Feasibility of a nursing guide for the oral management of outpatients with diabetes mellitus.

Support for nurses is necessary to enable them to practice the oral management of patients with diabetes; however, no support for nurses in this context has been reported. The objective of this study was to verify the feasibility of a nursing guide for the oral management of outpatients with type 2 diabetes, aimed at giving nurses the ability to independently practice oral management for patients with diabetes in an outpatient department. Questionnaires were administered to 25 certified diabetes educator nurses from 54 medical facilities. The evaluation and degree of understanding of the guide were assessed using items in the nursing guide. In addition, opinions and impressions about the guide in the form of free responses were requested. Descriptive statistics were calculated for all measured variables, and data gathered from the free responses were divided into categories based on their similarities and differences. The feasibility of the nursing guide was confirmed, and nurses confidently provided education regarding oral management to patients with diabetes using the guide. These results suggest that a guide may improve nurses' knowledge, skills, and confidence in providing patient education and improve the overall practice of oral management. Further improvements based on the opinions of nurses, such as the expression of terms, implementation of checklists for oral assessment, and identification of devices that can be utilized in a shorter time, are needed to facilitate the implementation of the guide into practice by nurses. Supplementary Information: The online version contains supplementary material available at 10.1007/s13340-023-00622-4.

Parental readiness for the transition to adulthood of children with a chronic disease.

PURPOSE: To investigate parental readiness for their child's transition to adulthood among pediatric patients with chronic disease in Japan. DESIGN AND METHODS: In this cross-sectional study, parents of children with chronic diseases attending a pediatric outpatient hospital completed an anonymous self-administered questionnaire to investigate demographics and parental readiness for children's transition to adulthood. Logistic regression analysis was conducted to determine whether parents' readiness differed according to their children's disease types. RESULTS: A total of 179 parents responded to the survey. Of these, 60% confirmed awareness and knowledge of their children's disease and treatment with their children. They also thought and accepted that there would be a time when their children would move from pediatrics to an adult department. More than half of parents had discussions with their children about the children's interests and would discuss with each other if their children's choice differed from the parents' opinion. <20% of parents had gathered information about the transition and made sure their children saw the outpatient clinic alone or encouraged them to write a record of their visits. The readiness of parents of children with diabetes and of children with cardiovascular disease was higher than those of children with cancer and blood diseases on several items. CONCLUSIONS: Parental readiness to support their children's transitions did not progress well, suggesting the need for relevant interventions. PRACTICE IMPLICATIONS: Children and parents should be supported in acquiring information about the transition to adulthood and in implementing child-oriented outpatient visits.

Oral symptoms and oral hygiene behaviours among patients with type 2 diabetes at a hospital in Japan: A cross-sectional study.

OBJECTIVES: Effective daily oral hygiene behaviour will prevent periodontal disease. This study aimed to examine the oral symptoms, oral hygiene behaviours and factors contributing to oral hygiene behaviours among patients with type 2 diabetes in a hospital in Japan. METHODS: A cross-sectional survey was conducted with 198 patients with type 2 diabetes. Oral symptoms were assessed using a dichotomous scale based on clinical guidelines. Oral hygiene behaviours were assessed based on the frequency of daily tooth brushing and the use of interdental cleaning aids. Chi-square tests and logistic regression analyses were also performed. RESULTS: Overall, 71.2% of the participants had oral symptoms. Of the participants, 80.3% performed twice daily tooth brushing and 61.1% did not perform interdental cleaning on a daily basis. Logistic regression analysis revealed that tooth brushing behaviour was negatively associated with male patients (odds ratio [OR] = 0.45, 95% confidence interval [CI]: 0.25-0.80), difficulty with mastication (OR = 0.63, CI: 0.43-0.92) and tooth loss (OR = 0.68, CI: 0.46-1.00) and positively associated with periodontal disease (OR = 1.73, CI: 1.10-2.72). There were no significant variables related to the use of interdental cleaning aids. CONCLUSIONS: Patients need to learn about the necessity for regular oral hygiene behaviours and the appropriate way. In particular, support for male patients, those who have difficulty with mastication, those who have experienced natural tooth loss, and those who have not been diagnosed with periodontal disease are needed.

