Type 2 Diabetes Self-management Research Articles

Supernatural Beliefs-Based Intervention to Improve Type-2 Diabetes Self-Management: A Pilot Randomized Controlled Trial from China.

China has over 100 million people living with type 2 diabetes mellitus (T2DM). Interventions framed around pre-existing personal beliefs in the supernatural may improve T2DM self-management, but such interventions are lacking in China. This pilot randomized controlled trial (RCT) assessed the feasibility of a full-scale RCT to evaluate the efficacy of a supernatural beliefs-based intervention on T2DM management self-efficacy in China. In 2019, 62 T2DM patients were enrolled at two hospitals in Suzhou, China. Participants were randomly assigned to view a 30-s control or intervention video at baseline. The control video showed general diabetes self-management information. The intervention video showed identical information, but also indicated that some diabetics with supernatural beliefs (chao ziran xinnian) have lower glycemic levels, because their beliefs enhance their confidence in diabetes self-management. Development of the intervention was guided by the theory of planned behavior and literature on spiritual framing health interventions. Baseline and follow-up measures after two weeks were assessed by interviewer administered surveys in-person and by telephone, respectively. Diabetes management self-efficacy was assessed with the diabetes management self-efficacy scale. Randomization of intervention allocation appeared to be successful. However, follow-up retention was low, especially for the intervention group (3% vs. 31%). A full-size efficacy RCT using the current study design is unlikely to succeed. T2DM patients shown the supernatural beliefs-based intervention had significantly higher loss to follow-up that was insurmountable. T2DM patients in Suzhou, China may not be receptive to brief, non-tailored supernatural beliefs-based interventions delivered to a general population in clinical settings.

A Quasi-experimental study on the effectiveness of primary caregiver social support capacity on self-management practices of clients living with type II diabetes in Machakos county, Kenya

Background: Diabetes is a fast-growing public health emergency, projected to affect 643 million people by 2045. While primary caregiver social support can influence the self-management practices of Type 2 diabetes (T2D) clients, there's often limited capacity to provide it. The study determined the effectiveness of enhanced caregivers' social support capacity on self-management practices of T2D clients in Machakos. Methods: A six-month quasi-experimental study design that adopted quantitative and qualitative data collection and analysis approaches. Primary caregivers at the Matungulu intervention site were trained on T2D self-management and types of social support, with no intervention conducted at the Masinga control site. Results: Over 90% of the 227 primary caregivers were female, with a mean age of 43.28, supporting approximately three T2D clients each. Post-intervention, a 27.2% change in capacity to identify all T2D self-management practices was noted compared to a 7.6% change in the control group. The greatest contribution was in the primary caregivers' ability to provide tangible, followed by emotional and informational social support, resulting in a statistically significant improvement in the self-management practices in the intervention site, B=0.140 (95% CI: 0.072, 0.208), t=4.046, p<0.001. Consequently, the difference in blood glucose levels was statistically significant, crude OR=3.213 [95% CI: 2.039, 5.063], p<0.001. Conclusions: Enhanced capacity to provide social support positively correlates with the T2D clients' self-management practices. Further investigation of factors that hinder the full realization of primary caregiver social support capacity benefits in improving self-management capacities among T2D clients is recommended.

Unmet and unperceived needs for type 2 diabetes self-management among slum dwellers in Iran: a cross-sectional study.

This study aimed to identify unmet and unperceived needs for T2D self-management among those residing in Tabriz slums, Iran, in 2022. Type 2 diabetes (T2D) and its complications are more common among slum dwellers. T2D is a lifelong disease that requires continuous care. By contrast, slum dwellers are less likely to adhere to standard health care. This study is cross-sectional. We included 400 patients using a systematic random sampling method. Unmet and unperceived needs were assessed through a researcher-made questionnaire. The questionnaire was developed based on Iran's Package of Essential Non-Communicable Diseases (IraPEN) instructions and an expert panel. Data were analyzed using SPSS version 22. Need for more healthcare cost coverage by insurance organizations (85.5%), financial support to provide medicine (68%), free and accessible sports equipment in the area (48.5%), continuous access to blood sugar test instruments (47.8%), know how to test blood sugar and interpret the results (47.7%), more communication with healthcare providers (42.3%), and detailed education from health professionals (41.2%) were the most common unmet needs. The least perceived need was to know how to care for feet (16%).

