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1.
J Clin Nurs ; 28(23-24): 4478-4487, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31410916

RESUMO

AIMS AND OBJECTIVES: To examine the effects of family functioning and resilience on self-management and glycaemic control among youth with type 1 diabetes and to determine whether resilience mediates the effects of family functioning on self-management and glycaemic control. BACKGROUND: Poor self-management and glycaemic control are common in youth with type 1 diabetes. Family functioning and resilience are known to be important psychosocial factors that contribute to individual health and development. However, no studies have explored the effects of family functioning and resilience on self-management and glycaemic control among youths with type 1 diabetes in mainland China. DESIGN: This study was conducted using a survey with a convenience sample following the STROBE guidelines. METHODS: A total of 204 Chinese youth who had been diagnosed with type 1 diabetes for at least 6 months were recruited. Family functioning, resilience, self-management and diabetes distress were measured using self-reports and standard measurement tools. Glycaemic control was assessed by glycated haemoglobin (HbA1C ) levels. A structural equation model was used to test the hypothesised model. RESULTS: The final model accounted for 52.1% and 19.5% of the total variance of self-management and HbA1C level, respectively. Resilience had a direct effect on self-management and an indirect effect on control of HbA1C . Family functioning had an indirect effect on both self-management and control of HbA1C through resilience. The model remained invariant across the mild-distress and severe-distress groups. CONCLUSION: In Chinese youth with type 1 diabetes, resilience positively affected self-management and ultimately optimised glycaemic control, even in the presence of diabetes distress. Family functioning positively affected self-management and glycaemic control by promoting resilience. RELEVANCE TO CLINICAL PRACTICE: This study found that family functioning and resilience had positive effects on self-management and glycaemic control in youth. This study confirms the importance of incorporating resilience assessments and family-based resilience interventions into clinical nursing practice with youth with type 1 diabetes.


Assuntos
Automonitorização da Glicemia/psicologia , Diabetes Mellitus Tipo 1/psicologia , Família/psicologia , Resiliência Psicológica , Autogestão/psicologia , Adolescente , Diabetes Mellitus Tipo 1/terapia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Autorrelato , Inquéritos e Questionários , Adulto Jovem
2.
Diabetes Educ ; 45(4): 380-396, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31195903

RESUMO

PURPOSE: The purpose of this study was to describe sociodemographic, clinical, and psychosocial correlates of diabetes self-care behaviors in adults with type 2 diabetes mellitus (T2D) and comorbid heart failure (HF). METHOD: Baseline data of 180 participants from a clinical trial that tested a 6-month integrated self-care intervention for persons with comorbid HF and T2D were analyzed. Correlational bivariate and multiple logistic regression analyses were performed to examine correlates of diabetes self-care behaviors. RESULT: Participants had a mean age of 58 ± 11years; the majority were male (n = 118, 66%) and African American (n = 119, 66%). Number of comorbidities >2 (P < .001), having more than a high school education (P < .05), and African American ethnicity (P < .05) predicted better exercise, self-monitoring blood glucose (SMBG), and foot care behaviors, respectively. The use of an aldosterone inhibitor (P < .05) predicted worse exercise performance, higher Charlson Comorbidity Index scores (P < .01) predicted worse SMBG, and treatment with diet plus medication (P < .05) and dyslipidemia (P < .001) predicted worse foot care. CONCLUSION: Findings from this study provide new insights into the complex self-care requirements for T2D patients with comorbid HF. Integrated self-care interventions are clearly warranted in persons living with multiple chronic conditions for optimal health outcomes and the prevention of complications. Our sample of predominately African American men showed they had better T2D self-care behaviors than whites than previously reported. Additional research is needed to determine racial and gender differences on health outcomes in persons with T2D and comorbid HF.


Assuntos
Diabetes Mellitus Tipo 2/psicologia , Insuficiência Cardíaca/psicologia , Autocuidado/psicologia , Afro-Americanos/psicologia , Idoso , Automonitorização da Glicemia/psicologia , Comorbidade , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/terapia , Dieta/psicologia , Exercício/psicologia , Feminino , Comportamentos Relacionados com a Saúde , Insuficiência Cardíaca/etnologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade
3.
Medicine (Baltimore) ; 98(22): e15849, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145334

