Seeing the Person, Not the Illness: Promoting Diabetes Medication Adherence Through Patient-Centered Collaboration

Enhancing patient-provider relationships with a whole person oriented healing pathway model

OBJECTIVE

This paper identifies provider characteristics, across medical specialties, that facilitate a healing pathway model for patients.

DESIGN

With a phenomenological approach, a prospective descriptive study design was used to conduct in-depth semi-structured focus groups and individual interviews, which elicited experiences facilitating healing. Thematic content analysis methods were used to organize and analyze data findings within the context of a healing pathway model.

SETTING

Data were collected in three geographically diverse areas representing various fields of practice in conventional and complementary and integrative health (CIH).

PATIENTS OR OTHER PARTICIPANTS

Snowball sampling was used to collect data from 52 providers from diverse healthcare settings.

RESULTS

As a group, participants described three healing domains, including (1) Provider Approach for Facilitating Healing; (2) Foundations of a Healing Pathway; and (3) Observation of Healing Outcomes.

CONCLUSIONS

As the dynamics of healthcare continue to become more complex, and consumeristic in nature, constructs emerge across disciplines reflecting an interpersonal approach to facilitate healing. These emergent constructs informed the development of a conceptually driven healing pathway model to identify points of intervening and informing how to leverage patient-provider relationships to facilitate healing.

Integrated in vitro, in silico, and in vivo approaches to elucidate the antidiabetic mechanisms of Cicer arietinum and Hordeum vulgare extract and secondary metabolites

Diabetes mellitus is a group of metabolic disorders that can lead to severe health problems, and the current treatments often have harmful side effects. Therefore, there is a growing interest in discovering new antidiabetic drugs with fewer adverse effects, and natural products are a promising source for this purpose. Cicer arietinum and Hordeum vulgare are plants with high levels of phytochemicals that have been shown to have therapeutic properties. This study investigates the anti-diabetic potential of C. arietinum and H. vulgare seeds and their secondary metabolites. We employed a comprehensive approach combining in vitro, in silico, and in vivo methods to evaluate the efficacy of the compounds. Our findings reveal that the extracts of C. arietinum (IC50 55.08 μg/mL) and H. vulgare (IC50 115.8 ± 5 μg/mL) demonstrated a stronger inhibitory effect on α-amylase compared to acarbose (standard drug) (IC50 196.3 ± 10 μg/mL). Similarly, both C. arietinum and H. vulgare exhibited significant inhibitory activity against α-glucosidase (IC50 100.2 ± 5 μg/mL and IC50 216.2 ± 5 μg/mL, respectively) compared to acarbose (IC50 246.5 ± 10 μg/mL). To further investigate their mechanism of action, a computational screening of 194 phytochemicals from these plants was conducted, followed by molecular docking with α-amylase (PDB ID#1B2Y) and α-Glucosidase (PDB ID# 5NN8) receptors. According to the binding affinities and molecular dynamics (MD) simulations, Medicagol, Euphol, Stigmasterol, and Beta-Sitosterol emerged as promising candidates for diabetes treatment. Molecular dynamics showed that Medicagol was a strong inhibitor against selected receptor proteins because the ligand-protein complexes remained stabilized during the entire simulation time of 100 ns. In vitro analysis also confirmed that Medicagol, stigmasterol, and Euphol have significant potential for type 2 diabetes prevention via inhibition of carbohydrates hydrolyzing enzymes. In vivo study demonstrated significant therapeutic effects in STZ-induced diabetes mice. Including reductions in hyperlipidemia, hyperglycemia, and insulin resistance. Histopathological analysis revealed that plant extracts mitigated STZ-induced pancreatic and liver damage. Additionally, extracts enhanced antioxidant defenses by increasing SOD, CAT, and GSH levels, while decreasing MDA levels in the liver, kidneys, and pancreas, highlighting their protective role against oxidative stress. These results support the potential of Cicer arietinum and Hordeum vulgare as natural sources for developing antidiabetic agents.

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.

Evolving Scope of Clinical Empathy in the Current Era of Medical Practice

Clinical empathy is one of the most essential tools of medical practice, and it is an act of correctly acknowledging the emotional state of another without experiencing that state oneself. Empathy comprises four components. Mounting evidence exists to support the use of clinical empathy as a tactic for effective health care. Resolving the multi-fold barriers of clinical empathy is important. Clinical empathy is very important in the current era, and a trust-based relationship in patient care is a way to optimal clinical outcomes that can be achieved through better communication and treatment-compliance plans between health care professionals and patients.

