The effectiveness of patient-centered care vs. usual care in type 2 diabetes self-management: A systematic review and meta-analysis

Nursing Care Management and Glycemic Control Among Children With Diabetes Enrolled in Medicaid

PURPOSE

The benefits of maintaining glycemic control for persons with diabetes include delaying the onset and slowing the progression of macro- and microvascular complications. However, many children and adolescents with diabetes do not regularly meet target hemoglobin A1c levels. Our pilot project aimed to improve glycemic control among children and adolescents, 8 to 17 years, with insulin-dependent diabetes at greatest risk for complications and enrolled in North Carolina Medicaid at least 1 month during the study period.

DESIGN AND METHODS

We used a pre-intervention post-intervention design. We implemented an intensive care management intervention, led by a nurse practitioner. The nursing intervention consisted of tele-health visits, emails, and MyChart messages with patients and caregivers to supplement in-clinic visits. Therapeutic communication skills were applied, including motivational interviewing techniques and unconditional positive regard. We measured glycosylated hemoglobin (HbA1c) at 6-month intervals before, during, and after the intervention period.

RESULTS

Mean participant (n = 12) HbA1c levels dropped by 1.5 percentage points from baseline (12.8%) to the 6-month study end point (11.3%). Seventy-five percent of participants experienced some decrease in HbA1c during the study period.

PRACTICE IMPLICATIONS

This pilot project demonstrated short-term success of care management and therapeutic communication interventions in reducing HbA1c levels among a sample of children and adolescents with complicated case histories. Our findings are consistent with other studies that found telephonic nursing support, care management, and motivational interviewing to be effective interventions among pediatric populations. These studies suggest that nurses can implement relatively low-resource interventions that add value to health services delivery for children and adolescents with insulin-dependent diabetes. However, more studies are needed to understand which combinations of interventions may be most effective.

Tirzepatide Was Associated with Improved Health-Related Quality of Life in Adults with Obesity or Overweight and Type 2 Diabetes: Results from the Phase 3 SURMOUNT-2 Trial

INTRODUCTION

In SURMOUNT-2, a phase 3, randomized clinical trial, tirzepatide treatment resulted in clinically meaningful reduction in bodyweight among people with obesity or overweight and T2D. The current analysis evaluated the effects of tirzepatide treatment on self-reported health-related quality of life (HRQoL) outcomes among SURMOUNT-2 participants.

METHODS

SURMOUNT-2 participants were randomly assigned (1:1:1) to receive either tirzepatide 10 mg (n = 312), tirzepatide 15 mg (n = 311), or placebo (n = 315) for 72 weeks as an adjunct to diet and exercise. Self-reported HRQoL was assessed in terms of changes from baseline to week 72 in Short Form-36 Version 2 Health Survey acute form (SF-36v2), Impact of Weight on Quality of Life-Lite-Clinical Trials Version (IWQOL-Lite-CT), EQ-5D 5-level Version (EQ-5D-5L) Health State Index (UK) and associated EQ visual analog scale (VAS), and Patient Global Impression of Status (PGIS) for Physical Activity. Post hoc analyses evaluated changes in HRQoL outcomes by categorical percent weight reduction targets (> 0 to < 5%, ≥ 5%, ≥ 10%, ≥ 15%, ≥ 20%, ≥ 25%, and ≥ 30%) and by self-reported baseline physical function limitations (based on PGIS) among tirzepatide-treated participants.

RESULTS

At week 72, tirzepatide treatment was associated with significantly larger improvements than placebo in the SF-36v2 Physical Component Summary score, SF-36v2 physical functioning, bodily pain, general health, vitality, and social functioning domain scores, all IWQOL-Lite-CT scores, and EQ VAS score. Tirzepatide-treated participants who achieved greater weight reduction targets showed numerically larger improvements in HRQoL scores relative to those with lower percent weight reduction. For all HRQoL measures, participants with physical function limitations at baseline showed greater improvements than those without limitations.

CONCLUSIONS

Tirzepatide treatment was associated with improved self-reported HRQoL outcomes compared with placebo among people with obesity or overweight with T2D. Participants achieving greater bodyweight reductions and those with physical function limitations at baseline showed greater improvements in HRQoL. CLINICAL TRIAL REGISTRATION NUMBER FOR SURMOUNT-2: NCT04657003.

A DiRECT approach to weight loss in a culturally diverse, low-income population: Pilot randomised controlled trial and meta-analysis of similar interventions

AIMS

To consider an intensive lifestyle intervention for weight loss in type 2 diabetes or prediabetes when delivered within a primary care service catering to indigenous (Māori), Pacific, refugee, and low-income clientele.

