Tailored Diabetes Education Research Articles

Understanding patient and health care provider perceptions of barriers and facilitators to diabetes care in immigrant and refugee populations

BackgroundThere is a lack of literature which assesses both patient and health care provider (HCP) perceptions of barriers and facilitators to diabetes health care in immigrant and refugee populations within the United States. This study uniquely incorporates both cohorts’ perceptions on the same topic to assess for congruency and discrepancies in perspectives.MethodsSurveys were deployed to patients with diabetes and HCPs to solicit perceptions of barriers and facilitators to diabetes care, with the intention to determine similarities and differences between cohorts. A literature review was conducted to explore barriers and facilitators to diabetes care in immigrant/refugee populations in the US to aid in development of the survey used in this study, as no validated survey existed. Broad recruitment strategies were used, including snowball sampling. Descriptive statistics were calculated and reported p-values were derived from a chi-squared or Fisher’s exact test and used for categorical data and a Wilcoxon rank sum or Kruskal–Wallis rank sum test was used for continuous data. Qualitive analysis was completed using the inductive analysis method.ResultsAmong 19 immigrant and refugee patients and 35 HCPs, almost all facilitators to diabetes care were endorsed by patients and HCPs as helpful. The highest ranked facilitator among patients and HCPs was having access to health insurance. Patients rated stress, while HCPs rated lack of health insurance as the biggest barriers to diabetes care for immigrants and refugees. Patients and HCPs differed in perspective on who held primary responsibility for diabetes management. Patients wanted more diabetes education and nutrition support, while HCPs thought understanding patients’ cultural context/sensitivity, providing more education, and having language/translation services were the most important things HCPs can do to care for patients’ diabetes.ConclusionsImmigrant/refugee patients and HCPs largely agree about what factors are most helpful in managing diabetes, with access to health insurance as the greatest facilitator. However, while HCPs identified lack of health insurance as the greatest barrier to care, immigrant and refugee patients cited the role of stress as the greatest challenge in managing their diabetes. There was a striking difference in perception of responsibility for diabetes management, with 89% of patient participants responding that the patient is responsible, while only 17% of HCPs responded that the patient was responsible. Future work should include surveys translated into languages other than English to further elicit the perspective of diabetes care in immigrant/refugee populations. Clinical recommendations based on this study include assessing and supporting patient stressors, assuring patients understand that diabetes management is a partnership, providing culturally tailored diabetes education, and increasing access to health insurance.

559-P: Evaluating the Feasibility and Preliminary Effectiveness of a Tailored Diabetes Education Program for Rural Residents

559-P: Evaluating the Feasibility and Preliminary Effectiveness of a Tailored Diabetes Education Program for Rural Residents

Effectiveness of a culturally tailored diabetes education curriculum with real-time continuous glucose monitoring in a Latinx population with type 2 diabetes: the CUT-DM with CGM for Latinx randomised controlled trial study protocol

IntroductionThe prevalence of type 2 diabetes (T2D) is increasing in the Latinx community. Despite telehealth and technology becoming more available, these resources are not reaching the Latinx population. Diabetes education...

Diabetes in the context of incarceration: A scoping review.

