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1.
BMC Public Health ; 24(1): 1267, 2024 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-38720267

RESUMO

OBJECTIVE: Bayesian network (BN) models were developed to explore the specific relationships between influencing factors and type 2 diabetes mellitus (T2DM), coronary heart disease (CAD), and their comorbidities. The aim was to predict disease occurrence and diagnose etiology using these models, thereby informing the development of effective prevention and control strategies for T2DM, CAD, and their comorbidities. METHOD: Employing a case-control design, the study compared individuals with T2DM, CAD, and their comorbidities (case group) with healthy counterparts (control group). Univariate and multivariate Logistic regression analyses were conducted to identify disease-influencing factors. The BN structure was learned using the Tabu search algorithm, with parameter estimation achieved through maximum likelihood estimation. The predictive performance of the BN model was assessed using the confusion matrix, and Netica software was utilized for visual prediction and diagnosis. RESULT: The study involved 3,824 participants, including 1,175 controls, 1,163 T2DM cases, 982 CAD cases, and 504 comorbidity cases. The BN model unveiled factors directly and indirectly impacting T2DM, such as age, region, education level, and family history (FH). Variables like exercise, LDL-C, TC, fruit, and sweet food intake exhibited direct effects, while smoking, alcohol consumption, occupation, heart rate, HDL-C, meat, and staple food intake had indirect effects. Similarly, for CAD, factors with direct and indirect effects included age, smoking, SBP, exercise, meat, and fruit intake, while sleeping time and heart rate showed direct effects. Regarding T2DM and CAD comorbidities, age, FBG, SBP, fruit, and sweet intake demonstrated both direct and indirect effects, whereas exercise and HDL-C exhibited direct effects, and region, education level, DBP, and TC showed indirect effects. CONCLUSION: The BN model constructed using the Tabu search algorithm showcased robust predictive performance, reliability, and applicability in forecasting disease probabilities for T2DM, CAD, and their comorbidities. These findings offer valuable insights for enhancing prevention and control strategies and exploring the application of BN in predicting and diagnosing chronic diseases.


Assuntos
Teorema de Bayes , Comorbidade , Doença das Coronárias , Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/epidemiologia , Pessoa de Meia-Idade , Feminino , Masculino , Doença das Coronárias/epidemiologia , Estudos de Casos e Controles , Idoso , Adulto , Fatores de Risco
2.
J Pediatr Nurs ; 2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38729898

RESUMO

AIM: Parents in the caregiving role for children with type 1 diabetes (T1D) are affected from many aspects including physically, psychologically, socially, financially and spiritually. The aim of this study was to determine the factors affecting the care burden and life satisfaction of parents caring for a child with T1D and to examine the relationship between them. METHOD: This research was completed with 293 parents of children with T1D aged 3-18 years, attending the pediatric health and diseases clinics in two state hospitals located in [redacted for peer review] from May 2023 to September 2023. For collection of data, a survey form, the Zarit Burden Interview (ZBI) and Adult Life Satisfaction Scale (ALSS) were used. Analysis of data used percentages, means, one-way ANOVA (post-hoc Tukey test), independent samples t-test, regression and correlation tests. Statistical significance level was accepted as p < 0.05. RESULTS: Parents had mean care burden scale scores of 56.30 ± 12.4, with mean adult life satisfaction scale scores of 69.39 ± 11.61. According to the regression analysis results, the ZBI scores were affected by the child's general health status after T1D diagnosis, impact on responsibilities after T1D diagnosis and diabetes management skills (p < 0.05). ALSS scores were affected by the variables of caregiver assessment of health status before and after the child's T1D diagnosis, income level, impact on responsibilities after T1D diagnosis and diabetes management skills (p < 0.05). There was a negative weak level of significant correlation identified between the ZBI and ALSS total scores (r = -0.36; p < 0.05). CONCLUSION: General health status after receiving T1D diagnosis, impact on responsibilities after diabetes diagnosis and diabetes management skills are factors affecting the care burden and life satisfaction of parents. Additionally, a negative relationship was determined between parents' care burden and life satisfaction. Nurses should develop family-centered care plans and work to reduce factors increasing care burden while increasing life satisfaction.

3.
BMJ Open ; 14(5): e081035, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38692716

RESUMO

INTRODUCTION: Despite potential links between diabetes and sensorineural hearing loss (SNHL), routine hearing assessments for diabetic patients are not standard practice. Our study aimed to investigate the prevalence of SNHL and its association with diabetes-related factors among patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS: This cross-sectional study was conducted at the Diabetes Clinic, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from May to September 2021. A total of 396 patients fulfilling the inclusion criteria participated after informed consent. Data collection involved a sociodemographic profile, Michigan Neuropathy Screening Instrument examination followed by pure-tone audiometry and laboratory tests including haemoglobin A1C (HbA1c). HL was defined using better ear four-frequency pure-tone average of ≥26 dB HL and graded as per WHO criteria. Statistical analyses were performed using SPSS. χ2, independent t-test and multinomial logistic regression analyses were applied. P<0.05 at 95% CI was considered significant. RESULTS: Our study revealed a high prevalence of SNHL among patients with T2DM. Mild HL was seen in 55.8%, while 18.7% suffered from moderate HL. Common audiological symptoms included difficulty understanding speech in noisy surroundings (44.2%), balance problems (42.9%), sentence repetition (35.9%), tinnitus (32.3%) and differentiating consonants (31.1%). Hearing impairment predominantly affected low (0.25-0.5 kHz) and high (4-8 kHz) frequencies with a significant difference at 4 kHz among both sexes (t (394)=2.8, p=0.004). Peripheral neuropathy was significantly associated with SNHL on multinomial logistic regression after adjusting with age, sex, body mass index and the presence of any comorbidities. Diabetes duration, HbA1c or family history of diabetes was found unrelated to SNHL severity. CONCLUSIONS: The study highlights the substantial prevalence of SNHL among patients with T2DM and emphasises the importance of targeted audiological care as part of a holistic approach to diabetes management. Addressing HL early may significantly improve communication and overall quality of life.