MATERIALS AND METHODS

Adults with obesity, type 2 diabetes or prediabetes, and a desire to lose weight were randomised to dietitian-supported usual care or the Diabetes Remission Clinical Trial (DiRECT)-type intervention (3 months of total diet replacement followed by 9 months of food reintroduction and supported weight loss maintenance). Both interventions included equal dietetic support delivered within primary care. Primary outcome was weight loss at 3 and 12 months. We performed random-effects meta-analysis of body weight of existing DiRECT-type interventions.

RESULTS

Forty participants were randomised to the dietitian-led DiRECT-type intervention or dietitian-supported usual care. At 3 months, weight loss among DiRECT-type intervention participants was -6.1 kg (95% CI -10.2, -2.0) greater than with dietetic support. At 12 months, this difference decreased to -3.8 kg (-7.6, -0.1) due to gradual weight loss with dietitian-supported usual care, not weight regain in DiRECT. Meta-analyses indicated -8.5 kg (-11.1, -5.9) and -6.0 kg (-8.4, -3.5) greater weight loss for DiRECT-type interventions than usual diabetes care (with or without dietary advice) at 3 and 12 months.

CONCLUSIONS

In this pilot effectiveness trial, the DiRECT-type intervention generated clinically relevant and greater weight loss than dietitian-supported usual care at 3 and 12 months. These results align with the effect sizes generated by meta-analyses of existing DiRECT-type interventions, demonstrating the potential use of DiRECT-type approaches across a much broader spectrum of the population than previously considered including those with both type 2 and prediabetes. ACTRN12622000151730.

Artificial Intelligence as a Tool for Self-Care in Patients with Type 1 and Type 2 Diabetes-An Integrative Literature Review

Background/Objectives: Diabetes is a common public health disease that affects patients mentally, physically, and economically. It requires lifestyle changes such as blood sugar control and regular contact with healthcare services. Artificial intelligence has developed rapidly in many different areas in recent years, including healthcare and nursing. The aim of this study is to explore how artificial intelligence can be used as a tool for patients with diabetes mellitus. Methods: An integrative literature review design was chosen according to Whittemore and Knafl (2005). Electronic searches in databases were conducted across Pub-Med, CINAHL Complete (EBSCO), and ACM Digital Library until September 2024. A total set of quantitative and qualitative articles (n = 15) was selected and reviewed using a Mixed Method Appraisal Tool. Results: Artificial intelligence is an effective tool for patients with diabetes mellitus, and various models are used. Three themes emerged: artificial intelligence as a tool for blood sugar monitoring for patients with diabetes mellitus, artificial intelligence as a decision support for diabetic wounds and complications, and patients' requests for artificial intelligence capabilities in relation to tools. Artificial intelligence can create better conditions for patient self-care. Conclusions: Artificial intelligence is a valuable tool for patients with diabetes mellitus and enables the district nurse to focus more on person-centered care. The technology facilitates the patient's blood sugar monitoring. However, more research is needed to ensure the safety of AI technology, the protection of patient privacy, and clarification of laws and regulations within diabetes care.

Factors influencing mobile health utilisation among patients with diabetes in Sichuan, China: a cross-sectional study based on Andersen's behavioural model

BACKGROUND

The development of mobile health (mHealth) in China has tremendous potential, especially for diabetes, which is one of the major chronic diseases affecting hundreds of millions of people. However, research on the current use of mHealth by patients with diabetes and the factors influencing their decision-making is insufficient. Most existing studies have approached the subject from a technological perspective and often overlooked the identity of patients as users of mHealth services. Based on the Andersen behavioural model, this study aimed to investigate the factors affecting patients' adoption of mHealth, with a special emphasis on individual patient characteristics, and provided recommendations for the promotion of mHealth and the management of diabetes.

METHOD

This was a cross-sectional study. A convenience sample survey was conducted in one tertiary hospital and two community health service centres, and an anonymous self-administered questionnaire survey was conducted among patients with diabetes. Based on Andersen's behavioural model, the questionnaire divided the influencing factors into predisposing factors, enabling factors and need factors. Multivariate logistic regression analysis was used to explore the factors influencing the utilisation of mHealth.

RESULTS

A total of 533 questionnaires were valid. In this study, 36.8% of patients with diabetes used mHealth services. Among the predisposing factors, having better education and mHealth knowledge were found to be facilitators of mHealth utilisation, and employment status was a factor associated with mHealth utilisation. Among the enabling factors, patients with internet access and living in urban areas were more likely to have access to mHealth, and higher health literacy positively influenced mHealth utilisation. Among the need factors, self-assessed health status was linked to mHealth utilisation, and diabetes duration had a negative impact on mobile health utilisation.

CONCLUSIONS

The rate of mobile health utilisation remained low. In the future, improvements can be made in multiple aspects, such as policy, promotion, infrastructure and health education, to advance the development of mobile health and the management and control of diabetes.

