Diabetes Self-Management Education and Association With Diabetes Self-Care and Clinical Preventive Care Practices

Purpose: The purpose of the study is to assess self-reported receipt of diabetes education among people with diabetes and its association with following recommended self-care and clinical preventive care practices. Methods: We analyzed data from the 2017 and 2018 Behavioral Risk Factor Surveillance System for 61 424 adults (≥18 years) with self-reported diabetes in 43 states and Washington, DC. Diabetes education was defined as ever taking a diabetes self-management class. The association of diabetes education with self-care practices (daily glucose testing, daily foot checks, smoking abstention, and engaging in leisure-time physical activity) and clinical practices (pneumococcal vaccination, biannual A1C test, and an annual dilated eye exam, influenza vaccination, health care visit for diabetes, and foot exam by a medical professional) was assessed. Multivariable logistic regression with predicted margins was used to predict the probability of following these practices, by diabetes education, controlling for sociodemographic factors. Results: Of adults with diabetes, only half reported receiving diabetes education. Results indicate that receipt of diabetes education is associated with following self-care and clinical preventive care practices. Those who did receive diabetes education had a higher predicted probability for following all 4 self-care practices (smoking abstention, daily glucose testing, daily foot check, and engaging in leisure-time physical activity) and all 6 clinical practices (pneumonia vaccination, biannual A1C test, and an annual eye exam, flu vaccination, health care visit, and medical foot exam). Conclusions: The prevalence of adults with diabetes receiving diabetes education remains low. Increasing receipt of diabetes education may improve diabetes-related preventive care.

The design of an evaluation framework for diabetes self-management education and support programs delivered nationally

Background The aim of this work was to develop a National Evaluation Framework to facilitate the standardization of delivery, quality, reporting, and evaluation of diabetes education and support programs delivered throughout Australia through the National Diabetes Services Scheme (NDSS). The NDSS is funded by the Australian Government, and provides access to diabetes information, education, support, and subsidized product across diverse settings in each state and territory of Australia through seven independent service-providers. This article reports the approach undertaken to develop the Framework. Methods A participatory approach was undertaken, focused on adopting nationally consistent outcomes and indicators, nominating objectives and measurement tools, specifying evaluation processes, and developing quality standards. Existing programs were classified based on related, overarching indicators enabling the adoption of a tiered system of evaluation. Results Two outcomes (i.e., improved clinical, reduced cost) and four indicators (i.e., improved knowledge and understanding, self-management, self-determination, psychosocial adjustment) were adopted from the Eigenmann and Colagiuri national consensus position statement for diabetes education. This allowed for the identification of objectives (i.e., improved empowerment, reduced distress, autonomy supportive program delivery, consumer satisfaction) and related measurement instruments. Programs were categorized as comprehensive, topic-specific, or basic education, with comprehensive programs allocated to receive the highest-level of evaluation. Eight quality standards were developed, with existing programs tested against those standards. Based on the results of testing, two comprehensive (OzDAFNE for people with type 1 diabetes, DESMOND for people with type 2 diabetes), and eight topic-specific (CarbSmart, ShopSmart, MonitorSmart, FootSmart, MedSmart, Living with Insulin, Insulin Pump Workshop, Ready Set Go – Let’s Move) structured diabetes self-management education and support programs were nominated for national delivery. Conclusions The National Evaluation Framework has facilitated consistency of program quality, delivery, and evaluation of programs delivered by multiple service providers across diverse contexts. The Framework could be applied by other service providers who facilitate multiple diabetes education and support programs and could be adapted for use in other chronic disease populations where education and support are indicated.

