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Chen TT, Su WC, Liu MI. Patient-centered care in diabetes care-concepts, relationships and practice. World J Diabetes 2024; 15:1417-1429. [PMID: 39099822 PMCID: PMC11292325 DOI: 10.4239/wjd.v15.i7.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/11/2024] [Accepted: 05/13/2024] [Indexed: 07/08/2024] Open
Abstract
We still do not have comprehensive knowledge of which framework of patient-centered care (PCC) is appropriate for diabetes care, which elements of PCC are evidence-based, and the mechanism by which PCC elements are associated with outcomes through mediators. In this review, we elaborate on these issues. We found that for diabetes care, PCC elements such as autonomy support (patient individuality), cooperation and collaboration (system-level approach), com-munication and education (behavior change techniques), emotional support (biopsychosocial approach), and family/other involvement and support are critically important. All of these factors are directly associated with different patient outcomes and indirectly associated with outcomes through patient activation. We present the practical implications of these PCC elements.
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Affiliation(s)
- Tsung-Tai Chen
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan
| | - Wei-Chih Su
- Department of Gastroenterology, Taipei Tzu-Chi Hospital, New Taipei 23142, Taiwan
| | - Mei-I Liu
- Department of Pediatric Endocrinology, Mackay Children's Hospital, Taipei 10449, Taiwan
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Okati-Aliabad H, Nazri-Panjaki A, Mohammadi M, Nejabat E, Ansari-Moghaddam A. Determinants of diabetes self-care activities in patients with type 2 diabetes based on self-determination theory. Acta Diabetol 2024; 61:297-307. [PMID: 37855999 DOI: 10.1007/s00592-023-02186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023]
Abstract
AIMS In type 2 diabetes control, self-management is an effective way to minimize the risk of developing complications and improve the quality of life. Self-determination theory (SDT) proposed a promising explanatory framework to predict self-regulated behavior which was particularly relevant for self-management. This study aimed to investigate whether SDT constructs can affect the self-management and controlling glycated hemoglobin A1c (HbA1c) levels in type 2 diabetic patients or not. METHODS This cross-sectional study was conducted from August to December 2022 at two diabetes clinics in Zahedan. The study included 300 patients with type 2 diabetes. Data collection was done using a researcher-administrated questionnaire that included demographic data, diabetes self-care activities, and self-determination constructs including autonomous support, autonomous motivation, and perceived competence. RESULTS The mean of the overall score of self-care activities was 34.62 ± 11.86 out of a maximum of 70. Patients in the fourth quarter (wealthiest) of the socioeconomic status had the highest mean self-care score (P = 0.003). There was a significant relationship between diet score with perceived competence (P = 0.009). Perceived competence (P<0.001) and controlled self-regulation (P<0.001) were the predictors of exercise score in diabetes patients. Independent self-regulation (P<0.001, r = 0.21) and overall self-regulation (P = 0.001, r = 0.19) were significantly related to blood-glucose testing score. There was a significant relationship between foot care score with perceived competence (P = 0.048, r = 0.11) and autonomous support (P = 0.013, r = 0.14). Multiple regression showed that exercise was the predictor of HbA1c (P = 0.014). CONCLUSION Exercise is crucial for achieving good individualized glycemic control and reducing the risk of diabetes complications. The findings provided valuable insights into the determinants of self-care activities in patients with type 2 diabetes and underscore the need for interventions that address socioeconomic disparities, enhance perceived competence, and provide autonomy support to improve diabetes self-care.
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Affiliation(s)
- Hassan Okati-Aliabad
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Athare Nazri-Panjaki
- Student Research Committee, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Mahdi Mohammadi
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Elham Nejabat
- Khatam Al Anbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
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Pratiwi IN, Nursalam N, Widyawati IY, Ramoo V. Spousal Involvement in Collaborative Management and Glycemic Behavior Change among Patients with Diabetes Mellitus: A Systematic Review. SAGE Open Nurs 2024; 10:23779608241245196. [PMID: 38638412 PMCID: PMC11025446 DOI: 10.1177/23779608241245196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/01/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction The marked increase in the number of individuals with diabetes mellitus (DM) worldwide each year has resulted in the importance of the spouse's contribution to the promotion and support of patient self-management programs. Objectives This study aimed to systematically explore the role or involvement of spouses in collaborative management and glycemic behavior change in DM. Methods Five databases including Scopus, PubMed, Cumulative Index of Nursing and Allied Health Literature, SAGE, and Web of Science were reviewed for relevant articles retrieved from 2017 to 2022. Literature search used keywords, including "Spouse," "Support," "Self-management," "Glycemic Control," and "Diabetes mellitus." The Joanna Briggs Institute guidelines were used for appraisal review of journals. The component of partner support in the self-management of patients with DM is associated with an increase in the patient's glycemic level. Results Twenty-five studies were identified that describe the different spousal roles and strategies in the promotion and support of DM management. Overall, spouses' involvement positively impacted healthy diets, higher self-efficacy, improved quality of psychological well-being, increased perceived support, and changes in glycemic-influenced behavior. Adaptation in the spouse patient relationship including maintaining cohesiveness can result in positive coping is essential in normalizing and contextualizing the chronic condition of DM. Partner-based collaboration is important for diabetes management, overcoming management barriers, and generating communal coping. Conclusion This systematic review observed that the involvement of a spouse is important in improving collaborative management and results in better glycemic behavior in patients with DM. A better understanding of the relationship between spousal involvement, coping strategies, and adherence in daily management and the subsequent use of this information are highly useful for creating targeted and effective interventions.
