Feasibility and acceptance of a virtual multidisciplinary care programme for patients with type 2 diabetes during the COVID-19 pandemic.

BACKGROUND AND AIMS: Type 2 diabetes mellitus is one of the major public health concerns. The current lifestyle and advances in technology resulted in the development of a virtual mode of professional healthcare, which is an effective alternative method of management of patients. This study aimed to assess the feasibility of implementation of a virtual comprehensive care programme during the COVID-19 pandemic, patients' acceptance and the changes in self-care behaviours, metabolic parameters and emotional factors. METHODS: The programme employed in this study included nine health interventions in 1 day. Due to the COVID-19 pandemic, the mode of interventions, including questionnaires, patient evaluations and a satisfaction survey, was modified to the virtual form in 2020. This study assessed the changes in self-care behaviours, metabolic parameters and emotional factors and compared the data pertaining to patients who received virtual healthcare in 2020 with those who received face-to-face modality of medical care in 2019. RESULTS: During June to November 2020, 130 patients received healthcare by means of the virtual modality. The change in modality of healthcare was feasible and 75% of the patients displayed good acceptance of the same. The evaluation of self-care behaviours included self-monitoring blood glucose (SMBG) levels, foot care and regular exercise. The duration of exercise decreased from 120 to 0 min/week (p < 0.001). However, there was no change in metabolic parameters. Regarding the mental health parameters, we observed an increase in the proportion of patients with anxiety (21.5% versus 11.1%), depressive symptoms (10.8% versus 4.3%), diabetes distress (18.5% versus 11.1%) and prescription of psychotropic drugs (32.8% versus 18.2%) (p < 0.05) in virtual versus face-to-face, respectively. CONCLUSION: The virtual comprehensive care programme for the management of patients with diabetes is a feasible approach that allows healthcare professionals to provide an adequate care during the COVID-19 pandemic.

Barriers to adherence to a nutritional plan and strategies to overcome them in patients with type 2 diabetes mellitus; results after two years of follow-up.

INTRODUCTION: Lifestyle changes in medical nutrition therapy (MNT) are associated to HbA1c decreases ranging from 0.3 to 2%. Evidence shows that people with barriers are less likely to adhere to a long-term nutritional plan. Little information is available on the barriers that prevent the implementation of a healthy nutritional plan, and the strategies used to overcome them. OBJECTIVE: To report the longitudinal changes in perceptions of barriers to adherence to a nutritional plan in T2DM. METHODS: A prospective cohort study with intervention. Follow-up was assessed at two years, and all patients received comprehensive care according to the CAIPaDi model. A questionnaire was used to detect the most common barriers to adherence to a nutritional plan at baseline and at 3 months and 1 and 2 years of follow-up. The analysis included data from 320 patients with complete evaluations from baseline to 2 years. Patients with T2DM aged 53.8±9.1 years (55.9% women), BMI 29.2±4.4kg/m2, and time since the diagnosis 1 (0-5) years were included in the study. RESULTS: At baseline, 78.4% of patients reported any barrier that limited adherence to a nutritional plan. The most common were "Lack of information on an adequate diet" (24.7%), "I eat away from home most of the time" (19.7%), and "Denial or refusal to make changes in my diet" (14.4%). After a structured nutritional intervention including strategies to eliminate each barrier, a 37% reduction (p<0.001) was seen in barriers at 2 years of follow-up. Patients with persistent barriers at two years had a greater proportion of HbA1c values >7% (24.7%) and triglyceride levels >150mg/dL (27.5%) out of the control range as compared to those with no barriers (11.6% and 14.4% respectively, p<0.05). CONCLUSIONS: Identification of barriers to adherence to a nutritional plan may allow healthcare professionals design interventions with the specific behavioral components needed to overcome such barrier, thus improving adherence to the nutritional plan with the resultant long-term changes.

Divergences in the perception of parental practices, positive behavior and problems between parents and children / Divergências na percepção de práticas parentais, comportamento positivo e problemáticas entre pais e filhos / Divergencias en la percepción de prácticas parentales, comportamiento positivo y problemáticas entre padres e hijos

Abstract The purpose of this study was to analyze the divergences in perception of parental practices, positive behavior and problems between parents and children. The participants, parents and adolescents, collaborated voluntarily and were examined in the following dyads: 248 fathers-sons, 241fathers-daughters, 237 mothers-sons, and 241 mothers-daughters. The psychometric instruments used were the Strengths and Difficulties Scale and the Parental Practices Scale for mothers and fathers. To achieve the main objective, correlation analysis, path analysis and differences of means with related samples were performed. The results showed correlations, from moderate to low, between parental practices, problems and prosocial behavior. In addition, different predictive factors of the children's behaviors were obtained, according to the sex of the parents and the parental practices they implemented. Finally, there were divergences between reports of parental practices, prosocial behavior and problems between parents and their children. Therefore, it is concluded that parental behavior is oriented according to the sexual role of their children, which involves social desirability.

Resumo O presente estudo teve como finalidade analisar as divergências na percepção das práticas parentais, no comportamento positivo e nas problemáticas entre pais e filhos. Os participantes, pais e adolescentes, colaboraram de maneira voluntária e foram avaliados nas seguintes díades: 248 pais-filhos, 241 pais-filhas, 237 mães-filhos e 241 mães-filhas. Os instrumentos utilizados foram a Escala de Capacidades e Dificuldades e a Escala de Práticas Parentais para mães e pais. Para alcançar o objetivo principal, realizaram-se análises de correlação, análises de caminhos e diferenças de médias com amostras relacionadas. Os resultados mostraram correlações - de moderadas a baixas - entre as práticas parentais, os problemas e a conduta pró-social, além de diferentes fatores preditivos das condutas dos filhos a partir do gênero dos pais e das práticas parentais exercidas. Houve divergências entre os relatórios de práticas parentais, conduta pró-social e problemas entre os pais e seus filhos. Conclui-se que a conduta parental é orientada de acordo com o gênero dos filhos, o que implica certa desejabilidade social relacionada com seu papel como homens ou como mulheres.

Resumen El presente estudio tuvo como finalidad analizar las divergencias en la percepción de las prácticas parentales, el comportamiento positivo y las problemáticas entre padres e hijos. Los participantes, padres y adolescentes, colaboraron de manera voluntaria y se evaluaron en las siguientes díadas: 248 padres-hijos, 241 padres-hijas, 237 madres-hijos, y 241 madres-hijas. Los instrumentos utilizados fueron la Escala de Capacidades y Dificultades y la Escala de Prácticas Parentales para madres y padres. Para lograr el objetivo principal se realizaron análisis de correlación, análisis de senderos y diferencias de medias con muestras relacionadas. Los resultados mostraron correlaciones -de moderadas a bajas- entre las prácticas parentales, los problemas y la conducta prosocial, además de diferentes factores predictores de las conductas de los hijos a partir del sexo de los padres y las prácticas parentales ejercidas. Se presentaron divergencias entre los reportes de prácticas parentales, conducta prosocial y problemas entre los padres y sus hijos. Se concluye que la conducta parental se orienta según el sexo de los hijos, lo cual implica cierta deseabilidad social relacionada con su rol como hombres o como mujeres.