Quality of care in the oncological outpatient setting: Individual interviews with people receiving cancer treatment

PURPOSE

To describe how patients receiving cancer treatment perceive quality of care in the oncological outpatient settings.

METHOD

A strategic sample of 20 adult patients with cancer treated in four oncological outpatient settings in four hospitals in Sweden participated in the study. Participants were interviewed using a semi-structured interview guide with open-ended questions. The interviews were audio-recorded, and the transcripts were analysed using a phenomenographic approach.

RESULTS

Three descriptive categories emerged from the data: The patient's care is designed to meet individual needs, The patient's dignity is respected, and The patient feels safe and secure with the care. Overall, quality of care in the oncological outpatient setting is perceived as something positive and described in normative terms by the participants.

CONCLUSION

The results emphasises that in order to achieve quality of care it is important to the patients that they are able to meet with the same well-educated, professional, caring and sensible health care professionals every time.

Integrating Pharmacological and Computational Approaches for the Phytochemical Analysis of Syzygium cumini and Its Anti-Diabetic Potential

Diabetes mellitus (DM) is a metabolic disease caused by improper insulin secretion leading to hyperglycemia. Syzygium cumini has excellent therapeutic properties due to its high levels of phytochemicals. The current research aimed to evaluate the anti-diabetic potential of S. cumini plant's seeds and the top two phytochemicals (kaempferol and gallic acid) were selected for further analysis. These phytochemicals were selected via computational tools and evaluated for α-Glucosidase inhibitory activity via enzymatic assay. Gallic acid (IC₅₀ 0.37 µM) and kaempferol (IC₅₀ 0.87 µM) have shown a stronger α-glucosidase inhibitory capacity than acarbose (5.26 µM). In addition, these phytochemicals demonstrated the highest binding energy, hydrogen bonding, protein-ligand interaction and the best MD simulation results at 100 ns compared to acarbose. Furthermore, the ADMET properties of gallic acid and kaempferol also fulfilled the safety criteria. Thus, it was concluded that S. cumini could potentially be used to treat DM. The potential bioactive molecules identified in this study (kaempferol and gallic acid) may be used as lead drugs against diabetes.

Coping with diabetes stress among adults in rural Dominican Republic: "I don't think about it"

OBJECTIVES

As type 2 diabetes prevalence increases across Latin America, understanding local approaches to coping with diabetes stress is essential to providing care that incorporates patients' values and preferences. This study explored a local phenomenon, "no le doy mente" (I don't think about it), used by adults with type 2 diabetes in the Dominican Republic to cope with diabetes stress.

METHODS

We conducted 19 qualitative in-depth interviews with adults with type 2 diabetes (10 men, 9 women) recruited from one rural clinic. Using an inductive analytic approach including iterative coding, memos, and matrices, we identified reasons, strategies, and perceived benefits of not thinking about type 2 diabetes among participants.

RESULTS

Participants described not thinking about diabetes as an active process to maintain a sense of normalcy despite significant life changes following diagnosis. They avoided thinking about diabetes by staying busy, proactively managing type 2 diabetes through diet and medication, and turning to their faith. Participants perceived that enacting no le doy mente helped to protect their overall health and well-being.

DISCUSSION

Future research should investigate provider perceptions of no le doy mente to align patient and provider communication and mindfulness-based stress reduction as a way to support people with type 2 diabetes avoid dwelling on negative thoughts about diabetes.

