Summary Of Diabetes Self-Care Activities Research Articles

Impact of a community-based diabetes self-management support program on adult self-care behaviors.

Diabetes is a chronic condition that has reached epidemic proportions in the United States, affecting nearly 34 million adults, and disproportionately affecting vulnerable populations, such as ethnic minorities, the elderly and individuals with low socioeconomic status. This study addresses the impact of the Health Extension for Diabetes (HED) program, a community-based diabetes self-management support program, on adult diabetes self-care behaviors. The Summary of Diabetes Self-Care Activities (SDSCA) was utilized to evaluate improvement in diabetes self-care behaviors. Descriptive statistics, univariate and multivariable regression models were conducted. Significant increases were observed among program participants (N = 149) in all five subscales of the SDSCA (general diet, specific diet, blood glucose testing, exercise and foot care; P-values < 0.001). A priority of this diabetes education program was helping underserved populations; over half (62%) of participants self-identified as Black/African Americans. After program participation, scores on all SDSCA subscales increased significantly among Black/African Americans (n = 93) by approximately 1 day per week. White/other races (n = 56) showed similar increases in four of the SDSCA subscales post-HED program participation. This study shows that increasing participation in community-based, diabetes self-management support programs, such as HED, can increase engagement in diabetes self-care behaviors among underserved groups.

The Role of the Person Focused IARA Model in Reducing Anxiety and Improving Body Awareness and Illness Management in Diabetics with Acquired Lipodystrophy: A Mixed-Method Study.

Background: Lipodystrophy is one of the most frequent complications in people with diabetes following subcutaneous insulin therapy, and poor management can lead to several problems, such as impaired glycemic control and adherence to therapy, anxiety, and depression. Poor injection technique represents the main risk factor for lipodystrophies. In order to enhance the patient’s insulin injection technique to heal lipodystrophy, improve psychological indices, and promote involvement in their health and care, the efficacy of emerging person-centered care called the IARA model was tested. Methods: A total of 49 patients were randomly allocated to the IARA group (Experimental; n = 25) or standard education (Control; n = 24). The following questionnaires were used in a mixed-method design: (i) State Anxiety Scale; (ii) Beck Depression Inventory; (iii) Italian Summary of Diabetes Self-Care Activities. An ad hoc open-ended questionnaire was structured for the qualitative analysis. Finally, photos were taken in order to verify if injection sites were changed until the follow-up at 12 months. The number of patients who participated until the completion of the study was 17 in the IARA and 11 in the Control group. Results: State anxiety was significantly reduced in people who followed IARA to follow-up at 3 and 6 months (p < 0.05). The IARA group also demonstrated better compliance in blood glucose monitoring and foot-care compared to Control at follow-up at 12 months. The management of insulin injections dramatically improved in participants who received IARA intervention. Conclusions: IARA could be considered an effective strategy to improve well-being and compliance in people affected with diabetes mellitus and lipodystrophy complications.

PSUN164 Feasibility of a telehealth-delivered diabetes foot care educational program

Abstract Background Diabetes-related nerve damage, foot ulcerations, and amputations occur as consequences of type 2 diabetes mellitus that is prevalent worldwide. Aims The study aims to investigate the preliminary effects and the feasibility of a telehealth educational program in patients with type 2 diabetes. Methods We conducted a single-arm, pre-mid-post measure study in two primary care practices in Texas. A total of 29 participants who met eligibility criteria (type 2 diabetes, Internet access, and English speaking) met with the research team once a month for 3 months via Zoom. The intervention involved telehealth visits with a board-certified family nurse practitioner/nurse educator for diabetes foot care and counseling, diabetes education, and discussion of self-management behaviors. Diabetes foot care behaviors, knowledge, and self-management activities were measured at baseline, 1.5 months, and 3 months. Results Initially, the mean score of the Diabetes Foot Self-Care Behavior Scale (DFSBS) was 17.75. The mean score of DFSBS increased to 21.59 at 1.5 months and rose to 25.46 at 3 months, indicating an improved frequency of foot care behaviors. Knowledge of diabetes was 70.48% correct at baseline and increased to 75.92% at 1.5 months and 83.89% at 3 months. At 1.5 months, the mean scores of the Summary of Diabetes Self-Care Activities improved by 0.4 days/week (d/w) for general diet, 0.29 d/w for exercise, 0.21 d/w for blood glucose testing, and 0.69 d/w for foot care. At 3 months, these values increased by 1.4 d/w for general diet, 1.13 d/w for exercise, 2.02 d/w for blood glucose testing, and 1.71 d/w for foot care compared with baseline. Of those enrolled, 87.18% completed the first telehealth visit, while 74.36% completed the second and third telehealth visits. Overall, 74.36% completed all three telehealth visits. Conclusions In two large primary care practices in Texas, a telehealth educational program that was centered on diabetes foot self-care management led to an improvement in self-care behaviors and knowledge for patients with type 2 diabetes. Clinical Implications: The promising results from this pilot study demonstrated the feasibility of a telehealth-delivered diabetes foot care educational program for patients with type 2 diabetes. Innovative strategies such as incorporating telehealth visits with in-person examinations may improve diabetes monitoring and prevent diabetes-related foot complications. Further research is needed to determine the long-term effects of a multi-disciplinary and personalized telehealth approach for monitoring diabetes foot care and self-management behaviors. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