The burden of chronic conditions, like diabetes, is disproportionately carried by people facing social disadvantages (e.g., those with experiences of incarceration). A dearth of knowledge remains about this topic. We conducted a scoping review to determine the extent of literature about diabetes management and/or self-management in relation to incarceration. We used the Arksey and O'Malley five stage process, recommendations by Levac etal., and the PRISMA Extension for Scoping Reviews Checklist. Core search terms for diabetes were combined using the Boolean operator AND with terms relevant to incarceration. We initially searched the following electronic academic databases on January 5, 2021, and then updated these searches on September 7, 2022: APA PsycInfo, CINAHL, Criminal Justice Abstracts, EMBASE, MEDLINE, Scopus, and SocINDEX. There were no restrictions on language, study design, quality, location, time, and sex or gender differences. We searched for research articles, conference proceedings, dissertations and theses, government documents, and organization documents. We then searched for other forms of literature using an electronic database (ProQuest Dissertations and Theses - Global), the internet search engine Google, and various corrections and diabetes websites in August 2021 and then updated these searches in September 2022. We also reviewed the reference lists of the final selected documents to identify additional literature. The search from the seven databases identified 3076 records. The search from other sources (e.g., websites) identified an additional 1077 records. A total of 40 documents met our final inclusion criteria and were included in this review. The type of research conducted was primarily quantitative in nature. Clinic and education interventions were most commonly investigated. Clinical outcomes were often reported. Most guidelines were targeted at healthcare providers. Much of the literature originated from high-income countries, which may not be fully applicable for different contexts like low-income countries. Many interventions were associated with improved outcomes. Administrators can use our findings to develop appropriate policies for this population. Tailored diabetes education for this population and healthcare providers may improve management practices. Our findings offer key insights for improving diabetes care and outcomes for this underserved population. Addressing the diabetes-specific health needs of these people may improve overall public health. KD has received the O'Brien Institute for Public Health Postdoctoral Scholarship (University of Calgary), Cumming School of Medicine Postdoctoral Scholarship (University of Calgary), and the Libin Cardiovascular Institute's 2021 Person to Population Seed Grant (University of Calgary).

Household Food Insecurity and Fear of Hypoglycemia in Adolescents and Young Adults With Diabetes and Parents of Youth With Diabetes.

To evaluate the relation between household food insecurity (HFI) and fear of hypoglycemia among young adults with type 1 and type 2 diabetes and adolescents with type 1 diabetes and their parents. We analyzed cross-sectional data of 1,676 young adults with youth-onset diabetes (84% type 1, 16% type 2) and 568 adolescents (<18 years old; mean age 15.1 years) with type 1 diabetes from the SEARCH for Diabetes in Youth study. Adult participants and parents of adolescent participants completed the U.S. Household Food Security Survey Module. Adults, adolescents, and parents of adolescents completed the Hypoglycemia Fear Survey, where answers range from 1 to 4. The outcomes were mean score for fear of hypoglycemia and the behavior and worry subscale scores. Linear regression models identified associations between HFI and fear of hypoglycemia scores. Adults with type 1 diabetes experiencing HFI had higher fear of hypoglycemia scores (0.22 units higher for behavior, 0.55 units for worry, 0.40 units for total; all P < 0.0001) than those without HFI. No differences by HFI status were found for adolescents with type 1 diabetes. Parents of adolescents reporting HFI had a 0.18 unit higher worry score than those not reporting HFI (P < 0.05). Adults with type 2 diabetes experiencing HFI had higher fear of hypoglycemia scores (0.19 units higher for behavior, 0.35 units for worry, 0.28 units for total; all P < 0.05) than those in food secure households. Screening for HFI and fear of hypoglycemia among people with diabetes can help providers tailor diabetes education for those who have HFI and therefore fear hypoglycemia.

Acquisition of Self-Care Responsibility in Youth With Type 1 Diabetes: Opportunities for Improving Tailored Diabetes Education and Support Programs.

There is gradual acquisition of type 1 diabetes self-care responsibility across childhood as youth mature and gain more independence from their family. Understanding the timing of diabetes self-care by youth can guide the tailoring of diabetes education and support programs. To investigate parent-perceived responsibility for diabetes self-care tasks across childhood. Parents/guardians of youth (ages 5-18 years) with type 1 diabetes reported parent involvement in diabetes management using the Diabetes Family Responsibility Questionnaire. Survey items were divided items into five domains: nutrition, monitoring, insulin dosing, communication, and health surveillance. Age-groups for analyses were 5-10 years (elementary school), 11-14 years (early adolescence), and 15-18 years (late adolescence). Demographic, diabetes management, and A1C data were collected at the time of survey completion. Youth (n = 148, 50% male) were a mean age of 12.9 ± 3.3 years, with a mean type 1 diabetes duration of 6.2 ± 3.6 years; 66% used insulin pump therapy, and the mean A1C was 8.4 ± 1.3%. Of the parents (84% mothers, 91% White), 83% were married, and 52% were college educated. Per parent report, less parental involvement was associated with older youth age (P <0.001). Across all age-groups, more overall parental involvement was related to lower A1C (P = 0.02). Youth self-care in the nutrition domain began in elementary school, whereas self-care in monitoring and insulin dosing began in early adolescence, and self-care with regard to communication started in late adolescence. Responsibility for health surveillance remained mainly under parent care throughout childhood and adolescence. Providing education and support for youth during their acquisition of self-care tasks, especially those relating to nutrition, monitoring, and insulin dosing, may help to prevent glycemic deterioration later in childhood and adolescence.