Nurses' knowledge, attitude, and practice regarding oral management for outpatients with type 2 diabetes: a national survey on certified diabetes educators.

The association among certified diabetes educator nurses' knowledge, attitudes, and practices related to oral management has not been well examined. The aim of this study was to examine the association between knowledge and attitude as variables for nurses' practice of oral management as certified diabetes educators at medical facilities in Japan. The questionnaires were administered to 300 certified diabetes educator nurses from 1277 medical facilities. The items regarding knowledge, attitude, and practice of oral management were assessed using items from the guidelines, reports, and books on diabetes and periodontal disease, as well as the exhaustive findings of previous studies. More than 70% of the participants did not practice adequate oral management. Logistic regression analysis revealed that all the items were negatively associated with nurses' confidence in oral management (Factor 1: odds ratio [OR] = 0.55; 95% confidence interval [CI] 0.37-0.83; Factor 2: OR = 0.35; 95% CI 0.18-0.70; Factor 3: OR = 0.38; 95% CI 0.24-0.61; Factor 4: OR = 0.29; 95% CI 0.18-0.49). The practice of oral management coupled with an explanation regarding periodontal disease as a diabetic complication (OR = 2.67; 95% CI 1.01-7.02), and supporting collaboration with multiple medical departments (OR = 2.65; 95% CI 1.24-5.65) were positively associated with nurses' education. These results suggest that more strategies for nurses' education are needed to understand the importance of oral management practices and to improve knowledge, attitudes, and confidence in patient oral management.

Factors associated with the practice of periodontal management by diabetes educator nurses for outpatients with diabetes: A nationwide survey in Japan.

AIMS: This study aimed to identify and prioritize factors contributing to the provision of periodontal care by certified diabetes nurse educators to outpatients with diabetes in medical settings in Japan. METHODS: Questionnaires were administered to 321 certified diabetes educator nurses from 1277 institutions. The practice of periodontal care was assessed, with factors contributing to periodontal care through items developed based on the capability, opportunity, and motivation-behavior model. Fisher's exact tests and logistic regression were performed. RESULTS: >70% of certified diabetes educator nurses did not provide periodontal care for diabetes patients. The respondents who assessed people's oral conditions were more likely to engage in individual or group education and consult for oral management professionals than those who did not. Significant factors for such assessment were low psychological capability and reflective motivation, irregular and weak intention to engage in oral management, and working at an institution without an outpatient department specializing in diabetes. CONCLUSIONS: The education for certified diabetes educator nurses who do not work at an institution with an outpatient department specialized in diabetes care should be prioritized. Particularly, education to improve knowledge, skills, and confidence in oral assessments and to make periodontal management regular is needed.

The role of knowledge and self-efficacy on dental consultation behavior of patients with type 2 diabetes.

AIM: This study aimed to examine the association of knowledge and self-efficacy as variables for behavior related to dental consultations among patients with type 2 diabetes, depending on the diagnosis of periodontal disease at a general hospital in Japan. METHODS: A cross-sectional survey was conducted with 198 patients with type 2 diabetes (mean age: 66.1 ± 10.1 years, men: 56.6%, mean glycated hemoglobin: 7.3 ± 1.0%). The self-efficacy of patients with periodontal disease was assessed using the Self-Efficacy Scale for Self-Care. Knowledge was measured using five dichotomous items based on reference to clinical guidelines. Dental consultation behavior was assessed from regular dental checkup behavior. RESULTS: In total, 31.8% of participants attended their regular dental checkup in the last year. Logistic regression analysis revealed that dental consultation behavior was positively associated with self-efficacy among patients diagnosed with periodontal disease (odds ratio [OR] = 1.26, 95% confidence interval [CI]: 1.10-1.45), and positively associated with the knowledge among patients not diagnosed with periodontal disease (OR = 1.54, 95%, CI: 1.09 - 2.16). CONCLUSION: Patients without periodontal disease need to learn about accurate knowledge regarding periodontal disease as a complication of diabetes and its prevention via dental checkups. Supportive consultation to improve self-efficacy with respect to dental consultations should be offered to patients with periodontal disease. Medical professionals will be able to support each patient with type 2 diabetes by changing the educational approach for promoting regular dental checkups at the time of diabetes consultations.