PSAT231 Perceived Cognitive Function Is Associated With Adherence to Diabetes Self-Management Behaviors Among Breast Cancer Survivors

Abstract Introduction In the United States, the annual incidence of breast cancer and comorbid type 2 diabetes mellitus (T2DM) in women is ∼40,000. Both conditions are associated with cognitive decline, which adversely affects self-management behaviors (SMBs) including adherence to medication, dietary and exercise recommendations. Patients with breast cancer also self-report decreased cognitive ability. Such perceptions can result from objective decline in cognitive function as well as factors such as anxiety and depression. Yet, the effect of perceived cognitive function on diabetes SMBs remains unclear. We evaluated the relationship between perceived cognitive function and adherence to SMBs in breast cancer survivors with T2DM. Hypothesis Greater adherence to diabetes SMBs will be associated with higher perceived cognitive function. Methodology We enrolled women ≥ 55 years with pre-existing T2DM who were diagnosed with Stage 0-IIIA breast cancer in the past 15 years, had completed adjuvant chemotherapy and/or prescribed hormonal therapy, and were taking ≥ 1 oral diabetes medication. We measured perceived cognitive function with the Functional Assessment of Cancer Therapy-Cognition (FACT-Cog, version 3) and diabetes SMBs adherence with the Summary of Diabetes Self Care Activities (SDSCA) questionnaire. Adherence to diabetes medications was assessed using an electronic monitoring bottlecap (eCAP). Data were dichotomized into adherent vs non-adherent. Wilcoxon rank-sum tests were used to compare cognition scores between groups. Results 239 patients (mean age: 66.5 years; 28% Black, 39% white, 6% Asian, 7% other, 20% unanswered) completed interviews. Cancer survivors who were non-adherent with their diabetes medication perceived themselves as having lower cognitive function (Total FACT-Cog median (interquartile range; IQR) 102 (36.7) vs. 115 (30), p&amp;lt; 0.05), with lower scores on the perceived cognitive ability and impact of cognitive impairments on quality of life (QOL) subscales (Cognitive-ability median (IQR) 20 (9) vs. 23 (7), p&amp;lt; 0.001; QOL median (IQR) 13 (6) vs 16 (3), p&amp;lt; 0.05). Similarly, those who reported healthy eating for &amp;lt;5 days over the past week and &amp;lt;5 days/week over the past month had lower cognitive self-perception scores (Total FACT-Cog median (IQR) 106 (37) vs. 114 (25), p&amp;lt; 0.05 and 106 (37) vs. 114 (26), p&amp;lt; 0.001 respectively), and significantly differed on the perceived cognitive impairment and comments from others subscales (Cognitive-impairment median (IQR) 55.1 (26) vs. 62 (17), p&amp;lt; 0.01 and 54.5 (25) vs. 62 (17), p&amp;lt; 0.001; Comments median (IQR) 16 (2) vs. 16 (1), p&amp;lt; 0.05 and 16 (2) vs. 16 (1), p&amp;lt; 0.001). Adherence to exercise and to blood glucose testing were not associated with differences in perceived cognitive function. Conclusion Among breast cancer survivors with T2DM, adherence to diet and medication was associated with greater self-perceptions of cognitive function. Future studies will test whether interventions to improve patients’ perceptions of their cognitive abilities can influence self-care. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Effects of Patient-Driven Lifestyle Modification Using Intermittently Scanned Continuous Glucose Monitoring in Patients With Type 2 Diabetes: Results From the Randomized Open-label PDF Study.

