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Wen MJ, Salihu EY, Yang C, Maurer M, Shiyanbola OO. Peer Ambassador Perspectives in a Culturally Tailored Self-Management Intervention for African Americans with Type 2 Diabetes: A Qualitative Study. PHARMACY 2024; 12:75. [PMID: 38804467 PMCID: PMC11130834 DOI: 10.3390/pharmacy12030075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/27/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE Diabetes disproportionately affects African Americans, leading to higher morbidity and mortality. This study explores the experiences of African American adults who successfully self-manage their type 2 diabetes (called Peer Ambassadors) and provided phone-based peer support in a 6-month culturally tailored diabetes self-management program for African Americans guided by the information-motivation-behavioral skills model. DESIGN A group discussion using a semi-structured discussion guide was conducted. Qualitative content analysis was used to identify the facilitators and barriers to completing the role of a Peer Ambassador and to develop strategies for overcoming possible challenges in the future. SETTING Key informant discussions were conducted in a community location to gain insights into Ambassadors' motivations and challenges in delivering peer support. PARTICIPANTS Three Peer Ambassadors completed ethics training and peer mentor training and received a phone call guide before providing support to their peers. RESULTS There were four core themes related to Peer Ambassador experiences: (1) Motivation to be a Peer Ambassador, (2) program elements that supported Peer Ambassador role, (3) key elements of achieving engagement, and (4) challenges related to being a Peer Ambassador. CONCLUSIONS This study showed Peer Ambassadors in a culturally tailored peer supported self-management program found fulfillment in sharing experiences and supporting peers. They highly valued educational group sessions for knowledge updates and sustaining their health-related goals, suggesting the potential benefits of recognizing milestones or providing advanced training for future program sustainability. Findings suggest the importance of recruiting motivated patients and providing effective facilitation for peer support roles, including addressing barriers such as time commitment and lack of socialization opportunities.
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Affiliation(s)
- Meng-Jung Wen
- Division of Social and Administrative Sciences in Pharmacy, School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA; (M.-J.W.); (E.Y.S.)
| | - Ejura Y. Salihu
- Division of Social and Administrative Sciences in Pharmacy, School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA; (M.-J.W.); (E.Y.S.)
| | - Choua Yang
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Martha Maurer
- Sonderegger Research Center for Improved Medication Outcomes, School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Olayinka O. Shiyanbola
- Division of Social and Administrative Sciences in Pharmacy, School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA; (M.-J.W.); (E.Y.S.)
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Wang X, Tian B, Zhang S, Zhang J, Yang W, Li J, Wang W, Wang Y, Zhang W. Diabetes knowledge predicts HbA1c levels of people with type 2 diabetes mellitus in rural China: a ten-month follow-up study. Sci Rep 2023; 13:18248. [PMID: 37880376 PMCID: PMC10600128 DOI: 10.1038/s41598-023-45312-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 10/18/2023] [Indexed: 10/27/2023] Open
Abstract
Improving diabetes self-management (DSM) is facing real-world challenges among people with type 2 diabetes mellitus (T2DM) who have a low education level in resource-limited areas. This study aimed to investigate whether diabetes knowledge could predict glycemic levels in people with T2DM in rural China. This analytical cross-sectional study recruited 321 people with T2DM from eight villages by purposive sampling at baseline. After 10 months, 206 patients completed the follow-up survey and HbA1c tests, with a response rate of 64.17% (206/321). Multiple regression analysis was employed to explore the correlation between diabetes knowledge and HbA1c levels. The patient's diabetes knowledge was significantly negatively correlated with HbA1c levels before and after controlling for covariates in both hierarchical multiple regression and multiple logistic regression (p < 0.01). In addition, other influencing factors, including sex, age, marital status, employment status, income, and HbA1c levels at baseline, were also identified. Diabetes knowledge could predict HbA1c levels significantly among patients with low education levels in rural China. Therefore, interventions on improving diabetes knowledge need to be strengthened for patients in rural China so that they can improve their health outcomes and reduce the disease burden.
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Affiliation(s)
- Xiaoying Wang
- School of Social Development and Public Policy, Center for Behavioral Health, Beijing Normal University, Beijing, China
| | - Bo Tian
- School of Social Development and Public Policy, Center for Behavioral Health, Beijing Normal University, Beijing, China
| | - Shengfa Zhang
- National Population Heath Data Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinsui Zhang
- School of Public Health, Fudan University, Shanghai, China
| | - Weiping Yang
- Yancheng Dafeng People's Hospital, Yancheng, Jiangsu Province, China
| | - Jina Li
- School of Social Development and Public Policy, Center for Behavioral Health, Beijing Normal University, Beijing, China
| | - Weiwei Wang
- School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Yuchen Wang
- North China Electric Power University, Beijing, China
| | - Weijun Zhang
- School of Social Development and Public Policy, Center for Behavioral Health, Beijing Normal University, Beijing, China.
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Smith IP, Whichello CL, de Bekker-Grob EW, Mölken MPMHRV, Veldwijk J, de Wit GA. The Impact of Video-Based Educational Materials with Voiceovers on Preferences for Glucose Monitoring Technology in Patients with Diabetes: A Randomised Study. THE PATIENT 2023; 16:223-237. [PMID: 36670244 PMCID: PMC10121708 DOI: 10.1007/s40271-022-00612-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Ensuring patients have enough information about healthcare choices prior to completing a preference study is necessary to support the validity of the findings. Patients are commonly informed using text-based information with supporting graphics. Video-based information may be more engaging for the general patient population. This study aimed to assess (1) the impact that educating patients using video-based educational materials with a voiceover has on patient preferences compared to traditional text, and (2) whether this impact is consistent between two countries. MATERIALS AND METHODS A video-based educational tool was developed to inform patients prior to completing a discrete choice experiment assessing preferences for glucose monitors. Patients with diabetes from the Netherlands and Poland were recruited through an online research panel. Respondents were randomised to receive information in either a text or a video with animations and a voiceover. Data were analysed using a mixed-logit model. RESULTS N = 981 completed surveys were analysed from the Netherlands (n = 459) and Poland (n = 522). Differences were found between the countries, but no interpretable pattern of differences was found between the two types of educational materials. Patients spent less time in the educational material than would be necessary to fully review all of the content. CONCLUSIONS Simply providing educational material in a video with animations and voiceovers does not necessarily lead to better engagement from respondents or different preference outcomes in a sample of diabetes patients when compared to text. Increasing engagement with educational materials should be a topic of future research for those conducting patient preference research as no amount of educational material will be helpful if respondents do not access it.
