Factors Related to Diabetes Self-Management Among Patients with Type 2 Diabetes: A Chinese Cross-Sectional Survey Based on Self-Determination Theory and Social Support Theory

Mediating role of disease acceptance in the relationship between social support and adherence to treatment in patients with type 2 diabetes

Type 2 diabetes is a widespread, chronic metabolic disease with significant consequences for public health. Poor adherence to treatment in type 2 diabetes patients is associated with inadequate glycemic control, increased medical costs, increased use of healthcare services, and increased mortality. Understanding how social support and disease acceptance influence treatment adherence can inform more effective diabetes management strategies. This study investigated the relationship between social support, disease acceptance, and treatment adherence in adults with type 2 diabetes. This cross-sectional correlational study was conducted on 332 individuals with type 2 diabetes in Türkiye. Data were collected using a patient information form, Acceptance of Illness Scale, Multidimensional Perceived Social Support Scale, and type 2 Diabetes Treatment Adherence Scale. Relationships between variables were analyzed using Pearson correlation coefficients, linear regression, and mediation analysis. The regression analysis indicated significant effects of social support on treatment adherence (β=-0.312, p < 0.001) and disease acceptance (β = 0.267, p < 0.001) and of disease acceptance on treatment adherence (β=-0.378, p < 0.001). Additionally, disease acceptance partially mediated the relationship between social support and treatment adherence (β=-0.101, %95 Cl [-0.154, -0.055]). The findings showed that high levels of social support and illness acceptance can improve treatment adherence and that social support may also indirectly enhance treatment adherence by promoting illness acceptance.

Diabetes Self-Management and Health Care Demand Procrastination Behavior Among Earthquake Victims with Type 2 Diabetes in Earthquake Zone

OBJECTIVES

The aim of this descriptive study was to assess diabetes self-management and health care demand procrastination behaviors among earthquake victims with type 2 diabetes.

METHODS

The population of the study consisted of earthquake victims with Type 2 diabetes in Hatay, Türkiye. The sample included 202 people with type 2 diabetes who lived in 7 distinct container cities. Data were collected using the Introductory Information Form, Diabetes Self-Management Scale, and Healthcare Demand Procrastination Scale via face-to-face interviews.

RESULTS

Participants' average score on the diabetes self-management scale was 58.34 ± 9.11. Being under the age of 60, employed, visiting a medical center on their own, having received diabetes education, and owning a glucometer were associated with better diabetes self-management, whereas being illiterate and having difficulty covering diabetes-related expenses were associated with poor diabetes management (P < 0.05). Participants' average score on the Healthcare Demand Procrastination Scale was 2.35 ± 0.72. Respondents who didn't have a nearby health care institution, whose diabetes diagnosis duration was between 1-5 years, and who didn't have a glucometer had significantly higher scores on the Healthcare Demand Procrastination Scale (P < 0.05).

CONCLUSIONS

Diabetes self-management among earthquake victims with Type 2 diabetes was low. It was also determined that participants' health care demand procrastination behaviors were at a moderate level.

Predicting diabetes self-management education engagement: machine learning algorithms and models

INTRODUCTION

Diabetes self-management education (DSME) is endorsed by the American Diabetes Association (ADA) as an essential component of diabetes management. However, the utilization of DSME remains limited in the USA. This study aimed to investigate current DSME participation among the older population and to identify comprehensive factors of DSME engagement through employing various machine learning (ML) models based on a US nationally representative survey linked to claims data.

RESEARCH DESIGN AND METHODS

Data from the Medicare Current Beneficiary Survey were employed, and this study included data on US Medicare beneficiaries with diabetes from 2017 to 2019. Comprehensive variables following the National Institute on Aging Health Disparities Research Framework were employed to ensure a comprehensive evaluation of factors associated with DSME using five common ML approaches.

RESULTS

In our study, 37.94% of participants received DSME after the application of inclusion and exclusion criteria. A total of 95 variables were used and all ML models achieved accuracy scores exceeding 70%. Random forest had better predictive performance, with an accuracy of 85%. Seventy-four of 95 variables were identified as key variables. Racial/ethnic disparities in predictors for DSME were identified in this study.

CONCLUSIONS

This study identified comprehensive and critical factors associated with DSME engagement from biological, behavioral, sociocultural, and environmental domains using different ML models, as well as related racial/ethnic disparities. Aligning these findings with the DSME National Standards from the ADA would enhance the guidelines' effectiveness, promoting tailored and equal diabetes management approaches that cater to diverse races/ethnicities.