To investigate the effects of patient-driven lifestyle modification using intermittently scanned continuous glucose monitoring (isCGM) in patients with type 2 diabetes (T2D). We conducted a 12-week, open-label, randomized controlled trial. A total of 126 participants were 1:1 randomized to either the intervention group (structured education + isCGM) or the control group (standard care with blood glucose monitoring). The Self-Evaluation Of Unhealthy foods by Looking at postprandial glucose (SEOUL) algorithm was developed and applied to aid structured education in guiding patients to follow healthy eating behavior depending on the postprandial glycemic response. The primary end point was the change in HbA1c level from baseline. Implementation of the SEOUL algorithm with isCGM was associated with greater improvement in HbA1c than with standard care (risk-adjusted difference -0.50%, 95% CI -0.74 to -0.26, P < 0.001). Participants in the intervention group had a greater reduction in fasting blood glucose and body weight (-16.5 mg/dL, 95% CI -30.0 to -3.0, P = 0.017; -1.5 kg, 95% CI -2.7 to -0.3, P = 0.013, respectively). The score sum for the Korean version of the revised Summary of Diabetes Self-Care Activities Questionnaire increased in both groups but to a greater extent in the intervention group (mean difference 4.8, 95% CI 1.7-8.0, P = 0.003). No severe hyperglycemia or hypoglycemia was reported in either group of patients. Patient-driven lifestyle modification primarily focused on eating behavior using isCGM effectively lowered HbA1c levels in patients with T2D.

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

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

The relationship between self-care activities, social support, and glycemic control in primary healthcare patients with type 2 diabetes.

ObjectiveEgyptian studies in assessing the relationship between diabetes self-care, social support, and glycemic control in primary healthcare (PHC) are limited. Therefore, this study aimed to assess this relationship, and to evaluate the associated factors of diabetes self-care, social support, and glycemic control in Egyptian PHC patients with type 2 diabetes (T2DM). MethodsA cross-sectional study was conducted on 320 T2DM patients at four PHC settings in Port Said city, affiliated with the General Authority of Healthcare. A semi-structured questionnaire was used to collect data, including demographic characteristics, socioeconomic status scale, disease profile, the Arabic versions of the Summary of Diabetes Self-Care Activities, and the received social support scales. Data were collected from January 2020 to June 2020.ResultsDiabetes self-care activities, and self-monitoring of blood glucose had a very weak negative correlations with glycated hemoglobin (HbA1c) levels (rho = − 0.125, p = 0.025, rho = − 0.112, p = 0.044, respectively). Receiving social support on following a meal correlated positively and very weakly with HbA1c levels (rho = 0.145, p = 0.010). Hardly positive correlation was found between receiving emotional support on feelings about diabetes, and following a specific diet (rho = 0.169, p = 0.002). Diabetes self-care activities were positively associated with higher education levels, and elevated BMI. Received social support was negatively associated with having coronary artery disease, and marital status e.g. divorced and widow. Increased age, and female gender were the predictors of good glycemic control. ConclusionDiabetes self-care activities were linked with reduced HBA1c levels. Further studies are needed to evaluate the buffering effect of social support on glycemic outcomes in PHC patients with T2DM.

Frailty in Community-Dwelling Adults Aged 40 Years and over with Type 2 Diabetes: Association with Self-Management Behaviors.

Background: Evidence is lacking on risk factors for frailty and prefrailty and their relationship with self-management behaviors in patients ≥40 years of age with type 2 diabetes. Methods: Participants were selected as a cross-sectional cohort at five communities in Shanghai, China during January–March 2021. The modified FRAIL scale and the Summary of Diabetes Self-Care Activities (SDSCA) measure were used. Results: Of the 558 participants, 10.2% were classified as frailty and 34.1% as prefrailty. The prevalence of frailty was higher in males than in females (p = 0.009), whereas females were associated with higher odds of prefrailty (aOR 1.67, 95% CI [1.08–2.60]). Multimorbidity, ≥3 chronic diseases, and hospitalization in the past year were considered risk factors for both frailty and prefrailty. Each point earned on SDSCA and physical activity were associated with lower odds of frailty (aOR 0.95, 95% CI [0.92–0.98]) and prefrailty (aOR 0.52, 95% CI [0.31–0.85]), respectively. Frail participants performed significantly worse self-care practice than prefrail and non-frail ones, especially on diet, physical activity, and medication adherence (p < 0.001). Conclusions: Frail patients ≥40 years of age with type 2 diabetes reported poorer self-care performance. Further interventional studies are warranted to clarify their causal relationship.