RESUMO

The objective of this study was to examine the association between patient satisfaction with community health service (CHS) and self-management behaviors in patients with type 2 diabetes mellitus (T2DM).In all, 1691 patients with T2DM from 8 community health centers in 5 provinces in China participated in the present study. The dependent variables included 4 measures of self-management behaviors: regular self-monitoring of blood glucose (SMBG), prescribed medication adherence, recommended dietary changes, and regular exercise. The independent variable was patient satisfaction with CHS. Multivariable logistic regression models were performed to examine the association between patient satisfaction with CHS and self-management behaviors.The mean satisfaction score in the participants was 3.14 (out of a maximum of 5). After adjusting for covariates including demographic factors, health status, health knowledge, and socioeconomic status (SES), diabetic patients with high CHS satisfaction had better medication adherence (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.02-1.55), increased exercise management (OR 1.19, 95% CI 1.06-1.35), and more SMBG (OR 1.16, 95% CI 1.03-1.32); all these associations varied across SES groups. The association between satisfaction and medication adherence was significant among participants younger than 65 years with lower education (OR 2.15, 95% CI 1.37-3.37), income (OR 1.62, 95% CI 1.13-2.32), and lower-status occupations (OR 1.69, 95% CI 1.16-2.47). Among participants younger than 65 years and had lower education attainment, the association between satisfaction and diet management was observed. There were positive associations between satisfaction and regular exercise among subgroups of participants younger than 65 years, except for lower education group. A significant association between satisfaction and SMBG among participants ≥65 years old, who also had lower SES and higher-status occupations, was also observed.The study findings suggested that T2DM patient satisfaction with CHS was moderate. High satisfaction with CHS indicated better medication adherence, exercise management, and SMBG, and these associations varied by SES.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Diabetes Mellitus Tipo 2/epidemiologia , Satisfação do Paciente/estatística & dados numéricos , Autogestão/estatística & dados numéricos , Classe Social , Idoso , Glicemia/análise , Automonitorização da Glicemia/psicologia , Automonitorização da Glicemia/estatística & dados numéricos , China/epidemiologia , Centros Comunitários de Saúde , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autogestão/psicologia , Inquéritos e Questionários
4.
J Clin Nurs ; 28(17-18): 3318-3329, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31090960

RESUMO

AIMS AND OBJECTIVES: To describe positively and negatively perceived situations experienced by adults with type 1 diabetes using continuous glucose monitoring and the actions they take to deal with these situations. BACKGROUND: Real-time continuous glucose monitoring has been shown to improve glycaemic control and reduce hypoglycaemia. Although many patients with type 1 diabetes report great benefits when using continuous glucose monitoring, a substantial number discontinue using the device. Little is known about the different situations and experiences with the daily use of continuous glucose monitoring that contribute to such differences. DESIGN: A descriptive design based on the critical incident technique was used. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ) (see File S1). METHODS: Individual interviews were conducted with a purposive sample of 23 adults with type 1 diabetes, including current and former users of continuous glucose monitoring from four different outpatient clinics. RESULTS: The participants described that they felt that the use of continuous glucose monitoring was a balance between benefits and barriers, and how, through their actions, they tried to adapt their use of continuous glucose monitoring to fit their lifestyles. Various life events affected and altered the balance between benefits and barriers and thus affected their use of continuous glucose monitoring. CONCLUSIONS: Continuous glucose monitoring is perceived as an effective and important tool in the self-management of diabetes type 1. It enables a better everyday life and increased satisfaction with treatment. At the same time, the use of continuous glucose monitoring can be both demanding and challenging. RELEVANCE TO CLINICAL PRACTICE: Understanding the complex interplay between perceived benefits, treatment burden and adherence to continuous glucose monitoring use is important for nurses engaged in diabetes care. Education and support regarding the use of continuous glucose monitoring must be based on the understanding and perspectives of the patient to alleviate stress and barriers and enhance self-efficacy. As the use of continuous glucose monitoring can change over time, this must be a continuous process beyond initial training.


Assuntos
Automonitorização da Glicemia/psicologia , Diabetes Mellitus Tipo 1/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Pesquisa Qualitativa , Autogestão/psicologia
5.
J Fam Psychol ; 33(7): 788-796, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31021129

RESUMO

Emerging adulthood is a transitional period for type 1 diabetes management, and aspects of family functioning such as family conflict and responsibility for diabetes management likely change following high school graduation. This study examined changes in diabetes-specific family conflict, family responsibility for diabetes management tasks, and associations with glycemic control up to 1 year after high school. Seventy-nine emerging adults with type 1 diabetes (M age = 18.09 ± .43 years; 51% female; 71% Caucasian) and their parents (73% female) completed self-report measures on diabetes-specific family conflict and family responsibility at 3 consecutive clinic visits, beginning in the spring of their senior year of high school. Hemoglobin A1c (HbA1c) was obtained from medical records. Diabetes-specific family conflict was relatively low; scores did not significantly change from baseline to Time 3. Parent responsibility for diabetes care decreased from baseline to Time 3. Higher parent- and emerging adult-reported family conflict and higher parent responsibility for diabetes care were associated with worse glycemic control (ps < .05). Parent-reported family conflict and the interaction between parent-reported family conflict and responsibility predicted HbA1c 1 year after high school. Conversely, HbA1c did not predict diabetes-specific family conflict or responsibility 1 year after high school. Findings indicate that diabetes-specific family conflict is associated with glycemic control after high school, even when emerging adults assume greater responsibility for diabetes self-care. Diabetes-specific family conflict levels were generally low and did not change over time despite this transitional period. If diabetes-specific conflict is present, it should be an important avenue for potential intervention for emerging adults with type 1 diabetes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Automonitorização da Glicemia/estatística & dados numéricos , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 1/terapia , Conflito Familiar/psicologia , Cooperação do Paciente/estatística & dados numéricos , Autocuidado/estatística & dados numéricos , Adolescente , Adulto , Automonitorização da Glicemia/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Cooperação do Paciente/psicologia , Autocuidado/psicologia , Adulto Jovem
6.
JMIR Mhealth Uhealth ; 7(3): e11933, 2019 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-30843865

