Glycemic control and awareness among diabetic patients of nutrition recommendations in diabetes.

Background. The incidence of diabetes has been rising rapidly, especially in urbanized countries. It is estimated that by 2035 the number of diabetics will have increased to almost 600 million around the world. There is a substantial amount of evidence which points to proper education as one of the most effective ways of delaying the diabetes-related development of complications.Objective. The aim of the study was to investigate the frequency of monitoring blood sugar by diabetic patients and their awareness of nutrition recommendations in diabetes.Materials and methods. The study included 303 patients with type 1 and 2 diabetes. The research tool was a questionnaire based on the KomPAN questionnaire that consisted of a nutrition knowledge test and several questions concerning glycaemic control. The statistical analysis was carried out using the PS IMAGO PRO 5 (IBM SPSS Statistics 25) software.Results. Most of the patients demonstrated a medium level of knowledge - 62% of them provided >50% of the correct answers. Only 8% of the respondents scored >80% of the correct answers. Better test results were achieved by patients with type 1 diabetes. The highest percentage of correct answers was observed in the questions regarding the need to limit sweets or introduce fibre-rich whole-grain products (>90%), the smallest percentage in the questions related to the assessment of carbohydrates and the glycaemic index of selected products (<30%). The majority of the patients checked their blood sugar levels every day, but 6% of them gave up glucose measurements at home. About half of the respondents did not take the HbA1c test - the majority of them were patients with type 2 diabetes.Conclusions. The level of knowledge of the examined patients was unsatisfactory and varied with the type of diabetes. Further education of patients about nutrition and glycaemic control is recommended.

Enablers and barriers for women with gestational diabetes mellitus to achieve optimal glycaemic control - a qualitative study using the theoretical domains framework.

BACKGROUND: Glycaemic target recommendations vary widely between international professional organisations for women with gestational diabetes mellitus (GDM). Some studies have reported women's experiences of having GDM, but little is known how this relates to their glycaemic targets. The aim of this study was to identify enablers and barriers for women with GDM to achieve optimal glycaemic control. METHODS: Women with GDM were recruited from two large, geographically different, hospitals in New Zealand to participate in a semi-structured interview to explore their views and experiences focusing on enablers and barriers to achieving optimal glycaemic control. Final thematic analysis was performed using the Theoretical Domains Framework. RESULTS: Sixty women participated in the study. Women reported a shift from their initial negative response to accepting their diagnosis but disliked the constant focus on numbers. Enablers and barriers were categorised into ten domains across the three study questions. Enablers included: the ability to attend group teaching sessions with family and hear from women who have had GDM; easy access to a diabetes dietitian with diet recommendations tailored to a woman's context including ethnic food and financial considerations; free capillary blood glucose (CBG) monitoring equipment, health shuttles to take women to appointments; child care when attending clinic appointments; and being taught CBG testing by a community pharmacist. Barriers included: lack of health information, teaching sessions, consultations, and food diaries in a woman's first language; long waiting times at clinic appointments; seeing a different health professional every clinic visit; inconsistent advice; no tailored physical activities assessments; not knowing where to access appropriate information on the internet; unsupportive partners, families, and workplaces; and unavailability of social media or support groups for women with GDM. Perceived judgement by others led some women only to share their GDM diagnosis with their partners. This created social isolation. CONCLUSION: Women with GDM report multiple enablers and barriers to achieving optimal glycaemic control. The findings of this study may assist health professionals and diabetes in pregnancy services to improve their care for women with GDM and support them to achieve optimal glycaemic control.

Fear of hypoglycemia: Influence on glycemic variability and self-management behavior in young adults with type 1 diabetes.

PURPOSE: The purpose of this study was to examine how fear of hypoglycemia (FOH) is associated with glycemic variability (GV) and self-management behavior in young adults (aged 18-35) with type 1 diabetes (T1DM). PROCEDURES: Using a prospective repeated-measures design, in 35 young adults, within- and between-person and temporal associations of FOH, specific self-management behaviors, and GV were measured. The data were collected using questionnaires and real-time measures using daily diaries, insulin pump downloads, actigraphy, and continuous glucose monitoring. FINDINGS: FOH was associated with greater glycemic variability. Significant temporal associations emerged. Concurrent day (glucose SD, p=.011) and previous-evening fear levels were associated with GV (glucose SD, p=.007). FOH was also associated with greater calorie intake (r=.492, p=.003) and less physical activity (light activity, r=-.341, p=.045). CONCLUSIONS: The significant associations of FOH with GV, dietary patterns, and physical activity provide evidence for FOH as an important psychological factor associated with diabetes care.