Diabetes Self-Efficacy and Associated Factors among People Living with Diabetes in Ibadan, Southwestern Nigeria

With the increasing prevalence of diabetes mellitus (DM) globally, including in Nigeria, self-care practices are universally recognized as imperative to keeping the illness under control and preventing complications. It is important to determine how competent patients feel about managing their diabetes; as well as their psychosocial adjustment. Self-efficacy measures these important aspects of diabetes care and act as a guide to health professionals on how best to tailor diabetes education and support. There is a dearth of studies on self-efficacy and associated influences, among people living with diabetes in Nigeria. Hence, this study was carried out to fill the lacunae. This descriptive study was carried out at the Out-patient Clinic of the University College Hospital (UCH), Ibadan, among 235 people receiving treatment for diabetes. A total sampling of all available patients who provided consent at the time of data collection was done. The instrument for data collection was a questionnaire consisting of a section on sociodemographic and clinical characteristics including fasting blood glucose; followed by a section on diabetes self-efficacy. Diabetes self-efficacy was measured using the validated and adapted Michigan Diabetes Empowerment scale (DES). Ethical approval was obtained from the University of Ibadan/University College Hospital Institutional Review Board (UI/UCH IRB). Data were entered into the Statistical Package for Social Sciences, version 20. Data were analysed using frequencies, percentages, mean, independent t-test and Pearson’s correlation at α 0.05. Participants were predominantly women (60.9%) and had a mean age of 59.3 ± 14.0 years. More than half of the participants (55%) had a high self-efficacy level. Educational level and having a family member who is a nurse or a doctor were significantly associated with high self-efficacy. Fasting blood glucose level was negatively correlated with self-efficacy and the domain of managing the psychological aspect of diabetes. A good percentage of people living with diabetes had high self-efficacy, which was influenced by educational level and having a health professional as a relative. Those with high self-efficacy had better glucose control. It is recommended that individually-tailored diabetes education be provided for people with poorly controlled glucose level.

Development and evaluation of a culturally tailored education module for type 1 diabetes in a resource-constrained setting: protocol for a mixed-methods study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Diabetes education is the key to successful diabetes management. There is a need for an education module for type 1 diabetes (T1D) that is culture-specific and suited to resource constraints.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A mixed-methods study will be conducted, in three phases, to develop and evaluate a culturally tailored diabetes education module for Indian children with T1D and their families. During the first phase, a qualitative study among health professionals and families of children with T1D for need assessment will be conducted. During the second phase, based on the themes from the last phase, an educational module will be developed. The third phase will involve an evaluation of the content, feasibility and effectiveness of the proposed module. The content evaluation will be done using the standardized 'suitability assessment of materials' checklist. For feasibility, a mixed-method approach will be used with iterative cycles of satisfaction scale, semi-structured interview and feasibility and observation checklist. The module will be revised after each cycle till no new changes are suggested. The effectiveness will be assessed by a quasi-experimental controlled trial assessing glycemic control, health-related quality of life, clinically important events and self-management practices in T1D children at baseline and three and six months.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study aims at development and validation of a novel culturally tailored diabetes education module for children with T1D, suited to their resource constraints. A module designed with the inputs from all stakeholders, and evaluated using iterative cycles, has the potential to suit the dynamic nature of diabetes management in children.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Trial registration:&lt;/strong&gt; Trial registration number is CTRI/2021/04/032739.&lt;/p&gt;

A Culturally Tailored Diabetes Education Program in an Underserved Community Clinic

Hispanic/Latino adults are disproportionately affected by type 2 diabetes mellitus (DM) than non-Hispanic Whites. Culturally tailored DM education has been proven to be an effective way of teaching self-management skills to this population. The purpose of this evidence-based practice project was to improve glycemic control in lower socioeconomic status Hispanic/Latino patients diagnosed with DM in a medically underserved community clinic using a culturally tailored DM education program. Pre/post results were analyzed at the conclusion of this project. Statistically significant improvements were noted in A1C levels, knowledge scores, and empowerment levels.

