Severe obesity and diabetes self-care attitudes, behaviours and burden: implications for weight management from a matched case-controlled study. Results from Diabetes MILES--Australia

Adherence to diabetic foot care recommendations and associated factors among people with diabetes in Eastern Ethiopia: a multicentre cross-sectional study

OBJECTIVE

This study aimed to determine the level of adherence to foot care recommendations and associated factors among people with diabetes on follow-up in public hospitals in Eastern Ethiopia.

SETTING

An institutional-based cross-sectional study was conducted in public hospitals found in Eastern Ethiopia from 25 February to 25 March 2022.

PARTICIPANTS

A total of 419 patients with chronic diabetes who visited diabetic clinics in public hospitals in Eastern Ethiopia for follow-up were included.

MAIN OUTCOME MEASURE

The level of adherence to diabetic foot care recommendations and associated factors.

RESULTS

The findings indicated that 44.3% (95% CI: 39.3, 49.0) of people with diabetes had inadequate adherence to diabetic foot care recommendations. Age between 28-37 (adjusted OR (AOR)=1.10; 95% CI: 1.27, 5.63) and 38-47 years (AOR=2.19; 95% CI: 2.74, 8.89), rural residence (AOR=1.71; 95% CI: 1.15, 2.57), absence of comorbidity (AOR=2.22; 95% CI:1.34, 5.14), obesity (AOR=1.43; 95% CI: 1.10, 5.05) and inadequate foot care knowledge (AOR=2.10; 95% CI: 1.52, 4.35) were factors significantly associated with inadequate adherence to diabetic foot care recommendations.

CONCLUSION

More than two-fifths of people with diabetes had inadequate adherence to diabetic foot care recommendations. Younger age, rural residence, absence of comorbidity, obesity and inadequate foot care knowledge were significantly associated with inadequate adherence to diabetic foot care recommendations. It is very essential to educate people with diabetes about the importance of foot care recommendations in preventing and delaying the risks of foot-related problems and complications.

Clinical factors influencing knowledge and self-care practice among adults with type 2 diabetes mellitus

AIM

The objective of the study was to determine the clinical factors associated with knowledge and self-care practice among adults living with type 2 diabetes mellitus.

DESIGN

Descriptive cross-sectional design.

METHODS

A convenience sample of 330 participants was recruited over 3-months in 2018 and data were collected using a structured instrument.

RESULTS

Participants on insulin treatment modality had four times higher odds of knowledge on diabetes (B = 4.17, p = 0.023) while those on combined therapy (both oral hypoglycaemic agent and insulin) had 7.26 times higher odds of knowledge (B = 7.26, p < 0.001). Participants without medically confirmed diabetic complications had 3.66 higher odds of knowledge of diabetes (B = 3.66, p = 0.002). Participants on insulin treatment modality had a 1.4-fold higher odds of self-care practice (B = 1.4, p = 0.028). It was revealed that participants with hypertension and diabetic foot had lower odds of self-care practice (B = -1.13, p = 0.021).

CONCLUSION

In particular, participants who were on insulin and combined therapy (tablet and insulin) had higher knowledge and better self-care practice. Self-care was significantly influenced among those with, than those without diabetic foot and hypertension as complications.

Assessment and Management of Obesity and Self-Maintenance (AMOS): An Evaluation of a Rural, Regional Multidisciplinary Program

Obesity is common in rural areas, and reduced specialist healthcare access impedes its management. A pilot nurse-practitioner-led Assessment and Management of Obesity and Self-Maintenance (AMOS) Clinic focused on individualised obesity care in people living with type 2 diabetes delivered in a rural setting. This study aimed to explore participant and staff experiences of the multidisciplinary obesity clinic to identify barriers and facilitators to self-care, health, and well-being. A two-stage, mixed-method design was used. Initially, three focus groups involving a sample of AMOS participants and semi-structured staff interviews helped identify key barriers/facilitators. These findings informed a survey delivered to all AMOS participants. Qualitative data were analysed using an inductive two-step thematic networks technique to identify themes. Quantitative data were summarised using descriptive statistics. A total of 54 AMOS participants and 4 staff participated in the study. Four themes were identified to describe AMOS participant experiences': 1. affordability; 2. multidisciplinary care; 3. person-centred care; and 4. motivation. Specialised, multidisciplinary and individualised obesity care available through one clinic facilitated self-care and improved health and well-being. Dedicated multidisciplinary obesity clinics are recommended in rural and remote areas.