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Affiliation(s)
- Ian P Smith
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Chiara L Whichello
- Evidera, London, UK.,Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Esther W de Bekker-Grob
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Jorien Veldwijk
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.,Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - G Ardine de Wit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Shiyanbola OO, Maurer M, Mott M, Schwerer L, Sarkarati N, Sharp LK, Ward E. A feasibility pilot trial of a peer-support educational behavioral intervention to improve diabetes medication adherence in African Americans. Pilot Feasibility Stud 2022; 8:240. [PMID: 36376960 PMCID: PMC9660113 DOI: 10.1186/s40814-022-01198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 10/31/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND African Americans are twice as likely to die from diabetes, compared to other racial and ethnic groups in the USA. Poor adherence to diabetes medications is common among African Americans and contributes to these disproportionally worse outcomes. A pilot study was conducted to determine the feasibility and acceptability of a peer-supported intervention targeting diabetes and medication beliefs, communication, and self-efficacy skills to enhance medication adherence among African Americans with type 2 diabetes. METHODS Based on the extended self-regulatory model and information-motivation-behavioral skills model, this intervention was piloted using a single group pre/post-intervention study design at two sites. Seventeen African Americans who self-reported as adherent to diabetes medicines (ambassadors) were paired with 22 African Americans with self-reported poor medication adherence (buddies). Feasibility outcomes evaluated recruitment, retention, and intervention adherence. Measures assessed at baseline and 1-month post-intervention included glycemic control (hemoglobin A1c), self-reported medication adherence, diabetes beliefs, concerns about diabetes medicines, and diabetes self-efficacy. Wilcoxon signed-rank tests assessed for differences in mean scores of outcome variables at baseline compared with a 3-month follow-up. Semi-structured 60-min interviews were conducted with each buddy to explore their acceptability of the intervention. To ensure the rigor of the qualitative data, we focused on analytic criteria such as credibility, confirmability, and transferability. RESULTS Most buddies and ambassadors were female and about 56 years old. Feasibility outcomes included recruitment success rates of 73% for buddies and 85% for ambassadors relative to our goals. Retention rate for hemoglobin A1c and medication adherence outcome assessment was 95% for buddies. Both buddies and ambassadors had excellent intervention adherence, with buddies having a mean attendance of 7.76 out of 8 sessions/phone calls and ambassadors completing > 99% of the 105 intervention calls with Buddies. Results showed a signal of change in hemoglobin A1c (effect size = 0.14) and medication adherence (effect size = 0.35) among buddies, reduction in buddies' negative beliefs about diabetes and an increase in necessity beliefs of diabetes medicines. Summative interviews with buddies showed they valued ambassador's encouragement of self-management behaviors. CONCLUSIONS Results support conduct of an efficacy trial to address medication adherence for African Americans with type 2 diabetes using a peer-supported tailored intervention. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04028076 .
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Affiliation(s)
- Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA.
| | - Martha Maurer
- Sonderegger Research Center, School of Pharmacy, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA
| | - Mattigan Mott
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Luke Schwerer
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Nassim Sarkarati
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Lisa K Sharp
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago, IL, USA
| | - Earlise Ward
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
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Hashim MJ, Mustafa H. Empowering Patients for Healthy Nutrition, Physical Activity, and Self-Care Using the Diabetes Score Questionnaire. DUBAI DIABETES AND ENDOCRINOLOGY JOURNAL 2021. [DOI: 10.1159/000519225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objectives: Lifestyle factors such as nutrition and physical activity play an important role in the management of diabetes mellitus. Unfortunately, adherence to lifestyle change remains low among patients with diabetes. The aim of this study was to evaluate the effectiveness of the Diabetes Score questionnaire in a clinical setting. Methods: The Diabetes Score is a 10-item shared decision-making tool designed to empower lifestyle change in individuals with diabetes. It yields an intuitive score from 0 to 100 based on a patient’s adherence to lifestyle recommendations. An observational study was conducted at an ambulatory health care center. After obtaining written informed consent, adult patients with type 2 diabetes mellitus were interviewed by a trained researcher using the Diabetes Score questionnaire. Patients’ Diabetes Score values were analyzed in reference to their glycemic control and other clinical and demographic factors. Results: A total of 60 individuals with type 2 diabetes participated in the study. The mean age was 56 years (minimum 43 years, maximum 70 years) with 60% being males. Higher Diabetes Scores correlated with better glycemic control (hemoglobin A1C; r = −0.23, p = 0.044) indicating the effect of lifestyle factors such as healthy nutrition, smaller portion sizes, active lifestyle, and aerobic exercise. The questionnaire showed internal consistency (alpha 0.66), construct validity, and high patient satisfaction (98%). Conclusion: Diabetes Score, a behavioral lifestyle questionnaire, correlates with glycemic control in type 2 diabetes. Diabetes Score can be used in clinical settings for measuring, discussing, and setting targets for lifestyle change among patients with diabetes.
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Litchman ML, Edelman LS. Perceptions of the Diabetes Online Community's Credibility, Social Capital, and Help and Harm: Cross-Sectional Comparison Between Baby Boomers and Younger Adults. JMIR Aging 2019; 2:e10857. [PMID: 31573907 PMCID: PMC6787528 DOI: 10.2196/10857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 02/01/2019] [Accepted: 04/04/2019] [Indexed: 01/05/2023] Open
Abstract
Background The use of online health communities such as the diabetes online community (DOC) is growing. Individuals who engage in the DOC are able to interact with peers who have the same medical condition. It is not known if older adults are perceiving the DOC differently compared with younger adults. Objective The purpose of this study was to explore and understand how the DOC is perceived in terms of social capital, source credibility, and help and harm. The findings from this study will shed light on how users of different age groups (baby boomers and younger adult counterparts) perceive DOC use. Methods This study represents a subset of participants from a larger study of DOC users. Baby boomers and younger adults with diabetes were recruited from the DOC to participate in a cross-sectional survey. Demographics, electronic health use (reasons to join the DOC, DOC intensity, DOC engagement, internet social capital, and help or harm from the DOC), source credibility, health-related quality of life, and diabetes self-care data were collected. We examined the differences between baby boomer and younger adult responses. Results The participants included baby boomers (N=76) and younger adult counterparts (N=102). Participants scored their diabetes health care team (mean 33.5 [SD 8]) significantly higher than the DOC (mean 32 [SD 6.4]) with regard to competence (P<.05) and trustworthiness (diabetes health care team mean 36.3 [SD 7.1]; DOC mean 33.6 [SD 6.2]; P<.001). High bonding and bridging social capital correlated with high DOC intensity (r=.629; P<.001 and r=.676; P<.001, respectively) and high DOC engagement (r=.474; P<.01 and r=.507; P≤.01, respectively). The greater majority (69.8%) reported the DOC as being helpful, and 1.8% reported that the DOC had caused minor harm. Baby boomers perceived DOC credibility, social capital, help, and harm similarly to their younger adult counterparts. Conclusions Baby boomers are using and perceiving the DOC similarly to younger adults. DOC users find the DOC to be credible; however, they scored their health care team higher with regard to competence and trustworthiness. The DOC is beneficial with low risk and may augment current diabetes care.