RESUMO

BACKGROUND: Technology has long been used to carry out self-management as well as to improve adherence to treatment in people with diabetes. However, most technology-based apps do not meet the basic requirements for engaging patients. OBJECTIVE: This study aimed to evaluate the effect of use frequency of a diabetes management app on glycemic control. METHODS: Overall, 2 analyses were performed. The first consisted of an examination of the reduction of blood glucose (BG) mean, using a randomly selected group of 211 users of the SocialDiabetes app (SDA). BG levels at baseline, month 3, and month 6 were calculated using the intercept of a regression model based on data from months 1, 4, and 7, respectively. In the second analysis, the impact of low and high BG risk was examined. A total of 2692 users logging SDA ≥5 days/month for ≥6 months were analyzed. The highest quartile regarding low blood glucose index (LBGI) and high blood glucose index (HBGI) at baseline (t1) was selected (n=74 for group A; n=440 for group B). Changes in HBGI and LBGI at month 6 (t2) were analyzed. RESULTS: For analysis 1, baseline BG results for type 1 diabetes mellitus (T1DM) groups A and B were 213.61 (SD 31.57) mg/dL and 206.43 (SD 18.65) mg/dL, respectively, which decreased at month 6 to 175.15 (SD 37.88) mg/dL and 180.6 (SD 40.47) mg/dL, respectively. For type 2 diabetes mellitus (T2DM), baseline BG was 218.77 (SD 40.18) mg/dL and 232.55 (SD 46.78) mg/dL, respectively, which decreased at month 6 to 160.51 (SD 39.32) mg/dL and 173.14 (SD 52.81) mg/dL for groups A and B, respectively. This represents a reduction of estimated A1c (eA1c) of approximately 1.3% (P<.001) and 0.9% (P=.001) for T1DM groups A and B, respectively, and 2% (P<.001) for both A and B T2DM groups, respectively. For analysis 2, T1DM baseline LBGI values for groups A and B were 5.2 (SD 3.9) and 4.4 (SD 2.3), respectively, which decreased at t2 to 3.4 (SD 3.3) and 3.4 (SD 1.9), respectively; this was a reduction of 34.6% (P=.005) and 22.7% (P=.02), respectively. Baseline HBGI values for groups A and B were 12.6 (SD 4.3) and 10.6 (SD 4.03), respectively, which decreased at t2 to 9.0 (SD 6.5) and 8.6 (SD 4.7), respectively; this was a reduction of 30% (P=.001) and 22% (P=.003), respectively. CONCLUSIONS: A significant reduction in BG was found in all groups, independent of the use frequency of the app. Better outcomes were found for T2DM patients. A significant reduction in LBGI and HBGI was found in all groups, regardless of the use frequency of the app. LBGI and HBGI indices of both groups tend to have similar values after 6 months of app use.


Assuntos
Automonitorização da Glicemia/instrumentação , Diabetes Mellitus/terapia , Aplicativos Móveis/normas , Adulto , Glicemia/análise , Automonitorização da Glicemia/métodos , Automonitorização da Glicemia/psicologia , Diabetes Mellitus/psicologia , Estudos de Avaliação como Assunto , Feminino , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Hipoglicemia/sangue , Hipoglicemia/diagnóstico , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Autogestão/métodos , Autogestão/psicologia
7.
Diabetes Technol Ther ; 21(3): 133-137, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30785768

RESUMO

BACKGROUND: There is limited published evidence regarding the psychological effect of use of continuous glucose monitoring (CGM) in the pediatric population with type 1 diabetes mellitus on metabolic control, fear of hypoglycemia, and patient or carer well-being. The aim of this study was to evaluate the effects of CGM on patient and carer well-being, worry, fear of hypoglycemia, and glycemic control. METHODS: Children aged >12 years independently completed the hypoglycemia fear survey (HFS). Parents and carers of children using CGM for a minimum of 12 months were asked to complete a modified version of the hypoglycemia fear survey for parents of young children (HFS-P) before and after CGM usage. RESULTS: Sixteen patients (8 boys) were included with median age of 13.5 years (2-17 years) and use of CGM for a minimum of 12 months. There was no significant improvement in the glycated hemoglobin after 12 months of CGM usage. Parents of all 16 patients completed the HFS-P survey. Of 12 young people eligible (age >12 years), 11 returned the HFS survey. Significant improvement was seen in both parental and patient fear of hypoglycemia after CGM (P < 0.001 and P = 0.003, respectively). CONCLUSION: The use of CGM did not show any significant improvement in glycemic control after 12 months; however, parental and children's fear of hypoglycemia and worry were significantly reduced after the use of CGM. Larger studies on the psychological effects of CGM are warranted.