Cost-Utility of an Online Education Platform and Diabetes Personal Health Record: Analysis Over Ten Years

Background and Aims: My Diabetes My Way (MDMW) is Scotland’s interactive website and mobile app for people with diabetes and their caregivers. It contains multimedia resources for diabetes education and offers access to electronic personal health records. This study aims to assess the cost-utility of MDMW compared with routine diabetes care in people with type 2 diabetes who do not use insulin. Materials and Methods: Analysis used the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model 2. Clinical parameters of MDMW users (n = 2576) were compared with a matched cohort of individuals receiving routine care alone (n = 11 628). Matching criteria: age, diabetes duration, sex, and socioeconomic status. Impact on life expectancy, quality-adjusted life years (QALYs), and costs of treatment and complications were simulated over ten years, including a 10% sensitivity analysis. Results: MDMW cohort: 1670 (64.8%) men; average age 64.3 years; duration of diabetes 5.5 years. 906 (35.2%) women: average age 61.6 years; duration 4.7 years. The cumulative mean QALY (95% CI) gain: 0.054 (0.044-0.062) years. Mean difference in cost: –£118.72 (–£150.16 to –£54.16) over ten years. Increasing MDMW costs (10%): –£50.49 (–£82.24-£14.14). Decreasing MDMW costs (10%): –£186.95 (–£218.53 to –£122.51). Conclusions: MDMW is “dominant” over usual care (cost-saving and life improving) in supporting self-management in people with type 2 diabetes not treated with insulin. Wider use may result in significant cost savings through delay or reduction of long-term complications and improved QALYs in Scotland and other countries. MDMW may be among the most cost-effective interventions currently available to support diabetes.

Study on the Nursing Effect of Diabetes Health Education Nursing Methods Applied to Diabetes Patients in the Endocrinology Department

The aim of this study was to explore the nursing effect of diabetes education and nursing methods applied to diabetic patients in the endocrinology department. From October 2019 to October 2020, 90 patients with diabetes who were admitted to the Department of Endocrinology in our hospital were selected as the research objects, and the medical records of all patients were retrospectively analyzed. The patients were randomly divided into two groups, 45 patients who were given regular care as the control group and 45 patients who were given the diabetes health education care model as the experimental group. Routine care was given to patients in the routine group; that is, we paid attention to the patients’ diet, medication, and blood glucose levels. The experimental group patients were given diabetes health education guidance. The nursing effect, blood sugar level, disease awareness level, occurrence of complications, and compliance of the two groups of patients were evaluated. In this study, diabetes health education was given to the experimental group of patients. The conditions of this group of patients were significantly better than those of the basic group using conventional nursing methods. Therefore, the application of diabetes health education is very effective. The recovery from the disease has positive significance.

Diabetes Self-Efficacy and Associated Factors among People Living with Diabetes in Ibadan, Southwestern Nigeria

With the increasing prevalence of diabetes mellitus (DM) globally, including in Nigeria, self-care practices are universally recognized as imperative to keeping the illness under control and preventing complications. It is important to determine how competent patients feel about managing their diabetes; as well as their psychosocial adjustment. Self-efficacy measures these important aspects of diabetes care and act as a guide to health professionals on how best to tailor diabetes education and support. There is a dearth of studies on self-efficacy and associated influences, among people living with diabetes in Nigeria. Hence, this study was carried out to fill the lacunae. This descriptive study was carried out at the Out-patient Clinic of the University College Hospital (UCH), Ibadan, among 235 people receiving treatment for diabetes. A total sampling of all available patients who provided consent at the time of data collection was done. The instrument for data collection was a questionnaire consisting of a section on sociodemographic and clinical characteristics including fasting blood glucose; followed by a section on diabetes self-efficacy. Diabetes self-efficacy was measured using the validated and adapted Michigan Diabetes Empowerment scale (DES). Ethical approval was obtained from the University of Ibadan/University College Hospital Institutional Review Board (UI/UCH IRB). Data were entered into the Statistical Package for Social Sciences, version 20. Data were analysed using frequencies, percentages, mean, independent t-test and Pearson’s correlation at α 0.05. Participants were predominantly women (60.9%) and had a mean age of 59.3 ± 14.0 years. More than half of the participants (55%) had a high self-efficacy level. Educational level and having a family member who is a nurse or a doctor were significantly associated with high self-efficacy. Fasting blood glucose level was negatively correlated with self-efficacy and the domain of managing the psychological aspect of diabetes. A good percentage of people living with diabetes had high self-efficacy, which was influenced by educational level and having a health professional as a relative. Those with high self-efficacy had better glucose control. It is recommended that individually-tailored diabetes education be provided for people with poorly controlled glucose level.

