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1.
Artigo em Inglês | MEDLINE | ID: mdl-33431602

RESUMO

INTRODUCTION: Lockdown measures have a profound effect on many aspects of daily life relevant for diabetes self-management. We assessed whether lockdown measures, in the context of the COVID-19 pandemic, differentially affect perceived stress, body weight, exercise and related this to glycemic control in people with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS: We performed a short-term observational cohort study at the Leiden University Medical Center. People with type 1 and type 2 diabetes ≥18 years were eligible to participate. Participants filled out online questionnaires, sent in blood for hemoglobin A1c (HbA1c) analysis and shared data of their flash or continuous glucose sensors. HbA1c during the lockdown was compared with the last known HbA1c before the lockdown. RESULTS: In total, 435 people were included (type 1 diabetes n=280, type 2 diabetes n=155). An increase in perceived stress and anxiety, weight gain and less exercise was observed in both groups. There was improvement in glycemic control in the group with the highest HbA1c tertile (type 1 diabetes: -0.39% (-4.3 mmol/mol) (p<0.0001 and type 2 diabetes: -0.62% (-6.8 mmol/mol) (p=0.0036). Perceived stress was associated with difficulty with glycemic control (p<0.0001). CONCLUSIONS: An increase in perceived stress and anxiety, weight gain and less exercise but no deterioration of glycemic control occurs in both people with relatively well-controlled type 1 and type 2 diabetes during short-term lockdown measures. As perceived stress showed to be associated with glycemic control, this provides opportunities for healthcare professionals to put more emphasis on psychological aspects during diabetes care consultations.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 2/sangue , Exercício Físico/fisiologia , Ganho de Peso/fisiologia , Adulto , Idoso , Automonitorização da Glicemia/psicologia , Automonitorização da Glicemia/tendências , /psicologia , Estudos de Coortes , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/psicologia , Exercício Físico/psicologia , Feminino , /tendências , Humanos , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar/tendências , Comportamento Sedentário
2.
Medicine (Baltimore) ; 99(51): e23793, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371150

RESUMO

ABSTRACT: To compare pregnancy outcomes between patients with gestational diabetes mellitus (GDM) with and without their own blood glucose meter.We conducted a retrospective-cohort study of 835 women with GDM at the Second Hospital of Tianjin Medical University, Tianjin, China from 1 January 2016 to 31 December 2018. Perinatal outcomes of these patients were monitored and collected in the Tianjin Maternal and Child Health System. Each patient was advised by a certified clinical nutritionist regarding dietary analysis and lifestyle recommendations. All pregnant women with GDM were divided into the following 2 groups according to whether they had their own blood glucose meter: women with self-measured blood glucose levels with a routine obstetric examination in the study group (n = 424); and those with non-self-measured blood glucose levels with a double obstetric examination in the control group (n = 411). Maternal and fetal pregnancy outcomes were compared between these 2 groups. According to different self-management modes, the women were also divided into eight subgroups to compare blood sugar control and compliance with recommended insulin therapy.The cesarean section rate was significantly lower in the study group than in the control group (P < .05). The prevalence of large-for-gestational age (P < .05) and macrosomia was significantly lower in the study group than in the control group (both P < .05). The prevalence of appropriate-for-gestational age was significantly higher in the study group than in the control group (P < .05). Birth weight was significantly lower in the study group than in the control group (P < .05). The mean times for blood sugar control and from the doctor recommendation for insulin treatment to the patient compliance in the study group were significantly shorter than those in the control group (both P < .05). The proportion of insulin required in the study group was significantly lower than that in the control group (P < .05). There were no significant differences in the time of controlling blood sugar and compliance among the 4 subgroups of the study group. However, subgroups with a dietary diary in the control group were better.Self-monitoring blood sugar plus a routine obstetric examination can help patients with GDM control blood sugar, even without dietary diaries and treadmills. In addition to increasing the number of obstetric examinations, recording dietary diaries is helpful for controlling blood sugar in patients with GDM who are unwilling to measure blood sugar by themselves.