Assuntos
Ansiedade/etiologia , Automonitorização da Glicemia/psicologia , Diabetes Mellitus Tipo 1/psicologia , Medo/psicologia , Hipoglicemia/psicologia , Adolescente , Glicemia/análise , Criança , Diabetes Mellitus Tipo 1/sangue , Feminino , Humanos , Hipoglicemia/etiologia , Masculino , Pais/psicologia
8.
Diabetes Technol Ther ; 21(3): 138-145, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30702335

RESUMO

BACKGROUND: The use of insulin pumps in pediatric patients with type 1 diabetes (T1D) has expanded; however, data comparing devices remain scarce. We compared glycemic control, technical difficulties, and quality of life (QOL) between pump devices of three companies. METHODS: This prospective observational trial is based on clinical data retrieved during 12 months of follow-up of pediatric patients who started pump therapy as part of their clinical care in four medical centers. The devices fully reimbursed by the national health insurance are as follows: MiniMed™ 640G, MiniMed® Veo™, Animas® Vibe®, and Abbott OmniPod®. Parameters investigated included discontinuation rate, glycated hemoglobin (HbA1c), mean self-monitoring of blood glucose (SMBG), total daily dose of insulin (TDD), pump setting parameters, body mass index (BMI), frequency of technical difficulties, significant skin reactions, and QOL. RESULTS: Of 113 children (mean age 9.1 ± 4.1 years, 46% females), 68 (60%) used Medtronic devices, 33 (29%) OmniPod, and 12 (11%) Animas devices. Twelve percent of the cohort stopped using the pump during the study period, with no difference according to device. There were no differences between groups regarding mean SMBG values (P = 0.86), insulin TDD (P = 0.24), BMI (P = 0.87), level of insertion site pain or local reaction (P = 0.51), technical problems (P = 0.66), and QOL (P = 0.38). Changes in HbA1c from study initiation to end were also not statistically significant for any of the devices: from 7.99% ± 1.14% to 7.93% ± 0.99% for Medtronic, from 7.71% ± 1.29% to 7.92% ± 1.38% for OmniPod, and from 8.75% ± 1.3% to 7.70% ± 1.33% for Animas (P = 0.63). CONCLUSIONS: Pump devices were comparable regarding glycemic control, weight gain, and satisfaction among pediatric patients with T1D.


Assuntos
Automonitorização da Glicemia/instrumentação , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/psicologia , Sistemas de Infusão de Insulina/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Adolescente , Glicemia/análise , Automonitorização da Glicemia/psicologia , Criança , Diabetes Mellitus Tipo 1/sangue , Feminino , Hemoglobina A Glicada/análise , Humanos , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Sistemas de Infusão de Insulina/psicologia , Masculino , Estudos Prospectivos , Qualidade de Vida
10.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(2): 206-211, 2019 Feb 06.
Artigo em Chinês | MEDLINE | ID: mdl-30744298

RESUMO

Objective: To evaluate the effect of a community-based intervention supporting type 2 diabetes mellitus patients in their self-management of the disease. Methods: This research was a randomized controlled trial conducted in communities in Fangshan District, Beijing, China. Adult patients with type 2 diabetes from 17 communities in 4 sub-district of Fangshan District were randomly assigned to either the intervention or control group. Participants in the intervention group participated in a three-month group-based diabetes self-management intervention service. Data were collected both in intervention and control group at baseline and after the intervention to evaluate the effect of the intervention. A questionnaire survey was completed by all participants to collect their demographic information, diabetes related health behaviors and skills. A physical examination and lab testing including height, weight, blood pressure, and waist circumference as well as HbA1c, fasting blood glucose, lipid profile were conducted before and after the intervention. Results: A total of 500 valid questionnaires were received, including 259 in the intervention group and 241 in the control group. Patients in the intervention group who learned how to conduct the self-monitoring of blood glucose increased from 56.76% (n=147) to 87.26% (n=226) after the intervention, higher than that of control group (63.07%, n=152) (P<0.001). 69.50% (n=180) patients in intervention group had blood glucose monitor at home, which was 60.62% (n=157) prior to the intervention and higher than that of control group (57.68%, n=139) (P=0.004). After the intervention, 3.09% (n=8) patients in intervention group ceased to take medicine by themselves, which was 16.22% (n=42) before the intervention, while the control group was 8.30% (n=20) after the intervention (P=0.009). Patients in the intervention group made significant improvements in implementing self monitoring on blood glucose (SMBG), which was increased from one day per week to 2 days per week, and foot self-examination, which increased from 2 days per week to 7 days per week. The body weight of patients in the intervention group reduced 1.62 kg on average after the intervention, while it increased 0.88 kg in the control group. Similar improvement was found in waist circumstance between the intervention and control group (-0.83 cm vs -0.16 m). There was a significant reduction on body weight and waist circumstance in the intervention group (P<0.05). Conclusion: The group activities focusing on people with type 2 diabetes resulted in improvement in their lifestyle and self management behaviors, as well as their body weight and waist circumstance.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Autogestão/psicologia , Autogestão/estatística & dados numéricos , Adulto , Pequim , Automonitorização da Glicemia/psicologia , Automonitorização da Glicemia/estatística & dados numéricos , Humanos , Avaliação de Programas e Projetos de Saúde
12.
J Clin Res Pediatr Endocrinol ; 11(2): 189-195, 2019 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-30701953