Self-management of type-2 diabetes

Type-2 diabetes or adult-onset diabetes is the most common type of diabetes which usually begins when a person is in his or her mid-50s. It is a major, lifestyle-related disease with increasing occurrence at a national level. It occurs when the body cannot make sufficient insulin or the body cannot utilize the produced insulin. It is the foremost reason for premature deaths. Inappropriately managed, it can result in several health problems, including heart disease, stroke, kidney disease, blindness, neuropathy, leg and foot amputations, and death. Slight modifications in lifestyle can significantly decrease the probability of getting the disease. So, self-management skills are very much essential to manage and control this disease. Still, with proper testing, treatment, lifestyle changes, healthy eating, drinking water and avoiding dehydration, taking medications as prescribed, promoting walking, exercises, and other physical activities, conducting self-foot checks, and monitoring other signs and symptoms caused by diabetes have useful effects on the management of diabetes, encouraging adherence to this pattern is possessing great public health importance.

A Study on Social Factors Fffecting Type 2 Diabetes Self-management, a Narrative Review

Context: Patients with type 2 diabetes (T2D) need to commit to permanent discipline to minimize the risks of disease. On the other hand, the approach to disease self-management has shifted from a solely biological and doctor-patient-oriented approach to a more comprehensive model with a cooperative approach that takes advantage of social factors such as the community and family. Therefore, it is necessary to comprehensively extract social factors affecting consumer discipline from scientific sources. Evidence Acquisition: This narrative review identified social factors T2D self-management. Relevant studies were retrieved from reputable databases including PubMed, Google Scholar, Iran Doc, Emerald, and ScienceDirect through a web search (with no temporal limitations). Out of the 18,082 retrieved articles, 68 studies resonating with research goals were selected and underwent qualitative analysis. Results: Four categories of social factors were identified, including family, diabetes educators, peers, and diabetes online communities. Family member behaviors were classified into three groups: Diabetes self-management facilitators, obstacles, and neutral behaviors. Studies on diabetes educators accentuated their essential capabilities. Also, two face-to-face peer support models were identified. Ultimately, diabetes online communities were investigated as an emerging context capable of identifying and covering the needs of diabetic patients and their families. Conclusions: Social factors, including family, educators, peers, and online communities, play a crucial role in T2D self-management. By recognizing these factors, healthcare professionals can design interventions that ultimately result in better outcomes for patients with T2D.

Type 2 Diabetes in High-risk Youth: Improving Identification and Interventions in Community Health with a Decade of Quality Improvement Efforts.

This manuscript describes quality improvement interventions with aims (1) to increase identification and follow-up testing of youth with prediabetes and type 2 diabetes (T2D) and (2) to improve outcomes for youth with prediabetes and low-range T2D (HbA1c 6.5-6.9%). Interventions included (a) dissemination of evidence-based guidelines and (b) creation of in-house weight management (WM) programs and programs to increase prediabetes follow-up testing and T2D self-management. Data from the electronic health record are presented. Between 2009-2020, T2D screening for obese youth increased from 24% to 76%. Two WM programs served 2,726 unique youth for 11,110 billable visits. Youth with prediabetes seen in WM clinic had a lower risk of developing T2D if they attended three or more visits. Teaching self-monitoring blood glucose showed promise for improving HbA1c outcomes in youth with low-range T2D. Interventions have increased identification, access to preventive services, and treatment for youth with prediabetes and T2D.

Religiosity and type 2 diabetes self-management among Muslims residing in California

Type 2 diabetes (T2D) is a public health issue that needs to be addressed. In the U.S., 11.3% of the population have diabetes. It is estimated that 90–95% of all diabetes cases are T2D cases. One of the best methods to address T2D is self-management. Prior research found a relationship between religiosity and T2D self-management. The purpose of this study was to examine religiosity and T2D self-management. This was a cross-sectional and qualitative study, which included Muslim adults, who have T2D and live in California. We utilized snowballing to recruit participants and the saturation concept to determine the number of participants. Additionally, we used semi-structured design for the interviews and focus groups. We had 30 participants for the interviews (however, only 25 provided demographic data) and 28 for the combined focus groups. Zoom was used to conduct the interviews and two focus groups. The grounded theory was used to deduce themes from the interviews and focus groups. The main themes for religiosity and self-management are Allah sustains life, everything will be ok/hope, faith gives strength, and the role of self within the fate concept. The themes for self-efficacy are diabetes requires new life approach, stress, and Islamic religious practices promote self-management. The main theme for perceived seriousness is taking action and making changes. Our findings provide significant insight about the relationship between religiosity, perceived seriousness, fatalism, and self-efficacy and self-management of T2D. A recommendation based on this study is that providers and health educators should be aware of the different experiences Muslims with T2D face, and tailor recommendations and programs based on that.