The relationship of diabetes-related distress and depressive symptoms with physical activity and dietary behaviors in adults with type 2 diabetes: A cross-sectional study.

AIMS: Diabetes-related distress (DD) and depressive symptoms (DS) may influence self-management behaviors in people living with type 2 diabetes (T2D). We examined the association of DD and DS with physical activity (PA) and adherence to recommended dietary behaviors in adults with T2D. METHODS: Using baseline data from 2040 adults with T2D in the Alberta's Caring for Diabetes (ABCD) cohort study, DD, DS, PA and adherence to dietary behaviors were assessed. A composite variable for presence of DD and DS was computed for analyses. ANOVA and logistic regression tested independent associations of DS and DD with PA and adherence to diet. RESULTS: Participants were 64±10.6years, 45% female, 76% with annual household income≤$80,000, and 86% with high school education or more. Those with DD alone were 1.8 times (95% CI 1.1, 2.9) and those with DD and DS combined were 2.0 times (95% CI 1.1, 3.7) more likely not to meet PA guidelines compared to those without DD or DS. The presence of DS alone was not significantly associated with meeting PA guidelines (OR 1.4; 95% CI 0.7, 3.0). Compared to those without DD or DS, patients with DD alone (OR 1.5; 95% CI 1.4, 3.4), DS alone (OR 5.2; 95% CI 2.7, 9.7), or DD and DS combined (OR 2.5; 95% CI 1.6, 3.8) were more likely to have poor adherence to recommended dietary behaviors. CONCLUSIONS: Greater distress or depressive symptoms were associated with worse self-management behaviors in adults with T2D. Attention to mental health status may improve participation in PA and adherence to diet recommendations in these patients.

Food insecurity and medication adherence in low-income older Medicare beneficiaries with type 2 diabetes.

Little is known about diabetes management among low-income older Americans. This study used statewide self-administered survey and Medicare claims data to examine the relationships of food insecurity and medication (re)fill adherence in a sample of Medicare Part D beneficiaries with type 2 diabetes in need of food assistance in Georgia in 2008 (n = 243, mean age 74.2 ± 7.8 years, 27.2% African American, 77.4% female). (Re)fill adherence to oral hypoglycemics was measured as Proportion of Days Covered. Food insecurity was assessed using a six-item validated standard measure. About 54% of the sample were food insecure. About 28% of the diabetic sample did not (re)fill any diabetes medication and over 80% had at least one diabetes complication. Food insecure participants showed comparable (re)fill adherence to food secure participants. However, 57% of food insecure participants were nonadherent to oral hypoglycemics. Underlying basic needs must be addressed to improve diabetes management in this population.

Prevalence of food insecurity in patients with diabetes in western Kenya.

AIMS: To determine the characteristics of patients with diabetes who reported food insecurity at three diabetes clinics in western Kenya. METHODS: This study includes routinely collected demographic data at the first presentation of patients with diabetes at clinics in western Kenya from 1 January 2006 to 24 September 2011. A validated questionnaire was used to assess food insecurity with descriptive and comparative statistics being used to analyse the food-secure and food-insecure populations. RESULTS: The number of patients presenting to these clinics who were food-secure and those who were food-insecure was 1179 (68.0%) and 554 (32.0%), respectively. Comparative analysis shows a statistically significant difference in weight, BMI, the presence of a caretaker, and use of insulin between the two groups. These variables were lower in the food-insecure group. The overall assessment of the clinic population revealed an abnormally high mean HbA1c concentration of 81 mmol/mol (9.6%). CONCLUSIONS: Despite the widely recognized contribution of caloric over-nutrition to the development of diabetes, this study highlights the high prevalence of food insecurity amongst patients with diabetes in rural, resource-constrained settings. Other factors, such as the lower prevalence of obesity, poor glucose control, challenges in the use of insulin because of the risk of hypoglycaemia, and varying subtypes of diabetes in this population, point to the need for additional research in understanding the aetiology, pathophysiology and optimum management of this condition, as well as understanding the effects of enhancing food security.