Knowledge of chronic complications of diabetes among persons living with type 2 diabetes mellitus in northern Ghana.

IntroductionDiabetes mellitus is a complex disease that affects many organ systems, leading to concerns about deteriorating population health status and ever-increasing healthcare expenditure. Many people with diabetes do not achieve optimal glycaemic control and other metabolic indices, leading to a heightened risk of developing complications. Adequate knowledge of diabetes complications is a prerequisite for risk-factor reduction and prevention of the consequences of the disease. Therefore, this study aimed to evaluate the knowledge of chronic complications of diabetes among persons living with type 2 diabetes mellitus in northern Ghana.MethodA descriptive cross-sectional study was conducted among 320 patients with type 2 diabetes mellitus in northern Ghana. The consecutive sampling technique was employed to recruit participants from September to November 2018. Data analysis was performed using IBM statistical package for social science version 23. Descriptive statistics such as frequencies and percentages were used. Both bivariate and multivariate logistic regression analysis were employed to determine associations between knowledge of diabetes complications and demographic/clinical characteristics of participants, at 95% confidence interval with statistical significance at P<0.05.ResultsThe majority of participants (54.1%) had inadequate knowledge and 45.9% had adequate knowledge of diabetes complications. The factors associated with inadequate level of knowledge were female gender [AOR = 0.29 (95%CI: 0.14–0.56), p<0.001], older age [AOR = 0.45 (95%CI:0.20–0.99), p = 0.049], primary education [AOR = 0.13 (95%CI: 0.03–0.51), p = 0.004], no formal education [AOR = 0.16 (95%CI: 0.05–0.50), p = 0.002], rural dwellers [AOR = 0.50 (95%CI: 0.27–0.95), p = 0.033] and unknown family history diabetes [AOR = 0.38 (95%CI: 0.17–0.82), p = 0.014].ConclusionMore than half of the studied population had inadequate knowledge of diabetes complications. Female gender, rural dwellers, and low education level were factors positively associated with inadequate knowledge of diabetes complications. A multisectoral approach is needed, where the government of Ghana together with other sectors of the economy such as the health, education and local government sectors work collaboratively in the development of locally tailored diabetes education programmes to promote healthy self-care behaviours relevant for the prevention of diabetes and its complications.

Depression as a predictor of hypoglycemia worry in parents of youth with recent-onset type 1 diabetes.

During the recent-onset period of type 1 diabetes (T1D), parents may be at increased risk for depression, stress, and hypoglycemia fear; however, current studies have not examined the parental psychological experience and anxiety from hypoglycemia fear (ie, hypoglycemia worry) over time. This study examined the trajectory of parental hypoglycemia worry (Hypoglycemia Fear Survey-Worry [HFS-Worry]) in families of children with recent-onset T1D and the effects of baseline parental depression on parents' trajectory of HFS-Worry. We enrolled 128 families of children ages 5- to 9-years-old with recent onset T1D in this study. At baseline, 125 parents completed measures of depression and HFS-Worry, followed by 111 at 6-month follow-up, 113 at 12-month follow-up, and 107 at 18-month follow-up. We used multilevel modeling to examine the 18-month trajectories of HFS-Worry and to examine if parental depression modified these trajectories. We found that parents HFS-Worry scores increased over time for parents with and without elevated depressive symptoms. Parents' baseline report of depression appeared to modify their trajectory of HFS-Worry over time such that parents with elevated depressive symptoms reported significantly higher levels of worry when compared to parents without depressive symptoms across the 18-month study period (P < .05). Parents of children with recent-onset T1D, who reported elevated depressive symptoms, reported higher HFS-Worry across the study period. Our findings suggest clinics should consider screening for parent depression and hypoglycemia worry following a T1D diagnosis. Integrating psychological screening for parents could help clinics to provide relevant treatment resources and tailor diabetes education for parents. Trial Registration NCT03698708.