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Affiliation(s)
| | - Linda S Edelman
- University of Utah, College of Nursing, Salt Lake City, UT, United States
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Caetano IRCES, Santiago LM, Marques M. Impact of written information on control and adherence in type 2 diabetes. ACTA ACUST UNITED AC 2018; 64:140-147. [PMID: 29641669 DOI: 10.1590/1806-9282.64.02.140] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/16/2017] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Diabetes therapeutic education and information by leaflets is important. This study aimed to understand the effectiveness of written information to diabetic patients, after six months, in the control of diabetes and medication adherence. METHOD Non-pharmacological clinical trial. Randomized sample of diabetic patients of 65 volunteer doctors, distributed among the five health regions in Portugal. At the first appointment, patients were randomized in four groups (three intervention with validated leaflets and one control), leaflet reading being reinforced at the follow-up appointments in a 6-months period. Variables collected: HbA1c, home blood glucose, weight, waist circumference, blood pressure, cigarettes smoked, physical activity level, adherence to medication, medication, height, diabetes progression, age, sex and educational background. Descriptive and inferential statistics. RESULTS From the 709 patients recruited, 702 were studied in this 6-months period with no statistical differences in the baseline variables studied. After six months of intervention, the adherence to medication improved in the leaflet group (p=0.034). This was noticed in those under 65 years of age (p=0.027), with diabetes for ≤ 5 years (p=0.010), with educational background up to 4 years (p=0.030) and 9 years (p=0.006) and with HbA1c ≥ 7% at the beginning of the study. CONCLUSION Interventions with leaflets handed in primary healthcare to people with diabetes type 2 can bring benefits in what concerns adherence to therapeutics, namely in younger people with a less studies.
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Affiliation(s)
| | | | - Margarida Marques
- Biostatistics Laboratory, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
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Litchman ML, Rothwell E, Edelman LS. The diabetes online community: Older adults supporting self-care through peer health. PATIENT EDUCATION AND COUNSELING 2018; 101:518-523. [PMID: 28947360 DOI: 10.1016/j.pec.2017.08.023] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/25/2017] [Accepted: 08/31/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The use of the diabetes online community (DOC) is growing across all age groups. The aim of this exploratory study was to describe why older adults participated in the DOC, and how DOC users interacted with their healthcare providers. METHODS Telephone interviews (N=20) were conducted with older adult DOC users (born between 1946 and 1964) living in the United States. Interviews were analyzed using qualitative content analysis adhering to rigor and reproducibility standards. RESULTS Themes that emerged from the data related to DOC participation included: information to improve self-care, emotional support, belonging to a community, validation of information, cause for concern and interaction with healthcare providers. Participants used the DOC for day to day diabetes management advice and healthcare providers for medical information and care. CONCLUSION Participants highly valued the DOC and regarded their participation as a way to increase knowledge to improve self-care and reciprocate emotional support with others for diabetes management. The DOC filled gaps in knowledge and support participants were not able to get elsewhere. PRACTICE IMPLICATIONS The DOC serves as an important source of information and support for individuals with diabetes and may be a cost-effective strategy to augment standard diabetes care.
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Affiliation(s)
- Michelle L Litchman
- University of Utah College of Nursing, 10 South 2000 East, Salt Lake City, UT, 84112, USA.
| | - Erin Rothwell
- University of Utah College of Nursing, 10 South 2000 East, Salt Lake City, UT, 84112, USA.
| | - Linda S Edelman
- University of Utah College of Nursing, 10 South 2000 East, Salt Lake City, UT, 84112, USA.
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Effect of telemedicine messages integrated with peer group support on glycemic control in type 2 diabetics, Kingdom of Saudi Arabia. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0608-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Saputri GZ, Akrom, Dini SM. Validation of behaviour measurement instrument of patients with diabetes mellitus and hypertension. ACTA ACUST UNITED AC 2017. [DOI: 10.1088/1757-899x/259/1/012014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ishak NH, Mohd Yusoff SS, Rahman RA, Kadir AA. Diabetes self-care and its associated factors among elderly diabetes in primary care. J Taibah Univ Med Sci 2017; 12:504-511. [PMID: 31435286 PMCID: PMC6694907 DOI: 10.1016/j.jtumed.2017.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/02/2017] [Accepted: 03/05/2017] [Indexed: 12/04/2022] Open
Abstract
Objectives Diabetes is a primarily self-manageable condition. Healthcare professionals usually offer education, treatment, and support, but patients themselves are responsible for the daily management of their condition. Increasing the effectiveness of self-management support may have a considerable impact on health care, especially for elderly people. The aim of this study was to describe diabetes self-care among elderly diabetics and to determine its associated factors. Methods This report describes a cross-sectional study involving 143 elderly diabetes patients in the outpatient department of the Hospital Universiti Sains Malaysia (HUSM). Self-care activities assessed in this study included dietary control, physical activity, self-monitoring of blood glucose, medication adherence, and situational related adherence behaviour, all of which were obtained using the validated Malay Elderly Diabetes Self-Care Questionnaire (MEDSCaQ). Results The mean (±SD) age of the subjects was 67.9 (±5.4) years old. A majority was Malay, with a mean HbA1c of 8.4 (±1.9). The mean diabetes self-care score was 26.5 (±8.0). Factors with a positive impact on diabetes self-care included being non-Malay (β = 5.275, p = 0.002), having family as care givers (β = 8.995, p = 0.004), having a higher level of family support (β = 0.159, p = 0.042), and possessing acceptable (β = 4.375, p = 0.001) or good knowledge of diabetes (β = 5.893, p = 0.004). The presence of neuropathy negatively impacted self-care, while diabetes nephropathy had a positive impact on self care (β = −4.053, p = 0.003). Conclusions Elderly individuals with type 2 diabetes in HUSM have a moderate score of diabetes self-care practice based on the MEDSCaQ. Determinants for good diabetes self-care include race, social support, having care-takers during periods of illness, diabetes knowledge, and diabetic microvascular complications.
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Affiliation(s)
- Nor H Ishak
- Klinik Kesihatan Jalan lanang, Sibu, Sarawak, Malaysia
| | - Siti S Mohd Yusoff
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kerian, Kelantan, Malaysia
| | - Razlina A Rahman
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kerian, Kelantan, Malaysia
| | - Azidah A Kadir
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kerian, Kelantan, Malaysia
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García-Donaire JA, Franch-Nadal J, Rodríguez-Fortúnez P, Labrador-Barba E, Orera-Peña ML, Rodríguez de Miguel M. Epidemiological multicentre study on the education provided to patients with type 2 diabetes mellitus in the Spanish Health Care System. The Forma2 study. Semergen 2017; 44:5-12. [PMID: 28511878 DOI: 10.1016/j.semerg.2017.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of the present study was to characterize the education that patients with type 2 diabetes mellitus receive, and to identify differences as regards the presence of insulin therapy or not. METHODS This crossover, multicentre and descriptive study involved 1066 Spanish physicians who completed a questionnaire on Internet. RESULTS The physicians that responded had a mean of 26.0 years of experience in healthcare, and mainly worked in a walk-in clinic in an urban area. Physicians rated the level of patient knowledge about their disease on a 5.0 point-scale. Fifty percent of them indicated that they spent between 15 and 30min in educating patients at the time of diagnosis. Previous control with HbA1c>9%, presence of microvascular complications, and a low socio-cultural level, were factors associated with spending more time in education. CONCLUSION This is the first study designed to evaluate the education provided to patients with type 2 diabetes mellitus from Spain. The time spent and the individualization of the education are important factors associated with better long-term control of the disease, and thus with the effectiveness of the clinical management.