527-P: mHealth Intervention for Low-Income Chinese Immigrant Families with Type 2 Diabetes—Feasibility, Acceptability, and Potential Efficacy

Objectives: To test the feasibility, acceptability, and potential efficacy of a mHealth intervention tailored for low-income Chinese immigrant families with type 2 diabetes (T2D). Methods: We conducted a RCT with baseline, 3-, and 6-month measurements. Participating dyads, Chinese immigrants with T2D and their families/friends from NYC were randomized into the intervention group (n=11) or the wait-list control group (n=12). Dyads in the intervention group received 2 videos weekly for 12 weeks. Video topics cover T2D self-management, behavioral techniques, and family-oriented sessions. Study staff helped participants set goals for T2D management, followed their progress biweekly, and addressed any concerns. Feasibility and acceptability were measured respectively by the retention rate and video watch rate, and a satisfaction survey. Patients’ HbA1c, weight, and self-management behaviors were also assessed. Results: Most patients (n = 23; mean age 56±9 years; 52% male) and families/friends (mean age 54±11 years; 52% female) had high school education or less (69% and 69%), annual household income > $25,000 (68%), and limited English proficiency (87% and 86%). The retention rates at both follow-ups were 87% with a mean watch rate of 76.7% (7.0%). Patients and families/friends rated satisfaction as 9.4 and 10 out of 10. Despite no between-group differences, the intervention group had significantly lower HbA1c (p=0.014) and improved self-management (p=0.009), and lost 12 lbs on average in 6 months (p=0.079). Conclusions: A culturally-tailored, family-based mHealth intervention is feasible and acceptable among low-income, limited English-proficient Chinese families with T2D in NYC. Significant changes in HbA1c and self-management in the intervention group indicate this intervention may have potential efficacy. Given the small sample size of this study, a future RCT with adequate power is needed to test efficacy. Disclosure Y.Shi: None. L.Hu: None. N.Islam: None. M.Sevick: None. H.Li: None. C.Wang: None. H.Bao: None. X.Xu: None. R.Lieu: None. Y.Jiang: None. Funding National Institutes of Health (P30DK111022)

An integrated approach to address diabetes in the context of food insecurity: Delivering health study protocol

BackgroundDiabetes self-management education and support (DSMES) interventions among food insecure individuals with type 2 diabetes (T2D) have found modest improvements in nutrition and health outcomes but are limited by barriers to attendance and retention. This study applies a community-based participatory research approach, engaging community members at all levels of intervention planning, development, implementation, and dissemination, to deliver a plain-language DSMES curriculum to food insecure community members with T2D. MethodsThis is a single-arm, pre-post design assessing the efficacy of a 12-week home-delivered DSMES curriculum and T2D-appropriate food box intervention to improve the nutrition and health outcomes of food insecure individuals with T2D. The intervention consists of a weekly food box delivery and handout with video links on key DSMES topics, developed and refined using community advisor feedback. Up to 100 English-, Spanish-, or Marshallese-speaking adult participants with T2D (HbA1c ≥ 7%) and food insecurity are being recruited from food pantries in northwest Arkansas. Data is collected at pre-intervention and immediately post-intervention. The primary study outcome is change in HbA1c. Secondary measures include diet quality (Healthy Eating Index-2015, calculated from 3 24-h dietary recall interviews via phone), body mass index, blood pressure, skin carotenoids, food security, T2D self-management behaviors, T2D self-efficacy, and T2D-related distress. ResultsRecruitment began in August 2021 and enrollment is anticipated to be complete in March 2023. ConclusionFindings from this study will provide a rich understanding of diabetes-related health outcomes and dietary patterns of individuals with food insecurity and T2D and inform future food-focused DSMES interventions in this setting.