Clinical and cost-effectiveness of a diabetes education and behavioural weight management programme versus a diabetes education programme in adults with a recent diagnosis of type 2 diabetes: study protocol for the Glucose Lowering through Weight management (GLoW) randomised controlled trial

IntroductionPeople with type 2 diabetes (T2D) can improve glycaemic control or even achieve remission through weight loss and reduce their use of medication and risk of cardiovascular disease. The Glucose...

Impact of a Culturally Tailored Diabetes Education and Empowerment Program in a Mexican American Population Along the US/Mexico Border: A Pragmatic Study.

BackgroundThe study purpose was to deliver a diabetes education program under real world conditions and evaluate its effect on diabetes-related clinical, self-management and psychosocial outcomes among Mexican Americans residing along the US/Mexico border.MethodsA pragmatic study was conducted among adult patients with diabetes in three primary care clinics located along the US/Mexico border. A bilingual culturally tailored diabetes education program incorporating hands-on participatory techniques was delivered in 4 - 8 weekly group sessions. Clinical, self-management and psychosocial outcomes were evaluated pre- and post-intervention with surveys and medical record review.ResultsA total of 209 participants were enrolled; mean age was 58.9 years (range 23 - 94, standard deviation: 11.2); 68.4% were female; 91.1% were Hispanic. Significant improvements were observed in glycated hemoglobin (-1.1%, P < 0.001, n = 79), total cholesterol (-17.2 mg/dL, P = 0.041, n = 63), glucose self-monitoring (+1.3 times a week, P = 0.021, n = 115), exercise less than once a week (-18.2%, P < 0.001, n = 129), nutritional behavior (+2.23, P < 0.001, n = 115), knowledge (+1. 83, P < 0.001, n = 141) and diabetes-related emotional distress (-7.32, P = 0.002, n = 111). Benefits were observed with attendance rates as low as 50%.ConclusionA clinic-based culturally competent diabetes education/self-management program resulted in significant improvements in outcomes among Hispanic participants. Experimentally tested culturally appropriate interventions adapted for real world situations can benefit Mexican American diabetic patients even when attendance is imperfect.

"It Was All Trial and Error"—The Perspective of Parents of Emerging Adults with Type 1 Diabetes during the Transition to Independence

Introduction: Emerging adults ages 18-25 years with type 1 diabetes (T1D) navigate the transition to independence in partnership with their parents. Few programs exist to meet the educational needs of parents during this transition, and little is known about their perceived knowledge deficits or readiness to provide guidance for their children. The purpose of this study was to describe the lived experience and diabetes-specific educational needs of parents of emerging adults with T1D. Methods: Parents of adults with T1D aged 18-25 years were recruited to participate. Written informed consent was obtained and participants then took part in a semi-structured interview. Interviews were digitally recorded and professionally transcribed. A descriptive content analysis of the transcripts began after the first interview and proceeded until saturation was reached. Following the interview, participants were sent links to the study’s diabetes education website that included information on transition topics. Results: Twenty-two parents (5 fathers, 17 mothers) of emerging adults participated in the study. Six themes emerged from the transcribed interviews: No Roadmap, Few Resources; Peers as Primary Source of Support; New Roles Require a New Communication Style; Parents Sometimes Excluded from Care; Begin Early, Go at the Child’s Pace; and Fears, Challenges, and Opportunities. All participants expressed openness to diverse education modalities, including in person, online, group videoconference, and social media. Participants received 110 push notifications, resulting in 964 page views on the study website. Conclusions: Parents of emerging adults with T1D have a central role in their child’s transition to independence, but may not receive adequate guidance to be successful in this endeavor. The results of this study underscore the need for a tailored diabetes education program for parents of emerging adults that includes a component of peer support. Disclosure A. Albanese-O'Neill: None. S.C. Westen: None. N.T. Thomas: None. M.J. Haller: None. D. Schatz: None.