Diabetes self-management education and support for adults with newly diagnosed type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials.

This systematic review aimed to identify the effectiveness of diabetes self-management education and support (DSMES) among adults within 12 months of diagnosis of type 2 diabetes mellitus (T2DM). We searched the Cochrane Library, MEDLINE, CINAHL, PsycINFO, ERIC, and other sources up to March 2019 to detect randomized controlled trials in the last decade based on the global guidelines' definition of DSMES. Data were categorized into biomedical, psychosocial, and behavioral outcomes and synthesized using a random-effects model. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. We scrutinized 12 studies that enrolled 2,386 adults with newly diagnosed T2DM. Biomedical outcomes presented the pooled effects of HbA1c -0.21% (95% confidence interval, -0.38, -0.04), body weight -2.36 kg (-5.77, 1.05), and waist circumference -1.8 cm (-5.63, 2.04) when the data from the two studies with low risk of bias were combined (N = 1,082). Psychosocial and behavioral effects were inconclusive owing to mixed results from various scales and reporting. The quality of the body of evidence was low. DSMES within 12 months of T2DM diagnosis might affect patient-centered outcomes. Further studies with higher precision using standardized measurement methods are required.

The role of illness schemata in self-care behaviors and glycemic control among patients with type 2 diabetes in Iran.

AIMS: The diabetes illness perception domains outlined by Leventhal's common-sense model may be weakly associated with hemoglobin A1c (HbA1c) and adherence to diabetes self-care behaviors. However, type 2 diabetes patients' illness schemata identified by clustering the illness perception domains remain to be explained. This study aimed to describe type 2 diabetes patients' illness schemata and to examine their association with self-care behaviors and glycemic control in Iran. METHODS: A cross-sectional survey was conducted with 200 patients (mean age 59.5±10.3; 70% female) who attended self-management classes at the Iranian Diabetes Society in Tehran. Illness perceptions and self-care behaviors were assessed using the Persian version of the Illness Perception Questionnaire Revised and the Summary of Diabetes Self-Care Activity. RESULTS: Three clusters of diabetes illness beliefs were identified: "empowered," "self-condemned," and "powerless." "Empowered" participants adhered most rigorously to general diet, fruit and vegetable intake, and exercise, and had the best glycemic control (HbA1c=7.2%, SD=0.2), followed by "self-condemned" and then "powerless" participants, who had the lowest adherence and the worst glycemic control (p<0.0001). CONCLUSIONS: The clustering method for identifying type 2 diabetes patients' illness schemata is useful for selecting patients who need further care and assistance with adhering to self-care behaviors and glycemic control.

[Required support・An examination of the subjective quality of life and related factors In elderly people eith a high functional capacity who need mild care].

AIM: We aimed to investigate subjective quality of life (QOL) and related factors in elderly people with a high functional capacity using daycare centers who require support and mild long-term care. METHODS: We collected data on the basic attributes, social background (hobbies, JST-Index of Competence), and subjective QOL (Revision PGC Morale Scale) through interviews with 238 people ≥65 years of age using daycare centers who required support and long-term care (level 1, 2). We conducted a t-test and χ2 test to compare male and female participants and a multiple regression analysis using sex, age, hobbies, eating together, and the JST-Index of Competence (using new devices, collecting information, living management, social participation) as independent variables to predict the subjective QOL (dependent variable). RESULTS: We observed no marked differences in the subjective QOL between men and women, but a significant difference was noted between sexes in the number of people who ate with others. We conducted a multiple regression analysis using the above independent variables with the body mass index and level of care as explanatory variables and subjective QOL as a dependent variable to predict the value of the dependent variable. The subjective QOL tended to be higher in participants with high scores for social participation (standard partial regression coefficient 0.26, 95% confidence interval 0.14-0.38), living management (0.23, 0.09-0.37), and hobbies (0.20, 0.09-0.32). CONCLUSIONS: In elderly subjects with a high functional capacity, living management, social participation, and presence of hobbies were found to be associated with a decreased QOL.