Study on self-care practices among type ii diabetes patient attending a rural and urban health training center, Tamilnadu

Background: Diabetes Mellitus is a chronic metabolic and non-communicable disease characterized by high blood glucose levels and has multiple aetiologies. According to the IDF Atlas recent edition, the Global prevalence of diabetes was 9.3% and currently, India holds second position globally with 77 million adults living with diabetes and in 2030 it was expected to cross 101 million. This high prevalence of diabetes was due to the interaction of multiple factors leading to a significant economic burden to the countries health system. Diabetes over the long term causes micro vascular and macro vascular complications, that were sometimes difficult to manage, necessitating the need for self-care practices to prevent the progression of the disease. Objective: To assess the prevalence of self-care practices among type II diabetes mellitus patients in rural and urban health training canters. Methodology: The study was carried out among Type II diabetes Mellitus patients attending Non-communicable disease (NCD) clinic in Rural and Urban health training center of Sri Ramachandra medical college and research institute, Chennai – 600116. After obtaining the informed consent, socio-demographic details were collected and the information on self-care practices was assessed using the revised Summary of Diabetes self-care Activities (SDSCA) questionnaire.

Translation and psychometric validation of the Arabic version of Summary of the Diabetes Self-Care Activities (SDSCA) among pregnant women with gestational diabetes

Background and purposeThere is a lack of validated tools to assess adherence to gestational diabetes (GDM) management plan among women with GDM. This study aimed to translate the Summary of Diabetes Self-Care Activity (SDSCA) into Arabic, culturally adapt it, and test its psychometric properties among women with GDM.MethodsA multiphase study was used to translate and evaluate the psychometric properties of the Arabic version of SDSCA using the following steps: (1) cultural and linguistic validation; (2) content and face validity testing; (3) construct validity testing; and (4) internal validity testing. Nineghty pregnant women with GDM were recruited to meet the purpose of this study.ResultsThe Arabic version of the adapted SDSCA tool revealed adequate content validity, satisfactory internal consistency (Cronbach’s alpha = 0.74), and test-retest reliability (Pearson correlation coefficient = .67). Exploratory factor analysis revealed three factors that fit data satisfactory: diet, exercise, and blood glucose monitoring.ConclusionsThis study showed that the adapted Arabic SDSCA tool is an easy, valid, and reliable tool to assess pregnant women’s adherence to GDM management plan.

Self-Care in Patients with Non-Optimal Diabetes Management in Brazilian Rural Areas: A Mixed-Methods Study

PurposeThis study aims to assess self-care in patients with non-optimal diabetes management (HbA1c >7.0% for adults and >8.0 for those aged 60 or over) and the positive and negative experiences associated with it in the rural communities of a Brazilian municipality.Patient and MethodsThis is a cross-sectional mixed-methods study. The data were collected from participants with high HbA1c through focus group discussions, subsequently performing thematic analysis, and through structured questionnaires (socioeconomic characteristics and the Summary of Diabetes Self-Care Activities (SDSCA)).ResultsThe mean HbA1c of the 156 study participants was 9.94% (95% confidence interval: 9.70–10.19%) and most participants (86.54%) had negative self-care behaviors, with an overall SDSCA mean score of 3.55. This mean was not positive for any of the socioeconomic characteristics. The self-care activities with the most satisfactory performance concerned non-smoking and the use of prescribed medications, and the poorest results were observed for the practice of specific physical activities. The qualitative data indicated that the study participants face many difficulties regarding self-care practices, especially those related to an adequate diet.ConclusionThe self-care assessment revealed unsatisfactory self-care behaviors as well as high HbA1c levels among the study participants and highlighted the various difficulties they encounter. This indicates the need for more attentive health teams to monitor patients, especially regarding actions focused on the non-pharmacological elements of self-care, such as lifestyle changes, which were found to be the dimensions with the most unsatisfactory results.

Foot self-care behaviour in type 2 diabetes adults with and without comorbid heart failure.

