problem was found to be heel fissures (29.4%), followed by deformed nails (15.2%), callus (5.2%), toe web infection (3.3%), and ulcer (2.8%). Monofilament test and vibration was not detectable in 12.3% and 15.2%, respectively. More than half of the participants were found to have good diabetic foot self-care practices. Diabetics having good knowledge on foot care and involving in regular physical activity showed good foot self-care practices.

Klinio mobile app for diabetes self-care: A pilot study of HbA1c improvement in type 2 diabetes patients

Diabetes mellitus (DM) is one of the leading causes of death globally. The incidence rate of DM is growing, and public health scientists estimate that the total number of patients diagnosed with the disease will reach 366 million in 2030. Given the scarcity of data on the effectiveness of mobile applications (apps) for diabetes control, we conducted a retrospective study reviewing the data from people using a diabetes mellitus management app called Klinio. The main objective of this study was to determine if there was a change in disease control reflected by changes in the level of HbA1c in the group of people using the mobile app. A logistic regression analysis was performed that could describe the factors (such as the number of logins, total time of use, gender, age, and BMI) linked to decreasing HbA1c. The main finding of this study was that users with type 2 diabetes and long and frequent use of the diabetes control app Klinio reduced their glycated hemoglobin level significantly. Users who logged into the app for 19 days and had at least 85 days from their first to their last login had a greater than two-fold increase in their chance to reduce the absolute HbA1c value by 0.5%.

StepAdd: A personalized mHealth intervention based on social cognitive theory to increase physical activity among type 2 diabetes patients

ObjectiveInvestigate the preliminary efficacy and feasibility of a personalized mobile health (mHealth) intervention based on social cognitive theory (SCT) to promote physical activity among type 2 diabetes patients via self-monitoring, goal setting, and automatic feedback. MethodsWe conducted a pilot study involving 33 type 2 diabetes patients attending Mitsui Memorial Hospital in Japan using a pre-post evaluation design over 12 weeks. Participants measured daily step count, body weight, and blood pressure at home, with the measurements synchronized with the StepAdd application (app) automatically. Participants used the app to review daily results, update personalized step goals, identify individualized barriers to achieving the step goals, find coping strategies to overcome each barrier, and implement these strategies, thereby building effective coping skills to meet the goals. Pharmacists examined the usage of the app and provided coaching on lifestyle modifications. Ultimately, patients established skills to enhance diabetes self-care by using the app. ResultsDaily step count increased dramatically with high statistical significance (p < 0.0001), from a mean of 5436 steps/day to 10,150 steps/day, an 86.7 % increase. HbA1c (p = 0.0001) and BMI (p = 0.0038) also improved. Diabetes self-care in diet, exercise, and foot care as well as self-management behavior, self-regulation, and self-efficacy in achieving daily step goals showed significant improvements. The retention rate of the study was very high, at 97.0 % (n = 32). ConclusionsA personalized smartphone-based mHealth intervention based on SCT is feasible and effective at promoting physical activity among type 2 diabetes patients. The methodology of the intervention could be readily applied to other patient populations.

Metabolic control and quality of life in type 1 diabetes: Do adherence, family support, and school support matter?

This study analyzed the relationship between clinical and demographic variables, family support, school support, and adherence on adolescents' metabolic control and quality of life (QoL) based on Adaptation to Chronic Disease in Childhood's model. The sample included 100 adolescents and 100 parents. Adolescents were assessed on adherence, family support, school support, and QoL. Parents were assessed on family functioning and parental coping. A path analysis was performed to assess the adequacy of the theoretical model to the sample. Daily glycemic monitoring was associated with better metabolic control and diabetes hospitalizations with worse metabolic control. The final model showed adherence, family support, school support, and family functioning having an indirect effect on the relationship between adolescence stage, number of daily glycemic monitorings, number of hospitalizations, and metabolic control/QoL. Adherence had an indirect effect on the relationship between glycemic monitoring and family and school support, suggesting that adolescents need both types of support to perform diabetes self-care tasks. QoL showed a direct effect on metabolic control revealing the importance of QoL in the design of interventions to promote metabolic control in adolescents.