Assuntos
Audiometria de Tons Puros , Diabetes Mellitus Tipo 2 , Perda Auditiva Neurossensorial , Humanos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Masculino , Feminino , Estudos Transversais , Perda Auditiva Neurossensorial/epidemiologia , Pessoa de Meia-Idade , Paquistão/epidemiologia , Prevalência , Adulto , Idoso , Neuropatias Diabéticas/epidemiologia , Doenças do Sistema Nervoso Periférico/epidemiologia , Hemoglobinas Glicadas/análise , Fatores de Risco
4.
BMJ Open ; 14(5): e079082, 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38719302

RESUMO

OBJECTIVES: To understand the lived experience of adults with overweight/obesity and early type 2 diabetes in a modern urban environment, and the interrelations among the various aspects of these experiences and participants' attitudes to weight management. DESIGN: Qualitative inductive approach to analysing data thematically from semistructured interviews and interpreted from a socioecological perspective. SETTING: Primary care clinics located in northern and central Singapore. PARTICIPANTS: 21 patients between 29 and 59 years old who are living with overweight/obese (Body Mass Index of 25.3-44.0kg/m2) and type 2 diabetes for 6 years or less. RESULTS: The main themes - everyday life, people around me and within me - pointed to a combination of barriers to weight and health management for participants. These included environmental factors such as easy physical and digital access to unhealthy food, and high-stress work environments; social factors such as ambiguous family support and dietary practices of peers; and individual factors such as challenges with self-regulation, prioritising work, dealing with co-existing medical conditions and the emotional significance of food. While lack of motivation and cultural dietary practices are hard to change, a problem-solving attitude, and presence of role models, may enable behaviour change. CONCLUSION: An exploration of the lifeworld of patients with overweight/obese and early type 2 diabetes revealed that work demands, dietary practices in the workplace and at home, and the easy availability of calorie-dense foods afforded by a technology-infused environment hindered the individual's efforts at maintaining a healthy weight and lifestyle. Policy and initiatives promoting work-life balance as well as individualised interventions can support participants' stress management, and problem-solving capability for behaviour change. These barriers stemmed from the various domains of the environmental, interpersonal and intrapersonal but were interrelated. They underscored the need for an integrated approach to weight and diabetes management.


Assuntos
Diabetes Mellitus Tipo 2 , Obesidade , Sobrepeso , Pesquisa Qualitativa , Humanos , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Singapura , Pessoa de Meia-Idade , Masculino , Feminino , Adulto , Obesidade/psicologia , Sobrepeso/psicologia , Entrevistas como Assunto
5.
JMIR Serious Games ; 12: e49478, 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38713496

RESUMO

BACKGROUND: Serious games, which are gaming applications used for purposes beyond entertainment to educate users on, and address, specific issues, may present a timely approach to promote healthy diabetes management behaviors among children with type 1 diabetes mellitus (T1DM). The lasting benefits associated with these serious games encompass improved patient education; enhanced glycemic control; the reinforcement of bonds within the community of people with diabetes; the facilitation of meaningful dialogues with caregivers, especially within the familial setting; and a significant reduction in the economic burdens associated with subsequent complications. OBJECTIVE: This paper primarily aims to provide a detailed overview of the iterative design process and the associated evaluation methods used in the development of the educational game. Furthermore, this study aims to enhance motivation for sustained and extended engagement with the game over time. The MyDiabetic game design aims to educate children on various aspects, including the connections among food, insulin, and physical activity. Furthermore, it seeks to impart knowledge related to the operation of a glucometer and an insulin pen, as well as more advanced technologies such as administering glucagon, measuring ketoacidosis, and continuous glucose monitoring. METHODS: The co-design methodology was applied, involving interviews, design workshops, and prototype feedback sessions. A combination of several approaches, such as tailoring, observational learning, social and family support, decision-making practice, and reward systems, was used to support children's compliance. Moreover, incorporating the literature, guidelines, and current practices into the design ensured that the game was aligned with established health care pathways and included relevant information and best practices for diabetes management. RESULTS: The game was tested on 32 children in 3 iterations. Positive responses were received from children who tested the game as well as their parents. The game was also presented to 5 schoolmates of children with T1DM who appreciated a better understanding of the disease and the opportunity to support their friends more efficiently in T1DM compensation. The involvement of children and clinicians in participatory co-design contributed to to the game's high acceptance. With regard to the game's impact on education, 1 week of testing revealed an enhancement in educational outcomes. CONCLUSIONS: The game is especially suitable for children newly diagnosed with T1DM because it acquaints them in a fun way with new terminology; for example, they can try to measure glycemia levels in an interactive way. The game also caters to children who still need to develop reading skills by including an audio guide. The guide ensures that children of all literacy levels can benefit from the game's educational content and interactive experiences. The game is available for download on Google Play and the Apple App Store.

