Diabetes education program for people with type 2 diabetes: An international perspective

Effect of online infographics for enhancing health literacy among patients with type 2 diabetes in primary care unit during the COVID-19 pandemic: a randomized controlled trial

BACKGROUND

Health literacy (HL) in patients with type 2 diabetes mellitus (DM) can help control disease and prevent complications. However, most patients with type 2 DM have inadequate HL; therefore, their HL must be further improved. This study aimed to determine the effects of online infographics on improving HL among patients with type 2 DM.

METHODS

This randomized controlled trial was conducted from July 2022 to September 2022, at the primary care unit of Songklanagarind Hospital, Thailand; 30 patients with type 2 DM were randomly assigned to the experimental (n = 15; three types of infographics) and control (n = 15; three types of pamphlets) groups. Infographics and pamphlets were distributed weekly via social media platforms. The S-TOFHLA Thai version and Thai-FCCHL were used to evaluate HL. Chi-square, Fisher's exact, Wilcoxon rank-sum, t-test, paired t-test, and McNemar's chi-square tests were used.

RESULTS

The median age of 30 participants was 56 years. The mean duration of DM was 9.6 years, with a median HbA1c level of 7.5 mg%. Most participants (80%) had adequate HL in S-TOFHLA, whereas 63.3% had adequate HL in FCCHL. All participants in the infographic group who had inadequate HL in the S-TOFHLA pre-test achieved adequate HL. Meanwhile, only 50% of patients in the pamphlet group achieved adequate HL. Regarding FCCHL, 50% of patients in the infographic group and 60% in the pamphlet group who had inadequate HL in the pretest achieved adequate HL. However, no statistical significance in achieving adequate HL was found in either group. The mean differences (SD) in S-TOFHLA between before and after intervention were 12.53 (8.77; p = 0.0007) and 10.13 (9.88; p = 0.001) in the infographic and pamphlet groups, respectively. Regarding FCCHL, the mean differences (SD) were 3.47 (4.29) and 3.20 (2.91) in the infographic group (p = 0.003) and pamphlet (p = 0.002) groups, respectively. No statistical significance in the mean difference was found between both groups.

CONCLUSIONS

Novel online infographics and pamphlets did not significantly differ in achieving adequate HL among patients with type 2 DM who should receive health education about disease control and complication prevention. However, both interventions can increase and maintain HL levels. Online educational media can be appropriate during the COVID-19 pandemic. Nevertheless, further larger-scale studies should be performed to examine the impact of other DM educational media on HL promotion.

TRIAL REGISTRATION

The Thai Clinical Trials Registry (TCTR) with registry ID TCTR20230425001 (date of registration 25/04/2023).

The effect of personalized intelligent digital systems for self-care training on type II diabetes: a systematic review and meta-analysis of clinical trials

AIMS

Type 2 diabetes (T2D) is rising worldwide. Self-care prevents diabetic complications. Lack of knowledge is one reason patients fail at self-care. Intelligent digital health (IDH) solutions have a promising role in training self-care behaviors based on patients' needs. This study reviews the effects of RCTs offering individualized self-care training systems for T2D patients.

METHODS

PubMed, Web of Science, Scopus, Cochrane Library, and Science Direct databases were searched. The included RCTs provided data-driven, individualized self-care training advice for T2D patients. Due to the repeated studies measurements, an all-time-points meta-analysis was conducted to analyze the trends over time. The revised Cochrane risk-of-bias tool (RoB 2.0) was used for quality assessment.

RESULTS

In total, 22 trials met the inclusion criteria, and 19 studies with 3071 participants were included in the meta-analysis. IDH interventions led to a significant reduction of HbA1c level in the intervention group at short-term (in the third month: SMD = - 0.224 with 95% CI - 0.319 to - 0.129, p value < 0.0; in the sixth month: SMD = - 0.548 with 95% CI - 0.860 to - 0.237, p value < 0.05). The difference in HbA1c reduction between groups varied based on patients' age and technological forms of IDH services delivery. The descriptive results confirmed the impact of M-Health technologies in improving HbA1c levels.

