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Authors:Sarah Bauerle Bass, Deborah Swavely, Shaneisha Allen, Patrick J. Kelly, Ariel Hoadley, Yaara Zisman-Ilani, Maryyam Durrani, Jesse Brajuha, Amy Iwamaye, Daniel J. Rubin Abstract: The Science of Diabetes Self-Management and Care, Ahead of Print. Purpose:The purpose of the study was to understand the role of perceived disease threat and self-efficacy in type 2 diabetes (T2DM) patients’ self-management by using the extended parallel processing model (EPPM) and sensemaking theory.Methods:Semistructured interviews (n = 25) were conducted with T2DM patients from an urban safety-net hospital. Participants were 50% male/female median age was 55 years and 76% were Black. Participants were categorized by EPPM group based on validated questionnaires (high/low disease threat [HT/LT]; high/low self-efficacy [HE/LE]). Nine were HT/HE, 7 HT/LE, 6 LT/HE, and 3 LT/LE. Interviews were transcribed and analyzed using inductive and deductive coding. Sensemaking theory was applied to contextualize and analyze data.Results:Those with HT indicated threat fluctuated throughout diagnosis but that certain triggers (eg, diabetic complications) drove changes in disease view. Those in the HT/HE group more frequently expressed disease acceptance, whereas the HT/LE group more often expressed anger or denial. HT/HE participants expressed having adequate social support and higher trust in health care providers. HT/LE participants reported limited problem-solving skills. In those with LT, the HE group took more ownership of self-management behaviors. The LT/LE group had heightened positive and negative emotional responses that appeared to limit their ability to perform self-care. They also less frequently described problem-solving skills, instead expressing reliance on medical guidance from their providers.Conclusions:EPPM and sensemaking theory are effective frameworks for understanding how perceived health threat and self-efficacy may impede T2DM self-care. A greater focus on these constructs is needed to improve care among low-income minority patients, especially those with low threat and self-efficacy. Citation: The Science of Diabetes Self-Management and Care PubDate: 2022-08-11T09:34:29Z DOI: 10.1177/26350106221116904
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Authors:Hee Sun Kang, Hyang Rang Park, Chun-Ja Kim, Savitri Singh-Carlson Abstract: The Science of Diabetes Self-Management and Care, Ahead of Print. Purpose:The purpose of the study was to understand the experiences of adults with diabetes wearing a continuous glucose monitor (CGM).Methods:This qualitative, descriptive study included 19 adults with type 1 diabetes or type 2 diabetes, who had used the FreeStyle Libre CGM for at least 4 weeks, from an outpatient clinic at a university-affiliated hospital in Korea. Data were collected through in-depth interviews and analyzed using an inductive content analysis approach.Results:The content analysis revealed 3 major themes—navigating glucose level fluctuations, reframing diabetes self-care and improving quality of life, and device improvement and service quality. Participants reported that CGMs offered convenient glucose level monitoring, allowed early response to rapid glucose changes, and facilitated effective patient-clinician communication. Participants expressed concerns about the financial burden and limited services, recommending improvements for devices, consumer services, and health insurance coverage.Conclusions:Study findings indicated that using wearable CGMs could improve self-care and quality of life in adults with diabetes. Using CGMs could improve patients’ understanding of how diabetes self-care management affects real-time glucose levels. Health care providers could support patients’ self-care by using device data. Improvements in quality, services, and insurance coverage could increase user satisfaction and promote self-care. Citation: The Science of Diabetes Self-Management and Care PubDate: 2022-08-02T11:37:56Z DOI: 10.1177/26350106221116899
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Authors:Angelina P. Nguyen, Alona D. Angosta, Weiming Ke, Thy M. Khong, Connie C. Tran, Miyong T. Kim Abstract: The Science of Diabetes Self-Management and Care, Ahead of Print. Purpose:The purpose of this study was to investigate the health status and needs of the Asian American/Pacific Islander (AAPI) population with diabetes in Texas.Methods:This was a cross-sectional secondary analysis of data collected from the Behavioral Risk Factors Surveillance System in Texas from 2015 to 2019 for non-Hispanic White (NHW) and AAPI adults.Results:Although the overall crude diabetes prevalence was lower in AAPI adults, age-adjusted diabetes prevalence was higher than in NHWs. Significant risk factors associated with diabetes in the AAPI group included being male, marital status, lower education levels, lower income, being overweight/obese, and having a sedentary lifestyle. Engagement in self-management activities (checking blood glucose, checking feet, attending a diabetes management course) was lower in AAPIs than in NHWs.Conclusions:Given stiff barriers to adequate screening and self-management support in diabetes care among ethnic populations such as AAPIs, targeted efforts to improve diabetes screening and effective care are warranted. Because today’s AAPI populations are predominantly first-generation immigrant groups who suffer from language barriers, efforts should be made to develop health surveys in multiple languages for wider inclusion of understudied groups like AAPIs in diabetes-related research. Citation: The Science of Diabetes Self-Management and Care PubDate: 2022-08-02T05:41:09Z DOI: 10.1177/26350106221116902