RESUMO

Objective: The aim of this study was to determine the prevalence of impaired hypoglycemia awareness (IHA) in children and adolescents with type 1 diabetes mellitus using a professional continuous glucose monitoring (CGM) system and to show the effect of structured education on glycemic variability (GV) in children and adolescents with IHA. Methods: Forty type 1 diabetic children and adolescents with a diabetes duration of at least five years were eligible for inclusion in this prospective, quantitative study. All subjects were asked about their history of being aware of the symptoms of hypoglycemia using a questionnaire. Professional CGM was conducted in all of the patients for six days. The frequency of IHA detected by comparison of CGM and logbook reports were analyzed. Patients with identified IHA underwent a structured training program. After three months, CGM was re-applied to patients with IHA. Results: The study was completed by 37 diabetic children and adolescents. After the initial CGM, nine patients (24.3%) were found to have had episodes of IHA. Area under the curve (AUC) for hypoglycemia and number of low excursions were; 1.81±0.95 and 8.33±3.60 for the IHA group at the beginning of the study. AUC for hypoglycemia was 0.43±0.47 after three months of structured education the IHA patients (p=0.01). Coefficient of variation which shows primary GV decreased significantly although unstable at the end of education in IHA patients (p=0.03). Conclusion: CGM is a valuable tool to diagnose IHA. IHA, GV and time in range can be improved by education-based intervention.


Assuntos
Biomarcadores/sangue , Automonitorização da Glicemia/estatística & dados numéricos , Diabetes Mellitus Tipo 1/sangue , Hipoglicemia/sangue , Hipoglicemia/prevenção & controle , Hipoglicemiantes/efeitos adversos , Educação de Pacientes como Assunto , Adolescente , Glicemia/análise , Automonitorização da Glicemia/psicologia , Automonitorização da Glicemia/normas , Criança , Diabetes Mellitus Tipo 1/tratamento farmacológico , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hipoglicemia/induzido quimicamente , Masculino , Prognóstico , Estudos Prospectivos , Medição de Risco
13.
Diabetes Technol Ther ; 21(3): 105-109, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30681363

RESUMO

BACKGROUND: Recent data demonstrating a lack of improvement in average hemoglobin A1c levels despite the increased use of insulin pumps and continuous glucose monitors (CGMs) suggest that patients are not using these technologies optimally. Suboptimal provider understanding of these devices may be a contributing factor. METHODS: We sought to assess fellows' knowledge, attitudes, and practices regarding insulin pumps and CGMs using a mixed-methods survey. We polled 42 pediatric endocrinology fellows and 69 attending physicians in pediatric endocrinology using items on a five-point Likert scale. RESULTS: Perceived fellow knowledge of insulin pumps and CGMs was only 3.6 ± 1.0 and 3.6 ± 0.9, respectively. Despite consensus about the need for pediatric endocrinologists to understand these technologies, only 14.7% of fellows reported the presence of a formal curriculum about these technologies at their institutions. Potential gaps identified in fellows' knowledge include general use and troubleshooting, advanced insulin pump features, infusion sets and dermatological complications, systematic approach to data, interpretation and application of CGM data, and keeping pace with technological advances. CONCLUSIONS: Our data suggest suboptimal fellow knowledge and understanding of insulin pumps and CGMs in pediatric type 1 diabetes management, which is likely attributable to inadequate education in fellowship training programs. The development of formal educational curricula targeting areas of weakness identified in this survey may improve clinician knowledge of these technologies and ultimately impact patient education and care.