AimsTo compare the correlates of foot self‐care behaviours among type 2 diabetes mellitus (T2D) adults with and without comorbid heart failure (HF).DesignCross‐sectional, correlational, comparative design.MethodsA 210 T2D adults (105 with HF and 105 without HF) participated from August–December 2020. Foot self‐care behaviour was measured using the foot care subscale of the Summary of Diabetes Self‐Care Activities (SDSCA) instrument. A stepwise logistic regression analysis was used to explore variables predicting foot self‐care behaviour.ResultsThe participants' mean age was 58.7 ± 10.9 years. Poor foot self‐care behaviour was reported in T2D adults both with (53.3%) and without (54.3%) HF. Participants with HF‐comorbidity were statistically significantly older and had higher total daily medication intake. Household income and the total number of daily medications statistically significantly predicted foot self‐care behaviour in HF‐comorbid T2D adults. Marital status, social support and body mass index predicted foot self‐care behaviour in the non‐HF group.

Illness perceptions, self-care practices, and glycemic control among type 2 diabetes patients in Chiang Mai, Thailand.

BackgroundDiabetes Self-Management Education (DSME) is a fundamental aspect of diabetes care, but no standard program exists in Thailand. Understanding current patterns of illness perceptions (concerns) and self-management practices among patients with diabetes in Thailand is vital to develop culturally tailored DSME programs. This study sought to explore the association between reported self-management practices and diabetes perceptions on glycemic control among patients with type 2 diabetes in Chiang Mai Province, Thailand. Specifically, the study examined whether the association between illness perceptions and diabetes control was mediated by self-management.MethodsThis was a cross-sectional study conducted among type 2 diabetes patients on outpatient care and follow-up in four districts hospitals in Chiang Mai, Thailand. Illness perceptions was measured by the Brief Illness Perceptions Questionnaire (BIPQ). Self-management practices were measured by Summary Diabetes Self-Care activities (SDSCA). For illness perceptions and self-management practices, patients were classified into two groups, high level and low level based on the median values. Univariate and multivariable analyses were done to determine the association between the determinant factors: self-care practices and illness perceptions and the outcome of interest- good glycemic control (HbA1c < 7%).ResultsOf the 200 participants recruited into the study, 180 completed the questionnaire. Only 35% of participants had good glycemic control (HBA1c < 7.0). Both illness perceptions and self-management practices were independently linked to glycemic control. Among illness perceptions, a sense of personal control was strongly associated with good glycemic control (p = 0.01). For self-management, appropriate diet (p = 0.03) and medication adherence (p = 0.05) were associated with good glycemic control. After adjustments for key baseline characteristics, patients with high levels of illness perceptions were less likely to achieve glycemic control (OR 0.55, 95% CI 0.29 to 1.14, p = 0.11) and those with high level of self-management were more likely to achieve glycemic control (OR 2.11, 95% CI 1.04 to 4.30, p = 0.04). The effect size for illness perception attenuated when further adjusted for levels of self-management (OR 0.88, 95% CI 0.39 to 1.96, p = 0.75) while the effect size for self-management and glycemic control did not materially change (OR 2.30, 95% CI 1.06 to 5.02, p = 0.04).ConclusionIllness perceptions and self-management practices are associated with glycemic control. Future culturally tailored interventions in Thailand aimed at improving glycemic should focus on personal control, improving diet and treatment adherence as these are more likely to help improve diabetes control as demonstrated in this study.

Effect of Religion, Self-Care, and Coping Mechanisms on Quality of Life in Diabetes Mellitus Patients