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Affiliation(s)
- Ika Nur Pratiwi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Nursalam Nursalam
- Advanced Nursing Department, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Ika Yuni Widyawati
- Advanced Nursing Department, Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Vimala Ramoo
- Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
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Velázquez-Jurado H, Flores-Torres A, Pérez-Peralta L, Salinas-Rivera E, Valle-Nava MD, Arcila-Martinez D, Hernández-Jiménez S. Cognitive behavioral treatment to improve psychological adjustment in people recently diagnosed with type 2 diabetes: Psychological treatment in type 2 diabetes. Health Psychol Behav Med 2023; 11:2179058. [PMID: 36846199 PMCID: PMC9946322 DOI: 10.1080/21642850.2023.2179058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic disease that affects a person's general well-being. Current evidence sets an association between psychological well-being and controlled metabolic parameters. People newly diagnosed with T2DM show higher prevalence of depression and anxiety symptoms. Cognitive behavioral therapy (CBT) has effectively improved psychological adjustment, but most studies do not specifically address recently diagnosed people nor usually include long-term follow-up measures. Objective We sought to assess changes in psychological variables in people with newly diagnosed diabetes who received a cognitive-behavioral intervention, within a comprehensive care program. Method 1208 adults with T2DM (≤5 years) who attended a national health institute in Mexico received a cognitive-behavioral intervention aimed at improving quality of life and reducing emotional distress that often interferes with diabetes control, as well as evaluating cognitive and emotional resources and social support. Measures of quality of life, diabetes-related distress, anxiety and depression questionnaires were compared at pre-test, post-test and follow up using Friedman's ANOVAs. Multiple logistic regression models evaluated glycosylated hemoglobin (HbA1c) and triglycerides control at post-test and follow up. Results Questionnaire measures and metabolic variables significantly decreased symptomatology at post-test and these changes maintained at follow-up. Significant associations were found between quality-of-life scores and HbA1c and triglycerides levels in post-test and follow-up. Diabetes-related distress scores increased the odds of having adequate HbA1c control at post-test. Conclusion This study contributes to the evidence on the importance of considering psychological factors as part of comprehensive diabetes care to improve quality of life and emotional burden and facilitate the achievement of metabolic goals.