Artificial intelligence tools in supporting healthcare professionals for tailored patient care

Artificial intelligence (AI) tools to support clinicians in providing patient-centered care can contribute to patient empowerment and care efficiency. We aimed to draft potential AI tools for tailored patient support corresponding to patients' needs and assess clinicians' perceptions about the usefulness of those AI tools. To define patients' issues, we analyzed 528,199 patient messages of 11,123 patients with diabetes by harnessing natural language processing and AI. Applying multiple prompt-engineering techniques, we drafted a series of AI tools, and five endocrinologists evaluated them for perceived usefulness and risk. Patient education and administrative support for timely and streamlined interaction were perceived as highly useful, yet deeper integration of AI tools into patient data was perceived as risky. This study proposes assorted AI applications as clinical assistance tailored to patients' needs substantiated by clinicians' evaluations. Findings could offer essential ramifications for developing potential AI tools for precision patient care for diabetes and beyond.

Multidisciplinary lifestyle treatment for type 2 diabetes in 12 European countries: protocol for a quasi-experimental study

BACKGROUND

The incidence and prevalence of type 2 diabetes (T2DM) are expected to continue rising. T2DM causes life-threatening, disabling and costly complications, and significantly reduces quality of life and life expectancy. The burden of T2DM can be reduced using comprehensive lifestyle modifications. The aim of this study is to evaluate the applicability and cost-effectiveness of a multicomponent, multidisciplinary lifestyle program in 22 European regions and to generate guidelines for transfer to European health care systems.

METHODS

A quasi-experimental study (without a control group) will be conducted to evaluate the CARE4DIABETES program, which is based on the Reverse Diabetes 2Now best practice. The program will involve more than 120 healthcare professionals and 860 people with T2DM from 12 European countries - Belgium, Bulgaria, Finland, Hungary, Italy, Greece, Malta, Poland, Portugal, Slovakia, Slovenia and Spain. Patients will be enrolled based on clinical criteria and motivation for change. The program will have two phases, an intensive phase (6 months) with face-to-face and online training to achieve behavioral change, and an online aftercare phase (6 months) to consolidate changes. The program will be evaluated for impact, sustainability and cost-effectiveness using a combination of validated questionnaires at baseline, six months and one year after the start of the intervention.

CLINICAL TRIAL NUMBER

Trial registration number: ISRCTN62063346.

Personalized Chronic Care for Diabetes Management in Pakistan: A Report of Two Cases

This case report evaluates the efficacy of a personalized, multidisciplinary chronic care management (CCM) program aimed at improving health outcomes for individuals with polychronic conditions within Pakistan's under-resourced healthcare system. Implemented in November 2023, the intervention was designed to help two office employees newly diagnosed with type 2 diabetes and associated comorbidities, such as hypertension and obesity. Over six months, the participants engaged in a structured program that included teleconsultations, personalized care plans, and biweekly follow-ups through a social media application. The 'care team,' comprising doctors, nutritionists, wellness coaches, and care attendants, facilitated these interactions. Specific outcomes included a reduction in hemoglobin A1c (HbA1c) from 15% to 5.4% with a 26.3 kg weight loss for Participant 1 and a 3 kg weight loss with a decrease in HbA1c from 6.5% to 6.1% for Participant 2. This report highlights the potential of comprehensive, integrated, and patient-centered diabetes management to enhance glycemic control and weight management in settings burdened by high disease prevalence and limited healthcare resources.

A qualitative exploration of illness-related experiences, emotions, and coping among adults with postural orthostatic tachycardia syndrome (POTS)

Postural orthostatic tachycardia syndrome (POTS) is a relatively common, burdensome condition of the autonomic nervous system characterized by orthostatic intolerance. This paper presents a subset of findings from a qualitative study investigating the lived experience and perspectives of adults with POTS. Twenty-nine individuals participated in a series of focus groups. We present a conceptual model which summarizes themes related to illness-related experiences, emotional reactions, and coping strategies, and distinguishes how these vary from pre- to post-diagnosis. Our findings emphasize the myriad challenges of living with a condition with diffuse and wide-ranging symptoms, significant quality of life impacts, and limited treatment options, as well as the role of active coping strategies in facing these challenges and their emotional impacts. Additionally, we summarize themes of patient-derived suggestions for improvement in care, which highlight the importance of compassionate, patient-centered care and mental health care to support adaptive coping.

Structural validity of the Brazilian version of the quality care questionnaire-palliative care for use in individuals with diabetes mellitus eligible for palliative care

BACKGROUND

The Brazilian version of the Quality Care Questionnaire-Palliative Care (QCQ-PC) is an instrument designed to assess the quality of care provided in palliative care from the user's perspective, featuring easy comprehension and applicability. It has demonstrated validity for use in individuals with cancer, but there is a need for validation in other populations due to the scarcity of instruments with this purpose.