The Determinants of Mental Illness Self-Management for Patients With Schizophrenia and Type 2 Diabetes: A Self-Determination Theory Approach

AIM

This study based on self-determination theory aimed to assess the relationship between motivation, competence in diabetes management and perceived autonomy support respectively and mental illness self-management; furthermore, the authors intended to explore the determinants of mental illness self-management for patients with schizophrenia and diabetes.

DESIGN

This was a cross-sectional study.

METHODS

One hundred ten participants were recruited at the psychiatric hospital and assessed with the Illness Management and Recovery Scale, the Treatment Self-Regulation Questionnaire, the Perceived Competence Scale for Diabetes and the Health-Care Climate Questionnaire.

RESULTS

Patients with lower educational levels, who were admitted to the chronic ward, were unemployed, had lower motivation in illness management, lower competence in diabetes management and perceived lower autonomy support all had lower mental illness self-management. Competence in diabetes management, employment status, autonomy support, educational levels and living alone were the determinants of mental illness self-management.

CONCLUSION

Recovery from schizophrenia and comorbid diabetes is an enduring and complicated process requiring support from healthcare providers. Health professionals should assess the levels of illness self-management and provide integrated care interventions for patients with schizophrenia and diabetes, helping them manage both conditions.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

The illness management programme could apply to patients with schizophrenia and diabetes and address patients' characteristics such as low levels of education, living alone and being unemployed while additionally promoting motivation and competence, and providing supporting autonomy.

REPORTING METHOD

The STROBE checklist was followed.

PATIENT OR PUBLIC CONTRIBUTION

Patients with schizophrenia and diabetes were recruited for this study and voluntarily completed the questionnaire.

Patient-centered care model based on self-efficacy to improve self-care and quality of life of people with type 2 diabetes mellitus: A PLS-SEM approach

Background

The current model for managing type 2 diabetes mellitus (T2DM) is healthcare provider-centered rather than patient-centered. This approach may overlook individual patients' unique needs, potentially impacting the effectiveness of T2DM management goals.

Objective

This study aimed to develop a patient-centered care model based on self-efficacy to enhance self-care and improve the quality of life for individuals with T2DM.

Methods

The study employed a cross-sectional design with a sample size of 250 respondents recruited through multistage random sampling, Jember regency, East Java, Indonesia. The study variables included exogenous factors (people with T2DM, situational treatment, family, and healthcare services) and endogenous factors (self-efficacy, self-care, and quality of life). Data were collected from August to December 2022 using a questionnaire and analyzed descriptively and inferentially using SEM-PLS.

Results

The developed model was a good fit with strong predictive relevance (SRMR = 0.065; Q2 = 0.049). All exogenous factors-people with T2DM, situational treatment, family, and healthcare services-significantly affected self-efficacy (42.2%, 37%, 8.1%, and 17.3%; p <0.001). Self-efficacy had a 61.6% effect on self-care, and self-care had a 27.1% effect on quality of life (p <0.001). Only situational treatment factors had a direct effect on self-care (21.7%; p <0.001). All exogenous factors also influenced the quality of life through self-efficacy and self-care (7%, 6.2%, 1.3%, and 2.9%; p <0.05).

Conclusions

A patient-centered care model based on self-efficacy for managing T2DM can improve self-care behaviors and quality of life for individuals with T2DM. This model can be utilized by nurses in healthcare services to enhance the management of T2DM.

Patient motivation: A concept analysis

Background

Patient motivation is crucial in maintaining health-improving activities and helping patients recover from illnesses. Despite extensive research on patient motivation, this concept has not been clearly defined and remains ambiguous. The latest analysis of patient motivation was over two decades ago, thus necessitating the need to reexamine it in more updated literature.

Objective

This study aims to explore the concept of patient motivation.

Methods

The eight-step approach of Walker and Avant was used: concept selection, determining analysis aim, identifying concept use, defining attributes, model case identification, borderline and contrary case identification, antecedents and consequences identification, and empirical referent identification. Five databases, CINAHL, Cochrane, Medline, PubMed, ProQuest, and ScienceDirect, were searched for published works between 2014 and 2024 using the keywords "patient" and "motivation."

Results

The identified attributes of patient motivation are a psychological drive, a desire to adopt healthy behaviors, and goal-directed action. Antecedents of patient motivation are self-efficacy, provider-patient communication, and social support. Patient motivation leads to consequences, including healthier lifestyles and greater adherence and compliance.

Conclusion

The present concept analysis draws upon current literature to suggest the antecedents, attributes, and consequences of patient motivation. Nurses can promote healthier lifestyles and greater adherence and compliance among patients by employing techniques to raise self-efficacy and provide social support while enhancing patient-centered interactions.

