Care Partner Support Following a Diabetes Self-Management Education and Support Intervention.

PURPOSE: The purpose of the study was to understand care partner (CP) perceptions of an interdisciplinary diabetes self-management education and support (DSMES) intervention and explore how the interdisciplinary DSMES intervention influences diabetes-specific day-to-day interactions from the CP's perspective. METHODS: A multiple-methods research design comprised of an online survey including demographics and supportive behaviors and a semistructured interview was conducted. The survey was completed by 16 CPs. Of the 16 CPs, 11 participated in semistructured interviews. Survey data were analyzed using descriptive statistics. Thematic analysis of semistructured interviews was conducted. RESULTS: CPs provided support in 3 primary areas: (1) meal planning and preparation (87.5%), (2) participating in physical activity (56.3%), and (3) assisting with technology (43.8%). The main themes described by CPs include (1) the importance of diabetes education for caregivers, including the information they retained from the program, the acquisition of tools to support the person with diabetes, and the desire for more and ongoing education; (2) diabetes education enhances the CP's ability to provide social support and the challenges associated with support; and (3) partners described collaborative diabetes management such as finding middle ground and making changes together. CONCLUSION: CPs play a significant role in patient diabetes self-management by providing social support and partnership. DSMES programs should seek to include CPs to enhance patient support.

A New Taxonomy for Technology-Enabled Diabetes Self-Management Interventions: Results of an Umbrella Review.

BACKGROUND: A 2017 umbrella review defined the technology-enabled self-management (TES) feedback loop associated with a significant reduction in A1C. The purpose of this 2021 review was to develop a taxonomy of intervention attributes in technology-enabled interventions; review recent, high-quality systematic reviews and meta-analyses to determine if the TES framework was described and if elements contribute to improved diabetes outcomes; and to identify gaps in the literature. METHODS: We identified key technology attributes needed to describe the active ingredients of TES interventions. We searched multiple databases for English language reviews published between April 2017 and April 2020, focused on PwD (population) receiving diabetes care and education (intervention) using technology-enabled self-management (comparator) in a randomized controlled trial, that impact glycemic, behavioral/psychosocial, and other diabetes self-management outcomes. AMSTAR-2 guidelines were used to assess 50 studies for methodological quality including risk of bias. RESULTS: The TES Taxonomy was developed to standardize the description of technology-enabled interventions; and ensure research uses the taxonomy for replication and evaluation. Of the 26 included reviews, most evaluated smartphones, mobile applications, texting, internet, and telehealth. Twenty-one meta-analyses with the TES feedback loop significantly lowered A1C. CONCLUSIONS: Technology-enabled diabetes self-management interventions continue to be associated with improved clinical outcomes. The ongoing rapid adoption and engagement of technology makes it important to focus on uniform measures for behavioral/psychosocial outcomes to highlight healthy coping. Using the TES Taxonomy as a standard approach to describe technology-enabled interventions will support understanding of the impact technology has on diabetes outcomes.

State of the science: A scoping review and gap analysis of adolescent insulin pump self-management.

PURPOSE: Adolescent diabetes outcomes remain poor despite increased use of diabetes technologies such as insulin pump therapy. Meaningful research examining adolescent insulin pump self-management has been done, however, a summary of these self-management findings has not been published. The aim of this literature review is to map, evaluate, and summarize existing adolescent insulin pump self-management research. METHOD: A scoping review of three databases was conducted to comprehensively report and synthesize relevant literature published before September 2019. RESULTS: Of the 1295 titles identified, 18 articles met the inclusion criteria and were included in this scoping review. Key insulin pump self-management behaviors were featured in the literature, most notably self-monitoring of blood glucose (SMBG) and bolus frequency. Several factors were found to influence pump self-management including psychological factors, parental support and self-management transition, insulin pump education and knowledge acquisition, and environmental factors. We uncovered five gaps in the literature including: an unclear delineation of adolescent age; limited minority representation; variability in the definitions and reporting of self-management behaviors; the role of data sharing and remote monitoring was not addressed; and there remains limited inquiry into diabetes burden and distress associated with insulin pump self-management. PRACTICE IMPLICATIONS: There exists a consensus that well-established behaviors, such as bolus and SMBG frequency, influence glycemic outcomes for adolescent insulin pump users, however, full insulin pump utilization and self-management is poorly understood. Diabetes clinicians should work to support adolescent insulin pump self-management practices by reinforcing bedrock behaviors while fostering supportive factors found to influence pump self-management.

