Increased knowledge levels of patients with diabetes in resource-limited communities after receiving peer-led education.

Diabetes self-management education through peer support has been beneficial, especially in regions with limited medical resources. Studying the effects of education offered by trained peers of patients will facilitate tailoring the peer-led education programs to the regions' specific needs. Here, we evaluated changes in diabetes-related indicators in Filipino patients who received a peer-led education. We used data on 23 patients (age, 67.83 ± 6.69 years; 82.6% female) who participated in all five surveys performed every 6 months from March 2017 to March 2019. After the second survey until the end of this study, the participants were educated in diabetes self-management by their 13 peers who previously had received the training in diabetes self-management. Participants' knowledge of diabetes and the related 'cause, risk factors, nature of diabetes and complications' subindicator were greater on all surveys after starting the peer-led education compared with those on the second survey (i.e. before starting the education); these values did not differ between the first two surveys. Because increasing patients' knowledge can enhance their ability to self-manage their disease and thus improve their quality of life, strategies to expand patients' knowledge about diabetes should be included when organizing peer-led education in regions with limited medical resources.

Cognitive and Emotional Changes in Peer Educators of Type 2 Diabetes Patients After Starting Peer-Support Activities.

Background: Diabetes self-management education through peer support has beneficial effects, especially in regions with limited medical resources. To ensure peer educators continue to provide peer-led education programs, it is important that they remain motivated to instruct patients. Here, to explore measures to enhance peer-educators' motivation toward such programs, we examined the cognitive and emotional changes in Filipino type 2 diabetics after 7-month activities as peer educators. Methods: We individually performed semi-structured interviews with 13 peer educators with 20 years of age or above in August 2017 (immediately before starting their peer-education activities) and in March 2018 (7 months after the start). The first interview was performed after the peer educators had received 2-day training of diabetes self-management. In both interviews, we asked the peer educators about their feelings toward peer-led educational activities (e.g., satisfaction, difficulty, reward, confidence, and challenges). Their replies about their own cognition and emotions were interpreted and integrated, and then analyzed qualitatively. Results: Four and seven categories were extracted from the first and second interviews, respectively. The category "Cognition of patients' active learning attitudes and of positive changes in patients' physical conditions and behavior" observed in the second interview led to "Cognition of growth as a peer educator" and "Satisfaction with supporting patients as a peer educator." These two feelings gave the peer educators' "Increased motivation to continue the activities as a peer educator." This motivation was also associated with "Active collaboration among peer educators," which was affected by "Difficulties and concerns in working as a peer educator." Conclusion: To sustain diabetic peer-led education programs, we suggest that interventions be implemented that increase peer educators' motivation toward their activities and stimulate their awareness of the importance of collaborating with one another. Such collaboration should help to overcome the difficulties they may face in providing peer-led education.

Physical Function and Low Back Pain in Leek Farmers: A Comparison with Non-Farmers.

Background: The purpose of this study was to investigate the low back pain (LBP) and physical function of young to middle aged farmers of leeks in western Tottori Prefecture. Methods: Fifteen farmers (55 years old or younger) cultivating leeks in western Tottori Prefecture were recruited as the subjects, and 14 non-farmers matching the age and sex of the subjects were recruited as the control group. A questionnaire survey was conducted to determine the presence or absence of LBP, smoking, and alcohol consumption. Physical functions were measured by anthropometry (body fat percentage and muscle mass), Finger-Floor distance (FFD), back muscle strength, and upper body bending, and lumbar muscle cross-sectional area (CSA) was evaluated by magnetic resonance imaging (MRI). Results: Weight, BMI, body fat percentage, upper body bending, back muscle strength, and L3/4 iliocostalis lumborum CSA, current LBP were significantly higher in the leek farmer group. One-way analysis of variance showed significant differences in upper body bending, and history of LBP. Conclusion: LBP was more common among leek farmers. The characteristics of leek farmers with LBP were history of LBP.

Effects of a Self-efficacy Theory-Based Training Program for Peers of Patients with Type 2 Diabetes.

