Addressing Diabetes Distress in Self-Management Programs: Results of a Randomized Feasibility Study

The Relationship Between Diabetes Knowledge and Diabetes Self-Care Behaviors in Relation to Diabetes Distress in Type 2 Diabetes Mellitus: A Cross-Sectional Study in Eastern Taiwan

Introduction

Diabetes is a highly prevalent metabolic disease worldwide. In Taiwan, healthcare services emphasize self-management strategies and interventions focusing on self-care. However, there is a lack of literature on diabetes distress (DD). Therefore, this study aims to explore the relationship between demographic characteristics, diabetes knowledge, and diabetes self-care behaviors with diabetes distress among Type 2 diabetes mellitus (T2DM) patients and identify predictive factors.

Methods

This study employs a cross-sectional survey, targeting T2DM patients from the internal medicine outpatient clinic of a regional hospital in eastern Taiwan. Participants were recruited through purposive sampling from April 11, 2023, to May 16, 2023. The study examines the correlation between diabetes knowledge, diabetes self-care behaviors, and diabetes distress, as well as other influencing factors. The data analysis methods include (1) differences in diabetes knowledge, diabetes self-care behaviors, and diabetes distress scores, analyzed using t-tests or ANOVA, (2) Scheffe's tests for significant differences identified by ANOVA to locate group differences in means, and (3) multiple regression analysis to identify key predictive factors of diabetes distress.

Results

The findings reveal that both diabetes knowledge (β=-0.046, p=0.029) and diabetes self-care behaviors (β=-0.186, p=0.006) significantly predict diabetes distress. Additionally, gender (β=0.251, p=0.004), family history of diabetes (β=0.213, p=0.017), and diabetes complications (β=0.228, p=0.018) are significant predictors of diabetes distress. The overall F-test reached significance (F=7.61, p<0.001), and the explanatory power of the regression model (R²=0.17) is statistically significant, indicating that diabetes knowledge, diabetes self-care behaviors, gender, family history of diabetes, and diabetes complications are important predictors of diabetes distress in T2DM patients. These findings can provide valuable insights for clinicians in identifying risk factors for diabetes distress and understanding the factors that influence diabetes distress in T2DM patients.

Conclusion

It is crucial to integrate the assessment and management of diabetes distress into routine diabetes care and even implement distress screening during the health promotion stage. Strengthening the ability of healthcare professionals to identify diabetes distress through early detection of risk factors and providing individualized interventions and care plans tailored to T2DM patients is of great importance.

Feasibility and acceptability pilot study of an online weight loss program in rural, underserved communities

Background

The purpose of this intervention was to investigate the feasibility, acceptability, and preliminary effectiveness of an online weight loss program, EMPOWER, in rural, underserved communities.

Methods

Adults with a body mass index (BMI) ≥ 25 kg/m2 living in rural counties were recruited through collaboration with University of Illinois Extension. The intervention lasted 1 year including online educations sessions, nutrition and lifestyle coaching, and diet and weight monitoring via a novel web application, MealPlot. Feasibility was measured by enrollment attainment, participant retention, online education session completion, and completion of anthropometric and dietary measures. Acceptability was measured by survey using Likert scales of satisfaction for all program components. Anthropometric measurements, 24-h dietary records, and food frequency questionnaires (FFQs) were measures of program efficacy. Additionally, two interviews were collected for program feedback.

Results

Enrollment of 16 participants was attained, however due to higher than anticipated dropout (retention 62.5%, N = 10) at 3-months, 62.5% of the education sessions were completed and 75.0% of anthropometric and dietary measures. The average satisfaction rating for the comprehensive program was 4.2/5 with lowest satisfaction being the MealPlot web application 2.7/5 (N = 11). On average a clinically significant (≥5% baseline weight) weight loss of 6.2 ± 6.0% body weight or 5.7 ± 5.3 kg and improvements to protein and fiber intake at 12 months (N = 10) were observed.

Conclusions

A novel online weight loss program showed adequate to strong feasibility and acceptability and preliminary results indicating efficacy among a pilot sample of rural residents. Future studies are required to investigate means of improving retention and reducing the burden on program collaborators.

Trends in thyrotoxicosis-related mortality in the United States from 1999 to 2020

PURPOSE

Thyrotoxicosis is defined as a condition caused by excessive thyroid hormone concentrations, with the main cause being inappropriately increased thyroid hormone production. Existing literature indicates a correlation between thyrotoxicosis and mortality. Thus, this descriptive analysis was conducted to assess the demographic and regional trends of thyrotoxicosis-related mortality in the United States.

METHODS

Death certificates from the Center of Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER) from 1999 to 2020 were retrieved for thyrotoxicosis-related mortality in the United States. The crude and age-adjusted mortality rates (AAMRs) per 1,000,000 population and annual percentage change (APCs) were calculated.

RESULTS

There were 33,253 thyrotoxicosis-related deaths from 1999 to 2020. Initially, the AAMR increased from 1999 to 2003 (APC: 3.09; 95% CI 0.83 to 8.16), followed by a steep decline from 2003 to 2008 (APC: -4.28; 95% CI -7.46 to -2.47), followed by a marginal decline from 2008 to 2018 (APC: -0.71; 95% CI -1.70 to 0.95), and concluded by a significant increase from 2018 to 2020 (APC: 11.72; 95% CI 5.06 to 15.32). Non-Hispanic (NH) Black or African American, Hispanic or Latino, and NH White populations demonstrated a significant rise in thyrotoxicosis-related mortality during 2018 to 2020. In contrast, the NH Asian or Pacific Islander population did not denote any significant variations within the included study timeframe. States including West Virginia, the District of Columbia, Vermont, California, and Montana were in the top 10th percentile of thyrotoxicosis-related mortality.

CONCLUSION

After an extended period of decline, the recent increments in thyrotoxicosis-related mortality rates are concerning. Further consideration is urged with respect to thyroid screening, especially among females, in order to reduce the overall thyrotoxicosis-related mortality.