Foot self-care behaviour in type 2 diabetes adults with and without comorbid heart failure

AIMS

To compare the correlates of foot self-care behaviours among type 2 diabetes mellitus (T2D) adults with and without comorbid heart failure (HF).

DESIGN

Cross-sectional, correlational, comparative design.

METHODS

A 210 T2D adults (105 with HF and 105 without HF) participated from August-December 2020. Foot self-care behaviour was measured using the foot care subscale of the Summary of Diabetes Self-Care Activities (SDSCA) instrument. A stepwise logistic regression analysis was used to explore variables predicting foot self-care behaviour.

RESULTS

The participants' mean age was 58.7 ± 10.9 years. Poor foot self-care behaviour was reported in T2D adults both with (53.3%) and without (54.3%) HF. Participants with HF-comorbidity were statistically significantly older and had higher total daily medication intake. Household income and the total number of daily medications statistically significantly predicted foot self-care behaviour in HF-comorbid T2D adults. Marital status, social support and body mass index predicted foot self-care behaviour in the non-HF group.

Association between gestational depression and weight management behaviors during pregnancy: A cross-sectional study in Eastern China

An undesirable psychological state may deteriorate individual's weight management-related behaviors. This study aims to see if ineffective weight control measures were linked to depressive symptoms during pregnancy. We conducted a cross-sectional questionnaire survey of 784 pregnant women and collected information on sociodemographic factors, maternal characteristics, depression, and weight management activities throughout pregnancy (exercise management, dietary management, self-monitoring regulation, and management objectives). About 17.5% of pregnant women exhibited depressive symptoms. The mean score on dietary management was upper-middle, exercise management and self-monitoring regulation were medium, and management objectives were lower-middle. Multivariable linear regression analysis revealed that pregnant women with depressive symptoms had lower levels of exercise management (β = -1.585, p = 0.005), dietary management (adjusted β = -0.984, p = 0.002), and management objectives (adjusted β = -0.726, p = 0.009). However, there was no significant relationship between depressive symptoms and pregnant women's self-monitoring regulating behavior (p > 0.05). The findings indicated the inverse association between depressive symptoms and gestational weight management behaviors. These results offer important indications for pregnancy weight management professionals by highlighting the need for mental health interventions for pregnant women experiencing depressive symptoms.

Diabesity in Adults With Type 2 Diabetes Mellitus: A Cross-sectional Study Exploring Self-care and Its Determinants

OBJECTIVES

The purpose of this study was to describe self-care maintenance, self-care monitoring, self-care management and self-care self-efficacy in adults with type 2 diabetes (T2DM) and body mass index (BMI)<30 kg/m2 and adults with T2DM and BMI≥30 kg/m2 ("diabesity"), and to identify their clinical and sociodemographic determinants. Self-care is one of the main treatments for adults with T2DM. However, self-care has been poorly described in people with diabesity, and differences in clinical and sociodemographic determinants of self-care between patients with diabesity and patients with T2DM and BMI<30 kg/m2 have, to our knowledge, not been assessed.

METHODS

A secondary analysis was performed of sociodemographic and clinical data using a multicentre, observational, cross-sectional design, wherein 540 adults diagnosed with T2DM were included in a consecutive and convenience sampling procedure.

RESULTS

Self-care maintenance and management were significantly lower among patients with diabesity (p<0.001 and p=0.025, respectively). Among patients with diabesity, low income (relative risk [RR]=3.27, p=0.01) and presence of diabetic neuropathy (RR=4.16; p=0.03) were strongly associated with inadequate self-care maintenance; completion of high school (RR=0.45; p=0.01), availability of a family caregiver (RR=0.52; p=0.04) and the use of insulin as the main treatment (RR=2.09; p=0.01) decreased the likelihood of inadequate self-care monitoring.

CONCLUSIONS

The unfavourable behavioural profile of patients with diabesity could be further worsened by their lower level of confidence in performing adequate self-care.