Impact of pharmacist-involved collaborative care on diabetes management in a primary healthcare setting using real-world data

Background Diabetes mellitus is a complex multi-system disorder, requiring multi-disciplinary care. The conventional care model, where physicians are the sole caregivers may not be optimal. Addition of other healthcare team members improves healthcare outcomes for patients with diabetes. Aim To evaluate the impact of pharmacist-involved collaborative care on diabetes-related outcomes among patients with diabetes attending a primary healthcare setting  in Qatar using real-world data. Method A retrospective cohort study was conducted among patients with diabetes attending Qatar Petroleum Diabetes Clinic. Patients were categorized as either receiving pharmacist-involved collaborative care (intervention group) or usual care (control group). Data were analyzed using SPSS^®. Glycemic control (glycated hemoglobin A₁c, HbA₁c), blood pressure, lipid profile, and body mass index were evaluated at baseline and up to 17 months of follow-up. Results After 17 months of follow-up, pharmacist-involved collaborative care compared to usual care resulted in a significant decrease in HbA₁c (6.8 ± 1.2% vs. 7.1 ± 1.3%, p < 0.01). Moreover, compared to baseline, pharmacist-involved collaborative care significantly improved (p < 0.05) the levels of HbA_1c (7.5% vs. 6.8%), low-density lipoprotein cholesterol (3.7 mmol/L vs. 2.8 mmol/L), total cholesterol (5.43 mmol/L vs. 4.34 mmol/L), and body mass index (30.42 kg/m² vs. 30.17 kg/m²) after 17 months within the intervention group. However, no significant changes for these parameters occurred within the control group. Conclusion The implementation of pharmacist-involved collaborative care in a primary healthcare setting improved several diabetes-related outcomes over 17 months. Future studies should determine the long-term impact of this care model.

Collaborative care model for diabetes in primary care settings in Qatar: a qualitative exploration among healthcare professionals and patients who experienced the service

BACKGROUND

Diabetes mellitus is highly prevalent and associated with huge economic burden globally. The conventional care and management of diabetes mellitus is highly fragmented and complex, warranting the need for a comprehensive Collaborative Care Model (CCM). Little is known about the perception of patients with diabetes and their healthcare providers about CCM, its barriers and facilitators. This study aimed to explore the value of CCM in diabetes care at a primary healthcare (PHC) setting from the perspective of patients with diabetes and healthcare professionals (HCPs), in an effort to expand our current knowledge on collaborative care in diabetes at primary care level for the purpose of quality improvement and service expansion.

METHODS

Using an exploratory case study approach, semi-structured interviews were conducted among patients and HCPs who encountered CCM in Qatar during 2019 and 2020. The semi-structured interviews were transcribed verbatim and the data were analysed and interpreted using a deductive-inductive thematic analysis approach.

RESULTS

Twelve patients and 12 HCPs at a diabetes clinic participated in one-to-one interviews. The interviews resulted in five different themes: the process and components of collaborative care model (four subthemes), current organizational support and resources (three subthemes), impact of collaborative care model on diabetes outcomes (three subthemes), enablers of collaborative care model (three subthemes), and barriers to collaborative care model (three subthemes). The participants indicated easy access to and communication with competent and pleasant HCPs. The patients appreciated the extra time spent with HCPs, frequent follow-up visits, and health education, which empowered them to self-manage diabetes. HCPs believed that successful CCM provision relied on their interest and commitment to care for patients with diabetes. Generally, participants identified barriers and facilitators that are related to patients, HCPs, and healthcare system.

CONCLUSIONS

The providers and users of CCM had an overall positive perception and appreciation of this model in PHC settings. Barriers to CCM such as undesirable attributes of HCPs and patients, unsupportive hospital system, and high workload must be addressed before implementing the model in other PHC settings.

Phytochemical Analysis and Antidiabetic Potential of Armoracia Rusticana: Pharmacological and Computational Approach

Aims & Objective: Armoracia rusticana has high medicinal values and is an excellent source of phytochemicals. This study was aimed to evaluate the antidiabetic potential of bioactive compounds from Armoracia rusticana.

METHODS

The antidiabetic analysis revealed that Armoracia rusticana was highly active against α- glucosidase with IC50 values of 5.6 μg/ml. Furthermore, molecular docking was used to identify the active constituents against α-glucosidase, while using acarbose as a controlled drug.

RESULTS

Upon phytochemical screening, it was found that six out of ten phytochemicals were successfully docked in the respective binding sites. The lead phytochemical was Quercetin 3-Obeta- D-xylopyranoside, which displayed a more binding score as compared to acarbose. They were subjected to analyze for drug-like properties, which further strengthen its validation.

CONCLUSION

It was, therefore, concluded that Armoracia rusticana might potentially be used in the amelioration of type 2 diabetes. Potential molecules identified from this study could be considered as a lead drug to cure diabetes mellitus.