CONCLUSIONS

IDH systems had significant and small effects on HbA1c reduction in T2D patients. IDH interventions' impact needs long-term RCTs. This review will help diabetic clinicians, self-care training system developers, and researchers interested in using IDH solutions to empower T2D patients.

Prevalence, knowledge, and lifestyle-associated risk factors of dyslipidemia among Ghanaian type-2 diabetes mellitus patients in rural and urban areas: A multicenter cross-sectional study

Background and Aims

Dyslipidemia in diabetes mellitus has been linked to unhealthy lifestyle and bad eating habits. However, this association has not been well studied among rural and urban Ghanaian populations. In this study, we determined the prevalence, knowledge, and lifestyle-associated risk factors of dyslipidemia among Ghanaian type-2 diabetes mellitus (T2DM) patients in rural and urban areas.

Methods

This comparative multicentre-cross-sectional study recruited 228 T2DM outpatients attending the St. Michael Hospital, Pramso (rural) and Kumasi South Regional Hospital (urban), Ghana for routine check-ups. Self-structured questionnaire was used to collect sociodemographic, knowledge, and lifestyle characteristics. Fasting blood samples were taken to measure lipid profiles. Dyslipidemia was defined per the American Diabetes Association criteria. All p < 0.05 were considered statistically significant.

Results

The overall prevalence of dyslipidemia was 79/228 (34.7%). Dyslipidemia was more prevalent among urban participants 43 (18.9%) than rural participants 36 (15.8%). Twenty-seven (11.7%) had adequate knowledge about the risk factors, complications, and management of diabetes. Eating supper after 7 p.m. [adjusted odds ratio = 3.77, 95% confidence interval (1.70-8.37), p = 0.001] significantly increased one's risk of having dyslipidemia by 3.8-fold compared to eating supper earlier (before 5 p.m.).

Conclusion

Dyslipidemia is increasing among T2DM patients in both urban and rural areas and it's independently influenced by eating supper after 7 p.m. Most participants were ignorant of the risk factors, complications, and management of diabetes. Adjusting eating habits and increasing diabetes awareness programs to sensitize the general public can mitigate the increasing prevalence of dyslipidemia in both urban and rural areas.

Lifestyle Interventions for Prevention and Management of Diet-Linked Non-Communicable Diseases among Adults in Arab Countries

The increased incidences of diet-related non-communicable diseases (NCDs) such as diabetes, obesity, and cardiovascular diseases among adults are becoming the chief public health concern in most Arab countries. Economic expansion has contributed to a nutrition shift from a traditional seasonal diet to Westernized eating habits coupled with a sedentary lifestyle. Despite the rising concern for NCD mortality, public health policies are inadequately addressed. This narrative review aims to discuss the effectiveness of nutritional interventions focusing on diet and physical activity in the management of NCDs among Arab adults. A comprehensive literature search was performed using different database platforms such as Cochrane reviews, Scopus, and PubMed for articles published between 1 December 2012 and 31 December 2021. Fifteen recent research articles addressing NCDs, mainly diabetes and obesity, from different Arab countries were included in this review. Structured lifestyle interventions involving behavioral therapy approaches and personalized goals for diet and physical activity were found to improve specific health outcomes in most studies. Significant improvements in health outcomes were reported for longer-duration interventions with follow-ups. A combination of both online and face-to-face sessions was found to be effective. It is important to identify barriers to physical activity for a culturally acceptable lifestyle intervention and conduct further studies to evaluate interventions for the long-term maintenance of health outcomes.

The effect of diabetes education based on learning modality in individuals with diabetes incompatible with treatment on compliance and metabolic goals: A randomized controlled trial

BACKGROUND

The purpose of this study is to examine the effect of education based on learning modality in diabetic individuals who are incompatible with treatment, on treatment compliance and metabolic goals.

METHODS

This study is a randomized controlled trial. Among the individuals who applied to the outpatient clinic and were eligible for inclusion in the study, the odd numbers were assigned to the intervention group (n:30), and the even numbers to the control group (n:30). The practice group of 30 people and the control group were divided into 3 groups. Three groups in the intervention group was given according to the learning modality. The auditory group in the post-training practice group; calling by phone, to the visual group; by Short Messaging Servis, to the tactile group; reminder alerts were made by phone + Short Messaging Servise. Standard training was given to the control group.