OBJECTIVE

To structurally validate the Brazilian version of the QCQ-PC for use in individuals with diabetes mellitus (DM) eligible for palliative care.

METHODS

This is a structural validation study of a questionnaire according to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). The study was conducted with 100 individuals with DM. Data collection occurred in differents care services in São Luís (northeast Brazil) by means of the application of the QCQ-PC and a form with sociodemographic, clinical, and daily habit data. Descriptive data analysis was performed using absolute values, relative frequencies, and measures of central tendency and dispersion. Structural validity was assessed by means of exploratory factor analysis (EFA).

RESULTS

Of the 100 participants included in the study, 66% were female, 54% were single, with a median age of 64 years, 44% were overweight (44%), 77% were on polypharmacy, and 70% were physically inactive. We found that one domain is the most appropriate for use of the QCQ-PC in individuals with DM eligible for palliative care, according to the parallel analysis implemented in the EFA. This domain was named "quality of care". The fit indices for this one-dimensional internal structure were adequate: Kaiser-Meyer-Olkin test = 0.71, p value < 0.01 in Bartlett's test, chi-square/degree of freedom = 1.07, comparative fit index = 0.993, Tucker-Lewis index. = 0.991, root mean square error of approximation = 0.028. The QCQ-PC presented factor loadings ranging from 0.480 to 0.883, maintaining a total of 12 items, which demonstrates the adequate relationship between the quality of care domain and its items.

CONCLUSION

Therefore, the internal structure with one domain (quality of care) is the most suitable for use in individuals with DM eligible for palliative care by means of the QCQ-PC.

Educational needs and preferences of adult patients with acute pain: a mixed-methods systematic review

ABSTRACT

Many patients experience acute pain, which has been associated with numerous negative consequences. Pain education has been proposed as a strategy to improve acute pain management. However, studies report limited effects with educational interventions for acute pain in adults, which can be explained by the underuse of the person-centered approach. Thus, we aimed to systematically review and synthetize current evidence from quantitative, qualitative and mixed-methods studies describing patients' needs and preferences for acute pain education in adults. We searched original studies and gray literature in 7 databases, from January 1990 to October 2023. Methodological quality was assessed with the Mixed Methods Appraisal Tool. A total of 32 studies were included (n = 1847 patients), two-thirds of which were qualitative studies of high methodological quality. Most of the studies were conducted over the last 15 years in patients with postsurgical and posttraumatic pain, identified as White, with a low level of education. Patients expressed the greatest need for education when it came to what to expect in pain intensity and duration, as well how to take the medication and its associated adverse effects. The most frequently reported educational preferences were for in-person education while involving caregivers and to obtain information first from physicians, then by other professionals. This review has highlighted the needs and preferences to be considered in pain education interventions, which should be embedded in an approach cultivating communication and partnership with patients and their caregivers. The results still need to be confirmed with different patient populations.

Navigating the food environment: Experiences of reduced calorie interventions to manage Type 2 Diabetes Mellitus

Research into achieving Type 2 Diabetes Mellitus remission through weight loss efforts has grown steadily in the past decade. Most of this research has focused on the effectiveness of weight loss as a method to achieve remission, rather than considering individuals experiences of engaging with such change. This paper aims to review the qualitative research on individuals' experience of proposed dietary modifications with a weight loss focus. Six databases were searched for qualitative and mixed-methods research studies, and studies were subject to analysis following Thomas and Hardin's guidelines. The search yielded 2945 results, of which 47 were reviewed in full, and nine were included for analysis. Four analytical themes were identified; variability in support; choosing dietary change; re-negotiating the food relationship; and looking beyond weight loss. Providing tailored nutritional information that is comprehensible and culturally appropriate must be the premise of the interventions offered. Supporting patients to understand their relationship with food and identify meaningful goals beyond weight loss is an important starting point.

The Ambulatory Diabetes Outreach Program (ADOP): Rigorous Evaluation of a Pharmacist and Nurse-Led Care Model

BACKGROUND

Although several systematic reviews found that ambulatory diabetes mellitus (DM) interventions involving pharmacists generally yielded better outcomes than the ones that did not, existing studies have limitations in rigor and study design.

OBJECTIVE

To examine the intention-to-treat effects of the Ambulatory Diabetes Outreach Program (ADOP) on participants' A1c values and healthcare utilization over a 52-month follow-up period.

DESIGN

Difference-in-differences with staggered adoption. Specifically, we employed the Callaway and Sant'Anna's "group-time average treatment effect" estimator using not-yet treated as controls adjusting for patient's age, BMI, sex, race, comorbidity, payor, and socio-economic status.