Looking Behind the Curtain: Identifying Factors Contributing to Changes on Care Outcomes During a Large Commercial EHR Implementation.

OBJECTIVE: To identify factors contributing to changes on quality, productivity, and safety outcomes during a large commercial electronic health record (EHR) implementation and to guide future research. METHODS: We conducted a mixed-methods study assessing the impact of a commercial EHR implementation. The method consisted of a quantitative longitudinal evaluation followed by qualitative semi-structured, in-depth interviews with clinical employees from the same implementation. Fourteen interviews were recorded and transcribed. Three authors independently coded interview narratives and via consensus identified factors contributing to changes on 15 outcomes of quality, productivity, and safety. RESULTS: We identified 14 factors that potentially affected the outcomes previously monitored. Our findings demonstrate that several factors related to the implementation (e.g., incomplete data migration), partially related (e.g., intentional decrease in volume of work), and not related (e.g., health insurance changes) may affect outcomes in different ways. DISCUSSION: This is the first study to investigate factors contributing to changes on a broad set of quality, productivity, and safety outcomes during an EHR implementation guided by the results of a large longitudinal evaluation. The diversity of factors identified indicates that the need for organizational adaptation to take full advantage of new technologies is as important for health care as it is for other services sectors. CONCLUSIONS: We recommend continuous identification and monitoring of these factors in future evaluations to hopefully increase our understanding of the full impact of health information technology interventions.

Hispanic Community-Engaged Research: Community Partners as Our Teachers to Improve Diabetes Self-Management.

INTRODUCTION: Community-based participatory research (CBPR) is a strategy often employed to address public health priorities. We explored how to build effective, trusting relationships with key community stakeholders and a group of Hispanic/Latinos with type 2 diabetes (T2D) to develop culturally appropriate projects. METHOD: In the process of implementing a Patient-Centered Outcome Research Initiative (PCORI) award, our Community Advisory Board (CAB) met monthly to develop a set of comparative effectiveness research questions along with the interventions to develop specific strategies to improve Hispanic/Latino individuals' self-management of T2D. An agenda was prepared for each meeting targeting the PCORI grant timeline. Notes were taken during these meetings and analyzed to determine effective strategies. RESULTS: Ten strategies were identified that led to the success of this CBPR project and to the current sustainability phase. Instrumental to our success was our partnership with a community health worker (CHW) who co-lead this research project. The CHW and CAB individualized general CBPR strategies to make this project successful in their community. CONCLUSION: Our community partners became influential knowledge holders throughout this research process. They improved researchers' understanding of how to address the needs of Hispanic/Latino individuals with T2D and how community members could become leaders within their community.

A Qualitative Analysis of Real-Time Continuous Glucose Monitoring Data Sharing with Care Partners: To Share or Not to Share?

BACKGROUND: Little research exists regarding how real-time continuous glucose monitoring (RT-CGM) data sharing plays a role in the relationship between patients and their care partners. OBJECTIVE: To (1) identify the benefits and challenges related to RT-CGM data sharing from the patient and care partner perspective and (2) to explore the number and type of individuals who share and follow RT-CGM data. METHODS: This qualitative content analysis was conducted by examining publicly available blogs focused on RT-CGM and data sharing. A thematic analysis of blogs and associated comments was conducted. RESULTS: A systematic appraisal of personal blogs examined 39 blogs with 206 corresponding comments. The results of the study provided insight about the benefits and challenges related to individuals with diabetes sharing their RT-CGM data with a care partner(s). The analysis resulted in three themes: (1) RT-CGM data sharing enhances feelings of safety, (2) the need to communicate boundaries to avoid judgment, and (3) choice about sharing and following RT-CGM data. RT-CGM data sharing occurred within dyads (n = 46), triads (n = 15), and tetrads (n = 2). CONCLUSIONS: Adults and children with type 1 diabetes and their care partners are empowered by the ability to share and follow RT-CGM data. Our findings suggest that RT-CGM data sharing between an individual with diabetes and their care partner can complicate relationships. Healthcare providers need to engage patients and care partners in discussions about best practices related to RT-CGM sharing and following to avoid frustrations within the relationship.