RESULT

It was observed that the total scale score of the intervention group decreased significantly after the training, while the total scale score of the control group increased significantly after the training. As a result of the diabetes education given based on learning modality, significant decreases were observed in A1C, fasting blood glucose, post-prandial blood glucose, body mass index, high-density lipoprotein and blood pressure values of the intervention group compared to the control group.

CONCLUSION

Study findings show that the diabetes education given to the intervention group according to their learning modality positively affects the diabetes management and treatment compliance of the individuals.

The effectiveness of an intervention designed based on health action process approach on diet and medication adherence among patients with type 2 diabetes: a randomized controlled trial

BACKGROUND

Diabetes is a major cause of worldwide morbidity and mortality. Diet and medication non-adherence are common among individuals with diabetes, making glycemic control difficult to attain. This study aimed to evaluate an intervention designed based on Health Action Process Approach (HAPA) to improve adherence to diet and medication among patients with type 2 diabetes in Tehran, Iran.

METHODS

The study was a randomized controlled trial. A total of 248 patients with type 2 diabetes who had low diet and medication adherence were randomly allocated into two intervention (n  = 124) and control (n  = 124) groups. Intervention group received educational intervention during three months. HAPA constructs, diet and medication adherence, and Hemoglobin A1c (HbA1c) levels were assessed at baseline, one month and six months after the intervention. Mixed Model Analysis was used to compare between and within group changes in the outcomes.

RESULTS

There was a statistically significant improvement in HbA1c levels after six months (7.77 ± 1.36% vs. 8.07 ± 1.52%, 95% CI, p  < 0.001). Diet and medication adherence, intention, task self-efficacy, coping self-efficacy, recovery self-efficacy, action and coping planning, barriers, benefits and perceived social support were significantly improved one month and six months after the intervention (p  < 0.001).

CONCLUSION

Our intervention designed based on health action process approach led to improvements in diet and medication adherence, and HbA1c among the patients within one and six months.

TRIAL REGISTRATION

IRCT, IRCT20151208025431N4. Registered 10 March 2018, https://fa.irct.ir.

Factors Influencing the Utilization of Diabetes Complication Tests Under the COVID-19 Pandemic: Machine Learning Approach

OBJECTIVE

There are still not enough studies on the prediction of non-utilization of a complication test or a glycated hemoglobin test for preventing diabetes complications by using large-scale community-based big data. This study identified the ratio of not taking a diabetes complication test (fundus examination and microprotein urination test) among adult diabetic patients over 19 years using a national survey conducted in South Korea and developed a model for predicting the probability of not taking a diabetes complication test based on it.

METHODS

This study analyzed 25,811 subjects who responded that they had been diagnosed with diabetes by a doctor in the 2020 Community Health Survey. Outcome variables were defined as the utilization of the microprotein urination test and the fundus examination during the past year. This study developed a model for predicting the utilization of a diabetes complication test using logistic regression analysis and nomogram to understand the relationship of predictive factors on the utilization of a diabetes complication test.

RESULTS

The results of this study confirmed that age, education level, the recognition of own blood glucose level, current diabetes treatment, diabetes management education, not conducting the glycated hemoglobin test in the past year, smoking, single-person household, subjectively good health, and living in the rural area were independently related to the non-utilization of diabetes complication test after the COVID-19 pandemic.

CONCLUSION

Additional longitudinal studies are required to confirm the causality of the non-utilization of diabetes complication screening tests.

Knowledge, attitude, and practice of patients with type 2 diabetes mellitus with regard to their disease: a cross-sectional study among Palestinians of the West Bank

Background

In Palestine, type 2 diabetes mellitus (T2DM) is a rapidly growing health concern. This study evaluated knowledge, attitude, and practice of patients with T2DM with regard to their disease. The study also investigated association and correlation between knowledge, attitude, and practice with sociodemographic and clinical characteristics of the patients. Predictors of higher knowledge, positive attitude, and good practice were also identified.