Assuntos
Automonitorização da Glicemia/instrumentação , Diabetes Gestacional/terapia , Resultado da Gravidez/psicologia , Adulto , Glicemia/análise , Automonitorização da Glicemia/psicologia , Automonitorização da Glicemia/normas , China , Estudos de Coortes , Diabetes Gestacional/sangue , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Estudos Retrospectivos
3.
Diabetes Metab Syndr ; 14(4): 579-582, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32416527

RESUMO

AIM: The management of diabetes has become a challenge due to the COVID 19 lockdown. An online-based pilot survey was conducted to study how people with diabetes were coping with their Diabetes during the COVID - 19 lockdown. METHOD: The questions were designed in an online survey, Survey Monkey, to conduct this cross-sectional study. The link was generated and sent to 100 registered patients of the MV Hospital for Diabetes Royapuram who had not contacted the hospital after the lockdown announcement. The survey was done between April 1 and April 15, 2020.Oral consent was obtained through telephone before the link was sent by Whatsapp to them.The questionnaire consisted of questions on home blood glucose monitoring, regularity in doing their physical activity and dietary compliance and anxiety about the viral infection. RESULTS: 92% of the participants had Type 2 diabetes. Only 28% of the participants were checking their blood glucose levels regularly. 80% of the participants mentioned that they were following regular exercise and diet control during the lockdown period. 40% of the participants were anxious about the Covid infection. CONCLUSION: SMBG needs to be practiced on regular basis, especially among the patients with diabetes on insulin therapy. Most of the people surveyed were coping well with their Diabetes. Patients have reported that they were able to maintain proper dietary compliance and be more physically active at home during this lockdown. These findings need to be ascertained in larger sample of patients.


Assuntos
Automonitorização da Glicemia/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/psicologia , Pandemias/prevenção & controle , Cooperação do Paciente/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Quarentena/psicologia , Adaptação Psicológica , Adolescente , Adulto , Idoso , Ansiedade , Betacoronavirus , Automonitorização da Glicemia/psicologia , Criança , Pré-Escolar , Estudos Transversais , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , Projetos Piloto , Adulto Jovem
4.
Curr Diab Rep ; 20(6): 21, 2020 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-32323022

RESUMO

PURPOSE OF REVIEW: Emerging adulthood (ages 18-29) presents many emotional, social, and developmental challenges that can contribute to an increased sense of burden when managing type 1 diabetes (T1D). Diabetes distress (DD) is the concept that captures the emotional burden, frustrations, and worries resulting from living with T1D. This integrative review sets out to examine the impact of developmental context by answering this question: How do the challenges of emerging adulthood inform our understanding of DD? RECENT FINDINGS: DD is highly prevalent in emerging adults and occurs at higher rates than in other age groups. Qualitative studies reveal that DD is embedded within the developmental challenges specific to living with T1D during this stage. Quantitative studies reveal the prevalence and correlates of DD in this age group, and qualitative studies augment these findings by capturing the scope and complexity of the emotional burden of living with T1D as an emerging adult.


Assuntos
Diabetes Mellitus Tipo 1/psicologia , Autogestão/psicologia , Transição para Assistência do Adulto , Adaptação Psicológica , Adolescente , Adulto , Glicemia/análise , Automonitorização da Glicemia/psicologia , Estudos de Coortes , Estudos Transversais , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/terapia , Feminino , Humanos , Masculino , Autonomia Pessoal , Projetos Piloto , Qualidade de Vida , Estresse Psicológico , Adulto Jovem
5.
J Clin Nurs ; 29(13-14): 2572-2588, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32279366