Self-Management and Glycemic Targets in Adult Haitian Immigrants With Type 2 Diabetes: Research Protocol.

Type 2 diabetes (T2D) is a chronic condition affecting more than 34.2 million U.S. adults, and people of African descent have a disproportionate burden. Haitian immigrants' unique cultural and biological factors put them at elevated risk for T2D-related complications. Despite prior research highlighting the success of multimethod approaches to T2D self-management behaviors on glycemic targets, a dearth of studies have used these methods to improve diabetes self-management in this marginalized population. This article describes a repeated-measures design protocol of a going study about self-management behaviors among adult Haitian immigrants with T2D and characterizing their barriers to T2D self-management. We will enroll 100 Haitian immigrants aged 18-64 years who have lived with T2D for at least 1 year. Using multiple recruitment methods and Research Electronic Data Capture, subjective and objective data on T2D self-management practices, glucose variability via continuous glucose monitor, and a comprehensive view of physical activity via actigraphy are collected. Data analysis will follow a two-part approach mirroring the two primary study objectives. Findings from the study will guide the development and testing of a culturally tailored diabetes self-management education program that will contribute essential information about best practices for this population and break barriers that may impede research on unique individuals and subsequent effective self-management.

The Role of Filial Piety in Dyadic Recruitment of Chinese American Parents With Type 2 Diabetes and Their Adult Children.

Type 2 diabetes (T2D) is prevalent among Asian Americans, yet limited health care studies report on the recruitment and retention of this population. This study focuses on recruiting Chinese American dyads for family support of T2D management. This is a descriptive study using active and passive recruitment strategies. Dyads consist of parents with T2D and their adult children without diabetes. All materials are culturally tailored and available in Chinese. The final sample included 54 dyads. There were characteristic differences among parent participants in English language proficiency and education levels. Filial piety manifested as respect and care for one's parents among Chinese American families contributed to recruitment success. This article shares strategies for recruiting Chinese American dyads to explore family support dynamics for T2D self-management. The findings potentially add to current knowledge about culture, nursing, and health care.

Diabetes-Related Quality of Life: Learning From Individuals Making Lifestyle Changes to Improve Type 2 Diabetes Control.

The purpose of this study was to explore how treatment adherence and lifestyle changes required for glycemic control in type 2 diabetes (T2D) are related to quality of life (QoL) among predominantly ethnic minority and socioeconomically disadvantaged adults engaged in making changes to improve T2D self-management. Adults with T2D in New York City were recruited for the parent study based on recent A1C (≥7.5%) and randomly assigned to 1 of 2 arms, receiving educational materials and additional self-management support calls, respectively. Substudy participants were recruited from both arms after study completion. Participants (N = 50; 62% Spanish speaking) were interviewed by phone using a semistructured guide and were asked to define QoL and share ways that T2D, treatment, self-management, and study participation influenced their QoL. Interviews were analyzed using thematic analysis. QoL was described as a multidimensional health-related construct with detracting and enhancing factors related to T2D. Detracting factors included financial strain, symptom progression and burden, perceived necessity to change cultural and lifestyle traditions, and dietary and medical limitations. Enhancing factors included social support, diabetes education, health behavior change, sociocultural connection. QoL for diverse and socioeconomically disadvantaged adults with T2D is multifaceted and includes aspects of health, independence, social support, culture, and lifestyle, which may not be captured by existing QoL measures. Findings may inform the development of a novel QoL measure for T2D.

Leveraging Social Media to Increase Access to an Evidence-Based Diabetes Intervention Among Low-Income Chinese Immigrants: Protocol for a Pilot Randomized Controlled Trial.