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Authors:Sun Ju Chang, Hee Jung Kim, Kyoung-eun Lee, Eunjin Yang Abstract: The Science of Diabetes Self-Management and Care, Ahead of Print. Purpose:The purpose of the study was to examine the factors associated with diabetes self-care behaviors (DSCB) in people with visual impairment (PVI), including demographics, disease-related characteristics, and psychosocial factors (self-efficacy, depression, and family support).Methods:A descriptive cross-sectional study was conducted. Adults with visual impairment and diabetes were recruited online and through posting notices, and a total of 141 participants were included. Measurements were completed using email and telephone surveys. Multiple linear regression analysis was performed to examine the factors associated with DSCB.Results:Higher self-efficacy and positive family support were significant predictors of better DSCB, whereas higher negative family support was a significant predictor of worse DSCB. Diabetes medication regimen was another major influencing factor on DSCB. However, depression was not associated with DSCB.Conclusion:Diabetes interventions for the visually impaired should have strategies to improve vulnerable areas of diabetes self-care, such as blood glucose monitoring. Health care providers are needed to consider diabetes education programs focused on improving self-efficacy or include family members in interventions to promote DSCB in PVI. Further studies are required to understand the problems and solutions for diabetes self-care in this population. Citation: The Science of Diabetes Self-Management and Care PubDate: 2022-08-02T05:37:02Z DOI: 10.1177/26350106221116023
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Authors:Jan Kavookjian, Jacqueline B. LaManna, Patricia Davidson, Jean W. Davis, Shahariar Mohammed Fahim, Cassidi C. McDaniel, Gladys Ekong, Andrew Todd, Kirsten Yehl, Carla Cox Abstract: The Science of Diabetes Self-Management and Care, Ahead of Print. Purpose:The persistent requirement of self-management for diabetes impacts quality of life (QoL), yet the literature for impact of diabetes self-management education and support (DSMES) on QoL in youth has not been synthesized and reported. The purpose of this review was to systematically identify and describe the state of the science exploring the impact of DSMES on self-reported QoL in youth with type 1 diabetes (T1DM) or type 2 diabetes (T2DM).Methods:A modified Cochrane review was conducted. Retained studies were published in the English language between January 1, 2007, and March 31, 2020. Included studies specified that the intervention had diabetes education addressing at least 1 or more of The Association of Diabetes Care & Education Specialists’ ADCES7 Self-Care BehaviorsTM (ADCES7™) and used an established self-reported QoL measure. Retained studies were assessed for risk of bias.Results:Eleven studies reported in 12 articles were retained. The interventions were primarily delivered to youth with T1DM or T2DM and included caregivers/families in some studies. The ADCES7™ were addressed across the retained studies. Five of the 11 studies assessed QoL as the primary outcome and 6 studies as a secondary outcome.Conclusion:To enhance the QoL outcomes and to provide insight into how to positively impact self-perceptions of QoL, ongoing generic and diabetes-specific QoL assessments are warranted for youth with T1DM or T2DM. Further research is needed in structured DSMES programs to help reduce variability in research designs, methods, measures, and outcomes to generate evidence for best practices that can be translated and disseminated into real-world settings. Citation: The Science of Diabetes Self-Management and Care PubDate: 2022-07-28T10:19:05Z DOI: 10.1177/26350106221115450
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Authors:Aaron Drovandi, Leonard Seng, Benjamin Crowley, Malindu E. Fernando, Rebecca Evans, Jonathan Golledge Abstract: The Science of Diabetes Self-Management and Care, Ahead of Print. Purpose:The purpose of this study was to explore the perceptions of health professionals regarding the ideal design of a remotely delivered diabetes-related foot disease (DFD) secondary prevention program.Methods:A qualitative study involving 33 semistructured phone interviews was conducted with health professionals with experience managing DFD. Interviews discussed the role of health professionals in managing DFD, their experience in using telehealth, perceived management priorities, preferences for a secondary prevention management program, and perceived barriers and facilitators for such a program. Interviews