Background: Uncontrolled diabetes is at a high risk for complications. This chronic complication can cause a decrease in the quality of life of DM patients. There are several factors that affect the quality of life of people with diabetes. Religiosity, self-care, and coping mechanisms together affect the quality of life. Religiosity is very important for patients to have as a foundation for maintaining quality of life. Self-care is a basic effort to control and prevent complications arising from DM. Coping mechanisms are problem-solving efforts and defense mechanisms used to protect themselves from DM problems. Purpose: This study aims to determine the effect of religiosity, self-care, and coping mechanisms on the quality of life of DM sufferers. Methods: This study uses a quantitative research design and a cross-sectional approach involving 130 respondents, using a total sampling technique. Data was collected using various questionnaires, including a Centrality Religiosity Scale (CRS) questionnaire, Summary of Diabetes Self-Care Activity (SDSCA), Coping Orientation to Problem Experienced (COPE), and Diabetes Quality of Life (DQOL). Inclusion criteria were patients with type 2 diabetes mellitus with blood glucose levels  200 mg/dl and patients with type 2 diabetes who had diabetes &gt; 1 year or more. Path Analysis is used to analyze data. Results: The religiosity of patients with type 2 diabetes has a mean of 49.47, a mean of 42.59 for self-care, a mean of 85.29 for coping mechanisms, and a mean of 42.56 for quality of life. There is an effect of religiosity (p = 0.000), coping mechanisms (p = 0.001), and self-care (p = 0.000) on the quality of life. Conclusion: Religiosity, coping mechanisms, and self-care affect the quality of life of people with Type 2 DM. Efforts that can be made by the hospital to increase health promotion related to improving the quality of life of people with diabetes mellitus.

Edukasi Penatalaksanaan Diabetes terhadap Manajemen Perawatan Diri Pasien Diabetes Mellitus Tipe II

This study aims to determine the effect of diabetes management education on self-care management of type II diabetes mellitus patients in the work area of the Kandis Public Health Center. The research design used in this study was quantitative with a pre-test design and a post-test approach with one group design. The results showed that there was a significant level of self-care management with a p-value of 0.000 using the paired sample t-test after receiving the Summary of Diabetes Self Care Activity (SDSCA) intervention through leaflets and flipcharts. In conclusion, there is an effect of diabetes management education on self-care management in type II diabetes mellitus patients in the Kandis Health Center Work Area, Merangin Regency.&#x0D; &#x0D; Keywords: Diabetes Mellitus, Education, Self Care

Assessing the mechanisms contributing to self-care behaviours in young and usual-onset diabetes.

Context: Young-onset diabetes (YOD) (age of onset 21-39 years) is associated with a poorer metabolic profile and a higher risk of complications, and poor self-care behaviours play a significant role. However, few studies have comprehensively examined the mechanisms (self-efficacy, dietary barriers, illness perceptions, knowledge, diabetes-related distress) that may contribute to poor self-care behaviours in YOD. Objectives: Our study aims to compare these mechanisms and self-care behaviours between participants with YOD and usualonset diabetes (age of onset 40-59 years). Study design: A cross-sectional survey was conducted in primary care clinics in participants with YOD or UOD, and type 2 diabetes for 10 years or less. Survey tools included the Diabetes Empowerment Scale short-form (DES-SF), dietary barriers of the Personal Diabetes Questionnaire (PDQ-DB), Brief Illness Perceptions Questionnaire (BIPQ), revised Michigan Diabetes Knowledge Test (DKT), diabetes distress scale (DDS), Summary of Diabetes Self-care Activities (SDSCA), International Physical Activity Questionnaire (IPAQ-SF) and medication adherence report scale (MARS-5), and means of both groups were compared using independent T-tests and effect sizes were analysed (Cohen's d). Results: 97 participants with YOD and 312 with UOD completed the survey. Compared with UOD, participants with YOD reported a lower adherence to a specific diet (d=0.45), with no significant differences in levels of physical activity or medication adherence. Participants with YOD experienced greater diabetes-related distress (d=0.35), especially with emotional (d=0.37), regimen-related (d=0.43) and interpersonal (d=0.39) distress. At the same time, perception of self-efficacy was significantly lower (d=0.27) and more dietary barriers were perceived (d=0.76). Participants with YOD also perceived that diabetes affected their lives more severely (consequence) (d=0.26), had a larger effect on their emotions (emotional representation) (d=0.28), will last longer (timeline) (d=0.37), and perceived that treatment was less likely help their diabetes (treatment control) (d=0.26). Conclusions: Participants with YOD experienced greater diabetes-related distress, lower self-efficacy and reported lower dietary adherence with more dietary barriers than those with UOD. Patients with YOD have distinctly different issues from UOD, and in providing care for YOD, clinicians should actively seek to identify and address these issues.

Social Media-Delivered Patient Education to Enhance Self-management and Attitudes of Patients with Type 2 Diabetes During the COVID-19 Pandemic: Randomized Controlled Trial.