RESUMO

AIMS AND OBJECTIVES: To describe individuals' with type 2 diabetes mellitus sense-making of blood glucose data and other influences impacting self-management behaviour. BACKGROUND: Type 2 diabetes mellitus prevalence is increasing globally. Adherence to effective diabetes self-management regimens is an ongoing healthcare challenge. Examining individuals' sense-making processes can advance staff knowledge of and improve diabetes self-management behaviour. DESIGN: A qualitative exploratory design examining how individuals make sense of blood glucose data and symptoms, and the influence on self-management decisions. METHODS: Sixteen one-on-one interviews with adults diagnosed with type 2 diabetes mellitus using a semi-structured interview guide were conducted from March-May 2018. An inductive-deductive thematic analysis of data using the Sensemaking Framework for Chronic Disease Self-Management was used. The consolidated criteria for reporting qualitative research (COREQ) checklist were used in completing this paper. RESULTS: Three main themes described participants' type 2 diabetes mellitus sense-making and influences on self-management decisions: classifying blood glucose data, building mental models and making self-management decisions. Participants classified glucose levels based on prior personal experiences. Participants learned about diabetes from classes, personal experience, health information technology and their social network. Seven participants expressed a need for periodic refreshing of diabetes knowledge. CONCLUSION: Individuals use self-monitored glucose values and/or HbA1C values to evaluate glucose control. When using glucose values, they analyse the context in which the value was obtained through the lens of personal parameters and expectations. Understanding how individuals make sense of glycaemic data and influences on diabetes self-management behaviour with periodic reassessment of this understanding can guide the healthcare team in optimising collaborative individualised care plans. RELEVANCE TO CLINICAL PRACTICE: Nurses must assess sense-making processes in self-management decisions. Periodic "refresher" diabetes education may be needed for individuals with type 2 diabetes mellitus.


Assuntos
Automonitorização da Glicemia/psicologia , Diabetes Mellitus Tipo 2/terapia , Autogestão/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Pesquisa Qualitativa
6.
Curr Diab Rep ; 20(3): 10, 2020 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-32080765

RESUMO

PURPOSE OF REVIEW: Diabetes is a chronic disease that, regardless of type, requires intensive, ongoing self-management. As a result, people with diabetes (PWD) often have complex environmental, social, behavioral, and informational needs, many of which are unmet in healthcare settings and systems. To help meet these needs, many PWD interact with diabetes online communities (DOCs), including platforms such as Facebook, Twitter, and blogs, to share real-life support, problems, and concerns with other PWD, offering a rich source of data on patient-reported outcomes. This article reviews recent psychosocial needs and outcomes identified by studies of DOCs and/or their users. RECENT FINDINGS: Participation in DOCs appears driven by a need for psychosocial support, unmet by providers and the healthcare system, as well as a sense of duty to provide it to others. The most common activities observed in DOCs are giving and receiving various types of support: psychosocial, technical, informational, and self-management. General and specific challenges (e.g., continuous glucose monitoring) as well as frustrations and worries associated with those challenges are commonly expressed, leading to reciprocal sharing, support, and encouragement, in a judgment-free manner, from other PWD. This leads users to feel more understood, empowered, validated, less alone, and more supported. Negative findings were reported very rarely and focused more on how other participants used social media rather than on the exchange of misplaced or dangerous information or advice. Diabetes online communities have grown from unmet needs for problem-solving and psychosocial support for living with a complex condition and from the availability of a new communications medium (i.e., social media). This has enabled communities of peers to both seek and receive support for living with diabetes, providing an important supplement to what is provided in healthcare settings and offering valuable information about what is most important to PWD and their families, with the potential to improve psychosocial care.


Assuntos
Cuidadores/psicologia , Diabetes Mellitus/psicologia , Mídias Sociais , Automonitorização da Glicemia/métodos , Automonitorização da Glicemia/psicologia , Diabetes Mellitus/terapia , Humanos , Autogestão , Apoio Social
7.
Curr Diabetes Rev ; 16(8): 874-880, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31057119