6.
BMC Pregnancy Childbirth ; 24(1): 346, 2024 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-38711005

RESUMO

BACKGROUND: The implementation of universal screening for Gestational Diabetes Mellitus (GDM) is challenged by several factors key amongst which is limited resources, hence the continued reliance on risk factor-based screening. Effective identification of high-risk women early in pregnancy may enable preventive intervention. This study aimed at developing a GDM prediction model based on maternal clinical risk factors that are easily assessable in the first trimester of pregnancy in a population of Nigerian women. METHODS: This was a multi-hospital prospective observational cohort study of 253 consecutively selected pregnant women from which maternal clinical data was collected at 8-12 weeks gestational age. Diagnosis of GDM was made via a one-step 75-gram Oral Glucose Tolerance Test (OGTT) at 24-28 weeks of gestation. A GDM prediction model and nomogram based on selected maternal clinical risk factors was developed using multiple logistic regression analysis, and its performance was assessed by Receiver Operator Curve (ROC) analysis. Data analysis was carried out using Statistical Package for Social Sciences (SPSS) version 25 and Python programming language (version 3.0). RESULTS: Increasing maternal age, higher body mass index (BMI), a family history of diabetes mellitus in first-degree relative and previous history of foetal macrosomia were the major predictors of GDM. The model equation was: LogitP = 6.358 - 0.066 × Age - 0.075 × First trimester BMI - 1.879 × First-degree relative with diabetes mellitus - 0.522 × History of foetal macrosomia. It had an area under the receiver operator characteristic (ROC) curve (AUC) of 0.814 (95% CI: 0.751-0.877; p-value < 0.001), and at a predicted probability threshold of 0.745, it had a sensitivity of 79.2% and specificity of 74.5%. CONCLUSION: This first trimester prediction model reliably identifies women at high risk for GDM development in the first trimester, and the nomogram enhances its practical applicability, contributing to improved clinical outcomes in the study population.


Assuntos
Diabetes Gestacional , Teste de Tolerância a Glucose , Nomogramas , Primeiro Trimestre da Gravidez , Humanos , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Gravidez , Feminino , Adulto , Fatores de Risco , Estudos Prospectivos , Teste de Tolerância a Glucose/métodos , Nigéria/epidemiologia , Idade Materna , Índice de Massa Corporal , Medição de Risco/métodos , Curva ROC , Adulto Jovem , Macrossomia Fetal/epidemiologia
7.
J Cross Cult Gerontol ; 39(2): 151-172, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38720112

RESUMO

Type 2 Diabetes (T2D) among older Asian American immigrants (AA) is a growing concern. Asian Americans represent 9% of diagnosed diabetes. Very little is known on how older Asian American immigrants with T2D navigate diabetes management, in particular the role of family support. This qualitative study examines Chinese and Filipino Americans, the two largest Asian subgroups in the US (4.2 million, and 3.6 million, respectively), and family support dynamics among adult children and their parents diagnosed with T2D. Ten dyads (n = 20) made up of adult children and aging parents participated in in-depth and dyadic interviews. Results indicate that family support occurs in a trajectory of stages. The following thematic patterns emerged in these dyads around support: independence, transitions, partnership, and stepping in. The findings point to various supportive stages that Asian American adult children and aging parents with T2D experience and the importance of developing supportive interventions for both adult children and aging parents at these various stages.


Assuntos
Filhos Adultos , Asiático , Diabetes Mellitus Tipo 2 , Emigrantes e Imigrantes , Pesquisa Qualitativa , Apoio Social , Humanos , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/psicologia , Asiático/psicologia , Masculino , Feminino , Emigrantes e Imigrantes/psicologia , Idoso , Pessoa de Meia-Idade , Filhos Adultos/etnologia , Filhos Adultos/psicologia , Filipinas/etnologia , China/etnologia , Adulto , Estados Unidos , Entrevistas como Assunto , Pais/psicologia , Idoso de 80 Anos ou mais , Apoio Familiar , População do Leste Asiático
8.
Horm Res Paediatr ; 2024 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-38718769