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Affiliation(s)
| | - J Franch-Nadal
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Primary Health Care Center Raval Sud, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
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Ahn S, Lee J, Bartlett-Prescott J, Carson L, Post L, Ward KD. Evaluation of a Behavioral Intervention With Multiple Components Among Low-Income and Uninsured Adults With Obesity and Diabetes. Am J Health Promot 2017; 32:409-422. [DOI: 10.1177/0890117117696250] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To examine the effects of a community-based behavioral intervention with multiple components on health outcomes among low-income and uninsured adults who were obese and had diabetes and treated in a “real-world” setting. Design: A longitudinal design with a retrospective comparison group was used to examine the ability of a health promotion program to improve body mass index (BMI) and hemoglobin A1c (HbA1c) among 87 treatment group and 62 comparison group participants. Setting: Urban/metropolitan city in the United States. Intervention: A community-based behavioral intervention with 3 components including health-coach visits, registered dietitian visits, and exercise consultations delivered over 12 months. Measures: Biometric measurements were collected at baseline, 3, 6, 9, 12, and 18 months, whereas self-reported measurements were collected at baseline, 6 months, and 12 months. Analysis: Linear mixed models with participant-level random intercepts were fitted for BMI and HbA1c. Results: The treatment group demonstrated reductions in BMI (percentage change = −2.1%, P < .001) and HbA1c (−0.6%, P < .001) as well as improvement in diabetes knowledge (+5.4%, P = .025), whereas the comparison group did not show any improvements in biometric measures. Dietitian visits were the most effective treatment component to reduce HbA1c (coefficient = −0.08, P = .025). Conclusion: Multiple component behavioral intervention in community settings, particularly when delivered by registered dietitians, shows promise to combat the dual epidemic of obesity and diabetes among low-income and uninsured patients.
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Affiliation(s)
- SangNam Ahn
- Division of Health Systems Management and Policy, The University of Memphis School of Public Health, Memphis, TN, USA
| | - Joonhyung Lee
- Fogelman College of Business and Economics, The University of Memphis, Memphis, TN, USA
| | | | - Lisa Carson
- Methodist Le Bonheur Healthcare Hospital, Memphis, TN, USA
| | - Lindsey Post
- Division of Health Systems Management and Policy, The University of Memphis School of Public Health, Memphis, TN, USA
| | - Kenneth D. Ward
- Division of Social and Behavioral Sciences, The University of Memphis School of Public Health, Memphis, TN, USA
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Sircar M, Bhatia A, Munshi M. Review of Hypoglycemia in the Older Adult: Clinical Implications and Management. Can J Diabetes 2015; 40:66-72. [PMID: 26752195 DOI: 10.1016/j.jcjd.2015.10.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/15/2015] [Accepted: 10/16/2015] [Indexed: 12/16/2022]
Abstract
The aging of the population is a worldwide phenomenon. The prevalence of diabetes rises with increasing age, so the personal and financial costs of diabetes in the aging population have become significant burdens. In 2012, 104 billion (59%) of the estimated $176 billion in United States healthcare expenditures attributable to diabetes were utilized by patients older than 65 years of age [American Diabetes Association (1)]. With improvement in diabetes management and better glycemic control in the general population, there is an increase in the prevalence of hypoglycemia, which is the complication of the treatment of diabetes. Older adults with diabetes have a higher risk for hypoglycemia due to altered adaptive physiologic responses to low glucose levels. These patients also have comorbidities, such as cognitive and functional loss, that interfere with prompt identification and/or appropriate treatment of hypoglycemia. Older adults who suffer from hypoglycemia also have increased risk for falls, fall-related fractures, seizures and comas and exacerbation of chronic conditions, such as cognitive dysfunction and cardiac events. Thus, hypoglycemia in the older adult must be proactively avoided to decrease significant morbidity and mortality. Education of the patients and caregivers is important in prevention and treatment of hypoglycemia. In this article, we discuss the important aspects and unique challenges pertaining to hypoglycemia in older population. We also highlight the risks, consequences and prevention and management strategies for hypoglycemia that can be used by healthcare providers caring for older populations.
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Affiliation(s)
- Mousumi Sircar
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Ashmeet Bhatia
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Medha Munshi
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Joslin Diabetes Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
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Hussain Z, Yusoff ZM, Sulaiman SAS. Evaluation of knowledge regarding gestational diabetes mellitus and its association with glycaemic level: A Malaysian study. Prim Care Diabetes 2015; 9:184-190. [PMID: 25132140 DOI: 10.1016/j.pcd.2014.07.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 07/02/2014] [Accepted: 07/14/2014] [Indexed: 01/11/2023]
Abstract
AIMS The aim of this study was to evaluate the knowledge about GDM and its corresponding relation with glycaemic level in GDM patients. METHOD A cross-sectional study was conducted in antenatal clinic of Hospital Pulau Pinang, Malaysia from June 2013 to December 2013 using Gestational Diabetes Mellitus Knowledge Questionnaire (GDMKQ) on the sample of 175 GDM patients. Three most recent fasting plasma glucose (FPG) values (mmol/l) were taken from patients profiles and mean was calculated. RESULTS A total of 166 patients were included in final analysis. A total mean knowledge score of 166 patients was 10.01±3.63 and total mean FPG value was 5.50±1.13. Knowledge had a significant negative association with FPG (r=- 0.306, P<0.01). Among different knowledge domains, highest mean score was seen for diet/food values domain and lowest for management of GDM. Educational level seems to be the most significant predictor of GDM knowledge and glycaemic control. Highest mean knowledge score and lowest mean glycaemic levels were recorded for patients aged 25-29 years, Malay ethnicity, working women and family history of DM. CONCLUSION Higher Knowledge about GDM is related to better glycaemic control. New educational strategies should be developed to improve the lower health literacy.