RESUMO

BACKGROUND: Technological developments concerning the treatment of Type 1 Diabetes Mellitus have been rapid in the latest years. Insulin infusion systems along with continuous glucose monitoring, as well as long-acting insulin analogues, are part of this progress. OBJECTIVE: The aim of this study is to present the illness perceptions in type 1 diabetes mellitus, with or without the use of an insulin pump. Sexual life and body image among therapy groups subjected to subcutaneous insulin infusion (CSII) therapy and multiple daily injections (MDI) therapy were also examined. METHODS: A modified version of the Brief Illness Perception Questionnaire was used. One hundred and nine adults with type 1 diabetes mellitus, (males / females ratio 1:2.3) completed the online survey. Thirty six of them (33%) used CSII therapy and 73 of them (67%) used MDI therapy. RESULTS: Statistically important differences among the CSII and MDI therapy groups were found in treatment control, illness comprehensibility, representations of control, representation of body image and in the perception of sex life. There was no statistically significant difference among the different types of therapy for participants' negative perception of diabetes. DISCUSSION AND CONCLUSION: Negative perceptions of MDI users in treatment control, illness comprehensibility, representations of control, body image and sex life with the insulin pump, differentiate CSII and MDI therapy groups to a significant degree. According to the research, these parameters seem to interfere with accepting CSII therapy for MDI users and discourage them.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/psicologia , Hipoglicemiantes/administração & dosagem , Sistemas de Infusão de Insulina , Adulto , Atitude Frente a Saúde , Glicemia/análise , Automonitorização da Glicemia/psicologia , Diabetes Mellitus Tipo 1/sangue , Feminino , Hemoglobina A Glicada/análise , Humanos , Injeções Subcutâneas/psicologia , Insulina/administração & dosagem , Sistemas de Infusão de Insulina/psicologia , Internet , Masculino , Pessoa de Meia-Idade , Percepção , Autogestão/métodos , Autogestão/psicologia , Inquéritos e Questionários , Adulto Jovem
8.
Intern Med J ; 50(1): 70-76, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31081194

RESUMO

BACKGROUND: Psychosocial assessment should be part of clinic visits for people with diabetes mellitus (DM). AIMS: To assess the usage and acceptance of a diabetes psychosocial assessment tool (DPAT) and to profile the clinical and psychosocial characteristics of young people with diabetes. METHODS: Over a 12-month period, young adults (18-25 years) attending diabetes clinic were offered DPAT. The tool embeds validated screening tools including the Problem Areas in Diabetes 20 (PAID-20) questionnaire, the Patient Health Questionnaire-4 (PHQ-4) and the World Health Organization Well-Being Index-5 (WHO-5). Baseline clinical data were collected and questions regarding social support, body image, eating concerns, hypoglycaemia and finances were included. RESULTS: Over the 12 month, the form was offered to 155 participants (64.6% of eligible attendees). The majority (96.1%) had type 1 DM with a mean duration of 10.5 (±5.3 SD) years. Average glycated haemoglobin (HbA1c) was 8.7% (±1.5 SD) (or 71.2 mmol/mol ±16.5 SD). Severe diabetes-related distress (PAID-20 ≥ 40) was found in 19.4%. Low WHO-5 scores (28-50 points) were seen in 14.8%. PHQ-4 identified 25.8% with anxiety and 16.1% with depression. Significant weight, shape and eating concerns were identified in 27.1, 26.6 and 28.4%, respectively. Serious hypoglycaemia concerns were raised by 4.5%. CONCLUSION: DPAT revealed a high prevalence of psychosocial stress among young adults with DM. The tool was easy to use and accepted by patients and may aid streamlining referrals to relevant members of a multidisciplinary team.


Assuntos
Depressão/diagnóstico , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 1/terapia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Hipoglicemia/psicologia , Estresse Psicológico/diagnóstico , Adolescente , Adulto , Austrália , Automonitorização da Glicemia/psicologia , Automonitorização da Glicemia/estatística & dados numéricos , Estudos Transversais , Depressão/epidemiologia , Depressão/terapia , Diabetes Mellitus Tipo 1/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Feminino , Hemoglobina A Glicada/análise , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/prevenção & controle , Masculino , Programas de Rastreamento , Valor Preditivo dos Testes , Testes Psicológicos , Autocuidado/psicologia , Apoio Social , Estresse Psicológico/epidemiologia , Estresse Psicológico/terapia , Inquéritos e Questionários , Transição para Assistência do Adulto , Adulto Jovem
9.
Acta Diabetol ; 57(1): 23-30, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31119455