Empowering diabetes management: The impact of patient-provider collaboration on type 2 diabetes outcomes through autonomy support and shared decision-making

OBJECTIVES

Through the lens of self-determination theory, this quantitative study investigates how patient-provider collaboration through perceived shared decision-making (SDM) and autonomy support impact type 2 diabetes (T2D) outcomes.

METHODS

We sampled 474 individuals over 18 years old who self-identified as having T2D. Completed and valid responses were received from 378 participants from two separate groups in an online survey. Data was analyzed using the IBM Statistical Package for Social Sciences (SPSS), AMOS package, version 28, and Mplus, version 8.8.

RESULTS

Patient-provider collaboration through autonomy support improved treatment satisfaction (β = .16, ρ < .05) and self-management adherence (β = .43, ρ < .001). While collaboration through SDM improved treatment satisfaction (β = .25, ρ < .01), it worsened SM adherence (β = -.31, ρ < .001). The negative impact of SDM on self-management adherence was mitigated by our moderator, coping ability. However, coping ability minimally impacted treatment satisfaction and SM adherence when autonomous support was provided.

CONCLUSIONS

Autonomy support increases treatment satisfaction and self-management adherence. SDM enhances treatment satisfaction but may adversely affect self-management adherence. The study also suggests that coping ability can mitigate the negative effect of SDM on self-management adherence, although its influence is limited when autonomy support is provided by the provider.

PRACTICAL IMPLICATIONS

For providers, SDM and autonomy support permits shared power over treatment decisions while fostering independence over self-management tasks. Providers should evaluate patients' coping ability and adapt their approach to care based on the patient's coping capacity.

Making the Most of Familismo to Curb the Diabetes Epidemic: Early Evidence of Success Delivering the Same Intervention to Latinas at Risk for and With Diabetes

Background/objectives

In the USA, diabetes disproportionately affects Hispanics/Latinx, continuing to contribute to health disparities. To address the diabetes epidemic, separate programs for pre-diabetes and diabetes are promoted nationwide. However, engagement by Hispanics/Latinx in either program is lagging. Recent evidence suggests that offering a single community health worker delivered intervention that includes both groups and allows family members to participate may be more effective and in harmony with Latino cultural values, especially if offered to Latino women (Latinas) who traditionally are in charge of food preparation. Our objective was to explore the results of an intervention delivered to low-income Latinas at various dysglycemic levels (diabetic and pre-diabetic).

Methods

In this quasi-experimental mixed-methods cohort study we longitudinally assessed biometric outcomes and health behaviors among obese Latinas at risk for-and with-diabetes, participating in the same intervention. Data were collected at baseline and 3 months post-intervention. Focus group discussions and interviews provided qualitative data to help contextualize findings.

Results

Participants at different levels of the dysglycemic spectrum benefited equally from the intervention across most measures. Among participants whose relatives had diabetes, weight loss exceeded that of participants without diagnosed relatives. Domestic partners' support, attending the program in a group setting, and previous diagnoses from a healthcare professional were associated with better results.

Conclusions

Our findings indicate that a community health worker-delivered intervention for Hispanics/Latinx with-and at-risk for-diabetes is feasible and could be more effective in reducing Hispanics/Latinx' diabetes burden. Health educators and clinicians should consider tapping into the collective nature of the Latinx/Hispanic culture to encourage healthy behaviors among individuals whose family members have diabetes, regardless of their dysglycemic status. We recommend replicating this study with a more rigorous randomized design, a larger number of participants and longer-term follow-up.

Adherence to Self-Monitoring of Blood Glucose and Its Related Factors Among Type 2 Diabetic Patients Attending Al-Ahsa Primary Health Care Centers in Saudi Arabia

BACKGROUND

Self-monitoring of blood glucose (SMBG) is a crucial component of diabetes management, but adherence remains suboptimal. This study aimed to evaluate adherence to SMBG among type 2 diabetic patients in Al-Ahsa, Saudi Arabia.

METHODS

A cross-sectional study was conducted among 398 type 2 diabetic patients attending primary healthcare centers. Data were collected through face-to-face or virtual interviews and electronic health records. Adherence levels were categorized as low, moderate, and high.

RESULTS

The majority of participants exhibited moderate adherence to SMBG (58.5%), while 27.1% had low adherence, and 14.3% were highly adherent. The use of oral hypoglycemic medications and insulin injections was associated with higher adherence (p<0.001). Comorbidities, physical exercise, diet, frequency of medical visits, and attendance at diabetes education sessions did not significantly influence adherence.