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Affiliation(s)
- Zahid Hussain
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia.
| | - Zuraidah Mohd Yusoff
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia
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Sanjay S, Chin YC, Sun Y, Ong EL, Au Eong KG. Awareness of HbA(1c) and its relationship with diabetic retinopathy among adult diabetic patients attending a tertiary ophthalmic center. Diabetes Care 2013; 36:e1. [PMID: 23264292 PMCID: PMC3526244 DOI: 10.2337/dc12-1320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Srinivasan Sanjay
- From the Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore; the
- Eye Clinic, Jurong Medical Centre, Singapore; the
| | - You Chuen Chin
- From the Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore; the
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yan Sun
- Health Services Outcome Research, Singapore; the
| | - Ee Lin Ong
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore; and the
| | - Kah Guan Au Eong
- From the Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore; the
- Singapore International Eye Cataract Retina Centre, Mount Elizabeth Medical Centre, Singapore
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Muchiri JW, Gericke GJ, Rheeder P. Needs and preferences for nutrition education of type 2 diabetic adults in a resource-limited setting in South Africa. Health SA 2012. [DOI: 10.4102/hsag.v17i1.614] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Diabetes self-management education is crucial in diabetes care. Education that is tailored to the needs of the patient is considered the most effective in improving health outcomes. Diet, a critical element of diabetes treatment, is reported as the most difficult to adhere to by both patients and health professionals. Tailored nutrition education (NE) could benefit diabetic individuals with low socio-economic status, who are amongst those noted to have poor health outcomes. This qualitative interpretive phenomenological study aimed to explore and describe the NE needs of adults with type 2 diabetes mellitus to guide development of a tailored NE programme for resource-poor settings. Participants were 31 non-insulin-dependent type 2 diabetic patients (convenience sample) and 10 health professionals. Focus group discussions using semi-structured questions were held with the diabetics, and open-ended self-administered questionnaires were used with the health professionals. Data analysis was done using Krueger’s framework approach. Disease-related knowledge deficits and inappropriate self-reported dietary practices, including intake of unbalanced meals, problems with food portion control and unsatisfactory intake of fruits and vegetables, were observed. Recommendations for the NE programme included topics related to the disease and others related to diet. Group education at the clinic, a competent educator and comprehensive education were indicated by the patients. Participation of family and provision of pamphlets were aspects recommended by patients and health professionals. Barriers that could impact the NE included financial constraints, food insecurity, conflict in family meal arrangements and access to appropriate foods. Support from family and health professionals and empowerment through education were identified as facilitators to following dietary recommendations by both groups of participants. Knowledge deficits, inappropriate dietary practices and barriers are issues that need addressing in an NE programme, whilst the suggestions for an NE programme and facilitators to dietary compliance need to be incorporated.Onderrig in die selfbestuur van diabetes is essensieel in diabetessorg. Onderrig wat spesifiek ooreenkomstig die behoeftes van die pasiënt aangepas is, word die mees doeltreffend in die verbetering van gesondheiduitkomste geag. Dieet, ’n kritiese element in diabetesbehandeling, word deur pasiënte en gesondheidpraktisyns as die moeilikste beskou om na te volg. Spesifiek beplande voedingonderrig kan tot voordeel van lae sosio-ekonomiese diabete wees wat deel van diegene wat swak gesondheiduitkomste toon, uitmaak. Die doel van hierdie kwalitatiewe interpreterende fenomologiese studie was om die voedingonderrigbehoeftes van volwassenes met tipe 2 diabetes mellitus te ondersoek en te beskryf ten einde die ontwikkeling van ’n voedingonderrigprogram wat op hulpbrondbeperkte omgewings afgestem is, te rig. Een en dertig nie-insulien afhanklike tipe 2 diabetes pasiënte (geriefsteekproef) en 10 gesondheidpraktisyns was evalueer. Fokusgroepbesprekings deur gebruikmaking van semi-gestruktureerde vrae, is met die diabete gehou. Self-geadministreerde oop-eindigende vraelyste is deur die gesondheidpraktisyns voltooi. Data-analise is volgens Krueger se raamwerkbenadering gedoen. Siekteverwante kennisgapings en ontoepaslike self-gerapporteerde dieetpraktyke, insluitend ongebalanseerde maaltye, probleme met porsiekontrole en ontoereikende inname van groente en vrugte is gerapporteer. Aanbevelings vir die voedingonderrigprogram het onderwerpe verwant aan die siekte en die dieet ingesluit. Die pasiënte het groeponderrig by die kliniek, ’n bevoegde onderrigpraktisyn en omvattende onderrig verkies. Die pasiënte en die gesondheidpraktisyns het gesinsdeelname en die beskikbaarstelling van pamflette aanbeveel. Struikelblokke wat negatief op die voedingonderrigprogram kon inwerk, het finansiële beperkinge, voedselinsekuriteit, konflik met gesinsmaaltydreëlings en toegang tot geskikte voedsels ingesluit. Ondersteuning van die gesin en gesondheidpraktisyns, sowel as bemagtiging deur kennis is as fasiliteerders ter bevordering van die navolging van dieetaanbevelings deur beide groepe deelnemers geïdentifiseer. Tekortkominge in kennis, ontoepaslike dieetpraktyke en struikelblokke is aspekte wat in ’n voedingonderrigprogram aangespreek behoort te word. Voorstelle wat vir die voedingonderrigprogram en fasiliteerders gemaak is vir dieetnavolging, behoort in die program ingesluit te word.
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Colleran K, Harding E, Kipp BJ, Zurawski A, MacMillan B, Jelinkova L, Kalishman S, Dion D, Som D, Arora S. Building Capacity to Reduce Disparities in Diabetes. DIABETES EDUCATOR 2012; 38:386-96. [DOI: 10.1177/0145721712441523] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this study is to determine whether an innovative interactive distance training program is an effective modality to train community health workers (CHWs) to become members of the diabetes health care team. The University of New Mexico Health Sciences Center has developed a rigorous diabetes training program for CHWs involving both distance and hands-on learning as part of Project ECHO™ (Extension for Community Healthcare Outcomes). Methods Twenty-three diverse CHW participants from across New Mexico were enrolled in the first training session. Participants completed surveys at baseline and at the end of the program. They attended a 3-day hands-on training session, followed by weekly participation in tele/video conferences for 6 months. Wilcoxon signed-rank statistics were used to compare pre- and posttest results. Results Participants demonstrated significant improvements in diabetes knowledge ( P = .002), diabetes attitudes ( P = .04) and confidence in both clinical and nonclinical skills ( P < .001 and P = .04, respectively). Additionally, during focus group discussions, participants reported numerous benefits from participation in the program. Conclusions Community health worker participation in the Project ECHO diabetes training program resulted in significant increases in knowledge, confidence, and attitudes in providing care to patients with diabetes. Studies are ongoing to determine whether the training has a positive impact on patient outcomes.
