A model clinical program for patients with diabetes and vision impairment

Diabetes Education for Visually Impaired Persons at Cleveland Sight Center

This article describes the structure, content, and function of a specialized adaptive diabetes education program in a large, community-based blindness rehabilitation agency.

Diabetes self-care behaviors in adults with disabilities: A systematic review

AIM

The integrated evidence on diabetes self-care behaviors in people with a disability is not commensurate with the growing number of people with both diabetes and a disability. This study aims to identify factors influencing self-care behaviors in adults with diabetes and a disability based on a thorough review of the current evidence.

METHODS

This review followed the Cochrane guidelines for systematic review research and complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. To find eligible articles, five electronic databases-PubMed, Embase, CINAHL, Psych-articles, and the Cochrane Library-were searched, from the beginning of the chronological period covered by each database to June 2017. Four researchers independently conducted study selections, extracted data, and assessed the data quality.

RESULTS

Twenty studies were reviewed to identify barriers to and facilitators of diabetes self-care behaviors. For people with developmental disabilities, the most prominent facilitator of self-care behaviors was the support they received for the behaviors. For people with visual impairments, that facilitator was the use of helpful assistive devices that take advantage of another sense. The main barriers to self-care behaviors were mobility limitation for people with physical disabilities and lack of accessibility for people with visual impairments.

CONCLUSIONS

This review has identified barriers to and facilitators of diabetes self-care behaviors by type of disability. Healthcare services need to be tailored to these facilitators and barriers, and differentiated by type of disability.

Effects of a Psychoeducational Group on Mood and Glycemic Control in Adults with Diabetes and Visual Impairments

This study evaluated the effectiveness of a 12-week psychoeducational group therapy program in improving mood and glycemic control in adults with diabetes and visual impairments. The participants made statistically significant gains in glycemic control, and there was a significant positive relationship between control and improvement in depression, but greater knowledge of diabetes self-care did not correlate with improved glycemic control.

Psychosocial interventions to improve mental health in adults with vision impairment: systematic review and meta-analysis

PURPOSE

To systematically assess the literature on psychosocial interventions to improve mental health (i.e. depression, anxiety, mental fatigue, loneliness, psychological stress and psychological well-being) in visually impaired adults (≥18 years).

METHODS

The databases Medline, Embase and Psychinfo were searched for relevant studies, which were categorised into randomised controlled trials (RCTs), non-RCTs and before and after comparisons (BA). The Cochrane Collaboration Risk of Bias Tool was used to assess study quality. Standardised mean differences (SMD) were calculated to quantitatively summarise the outcomes of the RCTs and non-RCTs in a meta-analysis. Meta-regression was used to explore sources of heterogeneity in the data.

RESULTS

The search identified 27 papers (published between 1981 and 2015), describing the outcomes of 22 different studies (14 RCTs, four non-RCTs, and four BAs). Pooled analyses showed that interventions significantly reduced depressive symptoms (SMD -0.30, 95% confidence interval (CI) -0.60 to -0.01), while effects on anxiety symptoms, mental fatigue, psychological stress and psychological well-being were non-significant. Meta-regression analyses showed homogeneity in effect sizes across a range of intervention, population, and study characteristics. Only a higher age of participants was associated with less effective results on depressive symptoms (b = 0.03, 95% CI 0.01 to 0.05), psychological stress (b = 0.07, 95% CI 0.01 to 0.13) and psychological well-being (b = -0.03, 95% CI -0.05 to 0.01). However, after removing a clear outlier the overall effect on depressive symptoms and the influence of age on depressive symptoms and psychological stress were no longer significant, while the influence of age on psychological well-being remained.

CONCLUSIONS

There is currently only limited evidence for the effectiveness of psychosocial interventions in the field of low vision. More well-designed trials are needed with specific attention for interventions tailored to the needs of elderly patients.

A comparison of dosing accuracy: visually impaired and sighted people using insulin pens

BACKGROUND

In the United States, 18% of people with diagnosed diabetes have visual impairment. Insulin pens are widely used by both blind and sighted people. However, major manufacturers include a disclaimer in the instructions warning against use by visually impaired people, without giving a rationale. Published studies neither support nor refute the disclaimer.

METHOD

The purpose of this study was to compare accuracy of dosing with insulin pens between visually impaired and sighted people. Inclusion criteria were self-reported diabetes and inability (visually impaired group) or ability (sighted group) to read regular print. The sole exclusion criterion was inability to pass a brief test of decisional capacity. Each participant received standardized instructions for insulin pen use, either in recorded (visually impaired group) or in printed (sighted group) format, and delivered 10 systematically varied doses into an injection ball, which was weighed on a precision laboratory balance.

RESULTS

No significant correlation with accuracy of insulin dosing was found for any of the analyzed variables: visual status, age, gender, years of having diabetes mellitus (DM), or treatment of DM with or without insulin.

CONCLUSIONS

This study provided preliminary evidence of the safety of use of insulin pens by visually impaired people and raised questions about the validity of the disclaimer. Further study of the safety of use of insulin pens by blind people is needed. Inclusion of people with disabilities in research on technology intended for patient use would ensure that people with disabilities can benefit from new technology.