Assuntos
Automonitorização da Glicemia/psicologia , Endocrinologia/educação , Sistemas de Infusão de Insulina/psicologia , Pediatria/educação , Estudantes de Medicina/psicologia , Adulto , Criança , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino
14.
Diabetes Technol Ther ; 21(3): 128-132, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30681379

RESUMO

BACKGROUND: Accuracy and feature sets of continuous glucose monitoring (CGM) systems may influence device utilization and outcomes. We compared clinical trial accuracy and real-world utilization and effectiveness of two different CGM systems. MATERIALS AND METHODS: Separately conducted accuracy studies of a fifth-generation and a sixth-generation CGM system involved 50 and 159 adults, respectively. For between-system performance comparisons, propensity score methods were utilized to balance cohort characteristics. Real-world outcomes were assessed in 10,000 anonymized patients who had switched from the fifth-generation to the sixth-generation system and had used connected mobile devices to upload data from both systems, allowing pairwise comparisons of device utilization and glucose concentration distributions. RESULTS: Propensity score-adjusted mean absolute relative differences for the fifth- and sixth-generation systems were 9.0% and 9.9%, and the percentages of values within ±20%/20 mg/dL were 93.1% and 92.5%, respectively. The sixth-generation system, but not the fifth-generation system, met accuracy criteria for interoperable CGM systems. Both systems had high real-world utilization rates (93.8% and 95.3% in the fifth- and sixth-generation systems, respectively). Use of the sixth-generation system was associated with fewer glucose values <55 mg/dL (<3.1 mmol/L) (0.7% vs. 1.1%, P < 0.001) and more values 70-180 mg/dL (3.9-10.0 mmol/L) (57.3% vs. 56.0%, P < 0.001) than the fifth-generation system. CONCLUSIONS: CGM performance outcomes can be compared through the propensity score analysis of clinical trial data and pairwise comparisons of real-world data. The systems compared here had nearly equivalent accuracy and utilization rates. Longer term biochemical and psychosocial benefits observed with the fifth-generation system are also expected with the sixth-generation system.


Assuntos
Automonitorização da Glicemia/instrumentação , Automonitorização da Glicemia/psicologia , Glicemia/análise , Diabetes Mellitus/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Diabetes Mellitus/sangue , Feminino , Humanos , Masculino , Pontuação de Propensão
15.
JMIR Mhealth Uhealth ; 7(1): e10321, 2019 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-30632972

RESUMO

BACKGROUND: As the increasing prevalence of type 2 diabetes mellitus has put pressure on health systems to appropriately manage these patients, there have been a growing number of mobile apps designed to improve the self-management of diabetes. One such app, BlueStar, has been shown to significantly reduce hemoglobin A1c (HbA1c) levels in small studies and is the first app in the United States to receive Food and Drug Administration approval as a mobile prescription therapy. However, the impact of the app across real-world population among different clinical sites and health systems remains unclear. OBJECTIVE: The primary objective of this study was to conduct a pragmatic randomized controlled trial of the BlueStar mobile app to determine if app usage leads to improved HbA1c levels among diverse participants in real-life clinical contexts. We hypothesized that this mobile app would improve self-management and HbA1c levels compared with controls. METHODS: The study consisted of a multicenter pragmatic randomized controlled trial. Overall, 110 participants randomized to the immediate treatment group (ITG) received the intervention for 6 months, and 113 participants randomized to the wait-list control (WLC) group received usual care for the first 3 months and then received the intervention for 3 months. The primary outcome was glucose control measured by HbA1c levels at 3 months. Secondary outcomes assessed intervention impact on patient self-management, experience of care, and self-reported health utilization using validated scales, including the Problem Areas in Diabetes, the Summary of Diabetes Self-Care Activities, and the EuroQol-5D. Intervention usage data were collected directly from the app. RESULTS: The results of an analysis of covariance controlling for baseline HbA1c levels did not show evidence of intervention impact on HbA1c levels at 3 months (mean difference [ITG-WLC] -0.42, 95% CI -1.05 to 0.21; P=.19). Similarly, there was no intervention effect on secondary outcomes measuring diabetes self-efficacy, quality of life, and health care utilization behaviors. An exploratory analysis of 57 ITG participants investigating the impact of app usage on HbA1c levels showed that each additional day of app use corresponded with a 0.016-point decrease in participants' 3-month HbA1c levels (95% CI -0.03 to -0.003). App usage varied significantly by site, as participants from 1 site logged in to the app a median of 36 days over 14 weeks (interquartile range [IQR] 10.5-124); those at another site used the app significantly less (median 9; IQR 6-51). CONCLUSIONS: The results showed no difference between intervention and control arms for the primary clinical outcome of glycemic control measured by HbA1c levels. Although there was low usage of the app among participants, results indicate contextual factors, particularly site, had a significant impact on overall usage. Future research into the patient and site-specific factors that increase app utilization are needed. TRIAL REGISTRATION: Clinicaltrials.gov NCT02813343; https://clinicaltrials.gov/ct2/show/NCT02813343 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02813343).