Coping strategies and adherence to treatment in patients with type 2 diabetes mellitus.

INTRODUCTION: Diverse psychosocial and cultural factors are related to adherence to treatment of type 2 Diabetes mellitus (DM2) such as social support, coping styles and the cost of medical attention. OBJECTIVE: To study the influence of diverse psychosocial factors on adherence to treatment in patients with DM2. MATERIAL AND METHODS: In a cross sectional design we studied adherence to diet and medication, and its relationship with CS for diabetes, belief in conventional medicine, social support, and the perception of the burden of treatment cost on family finances. RESULTS: We included 210 patients a mean age of 56.3 years, 9.4 years since diagnosis. Male DM patients had better adherence to medication (p<0.016) and social support (p<0.004), and higher rates for supportant CS (31.8 vs. 29.0; p<0.009). Adherence to diet was associated with belief in conventional medicine (p<0.035) and marginally related to fatalistic CS (p<0.05). After testing social security coverage as dummy variable, a marginal association was found (p<0.15). Adherence to medication was associated with supportant CS (p<0.02) and marginally with avoidant CS (p<0.05). CONCLUSIONS: Supportant CS was more frequent in men. Belief in conventional medicine, and supportant CS were associated with adherence to treatment. These factors should be considered for a more rational approach for the management of disease.

Support and influence in the context of diabetes management: do racial/ethnic differences exist?

This study examined the sources and frequency of, and dietary behavioral responses to, health-related social support and control in a racially/ethnically diverse sample of 1,361 adults with type 2 diabetes. Spouses were the most frequently reported sources of support/control for all racial/ethnic groups examined. Mexican Americans and Vietnamese Americans received more support/control compared to non-Hispanic whites. All types of social involvement were associated with good dietary behavior for Mexican Americans, whereas only support was associated with good dietary behavior for non-Hispanic whites. The findings underscore the importance of considering racial/ethnic differences in examining social network members' involvement in chronic disease management.

Illness and treatment perceptions are associated with adherence to medications, diet, and exercise in diabetic patients.

OBJECTIVE: To investigate diabetic patients' perceptions of illness and treatments, and explore relationships to adherence and blood glucose control. RESEARCH DESIGN AND METHODS: Forty-nine type 1 and one hundred and eight type 2 diabetic patients completed questionnaires assessing illness perceptions, treatment beliefs, and adherence to medications, diet, and exercise. Blood glucose control was assessed from blood tests. RESULTS: Patients rated medication more important than diet and exercise, and reported higher adherence to medications. Insulin was perceived as more helpful for diabetes, while antihypertensives and cholesterol medication were perceived more helpful for preventing heart problems. Perceptions were associated with adherence to insulin, cholesterol and antihypertensive medications, exercise, and diet. Blood glucose control in type 1 diabetic patients was associated with insulin adherence and perceived personal control, and in type 2 diabetic patients to being prescribed insulin or antihypertensives, and perceived personal control. CONCLUSIONS: Patients hold specific mental models about diabetes treatments, which are associated with adherence.

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.

Self-management behaviors, racial disparities, and glycemic control among adolescents with type 2 diabetes.

OBJECTIVE: Type 2 diabetes is a growing problem among adolescents, but little is known about self-management behaviors in this population. Our aim was to examine self-management behaviors and glycemic control among adolescents with type 2 diabetes. METHODS: From 2003 to 2005, a telephone survey of adolescents with type 2 diabetes was performed. Chart review obtained most recent glycated hemoglobin and clinical characteristics. Analyses compared patient characteristics and self-management behaviors to recent glycated hemoglobin levels. RESULTS: Of 139 patients contacted, 103 (74%) completed the study. The mean age was 15.4 years: 69% were girls, 47% were white, and 46% were black. Mean glycated hemoglobin was 7.7%, and the average duration of diabetes was 2.0 years. More than 80% of patients reported > or = 75% medication compliance, and 59% monitored blood glucose > 2 times daily. However, patients reported frequent episodes of overeating, drinking sugary drinks, and eating fast food. More than 70% of patients reported exercising > or = 2 times a week, but 68% reported watching > or = 2 hours of television daily. Nonwhite patients had higher glycated hemoglobin and hospitalizations per year compared with white patients. In multivariable analyses, nonwhite race remained significantly associated with higher glycated hemoglobin even after adjusting for age, gender, BMI, insurance status, and other factors. Nonwhite patients were more likely to watch > or = 2 hours of television per day (78% vs 56%), to report exercising < or = 1 time per week (35% vs 21%), and to drink > or = 1 sugary drink daily (27% vs 13%). CONCLUSION: Although patients reported good medication and monitoring adherence, they also reported poor diet and exercise habits and multiple barriers. Nonwhite race was significantly associated with poorer glycemic control even after adjusting for covariates. This may, in part, be related to disparities in lifestyle behaviors. Additional studies are indicated to further assess self-management behaviors and potential racial disparities in adolescents with type 2 diabetes.