Effects of time-restricted feeding in weight loss, metabolic syndrome and cardiovascular risk in obese women

BACKGROUND

The increasing prevalence of overweight and obesity among the worldwide population has been associated with a range of adverse health consequences such as Type 2 diabetes and cardiovascular diseases. The metabolic syndrome (MetS) is a cluster of cardiometabolic abnormalities that occur more commonly in overweight individuals. Time-restricted feeding (TRF) is a dietary approach used for weight loss and overall health. TRF may be an option for those subjects who struggle with extreme restriction diets with foods that generally do not belong to an individual's habits.

OBJECTIVE

The purpose of this study was to determine the effect of TRF on body composition and the association of weight loss with metabolic and cardiovascular risks in obese middle-aged women.

METHODS

A non-randomized controlled clinical trial was performed over 3 months in obese women (TRF group, n = 20, BMI 32.53 ± 1.13 vs. Control n = 12, BMI 34.55 ± 1.20). The TRF protocol adopted was 16 h without any energy intake followed by 8 h of normal food intake.

MAIN OUTCOMES AND MEASURES

Anthropometric measurements, body composition, blood biomarkers, cardiovascular risk in 30 years (CVDRisk30y), and quality of life were evaluated at baseline and after the 3 months.

RESULTS

TRF was effective in reducing weight (~ 4 kg), BMI, % of body fat (%BF), waist circumference from baseline without changes in blood biomarkers associated with MetS. TRF promoted a reduction in CVDRisk30y (12%) wich was moderately correlated with %BF (r = 0.62, n = 64, p < 0.001) and %MM (r = - 0.74, n = 64, p < 0.001).

CONCLUSIONS

TRF protocol reduces body weight without changes in biomarkers related to MetS. In addition, the anthropometric evaluation that predicts %BF and %MM could be used as an approach to follow individuals engaged in the TRF regimen since they correlate with cardiovascular risk.

The information-motivation-behavioral skills model explains physical activity levels for adults with type 2 diabetes across all weight classes

Physical activity is an evidence-based, effective treatment for type 2 diabetes mellitus (T2D), yet insufficient numbers of adults achieve recommended daily levels, particularly amongst higher weight classes. This cross-sectional study assessed whether the Information-Motivation-Behavioural Skills (IMB) Model explained physical activity levels in adults with T2D across different body mass index (BMI) levels (N = 381). Measures included the American Adults Knowledge of Exercise Recommendations (AAKER), Behavioural Regulation in Exercise Questionnaire (BREQ-2), Barriers Specific Self-Efficacy Scale (BARSE) and the outcome measure, International Physical Activity Questionnaire (IPAQ-short form). Analyses included structural equation modelling (SEM) and ordinal logistic regression models. SEM demonstrated a good fit of the IMB Model to the data, accounting for 44% of variance in physical activity levels. Both motivation and self-efficacy had a direct effect, and motivation indirectly predicted physical activity through self-efficacy. Further analyses found the effect of the IMB predictors did not vary according to BMI status. This study supports the application of the IMB Model in explaining physical activity behavior in adults with T2D. In particular, the contribution of motivation and self-efficacy as substantive and modifiable predictors of physical activity will facilitate the development of targeted and evidence-based interventions for individuals of all BMI classes.

The role of concordant and discordant comorbidities on performance of self-care behaviors in adults with type 2 diabetes: a systematic review

Background: Most patients with Type 2 diabetes (T2D) have high number of comorbid chronic conditions that can affect their self-care abilities. Guidelines for diabetes self-care behaviors are disease specific with little attention given to managing T2D with other comorbidities. Identifying comorbidities that either improve or potentially diminish the individual's capacity to perform effective self-care behaviors is essential to enhance clinical outcomes. One such framework conceptualizes comorbidities as concordant or discordant with diabetes pathophysiological pathways and care goals. Objective: The purpose of this systematic review was to examine the role of diabetes-concordant and discordant chronic conditions on the performance of self-care behaviors in adults with T2D. Methods: A comprehensive literature search was undertaken to identify published English language articles through the following five electronic databases: PubMed, CINAHL, PsycINFO, ISI Web of Science, and EMBASE. Quantitative studies published from March 2006 to April 2018 were included. Quality of evidence was evaluated using the Joanna Briggs Institutes Critical Appraisal Tools (JBI-CAT) and rated using Quality Assessment Tool for Quantitative Studies (QATQS). Results: The initial database search identified 1,136 articles but only 33 studies that met the inclusion criteria were included. The most common concordant comorbidity was hypertension while depression was the most common discordant condition. Adherence to medications was the most frequent diabetes self-care behavior reported and tended to be higher among concordant comorbidities. The findings showed mixed results concerning the effect of some concordant comorbidities such as hypertension, hyperlipidemia, retinopathy, and heart failure on diabetes self-care behaviors. But, there is agreement across studies that diabetes-discordant comorbidities have a more detrimental effect on self-care behaviors. Conclusions: Concordant comorbidities may improve diabetes self-care, but the evidence is inconclusive. Future research using well designed studies are needed to examine the complex relationship between diabetes self-care and comorbidities.