Type 2 diabetes (T2D) in Chinese Americans is a rising public health concern for the US health care system. The majority of Chinese Americans with T2D are foreign-born older immigrants and report limited English proficiency and health literacy. Multiple social determinants of health limit access to evidence-based diabetes interventions for underserved Chinese immigrants. A social media-based diabetes intervention may be feasible to reach this community. The purpose of the Chinese American Research and Education (CARE) study was to examine the potential efficacy of a social media-based intervention on glycemic control in Chinese Americans with T2D. Additionally, the study aimed to explore the potential effects of the intervention on psychosocial and behavioral factors involved in successful T2D management. In this report, we describe the design and protocol of the CARE trial. CARE was a pilot randomized controlled trial (RCT; n=60) of a 3-month intervention. Participants were randomized to one of two arms (n=30 each): wait-list control or CARE intervention. Each week, CARE intervention participants received two culturally and linguistically tailored diabetes self-management videos for a total of 12 weeks. Video links were delivered to participants via WeChat, a free and popular social media app among Chinese immigrants. In addition, CARE intervention participants received biweekly phone calls from the study's community health workers to set goals related to T2D self-management and work on addressing goal-achievement barriers. Hemoglobin A1c (HbA1c), self-efficacy, diabetes self-management behaviors, dietary intake, and physical activity were measured at baseline, 3 months, and 6 months. Piecewise linear mixed-effects modeling will be performed to examine intergroup differences in HbA1c and psychosocial and behavioral outcomes. This pilot RCT study was approved by the Institutional Review Board at NYU Grossman School of Medicine in March 2021. The first participant was enrolled in March 2021, and the recruitment goal (n=60) was met in March 2022. All data collection is expected to conclude by November 2022, with data analysis and study results ready for reporting by December 2023. Findings from this pilot RCT will further guide the team in planning a future large-scale study. This study will serve as an important first step in exploring scalable interventions to increase access to evidence-based diabetes interventions among underserved, low-income, immigrant populations. This has significant implications for chronic care in other high-risk immigrant groups, such as low-income Hispanic immigrants, who also bear a high T2D burden, face similar barriers to accessing diabetes programs, and report frequent social media use (eg, WhatsApp). ClinicalTrials.gov NCT03557697; https://clinicaltrials.gov/ct2/show/NCT03557697. DERR1-10.2196/42554.

Type 2 Diabetes Self-Management Interventions Among Asian Americans in the United States: A Scoping Review.

Introduction:Type 2 diabetes (T2D) is one of the leading causes of death among Asian Americans. Despite being a culturally diverse racial group with differences in history, language, religion, and values, Asian Americans are often viewed as a monolith. With the high prevalence rate of T2D, a careful examination of self-management interventions across Asian Americans is needed to develop effective and culturally sensitive interventions.Objective:To describe existing literature by examining study characteristics, different intervention components, and outcome measures of various T2D interventions among Asian Americans.Methods:Using Arksey and O'Malley's framework to ground this review, six online databases were used to identify studies.Results:A total of 18 publications were included. Thirteen studies were published after 2013, with 44% and 22% of these studies focused on Chinese Americans and Korean Americans. We found a lack of geographic diversity in the location of the studies. Majority of the participants were females. Most of the interventions were implemented in person. Licensed health care providers were the most common interventionists, with a number of studies using community health workers. Outcome measures focused on three key areas: physiological, psychosocial and behavioral, and program-related outcomes. Many of the studies measured changes in HbA1C, self-efficacy, distress, depression, and quality of life. Overall, we saw improvements in physiological measures in most of the studies. For example, majority of the studies showed a decline in the participants' HbA1C. Most studies showed an increase or improvement in healthy behaviors. Studies that measured efficacy, knowledge, attitude, motivation, quality of life, or general health showed improvement from baseline. All the studies that measured distress or depression showed a reduction of symptoms postintervention.Conclusion:Overall, we found that culturally tailored interventions that focus on specific Asian American subpopulations saw an improvement in physiological, psychosocial, or behavioral measures. There were several gaps in the existing T2D self-management programs or interventions among Asian Americans studied in the United States. Based on our analysis, we recommend when designing or implementing self-management interventions among Asian Americans, considerations should be made for targeted recruitment for understudied Asian American subgroups, gender, and location.