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Affiliation(s)
- Kathleen Colleran
- University of New Mexico Health Sciences Center, Department of Internal Medicine, Albuquerque, NM
| | - Erika Harding
- University of New Mexico Health Sciences Center, Department of Internal Medicine, Albuquerque, NM
| | - Billie Jo Kipp
- University of New Mexico School of Medicine, Center for Native American Health, Albuquerque, NM
| | - Andrea Zurawski
- University of New Mexico Health Sciences Center, Patient Education, Albuquerque, NM
| | - Barbara MacMillan
- University of New Mexico Health Sciences Center, Patient Education, Albuquerque, NM
| | - Lucie Jelinkova
- University of New Mexico Health Sciences Center, Department of Internal Medicine, Albuquerque, NM
| | - Summers Kalishman
- University of New Mexico Health Sciences Center, Office of Program Evaluation, Education and Research Albuquerque, NM
| | - Denise Dion
- University of New Mexico Health Sciences Center, Office of Program Evaluation, Education and Research Albuquerque, NM
| | - Dara Som
- University of New Mexico Health Sciences Center, Department of Internal Medicine, Albuquerque, NM
| | - Sanjeev Arora
- University of New Mexico Health Sciences Center, Department of Internal Medicine, Albuquerque, NM
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Al-Qazaz HK, Sulaiman SA, Hassali MA, Shafie AA, Sundram S. Diabetes knowledge and control of glycaemia among type 2 diabetes patients in Penang, Malaysia. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2012. [DOI: 10.1111/j.1759-8893.2011.00073.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lai PSM, Chua SS, Tan CH, Chan SP. Validation of the diabetes, hypertension and hyperlipidemia (DHL) knowledge instrument in Malaysia. BMC Med Res Methodol 2012; 12:18. [PMID: 22361093 PMCID: PMC3352255 DOI: 10.1186/1471-2288-12-18] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 02/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient's knowledge on diabetes, hypertension and hyperlipidaemia and its medications can be used as one of the outcome measures to assess the effectiveness of educational intervention. To date, no such instrument has been validated in Malaysia. Therefore, the aim of this study was to evaluate the validity and reliability of the Diabetes, Hypertension and Hyperlipidemia (DHL) knowledge instrument for assessing the knowledge of patients with type 2 diabetes in Malaysia. METHODS A 28-item instrument which comprised of 5 domains: diabetes, hypertension, hyperlipidemia, medications and general issues was designed and tested. One point was given for every correct answer, whilst zero was given for incorrect answers. Scores ranged from 0 to 28, which were then converted into percentage. This was administered to 77 patients with type 2 diabetes in a tertiary hospital, who were on medication(s) for diabetes and who could understand English (patient group), and to 40 pharmacists (professional group). The DHL knowledge instrument was administered again to the patient group after one month. Excluded were patients less than 18 years old. RESULTS Flesch reading ease was 60, which is satisfactory, while the mean difficulty factor(SD) was 0.74(0.21), indicating that DHL knowledge instrument was moderately easy. Internal consistency of the instrument was good, with Cronbach's α = 0.791. The test-retest scores showed no significant difference for 26 out of the 28 items, indicating that the questionnaire has achieved stable reliability. The overall mean(SD) knowledge scores was significantly different between the patient and professional groups [74.35(14.88) versus 93.84(6.47), p < 0.001]. This means that the DHL knowledge instrument could differentiate the knowledge levels of participants. The DHL knowledge instrument shows similar psychometric properties as other validated questionnaires. CONCLUSIONS The DHL knowledge instrument shows good promise to be adopted as an instrument for assessing diabetic patients' knowledge concerning their disease conditions and medications in Malaysia.
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Affiliation(s)
- Pauline SM Lai
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siew Siang Chua
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ching Hooi Tan
- Pharmacy Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Siew Pheng Chan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Jeppesen KM, Hull BP, Raines M, Miser WF. A validation study of the spoken knowledge in low literacy in diabetes scale (SKILLD). J Gen Intern Med 2012; 27:207-12. [PMID: 22005940 PMCID: PMC3270246 DOI: 10.1007/s11606-011-1900-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 09/06/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND In 2005 the Spoken Knowledge in Low Literacy in Diabetes scale (SKILLD) was introduced as a diabetes knowledge test. The SKILLD has not been validated since its introduction. OBJECTIVE To perform a validation analysis on the SKILLD. DESIGN AND PARTICIPANTS Cross-sectional observational study of 240 patients with diabetes at an academic family practice center. MAIN MEASURES SKILLD's correlation with an oral form of the Diabetes Knowledge Test (DKT) was used to assess criterion validity. A regression model tested construct validity, hypothesizing that SKILLD score was independently related to health literacy and education level. Content validity was tested using Cronbach's Alpha for inter-item relatedness and by comparing SKILLD items with the content of a National Institutes of Health (NIH) diabetes education website. We assessed inter-rater reliability and bias using Spearman correlation coefficients and sign-rank tests between interviewers scoring the same interview. KEY RESULTS The SKILLD demonstrated fair correlation with the DKT (Pearson's coefficient 0.54, 95% CI=0.49 to 0.66, p<0.001). Health literacy, education level, male gender, household income, and years with diabetes were independent predictors of SKILLD score in the regression model. Cronbach's Alpha for inter-item relatedness was 0.54. There were some topics on the NIH website not addressed by the SKILLD. The inter-rater correlation coefficient was 0.79 (95% CI 0.56 to 0.91, p<0.001). CONCLUSIONS The SKILLD is an adequate diabetes knowledge test and is appropriate for people of all literacy levels. However, it should be expanded to more completely evaluate diabetes knowledge.
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Affiliation(s)
- Kelly Marvin Jeppesen
- Department of Family Medicine, McKay-Dee Hospital Center, 4401 Harrison Blvd, Ogden, UT 84403, USA.
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Al-Qazaz HK, Hassali MA, Shafie AA, Sulaiman SAS, Sundram S. The 14-item Michigan Diabetes Knowledge Test: translation and validation study of the Malaysian version. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/pdi.1495] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Al-Qazaz HK, Hassali MA, Shafie AA, Syed Sulaiman SA, Sundram S. Perception and knowledge of patients with type 2 diabetes in Malaysia about their disease and medication: a qualitative study. Res Social Adm Pharm 2010; 7:180-91. [PMID: 21272545 DOI: 10.1016/j.sapharm.2010.04.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 04/29/2010] [Accepted: 04/29/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diabetic patients' experience and knowledge about their medication play an important role in determining the success of long-term adherence in their disease management. OBJECTIVE This study aimed to explore diabetic patients' experience and knowledge about diabetes and its medication and to understand the factors contributing to medication adherence in Malaysian population. METHODS A qualitative research approach was adopted to gain a better understanding of the current perceptions and knowledge held by diabetic patients. Twelve patients were interviewed using a semi-structured interview guide. Saturation point of the interview was reached after the 10th interview, and no more new themes emerged from the subsequent 2 interviews. All interviews were transcribed verbatim and analyzed by means of a standard content analysis framework. RESULTS A total of 4 themes were identified from the interview analysis: knowledge about diabetes and its medication, experiences of adverse effects of medication, issues related to adherence, and the impact of medical and family relationships on well-being. Most of the patients were aware of the disease known as diabetes but unaware which type of diabetes they were suffering from. None of the participants knew the adverse effects of their medication, and most of them considered it to be safe. Financial barriers, forgetfulness, self-medication, and quality of relationships with doctor and family members seem to be the factors that challenge adherence in our sample of diabetic patients. CONCLUSION This study identified a number of key themes that might be useful in enhancing the awareness of experiences, knowledge, adherence, and attitudes of Malaysian patients with diabetes. More efforts should be taken to estimate how diabetic patients take their medication, and a well-planned educational program is also required to educate and encourage patients to practice a healthy lifestyle.
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Affiliation(s)
- Harith Khalid Al-Qazaz
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia.