Depressive Symptoms Are Negatively Associated with Glucose Testing and Eating Meals on Time among Individuals with Diabetes in Zambia

BACKGROUND

Depression is an established risk factor for cardiovascular diseases and mortality among individuals living with diabetes, and impaired self-care behaviors may play a mediating role. In Africa, this association is not very well known. In this study, we examined the associations between depressive symptoms and different aspects of diabetes self-care in Zambian individuals with diabetes mellitus.

METHODS

A total of 157 individuals with diabetes mellitus participated. The sample was drawn from four city hospitals in Zambia. Diabetes self-care was assessed using the diabetes self-care inventory, and depression was assessed using the major depression inventory.

RESULTS

Fifty-nine percent of the sample had type 1 diabetes mellitus. Variations in self-care activities and behaviors were reported as least adhered to by individuals with type 1 and type 2 diabetes mellitus, in adolescent and adult patients. Regression analysis indicated that there was no association between total diabetes self-care and the depression total score. However, depression was associated with poor glucose testing and not eating meals on time by patients with diabetes.

CONCLUSION

Some variance on poor self-care was explained by demographic characteristics, specifically age, body mass index, and to some extent, socioeconomic status. Recognition and successful treatment of depression in patients with diabetes might help to optimize self-care behaviors, especially glucose testing and eating meals on time. However, this hypothesis needs further testing.

Self-care, quality of life and clinical outcomes of type 2 diabetes patients: an observational cross-sectional study

AIMS

To describe self-care of T2DM patients and to evaluate outcomes associated with self-care in T2DM patients.

METHODS

A multicentre cross-sectional study was conducted on a sample of 302 randomly selected T2DM patients. Clinical and socio-demographic data were collected by medical records. The Summary of Diabetes Self-care Activities was used to measure self-care about diet, blood testing, exercise and foot care. The EQ-5D was used to measure perceived quality of life. Multiple regression models were used to evaluate the associations between self-care and body mass index (BMI), glycated haemoglobin (HbA1c), presence of diabetes complications and quality of life (QoL).

RESULTS

Self-care was lower about exercise (median = 2.0) and foot care (median = 3.5) than about diet (median = 5.2) and blood testing (median = 4.5). HbA1c was associated with diet (p = 0.025), exercise (p = 0.017) and blood testing (p = 0.034). BMI was associated with exercise (p = 0.0071). Diabetes complications were associated with exercise (p = 0.031) and blood testing (p < 0.009). QoL was associated with exercise (p < 0.0001), blood testing (p = 0.032) and foot care (p = 0.013).

CONCLUSIONS

Self-care influences both clinical outcomes and quality of life of T2DM patients. Although exercise is more frequently associated with positive outcomes, it is particularly poor in T2DM population. Blood testing and foot care should be performed to prevent complications and not only when a health problem is already occurred. Interventions aimed to improve exercise are recommended. Further research is needed to explore barriers to exercise.

Adherence to and factors associated with self-care behaviours in type 2 diabetes patients in Ghana

BACKGROUND

Previous research has failed to examine more than one self-care behaviour in type 2 diabetes patients in Ghana. The purpose of this study is to investigate adult Ghanaian type 2 diabetes patients' adherence to four self-care activities: diet (general and specific), exercise, self-monitoring of blood glucose (SMBG) and foot care.