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Affiliation(s)
- Héctor Velázquez-Jurado
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico,Postgraduate Studies Division, National Autonomous University of Mexico (UNAM), Mexico City, Mexico, Héctor Velázquez-Jurado Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico; National Autonomous University of Mexico, Mexico City, Mexico; Av. Vasco de Quiroga #15, Col. Belisario Dominguez, Sección XVI, Alc. Tlalpan, C.P. 14080, Ciudad de Mexico
| | - Athena Flores-Torres
- Postgraduate Studies Division, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Liliana Pérez-Peralta
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Edgar Salinas-Rivera
- Department of Educational Psychology, National Pedagogic University (UPN), Mexico City, Mexico
| | - Marianne Daniela Valle-Nava
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico,Postgraduate Studies Division, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Denise Arcila-Martinez
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Sergio Hernández-Jiménez
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - for the CAIPaDi Study Group
- Centre for the Comprehensive Care of the Patient with Diabetes, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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Wang RH, Chen SY, Lee CM, Lu CH, Hsu HC. Resilience, self-efficacy and diabetes distress on self-management behaviours in patients newly diagnosed with type 2 diabetes: A moderated mediation analysis. J Adv Nurs 2023; 79:215-222. [PMID: 36317455 DOI: 10.1111/jan.15483] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/24/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
AIM To examine (1) the mediating role of self-efficacy between resilience and self-management behaviours and (2) the moderating role of diabetes distress on the relationship between self-efficacy and self-management behaviours in patients newly diagnosed with type 2 diabetes. DESIGN Cross-sectional design. METHODS Totally, 195 patients newly diagnosed with type 2 diabetes for more than 5 months but less than 18 months were recruited from three endocrine clinics in Taiwan through convenience sampling. Self-reported questionnaires including demographic and disease characteristics, resilience, self-efficacy and self-management behaviours were used to collect data from October 2020 to May 2021. Moderated mediation analysis was performed by Hayes's PROCESS macro. RESULT According to bootstrapping results, the indirect effect of resilience on self-management was significant, although the direct effect of resilience on self-management was not. Participants were categorized into with and without diabetes distress groups. The results of moderated mediation analysis indicated self-efficacy significantly correlated with self-management behaviours in participants without diabetes distress, although self-efficacy did not significantly correlate with self-management in participants with diabetes distress. CONCLUSION The association of resilience with self-management behaviours was fully mediated through self-efficacy with diabetes distress moderating the relationship between self-efficacy and self-management behaviours in patients newly diagnosed with type 2 diabetes. IMPACT Improving resilience could enhance self-efficacy leading to possible improvement in self-management behaviour, although improving self-efficacy might not benefit self-management behaviours for those with high levels of diabetes distress. Healthcare providers need to first assess and address the diabetes distress before intervening to improve self-efficacy to enhance self-management behaviours in patients newly diagnosed with type 2 diabetes. PATIENT OR PUBLIC CONTRIBUTION When designing this study, two patients newly diagnosed with diabetes were consulted about the importance of self-management behaviours for them personally.
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Affiliation(s)
- Ruey-Hsia Wang
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan.,National Pingtung University of Science and Technology, Kaohsiung City, Taiwan
| | - Shi-Yu Chen
- Tri-Service General Hospital, Taipei City, Taiwan
| | | | - Chieh-Hua Lu
- Tri-Service General Hospital, Taipei City, Taiwan
| | - Hui-Chun Hsu
- Lee's Endocrinology Clinic, Pingtung City, Taiwan
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Soriano EC, Lenhard MJ, Gonzalez JS, Tennen H, Otto AK, Perndorfer C, Shen BJ, Siegel SD, Laurenceau JP. Momentary Partner Involvement in Diabetes Self-Care and Continuously Measured Glucose: A Dynamic Analysis. Psychosom Med 2022; 84:808-812. [PMID: 35792706 PMCID: PMC9437115 DOI: 10.1097/psy.0000000000001106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examined the dynamic, real-time associations between partner involvement in diabetes self-care and continuous glucose monitor (CGM) metrics in adults with type 2 diabetes. METHODS For 1 week, 63 participants wore Dexcom G4 CGMs and provided momentary reports of partner involvement in diabetes self-care five times per day. Dynamic structural equation models were used to estimate the reciprocal lagged effects of partner involvement on next-hour CGM metrics (and vice versa). RESULTS Partner involvement predicted improved next-hour glucose control for five of six CGM metrics in analyses adjusted for time-varying covariates. The hour after partner involvement, the model predicted a 26.34 mg/dl decrease in glucose level (standardized β = -0.19), 30% greater odds of meeting target time in target range ( β = 0.07), 48% higher odds of target time below target range (TBR; β = 0.04; the only nonsignificant effect), 47% greater odds of target time above target range (β = 0.11), a 4.20 unit decrease in glucose standard deviation ( β = -0.19), and a 0.01 unit decrease in glucose coefficient of variation ( β = -0.08; all p values < .05). There was less consistent support for the reverse pathway, with only two metrics significantly related to next-hour partner involvement: glucose level ( β = 0.15) and TBR ( β = 0.21), such that having higher levels and meeting target TBR were significantly predictive of next-hour partner involvement. CONCLUSIONS This is the first study showing that partner involvement in daily diabetes management predicts short-term glucose control. More research is needed to understand how partners influence glycemic control and evaluate interventions that promote their involvement in diabetes care.