Methods

This cross-sectional study was conducted in primary healthcare facilities frequently visited by patients with T2DM across the West Bank of Palestine in the period of October 2018 to January 2019. An interviewer administered questionnaire was used to determine knowledge, attitude and practice of patients with T2DM with regard to their disease.

Results

Out of 300 patients invited, 220 (73.3%) patients responded. In this study, the median age was 57.0 years (51.0, 65.0), the median time elapsed since diagnosis with T2DM was 7.0 years (4.0, 14.0), the median fasting blood glucose was 150.0 mg/dL (128.8, 180.0), the median postprandial glucose was 230.0 mg/dL (200.0, 270.0), the median HbA_1c was 7.8% (7.0, 8.53), and the median BMI was 28.8 kg/m² (25.5, 33.1). The median knowledge score was 6.0/13.0 (4.5/13.0, 7.5/13.0), the median attitude score was 3.0/4.0 (2.0/4.0, 4.0/4.0), and the median practice score was 3.0 (1.0/5.0, 4.0/5.0). Having university education was strongly associated with having higher knowledge scores (p-value = 0.001). Additionally, having attended an educational program on diabetes was moderately associated with higher practice scores (p-value = 0.026).

Conclusions

Findings of this study highlighted the need for appropriately designed interventions to increase knowledge about T2DM among patients with low educational level. Well-designed educational programs might promote healthy practice among patients with T2DM. Future studies are still needed to assess if such interventions could be effective in improving health outcomes and quality of life of patients with T2DM in Palestine.

Effectiveness of an education intervention associated with an exercise program in improving disease-related knowledge and health behaviours among diabetes patients

OBJECTIVE

to assess the effectiveness of an education intervention associated with an exercise program in improving knowledge and health behaviours among diabetes patients.

METHODS

Diabetes and prediabetes patients were exposed to an evidence- and theoretically-based comprehensive education intervention over 24 weeks. Patients completed surveys assessing knowledge, physical activity, food intake, self-efficacy, and health literacy. Functional capacity was measured by oxygen uptake. All outcomes were assessed pre- and post-CR. Satisfaction about the education provided was assessed at post-CR. Paired t-tests, Pearson correlation coefficients, and linear regression models were computed to investigate the effectiveness of this intervention.

RESULTS

84 patients consented to participate, of which 47(56.0%) completed post-CR assessments. There was a significant improvement in patients' overall knowledge pre- to post-CR, as well as in physical activity, food intake, self-efficacy, and health literacy (p < 0.05). Peak VO₂ has clinically significant improved. Results showed a low significant positive correlation was between post-CR knowledge and food intake(r = 0.297;p = 0.04). Linear regression analysis revealed that age(B=-0.051; p = 0.01) was influential in changing post-CR knowledge.

CONCLUSION

The benefits of an education intervention designed for diabetes and prediabetes patients associated with an exercise program have been supported.

PRACTICE IMPLICATIONS

This work shows one effective education strategy taken in place that can be replicated in different settings.

Physical activity interventions promoted in the Arabic-speaking region: A review of the current literature

The Arabic-speaking region suffers from insufficient levels of physical activity (PA). Assessing the effectiveness of PA interventions presents a scientifically evaluated method to reduce and prevent the current high burden of noncommunicable diseases affecting this region. This review examined implemented PA interventions and corresponding measured health outcomes in this region. The review was limited to studies prior to January 2020 using nine electronic academic databases. Only intervention-focused articles incorporating PA as the primary intervention or as a component of a multibehavioural intervention were included. Thirty-nine PA intervention studies were identified. Published PA interventions were implemented among 50% of the countries in the region. Seventy percent of the studies were conducted in the Gulf region and 25% in North Africa. A third of the studies was designed for children and adolescents. Accordingly, 40% of interventions were for patients living with comorbidities. Seventy percent of the studies included PA as part of a multidisciplinary intervention. Most studies included body mass index as an outcome parameter. Significant improvement (P < .05) in measured health outcomes was seen in 97% of studies. Thorough analysis includes social and culturally congruent aspects of the PA interventions and discussion of resultant health outcomes. This information furthers the understanding of effective PA interventions that can be adapted to target sedentary lifestyle behaviours in this region.