CONCLUSIONS

Suboptimal adherence to SMBG was observed among type 2 diabetic patients in Al-Ahsa. Targeted interventions addressing individual barriers and integrating technology may improve SMBG adherence and diabetes management.

Effects of family support system on the self-management behaviour of patients with T2DM: a multi-centre cross-sectional study in community settings

BACKGROUND

The burden of type 2 diabetes mellitus (T2DM) in China continues to escalate.

OBJECTIVE

To investigate the impact of family support system on the self-management behaviour of patients with T2DM.

METHODS

In this cross-sectional study, 1,042 participants were sampled using a multistage stratified probability-proportionate-to-size method. On-site interviews were conducted using a structured questionnaire administered by 122 family doctors from 13 community health service centres in 8 administrative districts. A structural equation model was established to investigate the impact of individual factors and family support system on the self-management behaviour of T2DM patients. Statistical analysis was performed using the SPSS 25.0 software.

RESULTS

The self-management behaviour pass rate among individuals with T2DM was 40.9%. In terms of individual factors, those with a high school education level or above demonstrated higher self-management behaviour scores than those with a junior high school education level or lower. The structural equation model revealed a path of interactions among individual factors, family support system-related factors, and the self-management behaviour of patients with T2DM: Family function → Family support → Patients' self-management behaviour → Quality of life. The coefficient of the direct path from family function to family support was 0.74 (P < 0.001), while the coefficient of the direct path from family support to self-management behaviour was 0.68 (P = 0.001).

CONCLUSION

There is significant room for improvement in the self-management behaviour of T2DM patients in China. Family function can enhance the self-management behaviour of T2DM patients by promoting family support.

Determinants of diabetes self-care activities in patients with type 2 diabetes based on self-determination theory

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.

Effects of Telephone-Based Brief Motivational Interviewing on Self-Management, Medication Adherence, and Glycemic Control in Patients with Uncontrolled Type 2 Diabetes Mellitus in a Rural Community in Thailand

Introduction

Owing to the increased prevalence of type 2 diabetes mellitus (T2DM) and the high proportion of patients with uncontrolled T2DM, effective interventions for disease management are needed.

Objective

The study aim was to test the effects of brief motivational interviewing (MI) on patients' self-management, medication adherence, and glycemic control.

Methods

A single-group repeated measures trial was used to examine the effects of usual care only and usual care plus telephone-based brief MI. Participants were 29 patients with uncontrolled T2DM recruited from a rural primary care setting in Nakhon Sawan, Thailand. Participants received usual care during the first 4 weeks, followed by usual care plus brief MI during weeks 4-8. Outcomes of self-management, medication adherence, fasting blood sugar (FBS) levels, and hemoglobin A1c (HbA1c) levels were assessed at baseline, 4 weeks, and 8 weeks. Data were analyzed using descriptive statistics, one-way repeated measures analysis of variance, and Friedman test.

Results

Significant changes in self-management (p < 0.001), medication adherence (p < 0.001), and FBS (p < 0.05) were observed over the 8-week study. In multiple comparisons, self-management was the only parameter significantly different across baseline, 4, and 8 weeks (p <0.05, <0.001, and <0.001, respectively); medication adherence was significantly different between 4 and 8 weeks (p < 0.05), and between baseline and 8 weeks (p < 0.001); and FBS was significantly different between 4 and 8 weeks (p < 0.05). HbA1c declined over the 8-week study, but not significantly.

Conclusion

An intervention combining telephone-based brief MI with usual care significantly increased self-management, medication adherence, and glycemic control (ie, FBS) after 4 weeks, whereas usual care only significantly increased self-management. Phone-based brief MI may be an effective way for healthcare providers to remotely enhance patients' self-management and glycemic control, thus reducing barriers related to time and geographic location.

Current status and influential factors associated with adherence to self-monitoring of blood glucose with type 2 diabetes mellitus patients in grassroots communities: a cross-sectional survey based on information-motivation-behavior skills model in China

Objective

Self-monitoring of blood glucose (SMBG) plays a vital role in the maintenance of blood glucose with type 2 diabetes mellitus(T2DM) and pre-diabetes patients. The study was intended to describe the current status of SMBG with T2DM and pre-diabetes patients in grassroots communities, explore the relationship between SMBG frequency and blood glucose level and apply information-motivation-behavior(IMB) model to analyze the potential influencing factors of SMBG compliance based on electronic questionnaires.

Methods

A cross-sectional study was conducted with 1388 T2DM and pre-diabetes patients who completed electronic questionnaires composed of demographics and IMB model content. Chi-square test, Mann-Whitney U test and multivariable logistic regression model analysis were utilized to explore deeply causes of SMBG compliance.

