Evaluation of Diabetes Hotline Service Implemented During the COVID-19 Pandemic: A Dynamic Adaptation.

Background: The coronavirus disease 19 (COVID-19) pandemic presented major challenges for people living with diabetes. People with diabetes were identified as being at increased risk of serious illness from COVID-19. The lockdown and preventive measures, including social distancing measures, implemented worldwide to limit the spread of COVID-19 had negatively impacted access to diabetes care, including self-management services, challenging the way modern medicine had been practiced for decades. This article aims to shed light on the implementation and evaluation of the Diabetes hotline service run by trained diabetes patient educators during the pandemic in Qatar. Methods: The logic model is utilized to showcase the implemented strategies/activities and the output monitoring process. An online survey among hotline users was undertaken to gather feedback on patients' overall experience of using the service and physician feedback. Results: Of the 464 patients surveyed, over 92% stated that they would recommend the hotline service to others, and over 90% indicated that they considered the hotline a trusted and reliable resource for diabetes education and advice. Conclusion: It is expected that the lessons learned from maintaining health care delivery services during the COVID-19 pandemic have created new ways of providing standard care and meeting the needs of people with diabetes. Future research should study the clinical outcomes for patients who benefited from the hotline services and the impact on the well-being of people with diabetes.

A Delphi consensus study introducing a Problem And attRibutes-bAsed DIabetes self-manaGeMent (PARADIGM) intervention for patients with type 2 diabetes.

AIM: Encouraging patients to improve their self-management behavior based on a strict definition of the intervention is important for a standardized delivery but, until recently, there was no consensus on the core attributes that define such an intervention. The purpose of this study is to generate a core-attribute based and stakeholder-informed problem-based curriculum for promotion of type 2 diabetes self-management structured around five core attributes derived from a previous concept analysis that defined the intervention. METHODS: Using a Delphi process for consensus achievement, physicians, clinical epidemiologists and allied health care professionals completed eleven rounds of online meetings over 6 months. RESULTS: Core self-management skills were identified by consensus for each of the five attributes and then used to design a model case and interactions of a problem-based self-management education intervention for delivery in a health care setting. Five model cases and associated interactions were developed by consensus for delivery in group-based and problem-based learning sessions. CONCLUSIONS: The final structured curriculum will be useful to inform and standardize diabetes self-management based on a clear conceptual definition of the intervention and can thus help make the latter more effective tools for encouraging persons with type 2 diabetes to self manage their condition.

Perspectives of Persons With Type 2 Diabetes Toward Diabetes Self-Management: A Qualitative Study.

Background. The global increase in type 2 diabetes (T2D) poses a significant public health challenge worldwide. Due to the chronic and complex nature of the disease, management does not depend on pharmacotherapy alone; rather, a comprehensive medical and self-management plan is required. Diabetes Self-Management Education programs should address diabetes-specific behaviors and be grounded in patients' perceptions of their disease and its consequences. Aim. The study aims to understand perceptions of diabetes self-management (DSM) among persons of different nationalities with T2D living in Qatar. Method. A phenomenological qualitative study was implemented using four focus group interviews using Triandis Interpersonal Behavior Model to understand factors influencing DSM perceptions and behaviors. Therefore, deductive content analysis was used, also inductive content analysis used to find new emerging themes. Twenty-nine participants with T2D of 12 different nationalities were recruited. Results. Content analyses revealed that participants were mainly motivated to manage their diabetes by fear of future health complications-and the resulting impact on their families-triggered by witnessing these complications on other family members and friends. Factors that influenced DSM included cultural factors such as food content and holidays' customs, weather conditions, psychological distress, and social factors such as lack of family support. Furthermore, access to healthy food, number of working hours and time, and cost of DSM supplies were found to be among the barriers to DSM. Conclusion. Understanding and considering patients' perspectives is a core component of culturally competent and evidence-based DSM programs, and it should be considered in any DSM program.

Qatar Diabetes Mobile Application Trial (QDMAT): an open-label randomised controlled trial to examine the impact of using a mobile application to improve diabetes care in type 2 diabetes mellitus-a study protocol.