Symptoms of Mental Illness and Their Impact on Managing Type 2 Diabetes in Adults.

People with mental illnesses are more likely to experience diabetes-related complications that can reduce life expectancy by 10 to 15 years. Diabetes management and outcomes can be improved when lifestyle interventions addressing healthful eating habits and physical activity use content tailored to the learning needs of individuals or groups. Understanding the challenges that prevent adherence to diabetes recommendations can start to inform the design of tailored diabetes education care. The purpose of this pilot study was to explore the perspectives of clients with mental illnesses and type 2 diabetes with regard to challenges faced when engaging in diabetes self-care behaviours. Focus groups were held with 17 people who had type 2 diabetes and mental illnesses, including depressive disorder, bipolar disorder, anxiety disorder, schizophrenia and schizoaffective disorder. In the groups, participants were asked to share their experiences with diabetes self-care and access to diabetes-education services. Data were transcribed verbatim, assessed for quality and saturation and coded to identify relationships and meanings among identified themes. Participants identified many challenges and unmet needs that created multidimensional and interrelated barriers to care, ultimately resulting in poor diabetes self-care behaviours. Some challenges were psychological in nature and related to emotional states, lifestyles and food habits, perceptions of affordability, health literacy and value of health information. Other challenges included the physical states of health and social environments. Multidimensional diabetes education programs that consider psychological, physical and social challenges are needed to address the needs of people with mental illnesses.

Reducing Social Distress for Chronic Disease Patients in Primary Care: An Intervention for Latino Type 2 Diabetes Patients Seen at Community Health Centers.

Background.Social and behavioral factors have important direct and indirect effects on chronic disease onset and progression. The U.S. health care system is beginning to focus on assessment and management of social and behavioral problems through federal mandates related to meaningful use of electronic health records and improved patient outcomes.Methods.We examined the clinical adoption of a 20-item screening tool to measure social distress focusing on type 2 diabetes. This Internet-based survey tool was embedded within a diabetes team care dashboard used to manage Latino patients with poorly controlled type 2 diabetes (n = 399) seen at urban safety-net clinics with referral as needed to clinical, community, and social services.Results.Results showed a high baseline prevalence of many of the 20 social distress issues assessed. The control group had a mean 6.8 ± 4.3 items at baseline and 6.2 ± 4.3 items at 6 months; the intervention group had a mean 7.2 ± 4.5 items at baseline and 5.6 ± 4.6 items at 6 months. The majority of participants (>90%) reported having one or more social distress issues during the previous week. Moreover, 11 of 20 social distress items were identified by ≥30% of patients as being present. However, social distress was significantly reduced from our intervention based on a culturally sensitive team model focused on actively managing social distress issues compared to usual diabetes team care (P <0.01).Conclusion.Social distress issues are common but were significantly reduced with a 6-month diabetes team intervention involving initial screening followed by tailored diabetes education and referral to existing local services.

Caregiving for children with type 1 diabetes and clinical outcomes in central India: The IDREAM study.

Parental care influences outcomes for children's type 1 diabetes (T1D). There is little evidence about the impact of parental caregiving in developing countries, where fixed dose human insulin (conventional) therapy and limited self-monitoring of blood glucose are common. This article investigates whether performance of key T1D management tasks by children or their caregivers impacts hemoglobin A1c (HbA1c). We surveyed the caregivers of 179 children with T1D routinely treated in a specialized diabetes clinic in Maharashtra, India to determine who performs key diabetes care tasks: child or parent. We used linear regression to estimate the relationship between parental caregiving and HbA1c, and how this association varies by child age and time since diagnosis. Caregivers of older children were less involved in care tasks, though caregivers of 11- to 18-year olds performed more care for children diagnosed for a longer duration. Parental involvement in key insulin delivery tasks was associated with lower HbA1c levels for all children. These reductions were greatest among children 11 to 14 years old and diagnosed for less than 2 years: mean HbA1c levels were 8.5% (69 mmol/mol) if the caregiver, and 14.4% (134 mmol/mol) if the child, performed the tasks (P < .05). Parents of children diagnosed with T1D early in life remain involved in care throughout the child's adolescence. Parents of children diagnosed in late childhood and early adolescence are significantly less involved in care, and this is associated with worse glycemic control. Clinics must know who performs care tasks and tailor diabetes education appropriately.