RESUMO

AIMS: Psychological distress and family functioning have a considerable impact on diabetes self-management and glycaemic control in individuals with type 1 diabetes (T1D). However, the influence of both individual and family factors on glycaemic control has not been adequately investigated yet. This study aimed at examining the relationship between perceived family functioning and depressive symptoms with the frequency of capillary self-monitoring of blood glucose (SMBG) and glycaemic control (HbA1c) in a large sample of adults with T1D. METHODS: In a cross-sectional study design, we consecutively enrolled 90 adults with T1D diagnosis from at least 1 year and currently living in their family of origin or conjugal family from at least 1 year before the enrolment. Questionnaires were administered to assess family functioning and depressive symptoms. The SMBG frequency over the past 3 months and the most recent HbA1c measurement were also collected in each individual. Correlation and mediation analyses were carried out. RESULTS: Glycaemic control showed a positive relationship with depressive symptoms and family balanced cohesion, while SMBG frequency was correlated with family balanced flexibility and rigidity, but not with depressive symptoms. Mediation analyses showed that family rigidity mediates the effect of depressive symptoms on glycaemic control. CONCLUSIONS: This exploratory study highlighted the significance of a cohesive family context to facilitate the achievement of individual glycaemic goals in individuals with T1D. These observations, if confirmed in larger data sets, would timely call for a comprehensive family care assessment as part of the evaluations routinely carried out in the ambulatory care of these individuals.


Assuntos
Depressão/psicologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/psicologia , Adulto , Glicemia/metabolismo , Automonitorização da Glicemia/psicologia , Estudos Transversais , Depressão/sangue , Depressão/etiologia , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/terapia , Família/psicologia , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
10.
JMIR Mhealth Uhealth ; 7(9): e12956, 2019 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-31489842

RESUMO

BACKGROUND: A number of mobile health (mHealth) apps exist that focus specifically on promoting exercise behavior. To increase user engagement, prompts, such as text messages, emails, or push notifications, are often used. To date, little research has been done to understand whether, and for how long, these prompts influence exercise behavior. OBJECTIVE: This study aimed to assess the impact of prompts on mHealth self-monitoring and self-reported exercise in the days following a prompt and whether these effects differ based on exercise modality. METHODS: Of the possible 99 adults at risk for developing type II diabetes who participated in a diabetes prevention program, 69 were included in this secondary analysis. Participants were randomly assigned to 1 of the following 2 exercise conditions: high-intensity interval training or moderate-intensity continuous training. In the year following a brief, community-based diabetes prevention program involving counseling and supervised exercise sessions, all participants self-monitored their daily exercise behaviors on an mHealth app in which they were sent personalized prompts at varying frequencies. mHealth self-monitoring and self-reported exercise data from the app were averaged over 1, 3, 5, and 7 days preceding and following a prompt and subsequently compared using t tests. RESULTS: In the year following the diabetes prevention program, self-monitoring (t68=6.82; P<.001; d=0.46) and self-reported exercise (t68=2.16; P=.03; d=0.38) significantly increased in the 3 days following a prompt compared with the 3 days preceding. Prompts were most effective in the first half of the year, and there were no differences in self-monitoring or self-reported exercise behaviors between exercise modalities (P values >.05). In the first half of the year, self-monitoring was significant in the 3 days following a prompt (t68=8.61; P<.001; d=0.60), and self-reported exercise was significant in the 3 days (t68=3.7; P<.001; d=0.37), 5 days (t67=2.15; P=.04; d=0.14), and 7 days (t68=2.46; P=.02; d=0.15) following a prompt, whereas no significant changes were found in the second half of the year. CONCLUSIONS: This study provides preliminary evidence regarding the potential influence of prompts on mHealth self-monitoring and self-reported exercise and the duration for which prompts may be effective as exercise behavior change tools. Future studies should determine the optimal prompting frequency for influencing self-reported exercise behaviors. Optimizing prompt frequency can potentially reduce intervention costs and promote user engagement. Furthermore, it can encourage consumers to self-monitor using mHealth technology while ensuring prompts are sent when necessary and effective. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR2-10.2196/11226.