PARTICIPANTS

All patients with at least one ADOP treatment encounter from July 2017 to October 2021, regardless of program completion or length of exposure to the program.

INTERVENTION

ADOP, a collaborative population health program led by pharmacists and nurse specialists to provide individualized type 2 DM management and education within a large and diverse health system.

MAIN MEASURES

Patients' A1c values and healthcare utilization, including inpatient admission, inpatient days, and numbers of visits to the emergency department, urgent care, and primary care in recent 6 months.

KEY RESULTS

ADOP participation was associated with an overall average reduction of 1.04 percentage points (95%CI - 1.12, - 0.95) in A1c level. Similar A1c reductions were also observed in the subgroups by sex and race/ethnicity. An average of 2 months were required to reach the overall average effect, which persisted over 4 years. Compared to the respective utilization levels pre-intervention, participants also had average reductions in inpatient admissions by 32.4%, inpatient days by 81.6%, visits to the emergency department by 21.6%, and primary care by 17.9%.

CONCLUSIONS

The results suggest that a collaborative model of pharmacist and nurse-led type 2 DM intervention was effective in improving A1c outcomes and reducing healthcare utilization in the long term.

Therapeutic patient education and treatment intensification of diabetes and hypertension in subjects with newly diagnosed type 2 diabetes mellitus: a longitudinal study

PURPOSE

The aim of this study is to prospectively evaluate whether individual and group Therapeutic Patient Education (TPE) can reduce the need to intensify treatment of diabetes and hypertension in newly diagnosed type 2 diabetic patients.

METHODS

A total of 937 patients were recruited and followed-up for 42.7 ± 21.5 months. TPE was a structured comprehensive education delivered by trained nurses: 322 patients received individual TPE (ITPE), 291 underwent group TPE (GTPE), and 324 were in Usual Care (UC). The primary endpoints were intensification of diabetes treatment and intensification of hypertension treatment.

RESULTS

The rate of diabetes treatment intensification was 40.1% in patients receiving ITPE, 47.8% in patients undergoing GTPE, and 64.2% in patients in UC (p < 0.001). The rate of hypertension treatment intensification was 24.2% in patients following ITPE, 31.3% in patients receiving GTPE, and 41.0% in patients in UC (p < 0.001). Multivariate analysis showed that both ITPE and GTPE were associated with reduced intensification of diabetes (ITPE: HR:0.51; 95% IC:0.40-0.64; p < 0.001 - GTPE: HR:0.46; 95% IC:0.44-0.70; p < 0.001) and hypertension medication (ITPE: HR:0.45; 95% IC:0.34-0.61; p < 0.001 - GTPE: HR:0.49; 95% IC:0.38-0.65; p < 0.001). The association was independent of age, sex, BMI, HbA1c, and presence of hypertension at baseline.

CONCLUSIONS

TPE, delivered as both individual and group sessions, represents an effective tool to reduce the need to intensify treatment of both diabetes and hypertension. Therefore, it can ensure better control of diabetes and hypertension with fewer medications. This could reduce adverse effects and costs and improve quality of life and medication taking in patients with type 2 diabetes.

Evaluating the Preferences and Willingness-to-Pay for Oral Antidiabetic Drugs Among Patients with Type 2 Diabetes Mellitus in China: A Discrete Choice Experiment

PURPOSE

To quantify the preferences for an oral antidiabetic drug (OAD) among patients with type 2 diabetes mellitus (T2DM) in China.

METHODS

A discrete choice experiment (DCE) with hypothetical OAD profiles was performed among patients with T2DM recruited from both online and offline sources. Each patient completed 12 DCE choice tasks. The attributes, elicited through mixed methods, include blood glucose level decrease, blood glucose level stability, frequency of medication, gastrointestinal side effects, dose adjustment and out-of-pocket expense. The conditional logit regression model was used to analyze the data. Patients' willingness-to-pay (WTP) was also calculated. Subgroup analyses based on patient characteristics were also conducted.

RESULTS

A total of 741 respondents were included in the analysis sample, covering 456 respondents online and 285 offline. The result showed that all attributes and levels were statistically significant, except one level "dose adjustment required for patients with hepatic or renal insufficiency" in the attribute of dose adjustment. WTP results showed that patients were willing to pay 12.06 and 23.20 yuan, respectively to reduce the frequency of medication from "once per day" and "three times per day" to "once every 2 weeks", respectively. Subgroup analyses showed that the frequency of medication (once versus two to three times per day) had the largest impact and influenced most coefficient estimates.

