Diabetes self-management education: miles to go.

This meta-analysis assessed how successfully Diabetes Self-Management Education (DSME) interventions help people with type 2 diabetes achieve and maintain healthy blood glucose levels. We included 52 DSME programs with 9,631 participants that reported post-intervention A1c levels in randomized controlled trials. The training conditions resulted in significant reductions in A1c levels compared to control conditions. However, the impact of intervention was modest shifting of only 7.23% more participants from diabetic to pre-diabetic or normal status, relative to the control condition. Most intervention participants did not achieve healthy A1c levels. Further, few DSME studies assessed long-term maintenance of A1c gains. Past trends suggest that gains are difficult to sustain over time. Our results suggested that interventions delivered by nurses were more successful than those delivered by non-nursing personnel. We suggest that DSME programs might do better by going beyond procedural interventions. Most DSME programs relied heavily on rules and procedures to guide decisions about diet, exercise, and weight loss. Future DSME may need to include cognitive self-monitoring, diagnosis, and planning skills to help patients detect anomalies, identify possible causes, generate corrective action, and avoid future barriers to maintaining healthy A1c levels. Finally, comprehensive descriptions of DSME programs would advance future efforts.

Cultural differences in cognition: Rosetta Phase I.

Cultural differences in cognition are important during multinational commercial, military, and humanitarian operations. The Rosetta Project addresses definition and measurement of key cognitive dimensions. Six potential diagnostic measures related to Analytic-Holistic reasoning were assessed: the Exclusion Task, the Attribution Complexity Scale, the Syllogism Task, Categorization, the Framed Line Test, and the Facial Expression Task. 379 participants' ages ranged from 17 to 24 years (M = 19.8, SD = 1.4). 64.6% were women; Eastern Asian groups (Japan, Korea, and Taiwan) were assumed to have Holistic reasoning tendencies, and those from a Western group (USA) were assumed to have Analytic tendencies. Participants were recruited from subject pools in psychology using the procedures of each university. Results on the Exclusion and Categorization Tasks confirmed hypothesized differences in Analytic-Holistic reasoning. The Attribution Complex-ity Scale and the Facial Expression Task identified important differences among the four groups. Outcomes on the final two tasks were confounded by unrelated group differences, making comparisons difficult. Building on this exploratory study, Rosetta Phase II will include additional groups and cognitive tasks. Measures of complex cognition are also incorporated to link findings to the naturalistic contexts.

Portraits of patient cognition: how patients understand diabetes self-care.

Diabetes self-management is a complex dynamic process. Although patients are given guidelines for self-care, many still struggle with glucose control. This study uses techniques from naturalistic decision-making research to examine how patients with low, moderate, and good glycemic control conceptualize self-care. Eighteen people with type 2 diabetes were interviewed about their experiences with diabetes, understanding of the disease, and self-care behaviour. Qualitative methods were used to analyze responses and describe patterns of cognition. The authors describe participants' understanding of major areas of self-care and its relationship to self-management. The majority of participants failed to adequately understand the disease, typically because they were overwhelmed by or misunderstood rule-based instructions. Understanding of the dynamics underlying glucose regulation was found to be critical for effective self-management. Diabetes educators need to teach patients about the dynamics underlying self-management and to emphasize problem-solving and decision-making skills.

Everyday expertise: cognitive demands in diabetes selfmanagement.

OBJECTIVE: To assess the relationship between decision making and successful diabetes self-management. BACKGROUND: Patients with type II diabetes make routine but critical self-management decisions. METHOD: We conducted cognitive task analysis interviews with 18 patients to examine problem detection, functional relationships, problem-solving strategies, and types of knowledge used to make self-management decisions. We expected that these decision processes would be related to behavioral adherence and glycemic control. RESULTS: Verbal reports displaying problem detection skills, knowledge of functional relationships, and effective problem-solving strategies were all related to better adherence. Problem detection skill was linked to greater glycemic control. Participants differed in declarative and applied knowledge. CONCLUSION: Diabetes self-management draws on the same cognitive skills found in experts from diverse professional domains. Considering diabetes self-management as a form of expertise may support adherence. APPLICATION: Human factors approaches that support professional expertise may be useful for the decision making of patients with diabetes and other chronic diseases.