BackgroundThe use of mobile health technologies has been necessary to deliver patient education to patients with diabetes during the COVID-19 pandemic.ObjectiveThis open-label randomized controlled trial evaluated the effects of a diabetes educational platform—Taipei Medical University–LINE Oriented Video Education—delivered through a social media app.MethodsPatients with type 2 diabetes were recruited from a clinic through physician referral. The social media–based program included 51 videos: 10 about understanding diabetes, 10 about daily care, 6 about nutrition care, 21 about diabetes drugs, and 4 containing quizzes. The intervention group received two or three videos every week and care messages every 2 weeks through the social media platform for 3 months, in addition to usual care. The control group only received usual care. Outcomes were measured at clinical visits through self-reported face-to-face questionnaires at baseline and at 3 months after the intervention, including the Simplified Diabetes Knowledge Scale (true/false version), the Diabetes Care Profile–Attitudes Toward Diabetes Scales, the Summary of Diabetes Self-Care Activities, and glycated hemoglobin (HbA1c) levels. Health literacy was measured at baseline using the Newest Vital Sign tool. Differences in HbA1c levels and questionnaire scores before and after the intervention were compared between groups. The associations of knowledge, attitudes, and self-care activities with health literacy were assessed.ResultsPatients with type 2 diabetes completed the 3-month study, with 91 out of 181 (50.3%) patients in the intervention group and 90 (49.7%) in the control group. The change in HbA1c did not significantly differ between groups (intervention group: mean 6.9%, SD 0.8% to mean 7.0%, SD 0.9%, P=.34; control group: mean 6.7%, SD 0.6% to mean 6.7%, SD 0.7%, P=.91). Both groups showed increased mean knowledge scores at 12 weeks, increasing from 68.3% (SD 16.4%) to 76.7% (SD 11.7%; P<.001) in the intervention group and from 64.8% (SD 18.2%) to 73.2% (SD 12.6%; P<.001) in the control group. Positive improvements in attitudes and self-care activities were only observed in the intervention group (attitudes: mean difference 0.2, SD 0.5, P=.001; self-care activities: mean difference 0.3, SD 1.2, P=.03). A 100% utility rate was achieved for 8 out of 21 (38%) medication-related videos. Low health literacy was a significant risk factor for baseline knowledge scores in the intervention group, with an odds ratio of 2.80 (95% CI 1.28-6.12; P=.01); this became insignificant after 3 months.ConclusionsThe social media–based program was effective at enhancing the knowledge, attitudes, and self-care activities of patients with diabetes. This intervention was also helpful for patients with low health literacy in diabetes knowledge. The program represents a potentially useful tool for delivering diabetes education to patients through social media, especially during the COVID-19 pandemic.Trial RegistrationClinicalTrials.gov NCT04876274; https://clinicaltrials.gov/ct2/show/results/NCT04876274

Abstract P145: Health Literacy And Self-care Practices Among Rural Appalachian Adults

Introduction: The prevalence of cardiovascular disease (CVD) and type 2 diabetes (T2DM) in Appalachian communities is among the highest in the nation. Health literacy, one’s ability to understand and use information to make health-related decisions, influences self-care practices which, in turn, shape chronic disease prevalence and outcomes. Hypothesis: Higher levels of health literacy are associated with optimal self-care practices among rural Appalachian adults with T2DM. Methods: Adults (N=356) diagnosed with T2DM were recruited from community sites across six rural Appalachian counties in Kentucky. Health literacy was measured using the New Vital Sign (NVS), with scores ranging 0-6. T2DM self-care was assessed using the Summary of Diabetes Self-Care Activities (SDSCA), with scores ranging 0-35. Linear mixed-effects models with random effects to account for clustering at the community level and household within site were fit to examine the association between level of health literacy and self-care practices. Results: The majority of the sample identified as female (65%), with a mean age of 64.2 years (SD: 10.6). The mean and median health literacy scores were 4.0 (SD: 2.0) and 5, respectively, indicating moderate health literacy. T2DM self-care scores ranged from 4-33 (Median= 17, Mean=17.1, SD: 6.3), indicating room for improvement concerning frequency of self-care practices. Specifically, average rates of self-care practices per week included following a generally healthy diet 3 days (SD: 2), exercising for 30 minutes 2 days (SD: 2), measuring blood sugar level 4 days (SD: 3), and practicing foot care 5 days (SD: 1). Health literacy was not associated with self-care practices when controlling for age, sex and financial status. Conclusions: Contrary to our hypothesis, results do not suggest a direct association between health literacy and T2DM self-care practices among Appalachian adults. Future studies should explore other personal or socio-cultural factors that may influence T2DM self-care among vulnerable populations experiencing numerous risk factors of cardiometabolic disease.