Identifying Key Physical Activity Categories and Topics to Include in Health Professional Training Programs

Phenomenon: Healthcare is an important sector in promoting physical activity (PA). However, few health professional training programs include PA, nor does standardized guidance exist on implementing it in the curriculum. This study aimed to consolidate health professional expert opinion on key PA categories and topics that should be included in the curriculum of health professional training programs. Approach: A three-round, modified e-Delphi process examined the opinions of 73 experts from seven health professions (clinical nutrition, exercise physiology, medicine, nursing, occupational therapy, physical therapy, physician assistants). In Round 1, panelists reported importance, ranked, and scored five broad PA categories, and responded to open-ended prompts for additional categories. In Round 2, panelists received summary feedback, re-ranked and re-scored PA categories, and suggested key PA topics within the five categories. In the final round, panelists viewed, ranked, and scored the PA topics. Findings: Expert panelists felt that all PA categories were important, with Health Behavior Change ranking the highest (98.7%) followed by Cellular and Systemic Implications of Exercise, Clinical Exercise Physiology, and PA and Public Health. The Administrative Aspects of Integrating PA into Health Systems ranked least important (48.0%). A consensus on the key PA categories was considered reached after two rounds. Five to eight specific PA topics were generated within each PA category and ranked in order of importance. Insights: These findings highlight several key PA categories and topics that can serve as a foundation for a diverse number of health professional training programs.

Living Well With Type 1 Diabetes for 40 Years or More

Background

Although many studies explore the experiences of persons with type 1 diabetes, most examine the experience of children, adolescents, or persons in transition to adulthood. Few studies focus on the person living long term with type 1 diabetes.

Purpose

The purpose of this study was to explore the facilitators and barriers for people living well with type 1 diabetes over the long term.

Methods

An inductive interpretive description approach was used to explore living with type 1 diabetes for a duration of 40 years or more. Qualitative semistructured interviews with a convenience sample (n = 8) were conducted.

Results

Four dialectic themes were identified: accommodating and battling the disease, convenience and constraint of technology and treatment, self-reliance and reliance on others, and external and personal knowledge.

Conclusions

Recommendations for the health-care team emphasize person-centered care with acknowledgment of the person as expert and as more than their condition. Further research with this population would strengthen the implications for practice. Specifically, research is needed on diabetes distress, losses experienced due to diabetes, how to meet their educational needs, and how to tap into their expertise for the benefit of those with type 1 following them.

Therapeutic Inertia in Pediatric Diabetes: Challenges to and Strategies for Overcoming Acceptance of the Status Quo

Despite significant advances in therapies for pediatric type 1 diabetes, achievement of glycemic targets remains elusive, and management remains burdensome for patients and their families. This article identifies common challenges in diabetes management at the patient-provider and health care system levels and proposes practical approaches to overcoming therapeutic inertia to enhance health outcomes for youth with type 1 diabetes.

Basal Insulin Initiation and Maintenance in Adults with Type 2 Diabetes Mellitus in the United States

OBJECTIVE

A survey of US adults with type 2 diabetes mellitus was conducted to better understand patients' insulin initiation experiences and treatment persistence behaviors.

RESEARCH DESIGN AND METHODS

Participants were recruited from consumer panels and grouped by basal insulin treatment pattern: continuers (no gap of ≥7 days within 6 months of initiation); interrupters (gap ≥7 days, resumed treatment); discontinuers (stopped for ≥7 days, not resumed). A quota of approximately 50 respondents per persistence category was set.

RESULTS

A total of 154 respondents (52 continuers, 52 interrupters, 50 discontinuers) completed the survey. Mean age was 51.4 years; 51.9% male. Continuers were more likely to report their views being considered during initiation, and less likely to report a sense of failure. Concerns included insulin dependence (64.3% agree/strongly agree), frequent blood glucose monitoring (55.2%), costs/ability to pay (53.9%), fears of or mistakes during self-injection (52.6%), and weight gain (52.6%). Continuers were motivated by benefits of insulin therapy; experienced or potential side effects were notable factors for interruption/discontinuation. Healthcare provider instruction was indicated as a reason for continuing, stopping, and restarting therapy.