The prevalence of co-morbid depression among employees with type 2 diabetes in a Japanese corporation: a descriptive study using an integrated health database.

OBJECTIVE: To determine the prevalence of comorbid depression among people with type 2 diabetes using the integrated health database. METHODS: A total of 6543 people aged 18-65 years were selected from the employees of a Japanese corporation. Using the corporation's integrated health database, which consisted of medical claims data and a self-reported questionnaire from the fiscal year 2000, this study was undertaken to identify the prevalence, the odds ratio and some related factors. RESULTS: The prevalence of co-morbid depression among people with type 2 diabetes was 2.6%. The crude odds ratio of co-morbid depression among those with type 2 diabetes was 2.20 (95% CI 0.88-5.50). After adjustment for covariates (gender, age, alcohol drinking, smoking, exercise, and dietary restriction), the odds ratio of co-morbid depression among those with type 2 diabetes was 2.33 (0.86-6.33). CONCLUSIONS: Using the integrated health database, it was suggested that patients with type 2 diabetes were more likely to suffer from depression and there was a relationship between depression and dietary restriction of portion control.

Patients' readiness for dietary change at the beginning of counselling: a transtheoretical model-based assessment.

BACKGROUND: The purpose of this study was to explore patients' readiness for dietary change within a theoretical framework of the transtheoretical model. The patients were recently diagnosed to have type 2 diabetes or impaired glucose tolerance. We discuss the theoretical aspects of appropriate dietary counselling strategies from a standpoint of patient-specific stages of change. METHODS: The data included 32 audiotaped diabetes counselling sessions with 16 patients conducted by two nurses. The transcribed data was analysed by using deductive content analysis. RESULTS: The patients were at different stages of change of diabetes-affected dietary behaviour. Their stages of change varied in different dietary areas and within certain dietary habits. These stages of change could involve their overall dietary behaviour or some minor aspects of their diets. CONCLUSIONS: Understanding patient-specific stages of change orientates health counsellors to use the most appropriate counselling strategies. The transtheoretical framework helps counsellors to perceive the total range of patients' different stages of change and their effect on the implementation of counselling. However, determining patients' stages of change through examining counselling conversations is occasionally difficult. Further qualitative research is called for.

[Illness-specific knowledge, coping with illness and metabolic control in insulin-injecting diabetic patients in a random city population]. / Krankheitsbezogenes Wissen, Krankheitsbewältigung und Stoffwechseleinstellung bei insulinspritzenden Diabetikern in einer unausgewählten Stadtpopulation.

A knowledge test about diabetes using a standardized interview was assessed in 186 (81%) of 229 insulin treated patients below the age of 60 who are registered and treated in the diabetes care unit Jena. 90% of these patients were on conventional insulin therapy. The frequency of errors was positive correlated to glycosylated haemoglobin, age and body-mass-index, it was lower in type 1 than in type 2 diabetic patients and decreased with a better education level. Deficiencies of knowledge were detected in the following areas: hyperglycaemic coma, consequence of acetone and obesitas. Knowledge regarding late complications was on a high level. 20% of type 1 and 43% of type 2 diabetic patients did not know their daily carbohydrate units. But the metabolic control in these patients was not different from the patients who know their carbohydrates exactly. Most frequent missed subjects in the patient information were reported: modern therapy strategies, insulin pumps and nutrition. 77% of all patients did not feel ill because of their diabetes and 91% reported an unchanged relationship to their family after diabetes was diagnosed.