METHODS

Consenting type 2 diabetes patients attending diabetes outpatient clinic appointments at three hospitals in the Tamale Metropolis of Ghana completed a cross-sectional survey comprising the Summary of Diabetes Self-Care Activities Measure, and questions about demographic characteristics and diabetes history. Height and weight were also measured. Multiple linear regression analyses were conducted to identify the factors associated with adherence to each of the four self-care behaviours.

RESULTS

In the last 7 days, participants exercised for a mean (SD) of 4.78 (2.09) days and followed diet, foot care and SMBG for a mean (SD) of 4.40 (1.52), 2.86 (2.16) and 2.15 (0.65) days, respectively. More education was associated with a higher frequency of reported participation in exercise (r = 0.168, p = 0.022), following a healthy diet (r = 0.223, p = 0.002) and foot care (r = 0.153, p = 0.037) in the last 7 days. Males reported performing SMBG (r = 0.198, p = 0.007) more frequently than their female counterparts.

CONCLUSION

Adherence to diet, SMBG and checking of feet were relatively low. People with low education and women may need additional support to improve adherence to self-care behaviours in this type 2 diabetes population.

Cohort profiles of the cross-sectional and prospective participant groups in the second Diabetes MILES-Australia (MILES-2) study

PURPOSE

More research into the psychosocial aspects of diabetes is needed so that the health and quality of life of people with the condition can be improved. To fill this gap, we conducted the second Diabetes MILES-Australia study (MILES-2), a survey focused on psychological, behavioural and social aspects of diabetes. The aim of the MILES-2 study was to provide a (1) longitudinal follow-up of the original MILES 2011 study cohort; (2) cross-sectional assessment of a new cohort.

PARTICIPANTS

Eligible participants were English-speaking Australians with type 1 or type 2 diabetes, aged 18-75 years. Longitudinal cohort participants were mailed/emailed study invitations directly by researchers. Random sampling (stratified by diabetes type, insulin use, state) of the National Diabetes Services Scheme (NDSS) database and nationwide advertisements were used to recruit new cohort participants. The final sample included N=2342 eligible respondents (longitudinal cohort: n=504; 2015 new cohort: n=1838); 54% had type 2 diabetes.

FINDINGS TO DATE

Survey respondents were from an advantaged socioeconomic background compared to the general population. Respondents with type 1 diabetes were over-represented in the new cohort (45%) relative to the planned stratification (40% type 1 diabetes, 60% type 2 diabetes). Respondents with insulin-treated type 2 diabetes were under-represented in the new cohort relative to the stratified sampling (42% invited vs 50% response). Participants who completed both the 2011 and 2015 surveys were more likely than those completing the 2011 survey only to have type 1 diabetes, report a higher education and annual income, and live in metropolitan areas. Participant feedback indicated that the survey was perceived as relevant and valuable.

FUTURE PLANS

The depth and breadth of the data available in this large sample will highlight unmet needs and priority areas for future investigation and, crucially, will inform policy, programme and intervention development and evaluation in Australia.

The effects of intermittent compared to continuous energy restriction on glycaemic control in type 2 diabetes; a pragmatic pilot trial

AIMS

Weight loss improves glycaemic control in type 2 diabetes mellitus (T2DM). However, as achieving and maintaining weight loss is difficult, alternative strategies are needed. Our primary aim was to investigate the effects of intermittent energy restriction (IER) compared to continuous energy restriction (CER) on glycated haemoglobin A1c (HbA1c). Secondary aims were to assess effects on weight loss, body composition, medication changes and subjective measures of appetite. Using a 2-day IER method, we expected equal improvements to HbA1c and weight in both groups.

METHOD

Sixty-three overweight or obese participants (BMI 35.2±5kg/m²) with T2DM (HbA1c 7.4±1.3%) (57mmol/mol) were randomised to a 2-day severe energy restriction (1670-2500kJ/day) with 5days of habitual eating, compared to a moderate CER diet (5000-6500kJ/day) for 12weeks.

RESULTS

At 12weeks HbA1c (-0.7±0.9% P<0.001) and percent body weight reduction (-5.9±4% P<0.001) was similar in both groups with no group by time interaction. Similar reductions were also seen for medication dosages, all measures of body composition and subjective reports of appetite.

CONCLUSIONS

In this pilot trial, 2days of IER compared with CER resulted in similar improvements in glycaemic control and weight reduction offering a suitable alternative treatment strategy.