RESUMO

INTRODUCTION: This global survey evaluated the practices and adherence to international Clinical Practice Consensus Guidelines (CPCG) of physicians involved in pediatric diabetes care regarding screening, prevention and treatment of vascular complications of type 1 diabetes (T1D). METHOD: A web-based survey gathering data about respondents' background, practices related to screening, prevention, and treatment of diabetic nephropathy, retinopathy, neuropathy and macrovascular diseases and a self-assessment of physicians' knowledge based on the ISPAD CPCG 2018 was shared by ISPAD. RESULTS: We received 175 responses from 62 countries (60% female, median age 42.3 years, 72.0% ISPAD members). Two-thirds of respondents initiated nephropathy and retinopathy screening per CPCG recommendations. Only half of them adhered to recommendations for neuropathy and macrovascular disease risk factors (RFs). Over 85% of respondents used the recommended screening method for nephropathy, retinopathy and macrovascular disease RFs, and only 59% for neuropathy. Lack of access to neuropathy and macrovascular diseases RF screening methods was reported by 22.2% and 11.8% of respondents, respectively. Adherence to recommended screening frequency varied: 92% for nephropathy, around two-thirds for neuropathy and macrovascular disease RFs, and only 17.7% for retinopathy. Most participants aligned their practices for treating T1D complications with CPCG recommendations, except for nephropathy. Significant differences in adherence to CPCG and individuals' financial contributions reflected countries' income levels. Around 50% of the respondents were very familiar with the ISPAD CPCG content. CONCLUSION: Our study highlights global variation in adherence to CPCG for T1D vascular complications, which is influenced by country income and healthcare disparities. It also revealed knowledge gaps among physicians on this critical topic.

9.
PLoS One ; 19(5): e0302385, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38718093

RESUMO

OBJECTIVE: Africa presents a higher diabetic foot ulcer prevalence estimate of 7.2% against global figures of 6.3%. Engaging family members in self-care education interventions has been shown to be effective at preventing diabetes-related foot ulcers. This study culturally adapted and tested the feasibility and acceptability of an evidence-based footcare family intervention in Ghana. METHODS: The initial phase of the study involved stakeholder engagement, comprising Patient Public Involvement activities and interviews with key informant nurses and people with diabetes (N = 15). In the second phase, adults at risk of diabetes-related foot ulcers and nominated caregivers (N = 50 dyads) participated in an individually randomised feasibility trial of the adapted intervention (N = 25) compared to usual care (N = 25). The study aimed to assess feasibility outcomes and to identify efficacy signals on clinical outcomes at 12 weeks post randomisation. Patient reported outcomes were foot care behaviour, foot self-care efficacy, diabetes knowledge and caregiver diabetes distress. RESULTS: Adjustments were made to the evidence-based intervention to reflect the literacy, information needs and preferences of stakeholders and to develop a context appropriate diabetic foot self-care intervention. A feasibility trial was then conducted which met all recruitment, retention, data quality and randomisation progression criteria. At 12 weeks post randomisation, efficacy signals favoured the intervention group on improved footcare behaviour, foot self-care efficacy, diabetes knowledge and reduced diabetes distress. Future implementation issues to consider include the staff resources needed to deliver the intervention, family members availability to attend in-person sessions and consideration of remote intervention delivery. CONCLUSION: A contextual family-oriented foot self-care education intervention is feasible, acceptable, and may improve knowledge and self-care with the potential to decrease diabetes-related complications. The education intervention is a strategic approach to improving diabetes care and prevention of foot disease, especially in settings with limited diabetes care resources. Future research will investigate the possibility of remote delivery to better meet patient and staff needs. TRIAL REGISTRATION: Pan African Clinical Trials Registry (PACTR) - PACTR202201708421484: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=19363 or pactr.samrc.ac.za/Search.aspx.


Assuntos
Pé Diabético , Estudos de Viabilidade , Autocuidado , Humanos , Pé Diabético/prevenção & controle , Pé Diabético/terapia , Gana/epidemiologia , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Adulto , Cuidadores/psicologia , Família/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto/métodos
10.
Glob Health Action ; 17(1): 2341521, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-38693861

RESUMO

BACKGROUND: Gestational diabetes mellitus (GDM) is an abnormal glucose metabolism diagnosed during pregnancy that can have serious adverse consequences for mother and child. GDM is an exceptional health condition, as its management serves not only as treatment but also as prevention, reducing the risk of future diabetes in mother and child. OBJECTIVES: This qualitative study aimed to explore how pregnant women experience and respond to GDM, focusing particularly on the role of the family environment in shaping women's experiences. METHODS: The research was carried out in Vietnam's Thái Bình province in April-May 2023. We conducted in-depth ethnographic interviews with 21 women with GDM, visiting them in their homes. Our theoretical starting point was phenomenological anthropology, and the data were analysed using a thematic analysis approach. RESULTS: At the centre of women's experiences was the contrast between GDM as a biomedical and a social condition. Whereas GDM was biomedically diagnosed and managed in the healthcare system, it was often deemed insignificant or non-existent by family members. This made GDM a biomedically present but socially absent health condition. This paradox posed challenges to women's GDM self-care, placing them in pioneering social positions. CONCLUSIONS: The biomedical presence yet social absence of GDM turned women into pioneers at biomedical, digital, epidemiological, and family frontiers. This article calls for appreciation of pregnant women's pioneering roles and for health systems action to involve women and families in the development of GDM policies and programmes at a time of sweeping global health changes.


Main findings: Vietnamese women's experiences of gestational diabetes were affected by social splits between clinic and home; between biomedical and family worlds.Added knowledge: Gestational diabetes places pregnant women in Northern Vietnam in pioneering roles on biomedical, digital, epidemiological, and family frontiers.Global health impact for policy and action: Pregnant women should be involved in the development of policies and programmes addressing gestational diabetes, with particular attention to the connections between clinical and family worlds.