Optimising the effectiveness of diabetes education in an East Asian population.

To explore the collective patterns of learning behaviours and preferences of Chinese people during diabetes education. The study was carried out across three countries and aimed to identify strategies that could be used to tailor diabetes education to Chinese people. A case study approach was undertaken in three countries (Australia, China and Singapore) using participant observations and qualitative interviews. Purposive sampling was used to select field sites before a snowball technique was employed to identify relevant interviewees. Thematic analysis with pattern matching was used for data analysis. A total of 39 participant observations and 22 interviews were conducted. Chinese people with diabetes were observed seeking advice and recommendations from health professionals. When told clearly what to do, they strived for full compliance. They tended to be submissive during diabetes education and were not likely to raise concerns, negotiate or participate in making medical decisions. They appeared to prefer prescriptive concrete instructions rather than more flexible conceptual education and to believe that behavioural change should be achieved by individual willpower and determination, resulting in an 'all-or-nothing' approach. Regular repeated information sessions were reported to establish rapport and trust. For diabetes education to be culturally modified for Chinese people, there is a need to consider their unique philosophies and behaviours during education to support lifestyle changes. Building trust from the early stages of education was achieved by encouraging rapport through the provision of clear and precise instructions. This should be done before engaging in an open discussion of implementation strategies. Once the trust is built, healthy behaviour change may follow.

Clinical and Psychosocial Outcomes of a Structured Transition Program Among Young Adults With Type 1 Diabetes

PurposeWe identified and treated young adults with type 1 diabetes who had been lost to follow-up during their transfer from pediatric to adult care, comparing their clinical, psychosocial, and health care utilization outcomes to participants receiving continuous care (CC) throughout the transition to adult care. MethodsIndividuals in their last year of pediatric care (CC group, n = 51) and individuals lost to follow-up in the transfer to adult care (“lapsed care” [LC] group, n = 24) were followed prospectively for 12 months. All participants were provided developmentally tailored diabetes education, case management, and clinical care through a structured transition program. ResultsAt baseline, LC participants reported lapses in care of 11.6 months. Compared with CC participants, they had higher hemoglobin A1C (A1C; p = .005), depressive symptoms (p = .05), incidence of severe hypoglycemia (p = .005), and emergency department visits (p = .004). At 12-month follow-up, CC and LC participants did not differ on the number of diabetes care visits (p = .23), severe hypoglycemia (no events), or emergency department visits (p = .22). Both groups' A1C improved during the study period (CC: p = .03; LC: p = .02). LC participants' depressive symptoms remained elevated (p = .10), and they reported a decline in life satisfaction (p = .007). There was greater loss to follow-up in the LC group (p = .04). ConclusionsOur study suggests that, for young adults with a history of lapses in care, a structured transition program is effective in lowering A1C, reducing severe hypoglycemia and emergency department utilization, and improving uptake of routine diabetes care. Loss to follow-up and psychosocial concerns remain significant challenges in this population.

Culturally Tailored Diabetes Education for Chinese Patients: A Qualitative Case Study.

To explore the range of teaching approaches and cultural-tailoring elements used in diabetes educations directed at Chinese patients and to determine the strategies that appeared to best address Chinese patients' needs. A case study approach in three countries was employed, using multiple ethnographic data collection methods including participant observations and qualitative interviews. Data were collected from 39 participant observations and 22 interviews across seven cases. Collective didactic education was most common. Individual clarification at the end of an education session was used to allow patients to derive their own management plan. Clinicians mainly provided information and used knowledge reinforcement to facilitate behavioral change. Participatory diabetes education models borrowed from the West did not translate well culturally and did not appear to meet Chinese patients' needs. Conclusion and Practical Implications: Diabetes education for the Chinese may be enhanced by building on traditional Confucian education strategies.