Relationship between social engagement and diabetes incidence in a middle-aged population: Results from a longitudinal nationwide survey in Japan.

AIMS/INTRODUCTION: Social engagement can positively affect health status, but its effect on diabetes incidence remains unclear. The present study aimed to assess the relationship between social engagement and diabetes incidence in a middle-aged Japanese population. MATERIALS AND METHODS: We analyzed data on 31,615 people aged 50-59 years from a prospective national survey carried out in Japan from 2005 to 2013. Diabetes incidence was measured by asking respondents annually whether they had been diagnosed with diabetes by a physician in the previous year. We used the complementary log-log model for interval-censored survival time analysis. Social engagement was assessed at baseline as participation in social activities, having the companionship of friends, living with someone and employment status. Covariates including sex, age, health status and health behaviors were also measured at baseline. RESULTS: After adjusting for covariates measured at baseline, the effect size of social engagement on diabetes incidence was the same as or larger than that of the covariates. Respondents who participated in social activities (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.87-0.92), had the companionship of friends (HR 0.97, 95% CI: 0.95-1.00), lived with someone (HR 0.85, 95% CI: 0.82-0.89) and were employed (HR 0.94, 95% CI: 0.92-0.96) were significantly less vulnerable to diabetes than were those who did not. CONCLUSIONS: The present study found a prospective association between social engagement and diabetes incidence among a middle-aged population. Future strategies to prevent diabetes in Japan should focus on both social and personal factors.

Association of care recipients' care-need level with family caregiver participation in health check-ups in Japan.

AIM: The public mandatory long-term care insurance system in Japan has supposedly mitigated the care burden for family caregivers of older adults, whereas family caregivers still play a considerable role in providing care. The effect of informal caregiving on the caregiver's health has been of great interest. We investigated the relationship between the amplitude of informal caregiving and caregiver participation in health check-ups in Japan. METHODS: The present study was a cross-sectional analysis of nationally representative data in Japan (2010 Comprehensive Survey of Living Conditions). We investigated the relationship between care recipients' care-need level and in-home caregiver participation in health check-ups during the last year of the survey for caregivers. RESULTS: A total of 3354 caregiver/recipient pairs were included in the study. Crude proportions of caregivers completing a health check-up by care-need level were 68.4% (support required 1 and 2), 63.5% (care required 1-3) and 60.3% (care required 4 and 5). Higher care-need level was negatively associated with caregiver participation in health check-ups (support required 1 and 2as reference, care required 1-3: odds ratio 0.82, 95% confidence interval 0.75-0.90), care required 4 and 5: odds ratio 0.76, 95% confidence interval 0.74-0.79) after adjustment for possible confounders. Inclusion of the caregiver time devoted to care per day and caregiver self-rating of health as independent variables did not change the result. CONCLUSIONS: These results suggest that facilitating health check-up participation for family caregivers of care recipients with higher care-need levels might be an effective intervention for decreasing the gap in health behavior possibly caused by informal caregiving. Geriatr Gerontol Int 2018; 18: 26-32.

Reliability and validity of revised and short form versions of diabetes diet-related quality of life scale.

OBJECTIVE: To develop both a revised version of the Diabetes Diet-Related Quality of Life (DDRQOL-R) scale that can be applied to patients with nephropathy and a short form of the DDRQOL-R. METHOD: A total of 184 outpatients with type 2 diabetes were asked to complete the self-administered DDRQOL-R scale to confirm its psychometric properties. A short-form version was developed, based on two methods: the result of the developed DDRQOL-R scale and consensus using the Delphi method among medical experts. RESULTS: Correlations were generally strong between the DDRQOL-R factors extracted by factor analysis and each SF-36 subscale. Cronbach's α coefficients were at least 0.7, and intraclass correlation coefficients were between 0.59 and 0.78. The nine items that showed high factor loadings were also assessed as important by the medical experts and were selected for the short form of the scale. The reliability and validity of the short form were found to be similar to those of the DDRQOL-R scale. DISCUSSION: Our findings indicate that the DDRQOL-R scale and its short form have acceptable reliability and validity. The revised version is highly versatile, and the short form can be conveniently administered.