Assuntos
Antropologia Cultural , Diabetes Gestacional , Pesquisa Qualitativa , Humanos , Diabetes Gestacional/psicologia , Diabetes Gestacional/epidemiologia , Feminino , Gravidez , Vietnã , Adulto , Gestantes/psicologia , Entrevistas como Assunto , Adulto Jovem , Autocuidado/psicologia
11.
BMC Prim Care ; 25(1): 148, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38698355

RESUMO

BACKGROUND: Lifestyle changes, especially regarding diet quality and physical activity, are important in the management of type 2 diabetes (T2D). This mixed-methods study explores self-initiated lifestyle changes in patients with T2D who followed a periodic fasting-mimicking diet (FMD). METHODS: Quantitative data were obtained from the Fasting In diabetes Treatment trial (November 2018 to August 2021) in which 100 participants with T2D, using metformin only or no medication, were randomised to receive a monthly 5-day FMD for twelve months next to usual care, or usual care only. Diet quality and physical activity questionnaires were completed at baseline, six and twelve months. Changes over time were analysed using linear mixed models. Focus groups were organized with FMD participants to explore experiences regarding self-initiated lifestyle changes. The qualitative data was analysed using the Theoretical Domains Framework. RESULTS: Questionnaires were available from 49 FMD participants and 43 controls. No differences in diet quality were found. Total physical activity in the FMD participants changed from 34.6 to 38.5 h per week (h/wk) from baseline to twelve months, while in controls it changed from 34.9 to 29.0 h/wk (between group difference, p = 0.03). In six focus groups with FMD participants (n = 20), individual participants perceived the FMD as an encouragement for (minor) lifestyle changes. There were no barriers to behaviour change related to the FMD. Important facilitators of healthy behaviour were an increase in awareness of the impact of lifestyle on health (knowledge), better physical fitness (physical) and health improvement (reinforcement). Facilitators unrelated to the FMD included family support (social influences) and opportunities in the neighbourhood (environmental context and resources), while barriers unrelated to the FMD were experiencing health problems (physical) and social events (social influences). CONCLUSIONS: Using an FMD for five consecutive days per month did not affect diet quality in between FMD periods in quantitative analysis, but increased the number of hours per week spent on physical activity. Qualitative analysis revealed self-initiated improvements in both diet quality and physical activity in individual participants using an FMD. Healthcare professionals could use an FMD programme as a 'teachable moment' to stimulate additional lifestyle changes. TRIAL REGISTRATION: ClinicalTrials.gov; NCT03811587. Registered 22 January 2019.


Assuntos
Diabetes Mellitus Tipo 2 , Exercício Físico , Jejum , Humanos , Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/psicologia , Masculino , Feminino , Pessoa de Meia-Idade , Jejum/fisiologia , Exercício Físico/fisiologia , Exercício Físico/psicologia , Idoso , Estilo de Vida , Grupos Focais , Hipoglicemiantes/uso terapêutico , Hipoglicemiantes/administração & dosagem , Metformina/uso terapêutico , Dieta , Inquéritos e Questionários
12.
J Clin Transl Endocrinol ; 36: 100346, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38706464

RESUMO

Background: Patients newly diagnosed with type 2 diabetes mellitus (DM) and newly prescribed insulin need to learn essential self-care and management skills quickly. To optimize teaching, clinicians need to assess a patient's basic understanding of DM and their skills. While DM patient assessments exist, this study reports the development of an assessment of patient DM management skills and knowledge, using feedback from DM clinicians, patients, and caregivers. Research Design and Methods: A systematic search of Pubmed/Medline and Scopus (1980-2017) of DM knowledge assessments was performed. Twenty-four studies were identified. Content from the existing assessments was adapted to create a 12 item DM-Skills Knowledge Assessment (SKA) to assess a patient's DM management skills and knowledge. To assess cultural humility, modified cognitive interviews were conducted in individual user sessions and semi-structured focus groups. Audio-transcripts of the interviews/focus groups were independently coded, and codes were grouped into key themes. Participant demographic characteristics were assessed. Results: Five focus groups and eleven key informant interviews were conducted, including 10 DM clinicians, 12 patients/caregivers, and 15 laypersons. All 10 clinicians reported that the DM-SKA addresses the key domains of DM education deemed to be of highest importance during the transition from hospital to home and that their patients would be willing to complete the assessment. More than half of the patient/caregiver/layperson participants self-reported race/ethnicity other than non-Hispanic white and performed similarly to non-Hispanic white participants in understanding each item, willingness to complete the DM-SKA, and perception that family or community members would be willing to complete the DM-SKA. The DM-SKA has a baseline Flesch reading score of 81.3, indicating low complexity language. Conclusion: DM clinicians agreed that the DM-SKA assesses all essential DM management skills. For patients/caregivers, it has acceptable literacy, cognitive validity, and culturally acceptable for racial/ethnic minority populations in the study, including elderly persons.