Food insecurity, diabetes, and perceived diabetes self-management among Latinos in California: Differences by nativity and duration of residence

We examined associations between food security (FS) status and type 2 diabetes (T2D) prevalence and perceived T2D self-management by nativity and US duration of residence among Latinos living in California. We used the California Health Interview Survey (2012–2017) and included Latinos who lived below 200% of the federal poverty line (n = 16,254) and for our management outcome, those with T2D (n = 2284). Latinos with low FS (OR = 1.44, 95% CI 1.14–1.83) or very low FS (OR = 1.87, 95% CI 1.33–2.61) had a higher odds of T2D compared to their food-secure counterparts. When stratified by nativity/duration in the US, US-born Latinos and Latino immigrants with >10 years duration had a higher odds of T2D if they reported low FS (US-born: OR = 1.60, 95% CI 1.02–2.52; >10 yrs: OR = 1.48, 95% CI 1.12–1.97) or very low FS (US-born: OR = 2.37, 95% CI 1.45–3.86; >10 yrs: OR = 1.78, 95% CI 1.15–2.76) compared to their food-secure counterparts. There was no association among immigrants with <10 years duration. For perceived T2D self-management, those with low or very low FS had lower odds of reporting proper management (OR = 0.56, 95% CI 0.36–0.86; OR = 0.46, 95% CI 0.26–0.83) compared to their food-secure counterparts. When stratified by nativity, the US-born did not differ in their perceived self-management by FS status, while immigrants with low or very FS had lower odds of perceived self-management (OR = 0.54, 95% CI 0.34–0.86; OR = 0.36, 95% CI 0.17–0.74), compared to their food-secure counterparts. Food insecurity may be an important contributor to T2D prevalence and perceived T2D self-management for Latino immigrants.

Implementation of an Intensive Telehealth Intervention for Rural Patients with Clinic-Refractory Diabetes.

BackgroundRural patients with type 2 diabetes (T2D) may experience poor glycemic control due to limited access to T2D specialty care and self-management support. Telehealth can facilitate delivery of comprehensive T2D care to rural patients, but implementation in clinical practice is challenging.ObjectiveTo examine the implementation of Advanced Comprehensive Diabetes Care (ACDC), an evidence-based, comprehensive telehealth intervention for clinic-refractory, uncontrolled T2D. ACDC leverages existing Veterans Health Administration (VHA) Home Telehealth (HT) infrastructure, making delivery practical in rural areas.DesignMixed-methods implementation study.Participants230 patients with clinic-refractory, uncontrolled T2D.InterventionACDC bundles telemonitoring, self-management support, and specialist-guided medication management, and is delivered over 6 months using existing VHA HT clinical staffing/equipment. Patients may continue in a maintenance protocol after the initial 6-month intervention period.Main MeasuresImplementation was evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. The primary effectiveness outcome was hemoglobin A1c (HbA1c).Key ResultsFrom 2017 to 2020, ACDC was delivered to 230 patients across seven geographically diverse VHA sites; on average, patients were 59 years of age, 95% male, 80% white, and 14% Hispanic/Latinx. Patients completed an average of 10.1 of 12 scheduled encounters during the 6-month intervention period. Model-estimated mean baseline HbA1c was 9.56% and improved to 8.14% at 6 months (− 1.43%, 95% CI: − 1.64, − 1.21; P < .001). Benefits persisted at 12 (− 1.26%, 95% CI: − 1.48, − 1.05; P < .001) and 18 months (− 1.08%, 95% CI − 1.35, − 0.81; P < .001). Patients reported increased engagement in self-management and awareness of glycemic control, while clinicians and HT nurses reported a moderate workload increase. As of this submission, some sites have maintained delivery of ACDC for up to 4 years.ConclusionsWhen strategically designed to leverage existing infrastructure, comprehensive telehealth interventions can be implemented successfully, even in rural areas. ACDC produced sustained improvements in glycemic control in a previously refractory population.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07281-8.

Self-Management of Diabetes in Black Men: The Flint MANUP Intervention Study

The story of John Henry, the “steel-drivin’ man”, is well known to Black men in the United States. John Henry is considered a hero because he demonstrated tremendous strength and self-determination. The MANUP diabetes program used the John Henryism, defined as high-effort active coping in the face of adversity, as the basis of a diabetes intervention for Black men. MANUP conducted four community-based focus groups identifying topics of concern to Black men with type 2 diabetes (T2D). Interestingly, the men reported that high-effort active coping was crucial for successful diabetes self-management. MANUP then developed and implemented a longitudinal culturally targeted self-management program for 33 Black men with T2D in Flint, Michigan. MANUP included discussion groups, physical activity, and an app incorporating text-messaging, group-chat, and a blood glucose monitoring dashboard to improve glycemic control (A1c). This single-group, repeated measures intervention assessed A1c three times over a six-month period. Improvements in A1c were observed at: baseline – time 2: 8.9% vs 8.6%, p=0.14; time 2 – time 3: 8.6% vs 8.1%, p=0.21; and baseline – time 3: 8.9% vs 8.1%, p=0.005. After controlling for age and insulin use, the significant reduction in A1c over 6 months remained (p=0.01). These findings demonstrate that combining mobile health technology and moderate physical activity with culturally targeted discussion topics can improve T2D self-management and reduce A1c in Black men. More community-driven longitudinal intervention studies that improve diabetes self-management among Black men are needed to achieve gender and racial health equity..