Assuntos
Automonitorização da Glicemia/psicologia , Diabetes Mellitus Tipo 2/terapia , Exercício Físico/psicologia , Aplicativos Móveis/normas , Adulto , Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 2/psicologia , Feminino , Promoção da Saúde/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
11.
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
12.
Diabetes Technol Ther ; 21(12): 691-701, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31418591

RESUMO

Background: Glucose monitoring is an essential aspect of self-care for people with type 1 diabetes. With technologies developing rapidly, valid assessment of user experiences and satisfaction is needed. Our aim was to develop a novel measure: the Glucose Monitoring Experiences Questionnaire (GME-Q). Methods: Questionnaire design was informed by exploratory and cognitive debriefing interviews. The GME-Q was included in a large online survey enabling psychometric validation. Results: The interview sample included 17 adults (aged [mean ± SD] 46 ± 11 years, 53% women) with type 1 diabetes duration of 26 ± 14 years. The proposed conceptual framework included three domains: "Effectiveness", "Intrusiveness", and "Convenience", assessed with 25 items plus a single, overview item. The validation sample included 589 adults (aged 44 ± 15 years; 64% women) with type 1 diabetes (duration: 22 ± 14 years, self-monitoring blood glucose [SMBG] using finger-prick devices: median [IQR] 6 [4-7] daily checks). Questionnaire acceptability was indicated: 98% (n = 578) completion rate. After deleting 3 redundant items, principal components analysis supported a 22-item questionnaire with 3 domains ("Effectiveness" [9 items]; "Intrusiveness" [6 items]; "Convenience" [7 items]), accounting for 55% of variance, with good internal consistency reliability (α = 0.83-0.88). Subscales correlated significantly (rs = ±0.44-0.66, P < 0.001) with the single, overview item, together explaining 51% of the total variance in the single item score. Associations with demographic and clinical characteristics supported convergent and discriminant validity. Conclusions: Overall, the 22-item GME-Q is a brief, acceptable, valid, and reliable measure of satisfaction with glucose monitoring in adults with type 1 diabetes using SMBG, and this needs to be assessed among those using continuous glucose monitoring.


Assuntos
Automonitorização da Glicemia/psicologia , Glicemia/análise , Diabetes Mellitus Tipo 1/psicologia , Satisfação do Paciente , Adulto , Diabetes Mellitus Tipo 1/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Inquéritos e Questionários
13.
Diabetes Technol Ther ; 21(9): 493-498, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31287721

RESUMO

Background: Continuous glucose monitoring (CGM) has potential to address challenges of type 1 diabetes (T1D) management for young children. CGM use is increasing, yet remains underutilized. Characterizing parents' experiences with CGM can inform clinical strategies to help parents make decisions about diabetes management, overcome obstacles to initiating and sustaining CGM use, and maximize benefits of CGM use in their children's diabetes care. Methods: Transcripts from semistructured qualitative interviews with 55 parents of children aged 1 to <8 years, with T1D duration ≥6 months, and whose child currently or previously used CGM were coded and analyzed to derive themes about their experiences with CGM. Results: Participants were 88% mothers and the mean child age was 5.0 ± 1.5 years. Parents described benefits of CGM use: decreased worry about glucose excursions, improved sleep, increased sense of safety with children who cannot recognize or express symptoms of hypo- or hyperglycemia, and greater comfort with other caregivers, especially using remote monitoring functionality when away from children. Challenges included painful insertions, wearing multiple devices on small bodies, disruptive alerts, data gaps due to lost signals, skin/adhesive problems, and difficulty interpreting the amount of information generated by CGM. For some, the challenges outweighed potential benefits and they stopped CGM use. Conclusions: CGM may address unique challenges of T1D in young children and increase parental comfort with diabetes management, yet there are multiple barriers to initiating or maintaining CGM use. Education and behavioral support to address these benefits and barriers may equip caregivers with skills to address challenges of CGM use.


Assuntos
Ansiedade/psicologia , Automonitorização da Glicemia/psicologia , Diabetes Mellitus Tipo 1/psicologia , Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/tratamento farmacológico , Feminino , Humanos , Hiperglicemia/prevenção & controle , Hiperglicemia/psicologia , Hipoglicemia/prevenção & controle , Hipoglicemia/psicologia , Lactente , Masculino , Pesquisa Qualitativa
14.
Diabetes Technol Ther ; 21(9): 514-521, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31287736