Effect of Diabetes Distress and Self-care Activities on the Quality of Life of Type 2 Diabetic Patients: A Structural Equation Model

Background: Diabetes has debilitating and dangerous effects on any of the vital organs in the body. Its impact on quality of life, as well as the variables that impact it, is of great importance. Objectives: This study was conducted to design a structural equation model of the effect of diabetes distress and self-care activities on the quality of life of type 2 diabetes mellitus (T2DM) patients. Methods: This descriptive cross-sectional study included 398 patients with T2DM referred to medical centers affiliated with Ahvaz Jundishapur University of Medical Sciences in 2020; they were selected by convenience sampling method. Data collection tools included the Problem Areas in Diabetes Scale (PAID) used to identify depression and emotional stress associated with diabetes, Audit of Diabetes-Dependent Quality of Life 19 (ADDQoL-19) used to assess the physical, mental, and social status of patients, and Summary of Diabetes Self-care Activities used to evaluate the self-care behaviors of diabetic patients. Data were analyzed using SPSS version 26, Hayes PROCESS macro version 3.5, and path analysis regression. Results: The mean scores of diabetes distress, self-care activities, and quality of life were 3.69 ± 12.39, 65.57 ± 12.11, and 56.94 ± 18.62, respectively. Path analysis regression showed that for every 1-unit increase in the score of diabetes distress, quality of life decreased by 0.249, and for every 1-unit increase in the score of self-care activities, quality of life increased by 0.183 (P &lt; 0.001). Also, for every 1-unit increase in the score of self-care activities, diabetes distress increased by 0.138 (P &lt; 0.006). Conclusions: This study showed that T2DM patients who engaged in more diabetes self-care activities had a higher health-related quality of life. Also, patients with higher levels of diabetes-specific emotional distress have a lower health-related quality of life. Training on identifying and reducing the factors affecting distress and those promoting self-care behaviors in diabetic patients is highly recommended.

Glycemic Control and Its Relationship with Diabetes Self-Care Behaviors Among Patients with Type 2 Diabetes in Northern Jordan: A Cross-Sectional Study.

BackgroundType 2 diabetes mellitus (T2DM) is a chronic progressive disease that significantly impacts morbidity and mortality worldwide. Glycemic control is central in diabetes management, yet complex and challenging to achieve; it can be affected by various factors. Diabetes self-care behaviors are vital strategies for effective T2DM management.PurposeTo evaluate the levels of glycemic control and diabetes self-care behaviors, and the significance of each behavior on glycemic control among patients with T2DM in Jordan.Patients and MethodsThis cross-sectional study was conducted in medical and endocrinology outpatient clinics of three hospitals in northern Jordan. A convenience sample of 520 patients with T2DM participated in the study. Diabetes self-care behaviors, including diet, exercise, blood glucose testing, taking medication, and foot care behaviors, were measured using the Arabic version of the Summary of Diabetes Self-Care Activities (SDSCA-Arabic) questionnaire. Psychological distress was measured using the Arabic version of the 4-items Patient Health Questionnaire (PHQ-4). Glycated hemoglobin (HbA1c) levels were used to assess glycemic control.ResultsOut of 520 participants, 92.7% (n= 482) had poor glycemic control (HbA1c ≥7%), with a mean of 9.29% (SD=2.06) for HbA1c. The SDSCA overall mean score was 3.25 days (SD=0.88), indicating an unsatisfactory level, with 79.2% of participants having performed self-care activities 4-days/week. Greater adherence to diabetes self-care behaviors was associated with better glycemic control. Exercise was the most important predictor of HbA1c (p<0.001), followed by general diet (p<0.001), specific diet (p<0.001), and blood sugar testing (p<0.001). Moreover, the Body Mass Index (p<0.001), treatment type (p<0.001), and income (p=0.03) were significant predictors.ConclusionThe proportions of poor glycemic control and unsatisfactory self-care behaviors were high among T2DM patients. To enhance patients’ self-care behaviors and lifestyles changes, the patients need tailored diabetes self-care management educational and supportive programs, conducted by qualified diabetes educators using culturally sensitive strategies.