BACKGROUND: Training peer leaders to deliver patient education is expected to be a low-cost approach to providing healthcare in urban-poor areas affected by a shortage of healthcare professionals. The purpose of this study was to examine the effects of a training program on the self-efficacy and knowledge of peer leaders with type 2 diabetes. METHODS: A single-group longitudinal survey with baseline, intervention, and follow-up periods was conducted at a diabetes clinic in a small municipality in Metro Manila, Philippines. The intervention, a self-efficacy theory-based training program for peer-leaders of diabetic patients conducted in August 2017, comprised hands-on learning, demonstrations, quizzes, role-playing, group sharing, physical exercise, and a buffet lunch. The primary outcome was participants' self-efficacy for management of their diabetes. Secondary outcomes were participants' knowledge of diabetes and levels of emotional distress, motivation, and confidence for guiding their peers, satisfaction with the training program, hemoglobin A1c, and quality of life. RESULTS: At 12 and 18 months after the intervention, participants' knowledge of diabetes was significantly increased compared with baseline (both P < 0.05). At earlier time points, an increasing, but not significant, trend was observed. The change in knowledge of diabetes from baseline to 18 months after intervention tended to be positively correlated with the change in self-efficacy (r = 0.594, P = 0.054). No significant differences were observed for any of the other outcomes, although the descriptive statistics showed an increasing trend for all of the outcomes except motivation. CONCLUSION: The training program significantly improved participants' knowledge of diabetes at 12 and 18 months after the training programs compared with baseline. A positive correlation between the changes in the levels of knowledge and self-efficacy suggested that the observed improvement of self-efficacy was facilitated by the improvement of knowledge of diabetes.

Association between dental caries indicators and serum glycated hemoglobin-levels among patients with type 2 diabetes mellitus.

Diabetes mellitus (DM) with poor glycemic control is often linked to oral manifestations. This study aimed to investigate the association between dental caries (DC) and glycated hemoglobin (HbA1c) among patients with type 2 DM (T2DM). A health center-based cross-sectional study was conducted comprising 91 eligible patients with T2DM (21 males and 70 females) with a mean age (± standard deviation) of 61.49 ± 9.71 years. A structured interview, screening for DM-related factors, and oral examination were performed. Serum HbA1c levels were used as an index for glycemic control. A comparison between patients with controlled T2DM, i.e., HbA1c ≤7.0% (n = 46), and uncontrolled T2DM, i.e., HbA1c >7.0% (n = 45), showed significant differences in mean values of decayed teeth (DT) (P = 0.045); missing teeth (P = 0.002); and decayed, missing, and filled teeth (DMFT) index (P < 0.001). Results of multiple linear regression analysis revealed that the number of DT was significantly correlated with serum HbA1c levels (95% confidence interval [CI] 0.173 to 0.972, P = 0.005). Furthermore, DMFT index values and serum HbA1c levels (95% CI 0.532 to 1.658, P < 0.001) showed a significant association. This study provides substantial evidence on the association between DC indicators and serum HbA1c levels.

A Conceptual Model for Quality of Life Among People with Type 2 Diabetes in the Philippines.

BACKGROUND: The increased prevalence of chronic diseases is a social issue in developing countries. METHODS: To create a conceptual model representing the quality of life of low-income people with type 2 diabetes in the Philippines, 117 low-income adult participants in a public support group were studied, and the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores on quality of life (QOL) were analyzed in terms of their relationships with the following factors: basic attributes, physical factors (glycated hemoglobin level, complications, comorbidities, and symptoms), social factors (support, education, and financial status), and cognitive factors (knowledge, attitude, self-efficacy, and self-management behavior). RESULTS: Based on correlation coefficients among variables and goodness-of-fit test results through a path analysis, 2 models representing causal relationships were created, both of which showed sufficient goodness-of-fit. CONCLUSION: Glycated hemoglobin levels, knowledge of blood glucose levels, self-efficacy, and self-management behavior (exercise) influenced PCS scores, while age, glycated hemoglobin levels, neuropathy, knowledge of insulin, self-efficacy, and self-management behavior (exercise) influenced MCS scores. The influence of self-efficacy was prominent in both cases, providing an important insight for healthcare professionals to develop effective support methods.

Accelerometry-based gait analysis predicts falls among patients with a recent fracture who are ambulatory: a 1-year prospective study.

The aim of this prospective study was to assess whether accelerometry-based gait analysis is associated with the incidence of falls among individuals who are ambulatory and recently had a fracture, and to compare the ability to discriminate body function and structure and activity measures. A total of 100 patients who fulfilled our inclusion criteria were enrolled. At hospital discharge, the following outcomes were assessed: timed-up-and-go test, five-times-sit-to-stand test, one-leg standing test, 5-m gait test, and gait analysis using a wireless three-axis accelerometer. Root mean square (RMS) and autocorrelation (AC) values were analyzed on the basis of the acceleration waveform. Follow-up assessment of falls and subsequent fractures was performed 12 months after the fracture. Eighty-five percent of the participants completed the follow-up at 12 months. During the 12 months of follow-up, 61 falls were reported by 34 patients (31 women, three men), for a fall rate of 40.0% (34/85). The fall group had significantly poorer body function and structure and activity measures compared with the no-fall group. In accelerometry-based gait analysis, RMS and AC in the vertical axis and RMS in the anteroposterior axis were significantly lower in the fall group compared with the no-fall group. Multivariate logistic regression analysis showed that only AC in the vertical axis was a significant predictor of falls. This finding suggests that trunk acceleration AC in the vertical axis showed good discriminative ability for predicting the incidence of falls among patients who are ambulatory and recently had a fracture.