Assuntos
Diabetes Mellitus Tipo 2/psicologia , Aplicativos Móveis/normas , Autogestão/métodos , Adulto , Automonitorização da Glicemia/métodos , Automonitorização da Glicemia/psicologia , Diabetes Mellitus Tipo 2/terapia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Ensaios Clínicos Pragmáticos como Assunto , Autogestão/psicologia , Inquéritos e Questionários
16.
Can J Diabetes ; 43(1): 27-33, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30026045

RESUMO

OBJECTIVE: Intensive self-monitoring of blood glucose levels by patients with diabetes achieves optimal glucose control, hence reducing the likelihood of complications. METHODS: This is a prospective, cross-sectional study targeting adults with diabetes through community pharmacies and patient groups in Central and West London over a period of 10 weeks. RESULTS: In all, 195 adults with diabetes were included in the analysis of the results. When monitoring adherence was examined, 43.4% (n=33/76) of participants with type 1 diabetes reported that their health care professionals had asked them to monitor their blood glucose levels between 3 and 4 times per day; however, 10% of this group was not following their health-care professionals' directions. Participants with type 2 diabetes were asked the same question; 42.9% (n=51/119) were asked to monitor their blood glucose between 3 and 4 times a day, but only 2.5% (n=3/119) were following their health-care professionals' directions. When questioned about their reasons for poor adherence, the cohort indicated that it was due to the painful (29.2%, n=57/195), uncomfortable (33.8%, n=66/195) or inconvenient (36.9%, n=72/195) nature of testing. In addition, 75.3% (n=147/195) of the participants expressed their desire for a noninvasive monitoring device, and 74.3% (n=145/195) said they would be satisfied to use one of the preselected advanced technologies to monitor their blood glucose levels. CONCLUSIONS: The favoured advanced technology, selected by 49.7% (n=97/195) of participants, was the wristband. Statistical significance was seen between the type of diabetes and the device selected; patients with type 1 diabetes preferred contact lenses (p<0.05) and tattoos (p<0.0001), whereas participants with type 2 diabetes preferred earlobe sensors (p<0.0001) and saliva analyzers (p<0.0001). Participants' gender, age and ethnicity also influenced device selection.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 2/sangue , Invenções , Participação do Paciente , Percepção , Adulto , Automonitorização da Glicemia/psicologia , Automonitorização da Glicemia/tendências , Estudos Transversais , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Participação do Paciente/psicologia , Estudos Prospectivos , Inquéritos e Questionários , Adulto Jovem
17.
Diabetes Metab Res Rev ; 35(1): e3067, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30144264

RESUMO

AIM: To investigate the association between structured self-monitoring of blood glucose (SMBG) and diabetes self-efficacy in Chinese patients. METHODS: This study was a single-centre, open-label, prospective, randomized controlled trial. A total of 250 type 1 and type 2 diabetes patients were recruited and randomly assigned to the structured SMBG group and the control group in a 1:1 ratio. The main outcome observed in this subgroup analysis was a change in the diabetes self-efficacy scale (DSES) scores. A multivariate generalized estimating equation was used to evaluate factors affecting the DSES scores. RESULTS: We found that the DSES scores tended to decrease significantly with the follow-up time in the intervention group (Wald ß = 7.882, P < .001; Wald ß = 3.130, P = .003; Wald ß = 7.879, P < .001). However, no significant differences in the DSES scores were detected in the control group. Glycaemic control improved in both the intervention and control groups at the third month (P < .05). In the intervention group, sustained improvement of the DSES scores maintained the improvement in glycaemic control through the sixth month. In the control group, glycaemic control tended to deteriorate in the sixth month without the support of an improved DSES scores (P = .056). CONCLUSION: Structured SMBG could contribute to the effective and persistent improvement of diabetes self-efficacy. (ClinicalTrials.gov, NCT02225691).


Assuntos
Automonitorização da Glicemia/psicologia , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/psicologia , Autoeficácia , Idoso , Glicemia , China , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 2/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida
18.
J Clin Res Pediatr Endocrinol ; 11(2): 118-124, 2019 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-30282617

RESUMO

Objective: While past research found family conflict, disordered eating, body image concerns and anxious self-doubts may affect adolescent diabetic glucose control, available measures of adherence mainly focus on management tasks. The current study aimed to combine measures of emotional distress and beliefs with decisions concerning management in a new measure of resistance to treatment adherence: the 12-item Glucose Control Resistance Scale (GCRS). Methods: Participants included 135 adolescents and their parents from a pediatric diabetes clinic. Family conflict, body image concerns, anxious self-doubts and glucose control resistance were assessed. Results: Factor analysis identified 12 items, with loadings of ≥0.40, which were used to form the GCRS. The scale had adequate reliability and there was a significant correlation between child and parent GCRS scores. One factor, family conflict, was significantly related to hemoglobin A1c (HbA1c) levels, but a set of four factors explained a total of 12% of the variance in HbA1c levels. Of the demographic variables considered (gender, number of parents at home, age, body mass index z-score), only gender was significantly associated with adolescent perceptions of family conflict. Conclusion: The GCRS may allow diabetic care teams to better understand the origin of family conflict perceptions and the motivational beliefs that modify behavior and contribute to independent self-management and glucose control. Each question was designed to be meaningful in interventions by addressing common items of resistance to adherence and impulsive management decisions. The GCRS may be used by providers as an initial short screening survey on an annual or semi-annual basis.