CONCLUSION

The results suggest that Chinese patients with T2DM prioritized better efficacy, less frequency of medication, lower gastrointestinal side effects, no dose adjustment required for patients with hepatic or renal insufficiency, and less out-of-pocket expense of OAD treatment.

Approved and Commercialized Antidiabetic Medicines (Excluding Insulin) in Seven European Countries-A Cross-Sectional Comparison

Diabetes mellitus is a complex, multifactorial, progressive condition with a variety of approved therapeutic options. The purpose of this study was to offer an overview of the authorized antidiabetic medicines (excluding insulin) compared with marketed products in seven European countries. Data were obtained from primary sources, including the websites of national authorities and directly from specialists in the countries of interest. The range of marketed medicines compared with the authorized group was assessed in terms of active pharmaceutical ingredients (>60% in Bulgaria, France, Serbia), brand names (>70% in Bulgaria, the Czech Republic, Romania, Serbia, Spain), pharmaceutical forms (>60% in all countries), strengths (>60% in Bulgaria, the Czech Republic, Romania, Serbia, Spain), marketing authorization holder (≥50% in all countries) and the status of medicine. Spain was found to have the highest number of products based on most of these attributes. Over 90% of authorized medicines had a pharmacy price in Serbia. Regarding the newer class of GLP-1 receptor agonists, a retail price for all approved substances was available in Bulgaria, Romania, Serbia, and Spain. Only one brand name with one concentration was found available for some agents, being susceptible to drug shortages: glibenclamide (Romania, Serbia, Spain), glipizide (the Czech Republic, Poland, Romania, Spain), glisentide (Spain), acarbose (the Czech Republic), sitagliptin (Bulgaria, Poland), vildagliptin (the Czech Republic, Poland) and saxagliptin (the Czech Republic, France, Romania, Serbia). An overview of the national and international therapeutic options may allow competent authorities and health professionals to take rapid measures in case of supply problems or health crises.

Reflections on 'common' genetic medical history questions: Time to examine the what, why, and how

OBJECTIVE

A central goal of patient-centered care is to establish a therapeutic relationship. While remaining in tune with patient emotions, genetics providers must ask questions to understand medical histories that will inform the differential diagnosis, evaluation plan, and potential treatments.

METHODS

195 audio-recorded conversations between providers and caregivers of pediatric patients with suspected genetic conditions were coded and analyzed. Coders identified sensitive history-taking questions asked by providers related to exposures and complications during pregnancy; ancestry and consanguinity; educational attainment of the caregiver; and family structure.

RESULTS

We highlight examples of providers: using stigmatizing language about conception or consanguinity; not clarifying the intent behind questions related to caregivers' educational attainment and work history; and making presumptions or assumptions about caregivers' race and ethnicity, family structure, and exposures during pregnancy.

CONCLUSION

Some questions and phrasing considered routine by genetics providers may interfere with patient-centered care by straining attempts to establish a therapeutic, trusting relationship. Additional research is needed to assess how question asking and phrasing impact rapport building and patient experience during genetics encounters.

PRACTICE IMPLICATIONS

Review of the purpose and need for medical history questions common to genetics practice could serve to improve patient-centered care.

Automated Personalized Self-care Program for Patients With Type 2 Diabetes Mellitus: A Pilot Trial

PURPOSE

Providing continuous self-care support to the growing diabetes population is challenging. Strategies are needed to enhance engagement in self-care, utilizing innovative technologies for personalized feedback. This study aimed to assess the feasibility of the Automated Personalized Self-Care program among type 2 diabetes patients and evaluate its preliminary effectiveness.

METHODS

A parallel randomized pilot trial with qualitative interviews occurred from May 3, 2022, to September 27, 2022. Participants aged 40-69 years with type 2 diabetes and HbA1c ≥ 7.0% were recruited. The three-month program involved automated personalized goal setting, education, monitoring, and feedback. Feasibility was measured by participants' engagement and intervention usability. Preliminary effectiveness was examined through self-care self-efficacy, self-care behaviors, and health outcomes. Qualitative interviews were conducted with the intervention group.

RESULTS

A total of 404 patients were screened. Out of the 61 eligible patients, 32 were enrolled, resulting in a recruitment rate of 52.5%. Retention rates at three months were 84.2% and 84.6% in the intervention and control groups, respectively. Among the intervention group, 81.3% satisfied adherence criteria. Mobile application's usability scored 66.25, and participants' satisfaction was 8.06. Intention-to-treat analysis showed improvements in self-measured blood glucose testing, grain intake, and HbA1c in the intervention group. Qualitative content analysis identified nine themes.

CONCLUSION

Feasibility of the program was verified. A larger randomized controlled trial is needed to determine its effectiveness in self-care self-efficacy, self-care behaviors, and health outcomes among type 2 diabetes patients. This study offers insights for optimizing future trials assessing clinical effectiveness.