Type 2 diabetes self-management: spirituality, coping and responsibility

BackgroundIn England, although The National Institute of Health and Care Excellence recommends that patients’ religious beliefs should be incorporated into individual healthcare plans, these components are often neglected in diabetes management care plans. A literature review identified a paucity of research regarding how the spirituality of British people may influence their approach to their self-management of type 2 diabetes (T2D).AimsTo explore how the spirituality of a small group of adults with T2D, living in England, influenced their coping strategies and self-management of diet and exercise.MethodsBiographic Narrative Interpretive Method of two interviews per participant and thematic analysis for data interrogation (n = 8). Data as glycated haemoglobin, living situation, age, length of time since T2D diagnosis, body mass index and diabetic medicines contextualised the interview data.ResultsParticipants’ spirituality, health beliefs, coping and sense of responsibility for T2D self-management overlapped in complex layers. Three themes were generated: (a) spirituality influences expectations in life; (b) beliefs influence coping styles of diabetes self-management; and (c) responsibility influences diabetes self-management. A model was created to assist nurses in addressing these components.ConclusionNurses should consider how patients’ self-management of T2D may be influenced by their spirituality, health beliefs, coping and sense of responsibility.

Impact of Telehealth Care among Adults Living with Type 2 Diabetes in Primary Care: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Primary health care physicians are increasingly offering telehealth services to patients not only for its cost and time saving advantages but for the additional benefits telehealth can provide for patients with type 2 diabetes (T2D) such as improved self-management behaviours. To support the development of telehealth based T2D clinical care models in primary health care settings, a narrative synthesis and meta-analysis of randomised controlled trial studies was completed for 29 studies that evaluated the effect of one or more types of telehealth interventions on HbA1c levels compared to usual care alone. Results from the random effects meta-analysis demonstrated that telehealth interventions had a stronger influence on HbA1c compared to usual care with a mean difference in HbA1c \\% −0.18 (CI −0.35, −0.01), p = 0.04. Results from the subgroup meta-analysis demonstrated that telehealth interventions, when grouped by type of telemonitoring (mHealth and telephone communication), all have a stronger effect on lowering HbA1c levels; however, none of these findings were significant. Key findings from this review demonstrate that telehealth interventions that address T2D self-management behaviours and have higher levels of health care provider engagement, have greater effects on lowering HbA1c levels compared to usual care alone.

Knowledge and perceptions around self-management of type 2 diabetes among a Sudanese community in Australia: A qualitative study.

People from Sudanese background are more likely to be diagnosed with type 2 diabetes (T2D) as compared to the general population. In recent years, there has been an increase in the number of migrants from Sudan to Australia. However, there is a dearth of research exploring the perceptions and experiences of self-management strategies for diabetes among this migrant Sudanese population residing in Australia. This study aims to explore these experiences and perceptions as well as to identify cultural aspects related to T2D self-management strategies for people from this migrant group. A qualitative study using semi-structured in-depth interviews with Sudanese participants (n=12) living with T2D was conducted in Melbourne, Australia. The thematic analysis found barriers to self-management of diabetes to include language differences, the burden of self-management, difficulties in accommodating traditional dietary practices in self-management, as well as the expectations of familial and social obligations. Enablers included positive relationships with health professionals, support networks, involvement in religion and adopting traditional remedies. This study found cultural considerations, such as incorporating traditional dietary practices and familial obligations into self-management, to be the most significant influence for this group of Sudanese participants in the way they managed their diabetes. This study highlights the need for culturally appropriate provision of health services and resources for Sudanese people with T2D while recognising the value placed on traditional food choices. Importantly, the collectivist Sudanese culture must be considered for any future development and implementation of health promotion strategies.