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Mancuso JM. Impact of health literacy and patient trust on glycemic control in an urban USA population. Nurs Health Sci 2010; 12:94-104. [DOI: 10.1111/j.1442-2018.2009.00506.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Misra R, Lager J. Ethnic and gender differences in psychosocial factors, glycemic control, and quality of life among adult type 2 diabetic patients. J Diabetes Complications 2009; 23:54-64. [PMID: 18413181 DOI: 10.1016/j.jdiacomp.2007.11.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 07/18/2007] [Accepted: 11/09/2007] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To examine ethnic and gender differences in psychosocial factors, e.g., social support and acceptance of the disease, knowledge levels, perceived difficulty in adherence behaviors, and diabetes outcome (glycemic control and quality of life) in Type 2 diabetic patients. METHODS Data were collected via telephone interviews from 180 diabetic subjects (34% Hispanics, 27% Non-Hispanic whites, 18% African-Americans, and 20% Asian-Indians; 52% females) from 2 clinics. Hemoglobin A1c levels were obtained from patient charts. RESULTS Significant ethnic and gender differences existed in acceptance of the disease, in receiving social support, disease knowledge, perceived difficulty in self-management behaviors, glycemic control, and quality of life among Type 2 diabetic patients; differences were more pronounced by gender than by ethnicity. In general, social support and acceptance of the disease were high. However, perceived difficulty in self-management behaviors varied by racial/ethnic groups with self-monitoring of blood glucose perceived as most difficult by Hispanic respondents, dietary management was most difficult for non-Hispanic whites, while physical activity was the most difficult for African-Americans. Hispanic respondents had greatest severity of the disease (poorest metabolic control). CONCLUSIONS Ethnic and gender variations exist in social support, acceptance of diabetes, quality of life, and adherence behaviors. The outcomes of diabetes care can be improved if practitioners factor these differences in tailoring diabetes education and supportive care for individuals with Type 2 diabetes.
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Affiliation(s)
- Ranjita Misra
- Health and Kinesiology Department, 4243 TAMU, 158V Read Building, Texas A&M University, College Station, TX 77843-4243, USA.
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Wang S, Tikellis G, Wong N, Wong TY, Wang JJ. Lack of knowledge of glycosylated hemoglobin in patients with diabetic retinopathy. Diabetes Res Clin Pract 2008; 81:e15-7. [PMID: 18450314 DOI: 10.1016/j.diabres.2008.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 03/14/2008] [Indexed: 11/15/2022]
Abstract
We surveyed 220 patients with diabetic retinopathy attending a tertiary eye hospital in Australia, and found that knowledge of HbA(1c), and the proportion achieving target level of <7%, remained low in patients with diabetic retinopathy. These data re-emphasize the gap between clinical guidelines and actual management of patients with diabetes.
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Affiliation(s)
- Shiqi Wang
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Victoria, Australia.
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Misra R, Lager J. Predictors of quality of life among adults with type 2 diabetes mellitus. J Diabetes Complications 2008; 22:217-23. [PMID: 18413226 DOI: 10.1016/j.jdiacomp.2006.09.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 09/13/2006] [Indexed: 11/23/2022]
Abstract
Using a path model, this study examined the relationships among psychosocial factors (social support and acceptance of diabetes), knowledge of the disease, perceived difficulty of self-care behaviors (SCBs), and disease outcome [quality of life (QoL)] among 180 adults with type 2 diabetes mellitus. In general, respondents exhibited high levels of acceptance. The hypothesis that higher levels of social support and acceptance lead to lower perceived difficulty with SCBs was supported. High levels of social support increased acceptance and reduced SCBs. Knowledge reduced SCBs but was not associated with QoL. In the path model, SCBs influenced QoL and mediated the relationship between social support, acceptance, and QoL.
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Affiliation(s)
- Ranjita Misra
- Department of Health and Kinesiology, Texas A&M University, College Station, TX 77843, USA.
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McPherson ML, Smith SW, Powers A, Zuckerman IH. Association between diabetes patients' knowledge about medications and their blood glucose control. Res Social Adm Pharm 2008; 4:37-45. [DOI: 10.1016/j.sapharm.2007.01.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2006] [Revised: 01/13/2007] [Accepted: 01/14/2007] [Indexed: 10/22/2022]
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Jallinoja P, Absetz P, Kuronen R, Nissinen A, Talja M, Uutela A, Patja K. The dilemma of patient responsibility for lifestyle change: perceptions among primary care physicians and nurses. Scand J Prim Health Care 2007; 25:244-9. [PMID: 17934984 PMCID: PMC3379767 DOI: 10.1080/02813430701691778] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To explore physicians' and nurses' views on patient and professional roles in the management of lifestyle-related diseases and their risk factors. DESIGN A questionnaire study with a focus on adult obesity, dyslipidemia, high blood pressure, type 2 diabetes, and smoking. SETTING Healthcare centres in Päijät-Häme hospital district, Finland. SUBJECTS Physicians and nurses working in primary healthcare (n =220). MAIN OUTCOME MEASURES Perceptions of barriers to treatment of lifestyle-related conditions, perceptions of patients' responsibilities in self-care, experiences of awkwardness in intervening in obesity and smoking, perceptions of rushed schedules, and perceptions of health professionals' roles and own competence in lifestyle counselling. RESULTS A majority agreed that a major barrier to the treatment of lifestyle-related conditions is patients' unwillingness to change their habits. Patients' insufficient knowledge was considered as such a barrier less often. Self-care was actively encouraged. Although a majority of both physicians and nurses agreed that providing information, and motivating and supporting patients in lifestyle change are part of their tasks, only slightly more than one half estimated that they have sufficient skills in lifestyle counselling. Among nurses, those with less professional experience more often reported having sufficient skills than those with more experience. Two-thirds of the respondents reported that they had been able to help many patients to change their lifestyles into healthier ones. CONCLUSIONS The primary care professionals experienced a dilemma in patients' role in the treatment of lifestyle-related diseases: the patient was recognized as central in disease management but also, if reluctant to change, a major potential barrier to treatment.
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Abstract
BACKGROUND Diabetes self-management education (DSME) is a key component of effective glycemic control and an important part of clinical diabetes management. The effects of DSME in China have not been investigated. OBJECTIVES To identify factors that could enhance the quality of Chinese DSME programmes. The relationship between patients' diabetes knowledge and their glycemic control was explored. METHODS A non-experimental cross-sectional study was undertaken in a large Shanghai hospital in China. Forty inpatients and 60 outpatients with type 2 diabetes mellitus were recruited. A Chinese version of the Diabetes Knowledge Scale was used to assess subjects' diabetes knowledge and collect demographic data and HbA1c levels. RESULTS The mean diabetes knowledge scores among Chinese with type 2 diabetes was 22.1 +/- 3.76 out of a possible 30 marks. There was no difference in overall diabetes knowledge in people with HbA1c <7%, indicating good control and those with HbA1c >or=7%, indicating suboptimal glycemic control (t = -0.811, P = 0.419). However, there were differences in scores between the two groups for some specific questions on sick day management and food substitution. Moreover, sociodemographic characteristics such as age and occupation were significantly correlated with diabetes knowledge; age was negatively correlated with diabetes knowledge and white-collar workers had the highest mean knowledge score and housewives the lowest. CONCLUSION Sociodemographic characteristics need to be considered when developing diabetes self-management programmes for Chinese people with type 2 diabetes.