13.
Mhealth ; 10: 18, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38689617

RESUMO

Background: The global prevalence of diabetes has been increasing over the past 30 years, leading to a rise in complications; diabetes is the leading cause of amputations, blindness, and kidney failure in developed countries. Diabetes self-management is challenging due to the complex lifestyle changes required. Social support from family and friends plays a crucial role in overcoming barriers to healthy behavior choices. Integrating Internet and communication technologies with social support interventions has the potential to improve diabetes self-management. Methods: A scoping review was conducted by searching PubMed, Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Association for Computing Machinery (ACM) Digital Library databases for studies combining diabetes, Internet and communication technologies, and social support interventions. Inclusion criteria focused on adult patients with diabetes and primarily Internet and communication technologies-based strategies to initiate and enhance social support. Data abstraction included study population, design, outcomes, social support domains emphasized, support relationship intervention strategy, and Internet and communication technologies modality. Results: The review identified 39 articles and 33 unique studies representing 27 unique interventions utilizing peer web forums, interactive voice recordings, messaging-based interventions (including Short Message Service and instant messaging), and email as Internet and communication technologies modalities. Various outcomes were reported, including improvements in perception of social support, psychosocial well-being, behavior changes, and clinical outcomes. Existing support relationships may be more effective in promoting behavior change and clinical outcomes compared to developing new relationships. Studies that explicitly measured patients' perception of support consistently showed improvements in psycho-social, behavioral, and clinical outcomes. Conclusions: This scoping review highlights the pivotal role of social support in diabetes self-management. By integrating Internet and communication technologies into interventions, diverse modalities such as web forums and text messaging have shown promise in enhancing patients' perception of support and improving psychosocial well-being, behavior changes, and clinical outcomes. The emphasis on leveraging existing support relationships, rather than establishing new ones, underscores the effectiveness of personalized, patient-centered approaches. These findings provide essential insights for healthcare strategies, emphasizing the need to harness technology and existing social networks to empower individuals in managing diabetes effectively.

14.
J Diabetes Investig ; 2024 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-38741389

RESUMO

AIMS/INTRODUCTION: To estimate the prevalence, awareness, treatment, control rate, and influence factors of type 2 diabetes in Fujian province and provide the scientific basic for prevention. MATERIALS AND METHODS: A population-based study with the analysis of binary logistic regression was carried out to estimate the odds ratios of the influencing factor on type 2 diabetes. Data of the Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) in southeast China were used. The study sample originated from 12 counties in Fujian province and included 135,352 permanent residents aged 35-75 years in 2021. RESULTS: The prevalence of type 2 diabetes was 18.32% (24,801/135,352). Among them, 13,921 (56.13%) were aware of their condition, 11,894 (47.96%) were receiving treatment, and 4,537 (18.29%) had achieved control of blood glucose. Multivariate logistic regression analysis showed that older age, men, low-family income, low-education level, urban locality, no medical insurance, and histories of myocardial infarction, stroke, dyslipidemia, hypertension, alcohol consumption, and obesity were associated with a higher prevalence of type 2 diabetes. CONCLUSIONS: The prevalence of type 2 diabetes among residents aged 35-75 years in southeast China is high, whereas the status of its low awareness, treatment and control is severe, warranting a broad-based global strategy, including greater efforts in earlier screening, and more effective and affordable treatment is essential.

15.
Pilot Feasibility Stud ; 10(1): 68, 2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38689356

RESUMO

BACKGROUND: Among emerging adults with type 1 diabetes (T1D), self-regulation and social regulation skills can help avoid high A1c and diabetes distress. FAMS (Family/friend Activation to Motivate Self-care) is mobile phone-delivered intervention that supports development of these skills and is efficacious among adults with type 2 diabetes. However, the acceptability and feasibility of the FAMS intervention among emerging adults with T1D are unknown. METHODS: Therefore, we adapted FAMS for in a new disease context and developmental stage and then conducted a 3-month mixed-methods pre-post pilot study. Participants were emerging adults with T1D and a friend/family member enrolled as a support person (optional). Feasibility/acceptability outcomes and associated progression thresholds were recruitment (≥ 70% eligible emerging adults), retention (≥ 85%), intervention engagement (≥ 70%), and satisfaction (≥ 70%). We also collected qualitative feedback to determine if the intervention addressed relevant needs and explored changes in outcomes of interest (family/friend involvement, self-efficacy, self-management, distress, A1c). RESULTS: Recruitment rates indicate recruitment of emerging adults with T1D (n = 30) and their support persons (n = 20) is feasible - 79% of emerging adults who screened as eligible enrolled and 70% of enrolled emerging adults invited a support person. Emerging adults completed 98% of coaching sessions, and response rates to automated text messages were median 85% IQR [68%, 90%]. Changes in selected measures for outcomes of interest were in expected directions suggesting sensitivity to changes occasioned by the intervention in a future evaluative trial. Emerging adults said FAMS-T1D helped with setting realistic goals, motivated them to prioritize diabetes goals, and increased support, indicating acceptability of the intervention in this new disease and developmental context. CONCLUSIONS: Findings suggest potential for FAMS-T1D to engage emerging adults and their support persons and feasibility for an evaluative trial examining effects on self-regulation (self-efficacy, self-management), social regulation (family/friend involvement), and outcomes (diabetes distress, A1c). TRIAL REGISTRATION: We did not register this study on ClinicalTrials.gov because the purpose of the study was to assess the feasibility and acceptability of the intervention and study procedures and measures in preparation for a future trial. The purpose of that future trial will be to evaluate the effect of the intervention on health-related biomedical and behavioral outcomes, and that trial will be registered accordingly.