Results

The results of this study showed that among 1388 T2DM patients, only 26.2% (363/1388) patients reached SMBG standard, indicating low compliance with SMBG. Given that SMBG is one of the individual predictors of type 2 risk in prediabetes patients, this result suggests that the SMBG compliance rate needs to be improved. Patients with fixed occupation (OR=1.989, P=0.035), BMI in normal range (OR=1.336, P=0.049), smoking habit(OR=1.492, P=0.019), understanding SMBG frequency (OR=1.825, P<0.001), understanding control goal of blood glucose (OR=1.414, P<0.001), knowing all the functions of the blood glucose meter (OR=1.923, P<0.001), buying a blood glucose meter/test paper conveniently(OR=2.329, P=0.047), taking supplementary measurement when forgetting blood glucose test(OR=2.044, P=0.005), rotating all the fingers when measuring blood glucose (OR=1.616, P<0.001) and less pain at the needling site(OR=2.114, P<0.001)were independently promoting factors of adherence to SMBG. However, the lack of accessibility and convenience of blood glucose meter or heavy financial burden were blocking factors of adherence to SMBG. Moreover, there were still bottlenecks such as lack of health care knowledge and needle pricking pain.

Conclusion

This study verified the practicability of applying IMB model to SMBG with T2DM and pre-diabetes patients. Adherence to SMBG still remained to improved, and putting more emphasis in improvement of individual information, motivation and behavioral skills with patients might be beneficial to maintain better adherence to SMBG in long-term routine of diabetes self-management.

Biocolorants in food: Sources, extraction, applications and future prospects

Color of a food is one of the major factors influencing its acceptance by consumers. At presently synthetic dyes are the most commonly used food colorant in food industry by providing more esthetically appearance and as a means to quality control. However, the growing concern about health and environmental due to associated toxicity with synthetic food colorants has accelerated the global efforts to replace them with safer and healthy food colorants obtained from natural resources (plants, microorganisms, and animals). Further, many of these biocolorants not only provide myriad of colors to the food but also exert biological properties, thus they can be used as nutraceuticals in foods and beverages. In order to understand the importance of nature-derived pigments as food colorants, this review provides a thorough discussion on the natural origin of food colorants. Following this, different extraction methods for isolating biocolorants from plants and microbes were also discussed. Many of these biocolorants not only provide color, but also have many health promoting properties, for this reason their physicochemical and biological properties were also reviewed. Finally, current trends on the use of biocolorants in foods, and the challenges faced by the biocolorants in their effective utilization by food industry and possible solutions to these challenges were discussed.

Mediation Effect of Self-Efficacy Between Health Beliefs and Glycated Haemoglobin Levels in Elderly Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

Purpose

To explore the mediating effect of self-efficacy in the relationship between glycated haemoglobin (HbA1c) levels and health beliefs in community elderly patients with type 2 diabetes.

Patients and Methods

From January to March 2022, convenience sampling was adopted to investigate 200 elderly patients with type 2 diabetes in a community in Yangzhou, China. Data were collected using the Health Beliefs Questionnaire, Self-efficacy for Diabetes, and Medication Compliance Questionnaire. Laboratory parameters included HbA1c, fasting blood glucose, postprandial blood glucose, total cholesterol, triglyceride, high-density-lipoprotein cholesterol, and low-density-lipoprotein cholesterol levels. Correlation, linear regression, and mediation analyses were performed using SPSS 27.0.

Results

HbA1c levels were higher in men (women vs men: 6.80% [6.08%, 7.73%] vs.7.30% [6.30%, 9.18%]) and employed (employed vs not employed vs retired: 7.60% [6.90%, 10.45%] vs 5.85% [5.40%, 6.95%] vs 7.10% [6.20%, 8.20%]) and low self-efficacy (low vs high: 13.1% [6.55%, 13.85%] vs 6.8% [6.10%, 7.70%]). HbA1c levels were negatively associated with health beliefs (r = -0.246) and self-efficacy (r = -0.240; p<0.01). Linear regression showed that perceived susceptibility, severity, benefit, and barriers, cues to action, and self-efficacy explained 50% of the variance in HbA1c levels after adjusting for sex and current work status. The mediation effect of self-efficacy was partial between health beliefs and HbA1c levels and accounted for 24.65% of the total effect (p < 0.001).

Conclusion

Health beliefs influenced the improvement of self-efficacy in older patients with type 2 diabetes mellitus, which in turn could improve HbA1c control. Self-efficacy plays a partial mediating role between health beliefs and Hba1c levels in elderly patients with type 2 diabetes.