were audio-recorded and transcribed, and inductive thematic analysis was used to derive key themes.Results:Three themes were derived: (1) barriers in current model of DFD care, (2) facilitators and ideas for a remotely delivered secondary prevention program, and (3) potential challenges in implementation. DFD care remains acute-care focused, with variability in access to care and a lack of “clinical ownership.” Patients were perceived as often having poor knowledge and competing priorities, meaning engagement in self-care remains poor. Participants felt a remote secondary prevention program should be simple to follow and individualized to patients’ context, with embedded support from a case manager and local multidisciplinary service providers. Challenges to implementation included limited DFD awareness, poor patient motivation, patient-related issues with accessing and using technology, and the inability to accurately assess and treat the foot over telehealth.Conclusions:Health professionals felt that an ideal remotely delivered secondary prevention program should be tailored to patients’ needs with embedded support from a case manager and complemented with multidisciplinary collaboration with local service providers. Citation: The Science of Diabetes Self-Management and Care PubDate: 2022-07-15T09:19:28Z DOI: 10.1177/26350106221112115
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Authors:Katherine Wentzell, Rebecca Vitale, Lori Laffel Abstract: The Science of Diabetes Self-Management and Care, Ahead of Print. Purpose:The purpose of this study was to explore the emotional work of diabetes during emerging adulthood and to explicate the validity of a newly developed measure of diabetes distress (DD) for use with emerging adults living with type 1 diabetes mellitus (T1DM), the Problem Areas in Diabetes—Emerging Adult version (PAID-EA).Methods:Young people ages 18 to 30 with T1DM were recruited online to complete a cross-sectional survey including measures of DD, depressive symptomology, and the PAID-EA. To evaluate content validity, 2 open-ended questions asked what was the most significant emotion or worry discussed in the survey items and what feelings were missed in those items. Responses were analyzed using directed qualitative content analysis.Results:A total of 254 (87%) participants responded to at least 1 of the 2 open-ended questions. Three themes and 1 subtheme were identified: (1) fear of the future with the subtheme of worry about the cost of diabetes, (2) acute worries about living with diabetes, and (3) challenges with finding support. More PAID-EA items corresponded with these themes than items on the original Problem Areas in Diabetes or Center for Epidemiologic Studies Depression Scale, supporting the validity of the PAID-EA and clarifying the developmental-stage-specific aspects of DD.Conclusions:Emerging adulthood is a period in which the future should hold infinite possibility, but young people with T1DM describe a staggering fear of the future with markedly limited possibilities, supporting the need to measure the developmental-stage-specific experience of DD as captured on the PAID-EA. Citation: The Science of Diabetes Self-Management and Care PubDate: 2022-07-14T05:44:42Z DOI: 10.1177/26350106221110817
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Authors:Jihun Woo, Erum Z. Whyne, Jaylen I. Wright, H. Matthew Lehrer, Taha A. Alhalimi, Tianyu Wang, Victoria C. Saba, Susan K. Dubois, Hirofumi Tanaka, Sharon A. Brown, Mary A. Steinhardt First page: 204 Abstract: The Science of Diabetes Self-Management and Care, Ahead of Print. Purpose:The purpose of the study was to determine the feasibility of implementing A1C self-testing at home using the A1CNow® Self Check and to compare the accuracy of the A1CNow to a reference standard in African Americans with type 2 diabetes (T2D).Methods:African American adults with T2D were recruited from 13 different churches (N = 123). Phase 1, conducted during the early phase of the COVID-19 pandemic, examined the feasibility of A1C assessment using the A1CNow performed at home by untrained participants. Phase 2, conducted when in-person research resumed, compared A1C values concurrently measured using the A1CNow and the DCA Vantage™ Analyzer (reference standard) collected by research staff at church testing sites.Results:In Phase 1, 98.8% of participants successfully completed at least 1 at-home A1C test; the overall failure rate was 24.7%. In Phase 2, the failure rate of staff-performed A1CNow testing was 4.4%. The Bland-Altman plot reveals that A1CNow values were 0.68% lower than DCA values, and the mean differences (A1CNow minus DCA) ranged from −2.6% to 1.2% with a limit of agreement between −1.9% to 0.5%.Conclusions:A1C self-testing is feasible for use in community settings involving African American adults with T2D. The A1CNow Self-Check underestimated A1C values when compared with the reference standard. Ongoing improvements in point-of-care devices have the potential to expand research and clinical care, especially in underserved communities. Citation: The Science of Diabetes Self-Management and Care PubDate: 2022-06-04T11:30:09Z DOI: 10.1177/26350106221100536