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Affiliation(s)
| | - M. James Lenhard
- Christiana Care Health System, Section of Endocrinology and Metabolism
| | - Jeffrey S. Gonzalez
- Yeshiva University, Ferkauf Graduate School of Psychology & Albert Einstein College of Medicine, Dept. of Medicine, Epidemiology, & Population Health
| | - Howard Tennen
- University of Connecticut School of Medicine, Dept. of Community Medicine and Dept. of Psychiatry
| | - Amy K. Otto
- University of Delaware, Dept. of Psychological & Brain Sciences
| | | | | | - Scott D. Siegel
- Christiana Care Health System, Section of Endocrinology and Metabolism
| | - Jean-Philippe Laurenceau
- University of Delaware, Dept. of Psychological & Brain Sciences
- Christiana Care Health System, Section of Endocrinology and Metabolism
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Polonsky WH, Soriano EC, Fortmann AL. The Role of Retrospective Data Review in the Personal Use of Real-Time Continuous Glucose Monitoring: Perceived Impact on Quality of Life and Health Outcomes. Diabetes Technol Ther 2022; 24:492-501. [PMID: 35255224 DOI: 10.1089/dia.2021.0526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: To explore whether regularly reviewing one's own retrospective continuous glucose monitoring (CGM) data might be linked with perceived quality of life (QoL) and glycemic benefits. Methods: Adults with type 1 diabetes (N = 300) or insulin-using type 2 diabetes (N = 198) using the Dexcom G5 Mobile or G6 Real-Time CGM (RT-CGM) system and receiving the weekly CLARITY summary report of their glucose data completed a survey exploring their use of the report and its perceived value and impact on QoL and glycemic outcomes. Regression analyses examined whether personal use of the report was associated with QoL, perceived glycemic outcomes, and RT-CGM metrics. Results: The majority reported that receiving and viewing the report contributed to improved hypoglycemic confidence (75.9%) and overall well-being (50.0%), reduced diabetes distress (59.3%-74.1%), and helped to improve A1C (73.1%) and reduce problems with hypoglycemia (61.8%) and chronic hyperglycemia (73.1%). Regularly reviewing the report with family or friends (positive predictor) and doing nothing with the report's information (negative predictor) were independently associated with QoL and perceived glycemic outcomes. Surprisingly, both predictors were also associated with poorer glycemic control (e.g., greater % time above range >180). Conclusions: These findings suggest that receiving a weekly RT-CGM summary report may contribute to QoL and health benefits, especially if the individual chooses to actively review and make use of the report's findings and openly reviews the findings with family or friends. Prospective studies are needed to more precisely determine how retrospective RT-CGM data summaries can best be presented and utilized effectively by adults with diabetes to enhance health outcomes.
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Affiliation(s)
- William H Polonsky
- Behavioral Diabetes Institute, San Diego, California
- Department of Medicine, University of California, San Diego, California
| | - Emily C Soriano
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, California, USA
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, California, USA
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Wooldridge JS, Soriano EC, Harris DE, Afari N. Feasibility and Acceptability of Ecological Momentary Assessment of Psychosocial Factors and Self-Management Behaviors Among Veterans With Type 2 Diabetes. Diabetes Spectr 2022; 35:76-85. [PMID: 35308149 PMCID: PMC8914587 DOI: 10.2337/ds21-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Comorbid symptoms such as post-traumatic stress and pain are common barriers to optimal self-management among veterans with type 2 diabetes. Additionally, self-management behaviors occur in the context of veterans' daily routines and social environments. This study evaluated the feasibility and acceptability of ecological momentary assessment (EMA) among veterans with type 2 diabetes. Ten veterans with type 2 diabetes were asked to respond to random EMA surveys during preprogrammed intervals five times per day for 14 days. EMA surveys were delivered via a mobile application and assessed momentary physical location, activities, social interactions, mood, stress, and pain. The last survey of each day included additional items about daily post-traumatic stress symptoms, diabetes distress, social support, physical activity, self-management behaviors, and functioning. Participants completed interviews assessing their experience in the study and barriers to responding and indicated their likelihood of participating in similar studies. The mean survey response rate was 96%, providing 675 observations. The majority of participants completed the five momentary surveys in <1 minute and the daily EMA surveys in <5 minutes. Results revealed substantial individual day-to-day variability across symptoms and self-management behaviors that is not captured by aggregated means across all participants. Participants generally reported enjoying responding to surveys and experiencing few barriers. Nine of 10 participants reported being "extremely likely" to participate in a similar study. These pilot data suggest that intensive EMA designs are feasible and acceptable for veterans with type 2 diabetes and can inform the design of future larger studies.
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Affiliation(s)
- Jennalee S. Wooldridge
- VA San Diego Healthcare System, San Diego, CA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
- Center of Excellence for Stress and Mental Health, San Diego, CA
- Corresponding author: Jennalee S. Wooldridge,
| | - Emily C. Soriano
- VA San Diego Healthcare System, San Diego, CA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE
| | | | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
- Center of Excellence for Stress and Mental Health, San Diego, CA
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