Overcoming Barriers to Injectable Therapies: Development of the ORBIT Intervention Within a Behavioural Change Framework

It is estimated among individuals with type 2 diabetes (T2D) requiring injectable therapies to achieve optimal glycaemic control, one-third are reluctant to initiate therapies, with approximately 80% choosing to discontinue or interrupt injectable regimens soon after commencement. Initiation of injectables is a complex issue, with effectiveness of such treatments undermined by non-adherence or poor engagement. Poor engagement and adherence are attributed to psychological aspects such as individuals’ negative perceptions of injectables, depression, anxiety, feelings of shame, distress and perceived lack of control over their condition. The aim of this study was to describe the development of a structured diabetes intervention to address psychological barriers to injectable treatments among a cohort of those with T2D; conducted within a behavioural change framework. An evidence base was developed to inform on key psychological barriers to injectable therapies. A systematic review highlighted the need for theory-based, structured diabetes education focussed on associated psychological constructs to inform effective, patient-centric provisions to improve injectable initiation and persistence. Findings from the focus groups with individuals who had recently commenced injectable therapies, identified patient-centric barriers to initiation and persistence with injectables. Findings from the systematic review and focus groups were translated via Behavioural Change Wheel (BCW) framework to develop an intervention for people with T2D transitioning to injectable therapies: Overcoming and Removing Barriers to Injectable Treatment in T2D (ORBIT). This article describes how psychological barriers informed the intervention with these mapped onto relevant components, intervention functions and selected behaviour change techniques, and finally aligned with behaviour change techniques. This article outlines the systematic approach to intervention development within the BCW framework; guiding readers through the practical application of each stage. The use of the BCW framework has ensured the development of the intervention is theory driven, with the research able to be evaluated and validated through replication due to the clarity around processes and tasks completed at each stage.

Diabetic Foot Risk Factors and Effectiveness of Education in Saudi Arabia

Diabetes mellitus (DM) is a chronic disease with a remarkable global burden on the affected patients and healthcare systems. Among the reported complications, the diabetic foot has been reported to be a common one, which might be disabling, resulting in related amputations. Furthermore, we will provide evidence regarding the effect of education on the awareness and knowledge of diabetic Saudis about diabetic foot risk factors and management practices. Different risk factors were reported for developing diabetic foot among patients with DM. These will be studied in the current literature review, focusing on evidence that was conducted in Saudi Arabia. Age, gender, type of diabetes, education, duration of the disease, peripheral neuropathy, erythrocyte sedimentation rate, peripheral vascular disease, ischemic heart disease, renal artery disease, having a previous history of diabetic foot, and hypertension were all reported to be significant factors that were associated with the risk of developing diabetic foot across the Kingdom. The level of knowledge was variable across the different investigations. However, there is a poor attitude in general about the appropriate care practices of diabetic foot. Although it has been demonstrated that educational campaigns are effective, further efforts are still needed to increase awareness and attitude levels among diabetic patients in Saudi Arabia.

Who Needs Diabetes Education? A Qualitative Analysis of Emerging Adults With Type 1 Diabetes

Background The purpose of this study is to explore the diabetes self-management education (DSME) needs of emerging adults with type 1 diabetes mellitus (T1DM) because addressing these needs may facilitate optimal glycemic management during this challenging transitional period. Methods A hybrid qualitative design was utilized. Emerging adults and parents of emerging adults were recruited from endocrinology and primary care clinics and through a Utah-specific T1DM online community. Interviews were conducted to asses needs to achieve target A1C. Data were interpreted thematically. Results Emerging adults with T1DM (N = 33) and parents of emerging adults with T1DM (N = 17) were interviewed. Three main themes emerged: (1) mixed desire for personal DSME; (2) I don’t need the education, others do; and (3) health care provider (HCP) attributes that make a difference. Associated subthemes were reported. Conclusions Emerging adults reported that further education for themselves was not needed, although newly diagnosed individuals would benefit from increased training in diabetes management. Although many emerging adults had a supportive social network, they endorsed the need for greater public education to avoid diabetes misinformation. Emerging adults felt more connected with HCPs that had diabetes-specific training (ie, endocrinologist) or those who personally live with T1DM.