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Authors:Samereh Abdoli, Evah Odoi, Mehri Doosti-Irani, Paulo Fanti, Lora Humphrey Beebe First page: 213 Abstract: The Science of Diabetes Self-Management and Care, Ahead of Print. PurposeThe purpose of this study was to compare diabetes psychosocial comorbidities among adults with type 1 diabetes (T1D) across the United States during the onset of COVID-19 pandemic.MethodsAdults with T1D from 4 main US geographic regions including South (n = 367), West (n = 234), Northeast (n = 250), and Midwest (n = 247) completed a cross-sectional online survey between April and June 2020. Data collection was done on psychosocial measures, glycemic variability, sociodemographic characteristics, and various challenges related to the COVID-19 pandemic. Chi-square, Fisher’s exact, Kruskal-Wallis tests, ordinary least squares, proportional odds, and ordinal logistic regression methods were used for data analysis.ResultsIn the South, 51.2% of participants had moderate to high levels of diabetes distress, and this was significantly (P = .03) higher than other regions. Northeast region had the lowest prevalence of moderate to severe diabetes burnout (19.8%), but this was not significantly different compared to the other regions. Participants in the South had also the highest mean score on the 8-item Patient Health Questionnaire, with 30.3% of them reporting moderate to severe depressive symptoms. However, there were no significant differences in depressive symptoms among the regions. Glycemic control, demographic characteristics, and COVID-19-related challenges were associated with different psychosocial comorbidities in different regions.ConclusionsWhen providing information and support to individuals with diabetes in time of crisis like the COVID pandemic, providers should consider psychosocial aspects of diabetes care. Diabetes disparities and contextual factors vary geographically in the United States; these factors may impact the psychosocial comorbidities of diabetes in each region. Citation: The Science of Diabetes Self-Management and Care PubDate: 2022-06-01T05:23:00Z DOI: 10.1177/26350106221102863
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Authors:Kelly J. Mansfield, Vanessa D. Colicchio, Adonica I. Kauwe Tuitama, Eunjin Lee Tracy, Julie D. Neuberger, Michelle L. Litchman First page: 235 Abstract: The Science of Diabetes Self-Management and Care, Ahead of Print. Purpose:The purpose of the study was to understand care partner (CP) perceptions of an interdisciplinary diabetes self-management education and support (DSMES) intervention and explore how the interdisciplinary DSMES intervention influences diabetes-specific day-to-day interactions from the CP’s perspective.Methods:A multiple-methods research design comprised of an online survey including demographics and supportive behaviors and a semistructured interview was conducted. The survey was completed by 16 CPs. Of the 16 CPs, 11 participated in semistructured interviews. Survey data were analyzed using descriptive statistics. Thematic analysis of semistructured interviews was conducted.Results:CPs provided support in 3 primary areas: (1) meal planning and preparation (87.5%), (2) participating in physical activity (56.3%), and (3) assisting with technology (43.8%). The main themes described by CPs include (1) the importance of diabetes education for caregivers, including the information they retained from the program, the acquisition of tools to support the person with diabetes, and the desire for more and ongoing education; (2) diabetes education enhances the CP’s ability to provide social support and the challenges associated with support; and (3) partners described collaborative diabetes management such as finding middle ground and making changes together.Conclusion:CPs play a significant role in patient diabetes self-management by providing social support and partnership. DSMES programs should seek to include CPs to enhance patient support. Citation: The Science of Diabetes Self-Management and Care PubDate: 2022-06-04T11:26:48Z DOI: 10.1177/26350106221099872
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Authors:Jordyn A. Brown, Melissa Leonard, Tiffany Clinton, Julie K. Bower, Shannon L. Gillespie, Naleef Fareed, Nikki Thomas, Laura Prater, Allison Lorenz, Sara May, Christiane Voisin, Stephen Thung, Reena Oza-Frank, Seuli Bose Brill First page: 247 Abstract: The Science of Diabetes Self-Management and Care, Ahead of Print. Purpose:The purpose of this study is to characterize mothers’ experiences within a mother/infant dyad postpartum primary care program (Dyad) following gestational diabetes mellitus (GDM) to inform improvements in the delivery of care.Methods:A qualitative pilot study of women (n = 10) enrolled in a mother/infant Dyad program was conducted in a primary care practice at a large, urban academic medical center. Respondents were asked a series of open-ended questions about their experience with GDM, the Dyad program, and health behaviors. Interviews were audio-recorded, transcribed verbatim, and analyzed using ground theory with NVivo 12 Plus software.Results:Three key themes emerged: (1) Dyad program