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Heidgerken AD, Merlo L, Williams LB, Lewin AB, Gelfand K, Malasanos T, Silverstein JH, Storch EA, Geffken G. Diabetes Awareness and Reasoning Test: A Preliminary Analysis of Development and Psychometrics. CHILDRENS HEALTH CARE 2007. [DOI: 10.1080/02739610701334624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Dyck LR, Caron A, Aron D. Working on the positive emotional attractor through training in health care. JOURNAL OF MANAGEMENT DEVELOPMENT 2006. [DOI: 10.1108/02621710610678481] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Stallwood L. Relationship between caregiver knowledge and socioeconomic factors on glycemic outcomes of young children with diabetes. J SPEC PEDIATR NURS 2006; 11:158-65. [PMID: 16774526 DOI: 10.1111/j.1744-6155.2006.00062.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE To describe the relationship between caregiver diabetes knowledge and socioeconomic factors on glycemic outcomes of young children with type 1 diabetes. DESIGN AND METHODS Seventy-three caregivers of children less than 9 years of age were conveniently sampled and completed the Michigan Diabetes Research and Training Center Diabetes Knowledge Test and a demographic questionnaire. RESULTS Higher caregiver knowledge was associated with lower hemoglobin A1c (HbA1c) levels, higher income levels, and being married. Thirty-three (44%) children had HbA1c levels within the target range. PRACTICE IMPLICATIONS Perform ongoing knowledge assessments and educational interventions related to deficits, with a special focus on families in lower socioeconomic situations.
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Affiliation(s)
- Lynda Stallwood
- University of Colorado at Denver and Health Sciences Center, School of Nursing, Denver, CO, USA.
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Shim WS, Hong SB, Choi YS, Choi YJ, Ahn SH, Min KY, Kim EJ, Park IB, Nam M, Kim YS. Development of Two Parallel Diabetes Knowledge Tests. ACTA ACUST UNITED AC 2006. [DOI: 10.4093/jkda.2006.30.6.476] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Wan Sub Shim
- Department of Internal Medicine, Inha University College of Medicine, Korea
| | - Seong Bin Hong
- Department of Internal Medicine, Inha University College of Medicine, Korea
| | - Yeon Sil Choi
- Department of Internal Medicine, Inha University College of Medicine, Korea
| | - Yun Jin Choi
- Department of Internal Medicine, Inha University College of Medicine, Korea
| | - Sook Hee Ahn
- Department of Internal Medicine, Inha University College of Medicine, Korea
| | - Kee Young Min
- Department of Internal Medicine, Inha University College of Medicine, Korea
| | - Eun Joo Kim
- Department of Internal Medicine, Inha University College of Medicine, Korea
| | - Ie Byung Park
- Gachon University of Medicine and Science, Department of Endocrinology, Korea
| | - Moonsuk Nam
- Department of Internal Medicine Inha University College of Medicine, Korea
- Center for Advanced Medical Education (BK 21 Project), Inha University College of Medicine, Korea
| | - Yong Seong Kim
- Department of Internal Medicine, Inha University College of Medicine, Korea
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Abstract
OBJECTIVE To promote the role of the diabetes educator as an important team member in conjunction with the patient and other clinicians in optimizing diabetes management. METHODS The goal of the diabetes educator in facilitating changes in patient behavior is reviewed, and current trends and strategies for improvement of outcomes by means of diabetes education are outlined. RESULTS The American Association of Diabetes Educators (AADE) is a multidisciplinary group of healthcare professionals dedicated to the professional growth and development of personnel who are responsible for diabetes education. Diabetes management is best addressed by using a team approach in a patient-centered care environment. Diabetes education encompasses more than the dissemination of information; the goal is to facilitate changes in specific behaviors relating to both therapy and lifestyle that support good diabetes management and improved clinical outcomes. Diabetes educators currently frame their intervention on the basis of the AADE 7 Self-Care Behaviors: (1) healthful eating, (2) being active, (3) monitoring, (4) taking medication, (5) problem-solving, (6) healthful coping, and (7) reducing risks. Diabetes education is underutilized; approximately 60% to 70% of patients with diabetes have not received training in diabetes self-management. Diabetes educators are trained to identify and help overcome barriers to optimal diabetes care. CONCLUSION Individual patients and the overall health-care system will benefit when physicians and other health-care providers collaborate with diabetes educators to ensure that patients receive the information, training, and support needed to facilitate effective diabetes self-management.
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Holmstrom IM, Rosenqvist U. Misunderstandings about illness and treatment among patients with type 2 diabetes. J Adv Nurs 2005; 49:146-54. [DOI: 10.1111/j.1365-2648.2004.03274.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Achieving target glycaemic goals while avoiding hypoglycaemia is a major challenge in the management of elderly patients with diabetes mellitus. Repeated episodes of hypoglycaemia may cause extreme emotional distress in such patients, even when the episodes are relatively mild. Moreover, evidence is mounting that hypoglycaemia among elderly patients is a very real and costly health concern. The strongest predictors of severe hypoglycaemia in the elderly are advanced age, recent hospitalisation and polypharmacy. Education is the key to preventing recurrent or severe hypoglycaemia. As such, there should be close coordination of care between the patient, physician and all other healthcare providers in identifying the cause of hypoglycaemia in elderly patients, and appropriate steps should be taken to prevent further episodes. Prevention of hypoglycaemia has the potential to improve psychosocial aspects of elderly health, including enhanced quality of life, boosted confidence, improved compliance with antidiabetic regimens and avoidance of long-term complications. Since the elderly population represents a unique group, it is imperative to focus on the aetiologies that are exclusive to this group. Advanced age itself is a risk factor for hypoglycaemia, and elderly patients with comorbidities are at increased risk when they are hospitalised. Elderly patients with diabetes often have compromised renal function, which intereferes with drug elimination and thus predisposes them to prolonged life-threatening hypoglycaemia. In addition, patients on five or more prescription medications are prone to drug-associated hypoglycaemia. Although sulfonylurea-associated hypoglycaemia is common, drugs such as ACE inhibitors and nonselective beta-adrenoceptor antagonists can also predispose patients to hypoglycaemia. Greater attention should be paid to the avoidance of hypgolycaemia in nursing home residents. Recurrent hypoglycaemia in elderly patients is not only detrimental to achieving good glycaemic control, it is also a substantial economic burden. Once the causes of hypoglycaemia have been identified, it is crucial to formulate and institute a prevention plan. Firstly, global evaluation of the patient should be carried out to identify possible predisposing risk factors. Secondly, target glycaemic goals should be tailored to each patient. Thirdly, selection of antidiabetic agents should be judicious, then patients and family should be educated to recognise and treat hypoglycaemia. Finally, coordinated care should be provided to identify, treat and prevent hypoglycaemia.
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Affiliation(s)
- Aruna Chelliah
- Department of Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131-0001, USA
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