RESUMO

Background: Lifestyle interventions with personalized self-management programs have shown benefits for patients with type 2 diabetes mellitus (T2DM), a devastating highly prevalent disease worldwide. Despite advances in drug therapy and nonpharmacological strategies achieved in the past recent years, self-management programs to be implemented in everyday life are needed. The aim of the present prospective study was to evaluate the effects, in terms of glycated hemoglobin (HbA1c) values and self-management behavior, of a telemedicine-assisted self-management program offered to T2DM patients by a large private health insurance company. Methods: Participants with T2DM included 60 adults in the intervention group (M = 59.4 years) and 55 adults in the control group (M = 58.4 years). In the beginning of the study, the intervention group was provided with a tablet computer, a glucometer, and a step counter. Additionally, they received an individual need-based telephone coaching to address and improve motivation and diabetes self-management in daily life. The control group received care as usual and were not offered additional treatment. The study examined the results of a diabetes lifestyle program after 3 months. Results: The intervention resulted in significantly greater declines in HbA1c compared with the control group. In addition, tele-assisted participants showed significant improvements in Diabetes Self-Management scale score and body mass index compared with usual care participants. Conclusions: Patients with T2DM can benefit from telemedicine-assisted self-management programs, which may offer new options for treatment and prevention of disease progression. More follow-up and research is needed to assess feasibility and effectiveness on a larger scale.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Tutoria/métodos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Autogestão/métodos , Telemedicina/métodos , Automonitorização da Glicemia/métodos , Automonitorização da Glicemia/psicologia , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/psicologia , Feminino , Hemoglobina A Glicada/análise , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Motivação , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Autogestão/psicologia
15.
Pediatr Diabetes ; 20(7): 1007-1015, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31336011

RESUMO

BACKGROUND: Adaptive diabetes-specific attitudes and behaviors, known as diabetes strengths, relate to positive self-management and quality of life outcomes in type 1 diabetes (T1D), but have not been studied in preadolescence. To facilitate strengths-based care and research on this topic, we developed and evaluated the psychometric properties of a measure of diabetes strengths for children age 9 to 13. METHODS: Participants were 187 children receiving care for T1D at a tertiary care children's hospital. They completed the 12-item self-report Diabetes Strengths and Resilience scale for children (DSTAR-Child), which we adapted from a measure validated for adolescents. Youth completed the DSTAR-Child twice, and measures of relevant constructs at baseline: general and diabetes-related quality of life, depressive symptoms, and diabetes distress. Parents rated children's engagement in self-management behaviors and general resilience. We extracted HbA1c from the medical record. RESULTS: The DSTAR-Child total score demonstrated reliability, including internal consistency and stability across two time points. The total score was significantly associated in expected directions with psychosocial measures and glycemic control but not self-management behaviors. In confirmatory factor analyses, the best-fitting structure contained two latent factors tapping intrapersonal and interpersonal strengths. Resulting subscale scores also appeared reliable and valid. CONCLUSIONS: This brief, practical measure of diabetes strengths demonstrated sound psychometric properties. Diabetes strengths appeared unrelated to self-management behaviors, perhaps because of the primary role of adult caregivers in T1D management for preadolescents. As a research and clinical tool, the DSTAR-Child can facilitate greater understanding of diabetes strengths and inform strengths-based strategies to foster resilient T1D outcomes.


Assuntos
Diabetes Mellitus Tipo 1/psicologia , Psicologia da Criança/métodos , Psicometria/métodos , Resiliência Psicológica , Adolescente , Automonitorização da Glicemia/psicologia , Automonitorização da Glicemia/normas , Criança , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/terapia , Feminino , Comportamentos Relacionados com a Saúde/fisiologia , Humanos , Masculino , Angústia Psicológica , Qualidade de Vida , Autocuidado , Autorrelato , Inquéritos e Questionários
16.
Pediatr Diabetes ; 20(7): 997-1006, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31271239