Assuntos
Automonitorização da Glicemia/psicologia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/psicologia , Hipoglicemiantes/uso terapêutico , Relações Pais-Filho , Educação de Pacientes como Assunto , Adolescente , Adulto , Biomarcadores/análise , Glicemia/análise , Cuidadores , Criança , Diabetes Mellitus Tipo 1/sangue , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Humanos , Masculino , Pais/psicologia , Cooperação do Paciente , Prognóstico , Estresse Psicológico , Inquéritos e Questionários , Adulto Jovem
19.
Diabetes Educ ; 44(6): 489-500, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30295170

RESUMO

PURPOSE: The purpose of this study was to evaluate relationships between behavioral and psychosocial constructs, A1C, and diabetes-dependent quality of life (DQoL) among low-socioeconomic status, ethnically diverse young adults with diabetes. METHODS: Using baseline data of 81 participants in the Resilient, Empowered, Active Living (REAL) randomized controlled trial, behavioral, cognitive, affective, and experiential variables were correlated with A1C and DQoL while adjusting for demographic characteristics, and these relationships were examined for potential effect modification. RESULTS: The data indicate that depressive symptoms and satisfaction with daily activities are associated with both A1C and DQoL, while diabetes knowledge and participation in daily activities are associated with neither A1C nor DQoL. Two constructs, diabetes distress and life satisfaction, were associated with DQoL and were unrelated to A1C, while 2 constructs, self-monitoring of blood glucose and medication adherence, were associated with A1C but unrelated to DQoL. These relationships were largely unchanged by adjusting for demographic characteristics, while numerous effect modifications were found. CONCLUSION: The data suggest that when tailoring interventions, depressive symptoms and satisfaction with daily activities may be particularly fruitful intervention targets, as they represent modifiable risk factors that are associated with both A1C and DQoL.


Assuntos
Complicações do Diabetes/psicologia , Diabetes Mellitus/sangue , Diabetes Mellitus/psicologia , Hemoglobina A Glicada/análise , Qualidade de Vida , Adolescente , Adulto , Automonitorização da Glicemia/psicologia , Efeitos Psicossociais da Doença , Depressão/etiologia , Feminino , Humanos , Masculino , Adesão à Medicação , Fatores de Risco , Classe Social , Estresse Psicológico/etiologia , Adulto Jovem
20.
J Diabetes Sci Technol ; 12(6): 1125-1131, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30288999

RESUMO

AIMS: Closed-loop insulin delivery has the potential to improve day-to-day glucose control in type 1 diabetes pregnancy. However, the psychosocial impact of day-and-night usage of automated closed-loop systems during pregnancy is unknown. Our aim was to explore women's experiences and relationships between technology experience and levels of trust in closed-loop therapy. METHODS: We recruited 16 pregnant women with type 1 diabetes to a randomized crossover trial of sensor-augmented pump therapy compared to automated closed-loop therapy. We conducted semistructured qualitative interviews at baseline and follow-up. Findings from follow-up interviews are reported here. RESULTS: Women described benefits and burdens of closed-loop systems during pregnancy. Feelings of improved glucose control, excitement and peace of mind were counterbalanced by concerns about technical glitches, CGM inaccuracy, and the burden of maintenance requirements. Women expressed varied but mostly high levels of trust in closed-loop therapy. CONCLUSIONS: Women displayed complex psychosocial responses to day-and-night closed-loop therapy in pregnancy. Clinicians should consider closed-loop therapy not just in terms of its potential impact on biomedical outcomes but also in terms of its impact on users' lives.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 1 , Sistemas de Infusão de Insulina , Insulina/administração & dosagem , Gravidez em Diabéticas , Adulto , Automonitorização da Glicemia/instrumentação , Automonitorização da Glicemia/psicologia , Ritmo Circadiano , Efeitos Psicossociais da Doença , Estudos Cross-Over , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/psicologia , Feminino , Humanos , Sistemas de Infusão de Insulina/psicologia , Entrevistas como Assunto , Satisfação do Paciente , Gravidez , Gravidez em Diabéticas/sangue , Gravidez em Diabéticas/tratamento farmacológico , Gravidez em Diabéticas/psicologia , Medição de Risco , Confiança
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