CONCLUSION

Benefits of basal insulin therapy motivated continuers while side effects impacted interruption/discontinuation. Persistence on basal insulin is often influenced by provider actions. Earlier provider intervention upon signs of treatment discontinuation may promote persistence.

Coping with diabetes: Provider attributes that influence type 2 diabetes adherence

Diabetes, a chronic disease affecting over 29 million people in the United States, requires the integration of complex medical tasks into a person's daily life. Patient-centered care and compassion are recognized as essential dimensions of the quality care experience. This research examined provider attributes that influence adherence to type 2 diabetes mellitus (T2DM) regimens and sought to understand the phenomena of provider attributes, treatment adherence, and their relationship to coping ability and treatment outcomes. This quantitative study sampled 474 people with T2DM using a 62-item online survey administered to three different groups. The sample population included people over age 18 diagnosed with T2DM. The first group included 91 persons with T2DM identified through a Facebook group and personal social media connections, the second group included 120 Amazon Mechanical Turk participants with T2DM, and the third group included 263 respondents from a Qualtrics panel who had T2DM. Results indicated that perceived provider compassion (β = .41, ρ < .001) and optimism (β = .48, ρ < .001) positively affected coping ability. Additionally, full mediation effects for self-management were revealed, with coping ability positively mediating the effect of compassion on self-management and the effects of optimism on self-management. Furthermore, full mediation effects were found for treatment satisfaction, with coping ability positively mediating the effect of compassion on treatment satisfaction and the effects of optimism on treatment satisfaction. This research has implications for patients, healthcare professionals, and leaders suggesting that providers who communicate with optimism and compassion positively affect coping ability. As a result, healthcare providers and professionals have an opportunity to enhance self-management adherence by helping their patients cope with the burdens of diabetes. In addition, this study has implications for developing provider communication tools aimed at assessing patients' coping capacity and increasing compassionate communication.

Primary care physician perspectives on basal insulin initiation and maintenance in patients with type 2 diabetes mellitus

AIMS

To describe primary care physicians' (PCPs) perceptions of patient reactions and concerns about insulin initiation and identify opportunities for increased support.

METHODS

Cross-sectional, online survey of PCPs prescribing basal insulin to adults with type 2 diabetes mellitus (T2DM). PCPs were identified from administrative claims of a large commercial health plan and descriptive results of PCP responses were reported.

RESULTS

PCPs (N=100) treated an average of 17 patients receiving insulin during a typical week. More than 85% of insulin initiation recommendations originated with PCPs. Most offered glucose monitoring instructions (96%) and advice on diet, exercise, and diabetes management (96%); 35% provided insulin titration algorithms; 93% reported that patients often or always took their insulin daily within 3 months of initiation; 31% of PCPs reported monthly office contacts with patients for the first 3 months; 16% reported no outreach efforts; fewer than 20% connected patients with support groups. When starting basal insulin, PCPs reported patients feeling personal failure regarding their diabetes treatment (33% often/always) and lacking confidence in their ability to manage insulin therapy (38% often/always).

CONCLUSIONS

Study results identify additional opportunities for assisting patients in making the transition to insulin, including more frequent direct outreach to monitor insulin usage.

Clinical Application of Patient-Centered Diabetes Care for People With Serious Mental Illness

IN BRIEF Patients with serious mental illness (SMI) have markedly higher mortality rates than those without SMI. A large portion of this disparity is explained by higher rates of diabetes and cardiovascular illness, highlighting the need for people with diabetes and SMI to have access to the highest quality diabetes care. This article applies principles of patient-centered diabetes care to those with SMI, exploring a novel approach to diabetes care embedded within a community mental health setting.

Personalizing Type 2 Diabetes Management: Use of a Patient-Centered Approach to Individualizing A1C Goals and Pharmacological Regimens

IN BRIEF Caring for people with type 2 diabetes requires a patient-centered approach to treatment targets and medication regimens. Focusing on patients' individual characteristics, needs, and treatment responses can improve compliance and clinical outcomes. Medication selection can be guided by the mechanisms of action, advantages, disadvantages, and costs of available options; patients' behavioral and psychological variables, personal preferences, and socioeconomic status also should be taken into account. This article provides an overview of patient-centered and individualized diabetes management, offers pharmacological recommendations for specific clinical scenarios, and describes a complicated case illustrating the patient-centered approach in clinical practice.