experience, (2) implementation of health behavior changes, and (3) acknowledgment of future GDM and type 2 diabetes mellitus (T2DM) health risks. Respondents found the Dyad program respondents felt that the program conveniently served mother and infant health care needs in a single appointment. Respondents also valued support from primary care providers when implementing health behavior changes. The Dyad program provided an opportunity for respondents to understand their current and future risk for developing GDM and T2DM.Conclusions:Postpartum women enrolled in the Dyad program received highly personalized primary care services. The results of our study will help integrate patient-centered strategies into models for GDM care to maintain patient engagement in postpartum clinical services. Citation: The Science of Diabetes Self-Management and Care PubDate: 2022-06-04T11:32:50Z DOI: 10.1177/26350106221100539
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Authors:Fang Chen, Carolyn B. Jasik, Timothy M. Dall, Cynthia Veronica Siego First page: 258 Abstract: The Science of Diabetes Self-Management and Care, Ahead of Print. Objective:To analyze economic savings and health impacts associated with a virtual digitally enhanced diabetes self-management education and support (DSMES) program.Research design and methods:Participants (n = 1,494) were nonpregnant adults with diagnosed type 2 diabetes and baseline body mass index (BMI) of 25 kg/m2 (23 kg/m2 if of Asian descent) or higher who enrolled in virtual DSMES between February 2019 and April 2020 for at least 4 months. Participants’ changes in glycated hemoglobin (A1C) and body weight were calculated as the difference between program start and last recorded values between months 4 and 6. Outcomes for all participants were analyzed; subanalyses were done on 628 participants with starting A1C>7% (53 mmol/mol), who could benefit most from DSMES. Markov-based microsimulation approach was used to model the potential reductions in diabetes sequalae and medical expenditures if observed improvements in A1C and BMI were maintained.Results:DSMES participants with starting A1C>7% experienced average reductions of 0.9% A1C and 2.1 kg of body weight (−1.7% of BMI) within 6 months. If these improvements were maintained, simulated outcomes include reduced 5-year onset of ischemic heart disease by 9.2%, myocardial infarction by 10.6%, stroke by 12.1%, chronic kidney disease by 16.5%, and reduced onset of other sequelae. Simulated cumulative reduction in medical expenditures is $1160 after 1 year, $4150 after 3 years, $7790 after 5 years, and $18 020 after 10 years.Conclusions:Participation in virtual DSMES improves A1C and body weight, with the potential to slow onset of diabetes sequelae and reduce medical expenditures. Citation: The Science of Diabetes Self-Management and Care PubDate: 2022-06-04T11:35:50Z DOI: 10.1177/26350106221100779
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Authors:Jane K. Dickinson, Michelle L. Litchman First page: 270 Abstract: The Science of Diabetes Self-Management and Care, Ahead of Print. Purpose:The purpose of this study was to gain a better understanding of real-world hypoglycemia experiences from people living with diabetes.Methods:An exploratory cross-sectional study of a convenience sample of 374 English-speaking adults affected by diabetes using an online survey was conducted.Results:Participant mean age was 37 years with an average diabetes duration of 21 years. On average, participants reported feeling hypoglycemia at 64 mg/dL (3.6 mmol/L), worrying about hypoglycemia at 63 mg/dL (3.5 mmol/L), and treating hypoglycemia at 72 mg/dL (4 mmol/L). Terminology used by study participants did not match the current classifications of hypoglycemia used in clinical research. Participants who have been told they have hypoglycemia unawareness treat at a significantly lower level compared to those without hypoglycemia unawareness. Only 58% always carry hypoglycemia treatment; there was a relationship with increasing age and always carrying hypoglycemia treatment. Thirty-eight percent of participants treat hypoglycemia with the recommended 15 g of carbohydrate (CHO). Survey respondents who wore continuous glucose monitors reported using significantly less CHO to treat hypoglycemia.Conclusions:In the real world, experiences related to feeling, worrying about, and treating hypoglycemia trend higher than what is noted in the standardized hypoglycemia classifications. Study findings have implications for teaching and supporting people with diabetes who experience hypoglycemia. Consuming less CHO to treat hypoglycemia could lead to fewer episodes of rebound hyperglycemia and less weight gain. Increased support for continuous glucose monitoring is warranted. Citation: The Science of Diabetes Self-Management and Care PubDate: 2022-06-04T11:38:30Z DOI: 10.1177/26350106221102855
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First page: 281 Abstract: The Science of Diabetes Self-Management and Care, Ahead of Print.
Citation: The Science of Diabetes Self-Management and Care PubDate: 2022-06-22T12:23:21Z DOI: 10.1177/26350106221105805
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