TRIAL REGISTRATION

Clinical Research Information Service, KCT0008202 (registration date: 17 February 2023).

Health Literacy, Self-Efficacy and Glycemic Control in Patients With Diabetes Type 2 in a Greek Population

Aim  To investigate the relationship between health literacy (HL), self-efficacy (SE), and achievement of treatment goals in patients with type 2 diabetes mellitus (T2DM). Method The cross-sectional study was conducted with a random sample of patients with T2DM attending the diabetology clinic and the Home Care department of the General Hospital of Drama, Greece. They completed two questionnaires: the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) to measure HL and the Diabetes Management Self-Efficacy Scale (DMSES) for people with T2DM to measure SE. Medical history, demographic characteristics, and values related to glycemic control were also recorded. Linear regression analysis was used to search for the dependence of glycosylated hemoglobin (A1C) values with HL and SE and the dependence between them. Result About 120 patients with T2DM (response rate of 92.3%) were enrolled in the study. The mean age of the participants was 62.5 years [standard deviation (SD) = 10.6 years] and most of them were female (53.3%). A1C was found to be significantly negatively associated with diet, physical activity, and SE score. Also, a statistically significant positive correlation was found between HL and SE. HL was correlated with age, gender, education level, and A1C, with women and older people having lower HL, while conversely higher education level was significantly associated with higher HL. Higher A1C was significantly associated with lower HL. Also, SE partially mediates the relationship between HL and A1C, in a significant way. Conclusion The results of the study confirm the important role of HL and SE in the successful management of T2DM. Multi-level educational interventions for diabetic patients could improve HL and SE and promote diabetes self-management.

The effect of self-management intervention among type 2 diabetes: A systematic review and meta-analysis

BACKGROUND

Using self-management interventions in type 2 diabetes care helps to regulate blood sugar levels, reduce caregiver burden, improve health outcomes, and improve expense management. Despite these benefits, the efficacy of self-management interventions for type 2 diabetes care remains uncertain, with studies showing inconclusive results that are open to interpretation.

AIMS

The aim of this systematic review and meta-analysis was to examine the available data to determine the effectiveness of self-management strategies for individuals with type 2 diabetes.

METHODS

The search method was restricted to the Cumulative Index to Nursing and Allied Health Literature, PubMed, ProQuest, Science Direct, and Scopus from January 2012 to December 2022. SPSS version 28 was used for the meta-analysis.

RESULTS

Seven studies fulfilled the eligibility criteria, with 697 individuals with type 2 diabetes included. Six papers were designed as randomized control trials and one as a quasi-experimental study. Meta-analysis showed a significant difference between the self-management and control groups, with a standardized mean difference (Cohen's d) of -0.40, (95% confidence interval [-0.60 to -0.20]), p = .00.

LINKING EVIDENCE TO ACTION

This meta-analysis showed that self-management interventions in type 2 diabetes patients successfully reduced HbA1c. Self-management improves type 2 diabetes treatment by helping people stay healthy and adapt to their illnesses.

Consensus on potential interventions for improving glycaemic control among patients with type 2 diabetes in Kinshasa, Democratic Republic of the Congo: a Delphi study

BACKGROUND

Poor glycaemic control is a multifactorial and complex problem with dire clinical and economic implications. In the Democratic Republic of the Congo, recent studies have shown alarming poor control rates. There is no policy framework to guide corrective actions.

OBJECTIVES

To build a consensus on interventions to improve glycaemic control among patients with type 2 diabetes in Kinshasa, Democratic Republic of the Congo.

METHODS

This was a two-round electronic Delphi study involving 31 local and 5 international experts. The experts rated proposed interventions from previous studies on glycaemic control in sub-Saharan Africa and Kinshasa on a 4-Likert scale questionnaire. Additionally, the experts were asked to suggest other recommendations useful for the purpose. The mode, mean and standard deviation of each statement were calculated for each round.

RESULTS

Participants reached consensus in five domains that included 39 statements on how to improve glycaemic control in Kinshasa: strengthening the health system, enhancing the awareness of diabetes, alleviating the financial burden of diabetes, enhancing the adoption of lifestyle modifications, and reducing the proportion of undiagnosed diabetes.

CONCLUSIONS

Improved glycaemic control needs to be considered within the broader framework of managing noncommunicable diseases in a more integrated, coordinated and better financed healthcare system. Further studies are needed to operationalise the interventions identified for successful implementation.

Exploring views and experiences of the general public's adoption of digital technologies for healthy lifestyle in Singapore: a qualitative study

Objective

Little is known about the general adult population's adoption of digital technology to support healthy lifestyle, especially when they are expected to take greater personal responsibility for managing their health and well-being today. The current qualitative study intended to gain an in-depth understanding of determinants of digital technology adoption for healthy lifestyle among community-dwelling adults in Singapore.