Family-based intervention by pharmacists for type 2 diabetes: A randomised controlled trial

OBJECTIVES

To investigate the effectiveness of family intervention for type 2 diabetes and to examine predictors of glycaemic control.

METHODS

This was a prospective randomised controlled trial. Participants with type 2 diabetes were randomly assigned to an intervention group (n = 98) or a control group (n = 98). A pharmacist delivered the educational sessions and encouraged family members to take an active role in self-management practices for the intervention patients. The control patients received usual care.

RESULTS

At the end of the study (9-month follow-up), greater reduction in glycosylated haemoglobin (HbA_1c) occurred in the intervention group than in the control group (-1.37% and -0.21%, respectively; P < 0.001). Between-group differences in the improvements of low-density lipoprotein cholesterol (LDL-C) and blood pressure were found (P < 0.05). Higher scores in diabetes knowledge of patients, family support, medication adherence, self-management and self-efficacy were seen in the intervention group than in the control group (P < 0.05). Multivariable analysis showed family members who were spouses or women were strong predictors of improved glycaemic control.

CONCLUSION

Family-involvement intervention is helpful in diabetes management, especially having spouses or women as caregivers.

PRACTICE IMPLICATIONS

Family involvement should be encouraged in diabetes care.

Effectiveness of educational intervention based on psychological factors on achieving health outcomes in patients with type 2 diabetes

BACKGROUND

Managing type 2 diabetes (T2D) is assumed to be heavily dependent on patients' active participation in their own self-care behaviors including prescribed diets.

OBJECTIVES

The purpose of the present study was to investigate the effectiveness of educational intervention based on psychological factors on nutritional behaviors as well as levels of fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) in patients with T2D referring to diabetes clinics and healthcare centers in the city of Izeh, Iran.

METHODS

A total number of 145 patients were recruited in this clinical trial and then randomly assigned to two groups of intervention (n = 73 individuals) and control (n = 72 individuals). After that, a researcher-made multi-part questionnaire including a demographic characteristics information form, a nutritional perceptions and beliefs questionnaire; a scale measuring fears, concerns, and discomforts associated with diabetic diet, as well as the valid and reliable Perceived Dietary Adherence Questionnaire were used to collect the required data before and 3 months after the completion of the educational intervention. To this end, the patients in the intervention group attended an educational program for eight sessions but the individuals in the control group only received routine services. Data analysis was also conducted using the SPSS Statistics (Version 18) and via descriptive and inferential statistics.

RESULTS

The findings revealed that the mean scores of the sub-groups of nutritional perceptions and beliefs (but not exaggerated ones) in the patients assigned to the intervention group were significantly higher than those in the control group after 3 months (p = 0.001). As well, the mean scores of the sub-groups of fears, concerns, and discomforts in patients as well as exaggerated beliefs witnessed a significant decrease in the intervention group compared to those in the control group (p = 0.001) 3 months after the educational intervention. Furthermore, the mean scores of adherence to a healthy diet in the intervention group had significantly increased compared to those in the control group. There was correspondingly a significant descending trend in the average levels of fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) in the intervention group compared to those obtained in the control group (p = 0.001).

CONCLUSION

The results of this study shed light on the importance of the effectiveness of psychological factors on achieving health outcomes in patients with type 2 diabetes (T2D). Moreover, a new combination of diet-related psychological factors in patients with diabetes was introduced in the present study.Trial registration IRCT. IRCT20180308039008N1. Registered 15 April 2018, http://www.irct.ir.