BACKGROUND: Mobile health (mHealth) is increasingly advocated for diabetes management. It is unclear if mobile applications are effective in improving glycaemic control, clinical outcomes, quality of life and overall patient satisfaction in patients with type 2 diabetes (T2DM). A new mobile application was specifically built for people with T2DM with the help of the local expertise. The objective of the study was to evaluate the effectiveness of the mobile app. METHODS: The planned study is an ongoing open-label randomised controlled trial in which adults living with T2DM treated with insulin will be randomised 1:1 to the use of this diabetes application versus current standard care. The primary outcome will be the difference in mean HbA1c from baseline to 6 months. Other outcome measures include anthropometric measures, hypoglycaemic events, medication adjustments, number of clinical interactions and missed appointments and patient perceptions of their disease and diabetes self-management. The study will randomise 180 subjects for assessment of the primary outcome. DISCUSSION: We hypothesise that the diabetes-specific mobile application will improve glycaemic control, increase patient empowerment for self-management of diabetes and improve interaction between patients and healthcare providers. If the Qatar Diabetes Mobile Application Trial (QDMAT) demonstrates this, it will inform clinical services for the future self-management of T2DM. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03998267 . Registered on 26 June 2019.

Towards a better understanding of self-management interventions in type 2 diabetes: A concept analysis.

OBJECTIVES: Diabetes self-management educational (DSME) interventions can vary considerably, and it is unclear what is the operational conceptualization of the ideal delivery to individuals with type 2 diabetes (T2D). DESIGN: From a search conducted concurrently we extracted and evaluated the 50 most recently published DSME intervention studies. Based on an analysis of these studies, we undertook a concept analysis using the Walker and Avant framework. RESULTS: Five attributes describing the concept were recognized and organized into two groups. Group (a): skills related attributes that included (1) decision making, (2) problem solving and (3) taking action. Group (b): information related attributes that included (4) patient-provider interaction and (5) resource utilization. CONCLUSIONS: The outcomes of this study make the operational conceptualization of the ideal DSME intervention measurable through its attributes and hence clarifies its delivery. This will improve the implementation of the key attributes in diabetes self-management intervention programs for T2D.

Towards a better understanding of self-management interventions in type 2 diabetes: A meta-regression analysis.

AIMS: Attributes that operationally conceptualize diabetes self-management education (DSME) interventions have never been studied previously to assess their impact on relevant outcomes of interest in people with type 2 diabetes (T2D). The aim of this study was to determine the impact of existing interventions classified by their delivery of skills or information related attributes on immediate (knowledge), intermediate (physical activity), post-intermediate (HbA1c), and long-term (quality of life) outcomes in people with T2D. METHODS: PubMed, Embase, PsycINFO, and Cochrane Library/Cochrane CENTRAL as well as the grey literature were searched to identify interventional studies that examined the impact of DSME interventions on the four different outcomes. Eligible studies were selected and appraised independently by two reviewers. A meta-regression analysis was performed to determine the impact of delivery of the skills- and information-related attributes on the chosen outcomes. RESULTS: 142 studies (n = 25,511 participants) provided data, of which 39 studies (n = 5278) reported on knowledge, 39 studies (n = 8323) on physical activity, 99 studies (n = 17,178) on HbA1c and 24 studies (n = 5147) on quality of life outcomes. Meta-regression analyses demonstrated that skills-related attributes had an estimated effect suggesting improvement in knowledge (SMD [standardized mean difference] increase of 0.80; P = 0.025) and that information-related attributes had an estimated effect suggesting improvement in quality of life (SMD increase of 0.96; P = 0.405). Skill- and information-related attributes did not have an estimated effect suggesting improvement in physical activity or in HbA1c. CONCLUSIONS: The study findings demonstrate that the skills and information related attributes contribute to different outcomes for people with T2D. This study provides, for the first time, preliminary evidence for differential association of the individual DSME attributes with different levels of outcome.