Design

A qualitative study design, with thematic framework analysis was applied to develop themes from the data.

Setting

Semi-structured individual interviews were conducted with participants either face-to-face or online through a videoconferencing platform.

Participants

14 women and 16 men from the general population who were between the ages of 22 and 71 years.

Results

Three major themes were developed: (1) digitally disempowered (2) safety and perceived risks and harm; (3) cultural values and drives. Adoption of technology among the general population is needs-driven, and contingent on individual, technological and other cross-cultural contextual factors.

Conclusion

Our findings highlight there is no one solution which fits all individuals, emphasizing the challenges of catering to diverse groups to reduce barriers to adoption of digital technologies for healthy lifestyle. Digital guidance and training, as well as social influences, can motivate technological adoption in the population. However, technical problems as well as data security and privacy concerns should first be adequately addressed. This study provides rich cross-cultural insights and informs policy-making due to its alignment with government public health initiatives to promote healthy lifestyle.

Assessment of Labor Practices in Healthcare Using an Innovatory Framework for Sustainability

Background and Objectives: The concept of sustainability in healthcare is poorly researched. There is a perceived need for new theoretical and empirical studies, as well as for new instruments to assess the implementation of new labor practices in the field. Such practices address unmet social needs and consolidate the sustainable development systems which promote health equity. The objective of the research is to design an innovative reference framework for sustainable development and health equity of healthcare facilities, and to provide a practical validation of this framework. Materials and Methods: The research methods consist of designing the elements of the new frame of reference, designing an indicator matrix, elaborating indicator content, and assessing the reference framework. For the assessment stage, we used sustainable medical practices reported in the scientific literature as well as a pilot reference framework that was implemented in healthcare practice. Results: The new reference framework suggested by the present study is composed of 57 indicators organized in five areas: environmental responsibility, economic performance, social responsibility, institutional capacity, and provision of sustainable healthcare services. These indicators were adapted and integrated into the seven basic topics of the social responsibility standard. The study presents the content of the indicators in the field of labor practices, as well as their evaluation grids. The innovative format of the evaluation grids aims to describe achievement degrees, both qualitatively and quantitatively. The theoretical model was validated in practice through its implementation at the Emergency Hospital in Targu Mures. Conclusions: The conclusions of the study reflect the usefulness of the new reference framework, which is compatible with the requirements in the healthcare field, but differs from other existing frameworks, considering its objective regarding the promotion of sustainable development. This objective facilitates the continuous quantification of the sustainability level, the promotion of sustainable development strategies, and sustainability-oriented approaches on the part of interested parties.

A Patient-Centered Self-Management Intervention to Improve Glycemic Control, Self-Efficacy and Self-Care Behaviors in Adults with Type 2 Diabetes Mellitus: A SPIRIT Compliant Study Protocol for Randomized Controlled Trial

Background

The rising burden of type 2 diabetes mellitus (DM) and its associated complications is affecting the functional capacity of the individuals, their quality of life and demand for healthcare services with significant economic impact on health care systems and the national economies. Given the enormous health and economic impact, preventing type 2 DM progression and reducing the risk of complications require immediate attention. Evidence from western countries suggests that self-management can slow the progression of type 2 DM and minimize the risk of major complications lowering health-care costs. Effective self-management, however, demands patients' confidence and their full commitment to perform self-care tasks necessitating a patient-centered approach. This study aims to test the efficacy of a patient-centered self-management intervention to improve glycemic control, self-efficacy and self-care behaviors in adults with type 2 DM.

Patients and Methods

The study will be carried out as a parallel arm, randomized, controlled trial in four public tertiary care hospitals in Faisalabad, Pakistan. A total of 612 patients with type 2 DM will be recruited and randomly assigned to two groups: a control and an intervention group. The intervention group will receive a patient-centered self-management intervention for eight weeks duration. Subjects will be followed up for three months. The primary outcome will be glycemic control (HbA1c), and secondary outcome variables will include self-efficacy and self-care behaviors all measured at three points in time (baseline, at the end of intervention and at three months follow-up).

Discussion

This randomized controlled trial will provide critical information about the efficacy of patient-centered self-management intervention in improving HbA1c, self-efficacy and self-care behaviors. If successful, this evidence-based care intervention may be provided to all DM patients by updating hospital policies.

Trial Registration

NIH: US National Library of Medicine clinicaltrials.gov Identifier: NCT05491252, Shifa Tameer e Millat University Protocol Record: 335-21. Registration date: August 08, 2022. Recruitment began: April 21, 2022. Recruitment completed: July 27, 2022. URL http://www.clinicaltrials.gov.