Impact of a Booklet about Diabetes Genetic Susceptibility and Its Prevention on Attitudes towards Prevention and Perceived Behavioral Change in Patients with Type 2 Diabetes and Their Offspring.

Background. Offspring of type 2 diabetic patients are at a high risk of type 2 diabetes. Information on diabetes genetic susceptibility and prevention should be supplied to the offspring. Methods. A six-page booklet on diabetes genetic susceptibility and prevention was distributed to 173 patients who ere ordered to hand it to their offspring. The patients answered a self-administered questionnaire on booklet delivery and attitudinal and behavioral changes toward diabetes and its prevention in themselves and their offspring. Results. Valid responses were obtained from 130 patients. Forty-nine patients had actually handed the booklet. Booklet induces more relief than anxiety. From the patient's view, favorable attitudinal and/or behavioral changes occurred in more than half of the offspring who were delivered the booklet. Conclusion. The booklet worked effectively on attitudes and behaviors toward diabetes and its prevention both in patients and their offspring. However, the effectiveness of patients as information deliverers was limited.

Influence of dietary therapy appraisal on future perceived control of type 2 diabetes.

We sought to elucidate the causal effect of patients' self-appraisal of their dietary regimen on their control beliefs among adults with type 2 diabetes. Data from 176 outpatients were assessed using a two-wave cross-lagged panel model. We found that a cross-lagged path connecting dietary appraisal at baseline to perceived control at one year (ß = .30, p = .003) was larger than a path connecting perceived control at baseline to dietary appraisal at one year (ß = -.16, p = .07). We conclude that dietary appraisal has a feedback effect on the future perceived control of type 2 diabetes.

Dietary intake and body composition of Japanese ulcerative colitis patients in remission.

The purpose of this pilot study (N=26) was to investigate dietary intake and body composition and problems associated with dietary intake (such as unnecessary dietary restriction) in Japanese patients in remission from ulcerative colitis. Findings revealed the macronutrient intake and dietary fiber (absolute amount) were lower than the national average in men, but this may have been due to differences in the methods used to measure dietary intake. Although the fat intake (%E) of ulcerative colitis patients in this study was similar to that of the Japanese population, it differed greatly from that of people in Western countries. No significant differences in weight, height, or body mass index were found when comparing the sample of individuals living with ulcerative colitis with the general Japanese population. Seventeen patients (65.4%) reported being cautious about what they ate even though in remission, and 6 patients were even more cautious about what they ate now than they had been in the past. The authors suggest further research to clarify the problems that unnecessary dietary restriction cause for ulcerative colitis patients who are in remission.

Effectiveness of lifestyle counseling by certified expert nurse of Japan for non-insulin-treated diabetic outpatients: a 1-year randomized controlled trial.

We examine whether one-to-one lifestyle counseling for non-insulin-treated diabetic outpatients by a Certified Expert Nurse (CEN) can improve patients' health outcomes. Participants were randomly assigned to a 1-year lifestyle intervention (n=67) or to a usual care group (n=67). Main outcome measures were changes from baseline in: HbA(1C) and score of health related quality of life scales (SF-36 and Problem Areas in Diabetes Scale). Cognitive/behavioral modification for 1 year and satisfaction in CEN counseling was also measured by self-produced items. We found no significant differences in HbA(1C), BMI, blood pressure, serum lipids, or health related quality of life over 1 year between the two groups. Patients in the intervention group, however, showed modest but more favorable modification of cognition (p=0.004) and behavior (p<0.001) than subjects in usual care group. The low attrition rate (9%), more frequent hospital visit (12+/-2 times versus 11+/-3 times; p=0.03) and high degree of satisfaction (95%) in the intervention group indicate feasibility of the monthly CEN counseling in the outpatient settings of Japanese hospitals. Future research should confirm the long-term effectiveness of the CEN counseling on clinical outcomes and the cost effectiveness of a possibly time-consuming intervention.