16.
Aten. prim. (Barc., Ed. impr.) ; 56(4): [102815], Abr. 2024. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-231750

RESUMO

Objetivos: Determinar los cambios de frecuentación de consultas presenciales (CP) y telemáticas (CT) a su médico de familia en pacientes con diabetes tipo 2 (DM2) durante la pandemia de COVID-19 y su relación con el control de su enfermedad. Diseño: Estudio multicéntrico de seguimiento retrospectivo. Emplazamiento: Siete centros de salud en Tenerife, España. Participantes: Un total de 3.543 pacientes con DM2. Mediciones: Sexo, edad, CP, CT y control de DM2 mediante hemoglobina glicosilada (A1c) durante el periodo 2019-2021. Se ajustaron modelos de regresión logística con el control de DM2 como efecto, y con las demás mediciones como variables independientes. Resultados: El 50% eran mujeres. El 38% tenía 65 años o menos. Se midió la A1c al 84% de los pacientes en 2019, 68% en 2020, y 77% en 2021. Presentaron buen control el 58,4% en 2019, 46,1% en 2020 y 50,3% en 2021. Las CP fueron 7 en 2019, 4 en 2020 y 5 en 2021 (p<0,001). Las razones de ventaja (IC95%) de buen control en 2019 fueron 1,04 (1,04-1,05) por cada año más de edad y 1,03 (1,01-1,04) por cada CP más; en 2020 fueron 1,04 (1,03-1,05) por cada año más de edad, 1,05 (1,04-1,07) por cada CP más y 1,04 (1,02-1,07) por cada CT más; en 2021 fueron 1,04 (1,04-1,05) por cada año más de edad, 1,05 (1,03-1,06) por cada CP más y 1,02 (1,00-1,04) por cada CT más. Conclusiones: El control de pacientes con DM2 durante 2019-2021 tuvo una relación directa con el cambio de frecuentación al centro de salud, con diferencias según el tipo de consulta y la edad.(AU)


Objectives: To determine whether in patients with type 2 diabetes (DM2) the changes in their relationship with family doctors during the COVID-19 pandemic, in-person (iPC) and telematic (TC) consultations, were associated with control of their disease. Design: Multicentric study of retrospective follow-up. Setting: Seven health centers in Tenerife, Spain. Participants: 3543 patients with DM2. Main measurements: Sex, age, iPC, TC and DM2 control using glycosylated hemoglobin (A1c) during the period 2019-2021. Logistic regression models were fitted with DM2 control as an effect, and with the other measurements as independent variables. Results: 50% were women. 38% were less than 65 years old. A1c was measured in 84% of patients in 2019, 68% in 2020, and 77% in 2021. 58.4% had good control in 2019, 46.1% in 2020, and 50.3% in 2021. Median iPC were 7 in 2019, 4 in 2020 and 5 in 2021 (p<0.001). The OR(95%CI) of good control in 2019 were 1.04(1.04-1.05) per year of age and 1.03(1.01-1.04) for each iPC; In 2020 they were 1.04 (1.03-1.05) per year of age, 1.05 (1.04-1.07) for each iPC and 1.04 (1.02-1.07) for each TC; in 2021 they were 1.04 (1.04-1.05) per year of age, 1.05 (1.03-1.06) for each iPC and 1.02 (1.00-1.04) for each TC. Conclusions: The control of patients with DM2 during the period 2019-2021 had a direct relationship with the change in the frequency of consultations at the health center, with differences depending on the type of consultation and the age of the patient.(AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Médicos de Família , Atenção Primária à Saúde , /epidemiologia , Diabetes Mellitus Tipo 2 , Consulta Remota , Espanha , Assistência ao Paciente , Telemedicina , Estudos Retrospectivos
17.
Cult. cuid ; 28(68): 117-126, Abr 10, 2024.
Artigo em Espanhol | IBECS | ID: ibc-232316

RESUMO

Objeto del presente ensayo reflexivo: Mostrar y reflexionarsobre la utilidad que tiene la investigación cualitativa y/ofenomenológica en la atención del paciente que presenta diabetes.Desarrollo: la atención integral de una forma biopsicosocial,cultural y espiritual tanto al paciente como a la familia del mismopor parte del profesional sanitario, juega un papel importantea la hora de tener calidad de vida en el nuevo estilo de vida.Conclusiones y reflexiones finales: La investigación cualitativaen enfermería, ayuda a interpretar el sufrimiento del paciente,su relación con su entorno social y cultural y sus sentimientose inquietudes dentro de la diabetes.(AU)


The main objective of this reflective essay is to show theusefulness of qualitative and / or phenomenological researchin the care of patients with diabetes. Comprehensive carein a biopsychosocial, cultural and spiritual way for both thepatient and the family of the same by the health professional,plays an important role when it comes to having quality oflife in the new lifestyle. Qualitative research in nursing helpsto interpret the suffering of the patient, her relationshipwith her social and cultural environment and her feelingsand concerns within diabetes.(AU)


Objetivo: mostrar e refletir sobre a utilidade da pesquisaqualitativa e/ou fenomenológica no cuidado ao paciente comdiabetes.Desenvolvimento: o cuidado integral de forma biopsicossocial,cultural e espiritual tanto para o paciente quanto para suafamília pelo profissional de saúde, desempenha um papelimportante quando se trata de ter qualidade de vida nonovo estilo de vida.Conclusões e reflexões finais: A pesquisa qualitativa emenfermagem ajuda a interpretar o sofrimento do paciente,sua relação com seu meio social e cultural, seus sentimentose preocupações frente ao diabetes.(AU)