Differential Relationships Between Diabetes Knowledge Scales and Diabetes Outcomes

Background Diabetes affects more than 29 million people in the US and requires daily self-management in addition to knowledge of the disease. Three knowledge assessments used are the Michigan Brief Diabetes Knowledge Test (DKT), Starr County Diabetes Knowledge Questionnaire (DKQ), and Kaiser DISTANCE Survey (DISTANCE). Purpose The purpose of the study was to test the discriminate validity of 3 diabetes knowledge scales and determine which is best associated with diabetes self-care and glycemic control. Methods Three hundred sixty-one adults with type 2 diabetes were recruited from primary care clinics. Four analyses were conducted to investigate the validity and relationships of the scale: alpha statistic to test internal validity, factor analysis to determine how much of the variance was explained, Pearson's correlation between the 3 scales, and Pearson's correlation between each scale, self-care, and outcomes. Results The DKQ had an alpha of 0.75, the DKT had an alpha of 0.49, and DISTANCE had an alpha of 0.36. The DKQ was significantly correlated with glycemic control. The DKT scale was significantly associated with general diet, the DISTANCE survey was significantly associated with exercise, and both DKT and DISTANCE were significantly associated with foot care. Conclusion Correlations among the 3 scales were modest, suggesting the scales are not measuring the same underlying construct. These findings indicate that researchers should carefully select scales appropriate for study goals or to appropriately capture the information being sought to inform practice.

A qualitative assessment of West Virginia pharmacist activities and attitude in diabetes management

AIMS AND OBJECTIVES

The role of pharmacists in chronic disease state management has been shown to significantly improve patient health outcomes and reduce overall health care costs. The current study is designed to assess the roles and attitudes of West Virginia (WV) pharmacists toward diabetes, evaluate services provided, address pharmacist clinical understanding and training, and demonstrate the challenges that limit pharmacists ability to deliver an efficient disease state management.

METHODS

We invited 435 preceptors affiliated with the University of Charleston School of Pharmacy to participate in the study using Qualtrics online survey software. The survey was divided into sections related to pharmacists, practice environment, pharmacist's roles in diabetes management, and challenges faced that limit their ability to deliver effective care to diabetic patients. Data were analyzed using 1-way analysis of variance, and a P value ≤.05 was considered statistically significant.

RESULTS

Of all eligible invited preceptors, 104 accessed the online survey based on the Qualtrics tracking tool, while 58 participated in the survey with a 56% response rate. Generally, WV pharmacists have positive attitudes regarding the provision of primary activities related to drug use and its associated problems. However, we report that WV pharmacists are less involved in providing education or recommendations regarding diabetes-associated risk factors such as nephropathy, retinopathy, foot care, and gastroparesis. In addition, the majority of pharmacists indicated that they face many challenges related to patient and the practice site environment that limit their ability to provide optimum diabetes patient care services.

CONCLUSION

Despite the mounting evidence that pharmacists can improve diabetic patient outcomes while significantly reducing overall costs, WV pharmacists are less involved in providing education or counseling in a variety of areas related to disease state management. In addition, identifying pharmacist challenges provides significant information for future planning toward improving diabetic patient care.

Sustaining Effect of Intensive Nutritional Intervention Combined with Health Education on Dietary Behavior and Plasma Glucose in Type 2 Diabetes Mellitus Patients

Diabetes mellitus is very common in elderly Chinese individuals. Although nutritional intervention can provide a balanced diet, the sustaining effect on at-home dietary behavior and long-term plasma glucose control is not clear. Consequently, we conducted a long-term survey following one month of experiential nutritional intervention combined with health education. Based on the Dietary Guidelines for a Chinese Resident, we found that the food items met the recommended values, the percentages of energy provided from fat, protein, and carbohydrate were more reasonable after one year. The newly formed dietary patterns were “Healthy”, “Monotonous”, “Vegetarian”, “Japanese”, “Low energy”, and “Traditional” diets. The 2h-PG of female participants as well as those favoring the “Japanese diet” decreased above 12 mmol/L. Participants who selected “Japanese” and “Healthy” diets showed an obvious reduction in FPG while the FPG of participants from Group A declined slightly. “Japanese” and “Healthy” diets also obtained the highest DDP scores, and thus can be considered suitable for T2DM treatment in China. The results of the newly formed dietary patterns, “Japanese” and “Healthy” diets, confirmed the profound efficacy of nutritional intervention combined with health education for improving dietary behavior and glycemic control although health education played a more important role. The present study is encouraging with regard to further exploration of comprehensive diabetes care.