A systematic review of psychosocial outcomes following education, self-management and psychological interventions in diabetes mellitus

Self-management and psychological interventions for diabetes have become increasingly common and have shown some positive impact on glycemic control. The association of such interventions with psychosocial outcomes is however, less clear. The current review examines the impact of these interventions on psychosocial outcomes including depression, anxiety, adjustment and quality of life. A systematic search of the literature was performed on Medline, Embase and Psychlit. Reference lists were screened for studies that met inclusion/exclusion criteria. Studies were coded on outcomes both over time and relative to control groups. In addition studies were classified as being principally educational, self-management or psychological in type, and the different components in the intervention were determined. Thirty-six studies were identified. Detrimental effects were not generally seen following any type of intervention. Depression seemed to be particularly improved following psychological interventions, whilst quality of life improved more following self-management interventions. A number of methodological issues, such as the specificity of measure used, characteristics of the population and type of intervention were however, influential in the impact of interventions on outcomes. It is recommended that future studies would benefit from being larger with controlled designs, using diabetes specific measures and providing clearer descriptions of intervention components. This will allow greater understanding of what contexts different interventions are most suited to, and which components are key to, improving psychological well-being and quality of life.

A time-limited, problem-orientated psychotherapeutic intervention in Type 1 diabetic patients with complications: a randomized controlled trial

AIMS

To examine the effects of a time-limited, problem-orientated psychotherapeutic intervention on self-defined psychological problems and metabolic control in Type 1 diabetic patients with microvascular complications.

DESIGN

Randomized wait-list controlled trial with a follow-up of 6 months.

SETTING

Out-patient clinic of a university diabetes centre.

PARTICIPANTS

Forty-six Type 1 diabetic patients with intensified insulin therapy and presence of microvascular diabetic complications. Twenty-four patients were randomly allocated to the intervention group and 22 patients to the control group.

INTERVENTION

Participation in a structured, problem-orientated, time-limited psychotherapeutic intervention (IG). The control group (CG) patients received routine diabetes care in a specialized diabetes university clinic.

OUTCOME MEASURES

Degree of change of three self-defined main psychological and psychosocial problems (no. 1, no. 2 and no. 3) on a 1-10 graded scale and glycosylated haemoglobin HbA1c values.

RESULTS

Two patients (one in each group) died during the study period. All remaining patients were followed for 6 months. Problem scores were high at baseline in both groups: IG/CG (mean values, standard deviation in parentheses): problem no. 1, 7.8 (2.0)/8.3 (1.7); problem no. 2, 7.7 (2.3)/7.6 (1.8); and problem no. 3, 7.7 (2.3)/7.4 (2.6). At follow-up, all problems were significantly lower in the intervention group (IG) when compared with the CG: IG/CG: problem no. 1, 4.3 (2.9)/6.8 (3.0), P = 0.03; problem no. 2, 3.9 (2.4)/5.8 (2.8), P = 0.03; problem no. 3, 4.7 (2.4)/6.8 (2.4), P = 0.02. Mean HbA1c decreased in the intervention group by 0.6 (1.2)% and increased in the control group by 0.1 (0.7)%, P = 0.016. In patients with suboptimal metabolic control, i.e. HbA1c > 8%, mean HbA1c decreased by 1.0 (1.2)% in the IG and increased by 0.1 (0.7)% in the CG, P = 0.011.

CONCLUSION

A time-limited, structured, problem-orientated psychotherapeutic intervention decreases the severity of psychological problems and improves metabolic control in Type 1 diabetic patients with microvascular complications and self-management of intensified insulin therapy.

Self-esteem as a characteristic of adherence to diabetes and dental self-care regimens

BACKGROUND, AIMS

There are biological associations between diabetes control and oral infections. We have also found psychological associations between diabetes self-care and oral health behavior. The aim of this study was to evaluate whether self-esteem can determine diabetes adherence and oral health behavior, both of with require daily, persistent self-care.

METHOD

Cross-sectional data on 149 IDDM patients was collected by means of a quantitative self-completed questionnaire.

RESULTS

High self-esteem was found to relate to good adherence with exercise regimens (p=0.005) and adjustment of insulin doses (p=0.040). These associations were also found when standardized for socio-demographic variables and HbA1c-level. In the dental sphere, logistic regression analysis showed an association between self-esteem and frequency of tooth brushing.

CONCLUSIONS

It can be concluded that self-esteem may be a common psychological factor influencing diabetes and dental self-care. Strengthening patients' self-esteem could help patients to maintain daily self-care.

The scope of practice of diabetes educators in the state of Georgia

PURPOSE

The purpose of this study was to identify and describe the scope of practice trends of diabetes educators in the state of Georgia.

METHODS

The Diabetes Educator Responsibilities Questionnaire (DERQ) was sent to 221 members of the American Association of Diabetes Educators listed in the 1995 membership directory in Georgia. Of the 221 members, 97 returned completed questionnaires. This population of healthcare professionals comprised the sample population.

RESULTS

In assessing the primary responsibilities of the sample, more than 50% of the respondents performed six of the nine educator roles. Less than 50% of the respondents indicated that they "Always" or "Frequently" used behavior modification strategies in teaching people with diabetes.

CONCLUSIONS

The questionnaire used in this study should be expanded to elicit more detailed information regarding decisions to use or not use behavior modification techniques in diabetes education.