Assuntos
Humanos , Masculino , Feminino , Diabetes Mellitus , Pesquisa Qualitativa , Enfermagem , Pesquisa em Enfermagem
18.
BMC Health Serv Res ; 24(1): 476, 2024 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-38632612

RESUMO

BACKGROUND: The transition from hospital to outpatient care is a particularly vulnerable period for patients as they move from regular health monitoring to self-management. This study aimed to map and investigate the journey of patients with polymorbidities, including type 2 diabetes (T2D), in the 2 months following hospital discharge and examine patients' encounters with healthcare professionals (HCPs). METHODS: Patients discharged with T2D and at least two other comorbidities were recruited during hospitalization. This qualitative longitudinal study consisted of four semi-structured interviews per participant conducted from discharge up to 2 months after discharge. The interviews were based on a guide, transcribed verbatim, and thematically analyzed. Patient journeys through the healthcare system were represented using the patient journey mapping methodology. RESULTS: Seventy-five interviews with 21 participants were conducted from October 2020 to July 2021. The participants had a median of 11 encounters (min-max: 6-28) with HCPs. The patient journey was categorized into six key steps: hospitalization, discharge, dispensing prescribed medications by the community pharmacist, follow-up calls, the first medical appointment, and outpatient care. CONCLUSIONS: The outpatient journey in the 2 months following discharge is a complex and adaptive process. Despite the active role of numerous HCPs, navigation in outpatient care after discharge relies heavily on the involvement and responsibilities of patients. Preparation for discharge, post-hospitalization follow-up, and the first visit to the pharmacy and general practitioner are key moments for carefully considering patient care. Our findings underline the need for clarified roles and a standardized approach to discharge planning and post-discharge care in partnership with patients, family caregivers, and all stakeholders involved.


Assuntos
Diabetes Mellitus Tipo 2 , Alta do Paciente , Humanos , Assistência ao Convalescente , Estudos Longitudinais , Assistência Ambulatorial , Pesquisa Qualitativa , Hospitais
19.
Ital J Pediatr ; 50(1): 73, 2024 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-38637868

RESUMO

BACKGROUND: In response to the imperative need for standardized support for adolescent Gender Dysphoria (GD), the Italian Academy of Pediatrics, in collaboration with the Italian Society of Pediatrics, the Italian Society for Pediatric Endocrinology and Diabetes, Italian Society of Adolescent Medicine and Italian Society of Child and Adolescent Neuropsychiatry is drafting a position paper. The purpose of this paper is to convey the author's opinion on the topic, offering foundational information on potential aspects of gender-affirming care and emphasizing the care and protection of children and adolescents with GD. MAIN BODY: Recognizing that adolescents may choose interventions based on their unique needs and goals and understanding that every individual within this group has a distinct trajectory, it is crucial to ensure that each one is welcomed and supported. The approach to managing individuals with GD is a multi-stage process involving a multidisciplinary team throughout all phases. Decisions regarding treatment should be reached collaboratively by healthcare professionals and the family, while considering the unique needs and circumstances of the individual and be guided by scientific evidence rather than biases or ideologies. Politicians and high court judges should address discrimination based on gender identity in legislation and support service development that aligns with the needs of young people. It is essential to establish accredited multidisciplinary centers equipped with the requisite skills and experience to effectively manage adolescents with GD, thereby ensuring the delivery of high-quality care. CONCLUSION: Maintaining an evidence-based approach is essential to safeguard the well-being of transgender and gender diverse adolescents.


Assuntos
Medicina do Adolescente , Diabetes Mellitus , Disforia de Gênero , Neuropsiquiatria , Humanos , Criança , Adolescente , Masculino , Feminino , Identidade de Gênero , Disforia de Gênero/terapia , Itália
20.
Curr Opin Pediatr ; 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38655800

RESUMO

PURPOSE OF REVIEW: Adolescents with Type 1 diabetes (T1D) are at significantly greater risk for disordered eating behaviors compared to their peers without T1D. Given that this is a dangerous and potentially lethal combination, this review aims to support pediatric medical providers in increasing competence in identification, assessment, and prevention of disordered eating behaviors in adolescents with T1D. RECENT FINDINGS: This review provides an up-to-date synthesis of unique risk factors for disordered eating behaviors in adolescents with T1D, including the daily diabetes management tasks, effects of insulin on weight and hunger, family conflict, and reinforcement from their environment for disordered behaviors. This review recommends two brief screening tools, the Diabetes Eating Problems Survey-Revised (DEPS-R) and Modified SCOFF (mSCOFF), to be used in busy practices; it also provides practical strategies for providersto use with patients in the form of effective, nonjudgmental language. SUMMARY: A clear understanding of unique experiences impacting adolescents with T1D may increase use of evidence-based screening tools and identification of disordered eating behaviors among a high-risk population in clinic/practice. In addition, providers' intentional use of nonjudgmental and de-stigmatizing language may lead to more positive interactions for adolescents and willingness to engage in further treatment.

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