Cultural-Based Diabetes Self-Care Management Education for People with Type 2 Diabetes Mellitus: Empowering Community Health Workers (Kaders) Program Evaluation

Aim: The aim of this study was to understand the perspectives of Kaders, community health nurses (CHNs), and the community on an empowerment program for Kaders in Indonesia. The program aimed to help Kaders provide cultural-based diabetes self-care management education for people with type 2 diabetes mellitus (T2DM). Methods: The empowerment program consisted of a four-month training program, including two full-day sessions on cultural-based health education for people with T2DM, followed by four months of monitoring T2DM patients. Fifteen Kaders from community health centers in Makassar City participated in the program. Focus group discussions (FGDs) were conducted with Kaders to explore their perceptions and experiences related to the program. Interviews were also conducted with CHNs and people with T2DM regarding their perceptions of the program. Results: The FGDs with Kaders resulted in four themes: overall training, guideline book, education and monitoring program, and potential obstacles. CHNs highlighted the benefits of the program, the guideline book, and the impact on patients. Patients identified three themes, including the benefits of the program, what was taught, and what was improved. Conclusion: The empowerment program for Kaders in Indonesia has proven to be beneficial for Kaders, CHNs, and the community. Kaders have the potential to provide effective and efficient health education with proper preparation and empowerment through knowledge and skills.

Evaluation of foot self-care status and foot screening problems in patients with diabetes in Iran: a national multicenter study

Background and purposeThe lack of timely foot care among individuals with diabetics often lead to ulceration followed by infection and amputation. This study aimed to evaluate the foot self-care status and foot screening practices among patients with type 2 diabetes in various cities across Iran.MethodsThe cross-sectional descriptive study was performed on patients with type 2 diabetes in 10 main cities of Iran. The information about demographic and lifestyle factors, diabetes history, and diabetic foot self-care (DFSQ) was assessed. Additionally, the neurological and vascular condition of the foot were screened by Inlow’s 60-Second Screen.ResultsThe study included 1094 diabetic patients with, with a majority being female (64.8%) and married (92.5%). The average age of the participants was 57.6 ± 10.21 (mean ± SD), and the mean duration of diabetes was 11.56 ± 7.41 years. Based on Inlow’s 60-Second Screen criteria, 58% of the patients should undergo yearly foot ulcer screening, 47% exhibited peripheral neuropathy, and 37% were found to have inappropriate footwear.ConclusionThe high prevalence of peripheral neuropathy observed in approximately half of the participants across different regions of Iran underscores the importance of continuous patient education regarding foot care and appropriate footwear. Furthermore, regular foot ulcer screenings, following the recommended intervals outlined in Inlow’s screening protocol, should be implemented to effectively manage diabetic foot complications.

A systematic literature review for understanding the effectiveness of advanced techniques in diabetes self-care management

This article includes a systematic review that identifies and summarizes the many behavioral change techniques (BCTs), behavioral health theories, and advanced techniques based on artificial intelligence (AI) currently used to manage diabetes. The review focuses on assessing the efficacy of diabetes self-care applications that leverage these cutting-edge techniques in their development and use. The study provides thelatest comprehensive review and the findings of the report through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 reporting guidelines. After carefully reviewing and choosing pertinent studies from well-known bibliographic databases, the review finds that self-care treatments favor behavior change, blood glucose reduction, healthier habits,and substantial weight loss.According to the results, investigations that use these methodologies and ideas and AI-based ones are more likely to succeed. The evaluation ends by highlighting its shortcomings and outlining potential future research and application design areas. It alsohighlights the possibility of incorporating BCT methodologies, theories, and AI-based techniques in creating self-management interventions. The knowledge gained from this systematic review can help application developers create frameworks for effective diabetes self-care interventions based on the identified cutting-edge techniques.