RESUMO

BACKGROUND: This randomized, controlled trial evaluated a monetary-based reinforcement intervention for increasing self-monitoring of blood glucose (SMBG) among youth with poorly controlled type 1 diabetes. METHODS: After a 2-week baseline, 60 participants were randomized to enhanced usual care (EUC) or Reinforcers. The Reinforcers group earned monetary rewards for SMBG and associated behaviors such as uploading glucose meters. Reinforcers were withdrawn at 24 weeks. A follow-up evaluation occurred at 36 weeks. RESULTS: Participants in the reinforcers group increased the proportion of days they completed ≥4 SMBG from 14.6% at baseline to 64.4%, 47.5%, and 37.8% at 6, 12, and 24 weeks, respectively. In contrast, EUC participants declined from 22.7% at baseline to 17.5%, 10.5%, and 11.1% (Ps < .01 vs EUC at all time points). Group differences were attenuated but remained significant after withdrawal of reinforcers. Effect sizes for SMBG were very large during reinforcement and large after withdrawal of reinforcers. In the reinforcers group, mean A1c dropped from 9.5% ± 1.2% at baseline to 9.0% ± 1.3% at week 6 and 9.0% ± 1.4% at week 12. For EUC, A1c was 9.2% ± 0.2% at baseline and ranged from 9.2% ± 1.5% to 9.6% ± 1.6% throughout the study (P < .05 vs EUC). Group differences in A1c were no longer significant at weeks 24 and 36. Effect sizes for A1c were small during reinforcement and also after withdrawal of reinforcement. CONCLUSIONS: Monetary-based reinforcement of adolescents with type 1 diabetes caused durable increases in SMBG. Modification of the reinforcement structure may be needed to sustain improved metabolic control in this challenging age group.


Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Recompensa , Salários e Benefícios , Autogestão , Adolescente , Comportamento do Adolescente/fisiologia , Adulto , Glicemia/metabolismo , Automonitorização da Glicemia/economia , Automonitorização da Glicemia/psicologia , Criança , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/economia , Feminino , Humanos , Masculino , Reforço Psicológico , Autogestão/economia , Autogestão/psicologia , Padrão de Cuidado , Adulto Jovem
17.
J Diabetes Sci Technol ; 13(6): 1169-1174, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31200613

RESUMO

This commentary aims to discuss the parallels between nonadherence to continuous glucose level monitoring and nonadherence to medication in people with diabetes and to investigate specific reasons for the difficulties involved in glucose monitoring. To this end, examples are given from both continuous and discontinuous glucose monitoring (CGM and SMBG, respectively).


Assuntos
Automonitorização da Glicemia/psicologia , Glicemia/análise , Tomada de Decisões/fisiologia , Diabetes Mellitus Tipo 1/sangue , Hipoglicemia/sangue , Adesão à Medicação/psicologia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Humanos , Hipoglicemiantes/uso terapêutico
18.
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 Físico/psicologia , Feminino , Comportamentos Relacionados com a Saúde , Insuficiência Cardíaca/etnologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade
19.
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
20.
Contemp Clin Trials ; 82: 60-65, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31129370

RESUMO

Parents of young children with type 1 diabetes (T1D) experience unique, developmental challenges in managing their child's T1D, resulting in psychosocial distress. Only a small portion of young children reach glucose goals and adherence to diabetes devices that help improve T1D management have historically been low in this population. The purpose of this study is to test four interventions that couple developmentally tailored behavioral supports with education to optimize use of diabetes devices, improve glucose control, and reduce psychosocial distress for parents of young children with T1D. The study team designed four behavioral interventions, two aimed at improving glucose control and two aimed at optimizing use of diabetes devices. The goal of this paper is to describe the behavioral interventions developed for this study, including the results of a pilot test, and describe the methods and analysis plan to test this intervention strategy with ninety participants in a large-scale, randomized trial using a sequential multiple assignment randomization trial (SMART) design. A SMART design will permit a clinically relevant evaluation of the intervention strategy, as it allows multiple randomizations based on individualized assessments throughout the study instead of a fixed intervention dose seen in most traditional randomized controlled trials.


Assuntos
Automonitorização da Glicemia/métodos , Glicemia/análise , Diabetes Mellitus Tipo 1/diagnóstico , Adulto , Automonitorização da Glicemia/psicologia , Pré-Escolar , Diabetes Mellitus Tipo 1/terapia , Humanos , Lactente , Pais/educação , Pais/psicologia , Cooperação do Paciente/psicologia , Educação de Pacientes como Assunto/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Inquéritos e Questionários
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