Relationships among Self-Management, Patient Perceptions of Care, and Health Economic Outcomes for Decision-Making and Clinical Practice in Type 2 Diabetes

People with type 2 diabetes risk disability and early death when they fail to control their blood glucose levels. Despite advances in medicine, pharmacology, human factors, and education, dangerous glucose levels remain endemic. To investigate cognitive barriers to control, we observed American Diabetes Association (ADA) certified training programs; reviewed ADA and National Institute of Health diabetes Web sites; and interviewed patients with type 2 diabetes using a critical decision method. A consistent picture emerged. The prevailing rules and procedures approaches are not preparing patients for the dynamic control task they face. Patients are often unable to understand and use the rules and procedures provided. They are unprepared to detect problems, make sense of dynamic relationships, and manage complex situations. Our results suggest that glucose self-regulation is better conceptualized as a dynamic control challenge requiring complex processes, including problem detection, sensemaking, decision making, and planning/replanning. The mismatch between most patient training and the dynamic demands of glucose regulation helps explain limitations in existing training and poor patient outcomes. We argue that constructs gleaned from naturalistic decision-making research in other complex domains can help many but not all patients develop the cognition necessary for effective blood glucose self-management.

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Factors influencing self-management priority setting and decision-making among Chinese patients with acute coronary syndrome and type 2 diabetes mellitus

European Journal of Cardiovascular Nursing ◽

10.1177/1474515119863178 ◽

2019 ◽

Vol 18 (8) ◽

pp. 700-710 ◽

Cited By ~ 1

Author(s):

Xian-Liang Liu ◽

Karen Willis ◽

Paul Fulbrook ◽

Chiung-Jung (Jo) Wu ◽

Yan Shi ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Decision Making ◽

Type 2 Diabetes Mellitus ◽

Acute Coronary Syndrome ◽

Priority Setting ◽

Self Management ◽

Internal Factors ◽

Coronary Syndrome

Background: Priority setting and decision-making in relation to self-management of multiple conditions is particularly challenging for both patients and health professionals. The aim of this study was to validate a conceptual model of self-management priority setting and decision-making in multimorbidity and confirm factors that influence self-management prioritizing and decision-making in a sample of patients with acute coronary syndrome and type 2 diabetes mellitus. Methods: This was a qualitative study using deductive directed content analysis. A purposive sample of 21 participants with acute coronary syndrome and type 2 diabetes mellitus that were admitted to a Shanghai hospital were interviewed. Results: Participants provided evidence to confirm all but one of the factors from the conceptual model. Internal factors influencing self-management predominated. Agreement with recommended treatment, functional capacity and perceived synergies, antagonistic effects, or interactions among the conditions and prescribed treatments, was emphasized. The facilitators and barriers to priority setting and decision-making were related to available resources, provider communication and, to a lesser extent, confusion about recommendations, and treatment complexity. Some participants were also concerned about treatment side effects. Conclusions: Internal factors (personal beliefs, preferences, and attitudes) and facilitators and barriers (knowledge, finances, social support, and transportation) were related to changes in priority setting and decision-making and self-management behavior in this sample. Health education, which includes case studies with shifting self-management priorities is recommended, rather than a unique disease-specific focus. Further research, exploring the relationship between these factors and changes in the dominant condition and related management, using valid and reliable instruments that capture these key factors, is recommended.

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ALTERNATIVE APPROACHES TO MODELLING HBA1C PROGRESSION IN TYPE 2 DIABETES AND THEIR IMPACT ON HEALTH ECONOMIC OUTCOMES

Value in Health ◽

10.1016/j.jval.2016.03.1808 ◽

2016 ◽

Vol 19 (3) ◽

pp. A88

Author(s):

P. McEwan ◽

H. Bennett ◽

J. Fellows ◽

R. Yapp ◽

K. Bergenheim ◽

...

Keyword(s):

Type 2 Diabetes ◽

Health Economic ◽

Economic Outcomes ◽

Alternative Approaches

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Mexican-Born Immigrant Decision-Making About Self-Management of Type 2 Diabetes

10.22371/07.2017.009 ◽

2017 ◽

Author(s):

Virginia Hart-Kepler

Keyword(s):

Type 2 Diabetes ◽

Decision Making ◽

Self Management

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A Systematic Review of Patient-Reported and Economic Outcomes: Value to Stakeholders in the Decision-Making Process in Patients With Type 2 Diabetes Mellitus

Clinical Therapeutics ◽

10.1016/j.clinthera.2011.07.013 ◽

2011 ◽

Vol 33 (9) ◽

pp. 1225-1245 ◽

Cited By ~ 11

Author(s):

Ana Vieta ◽

Xavier Badia ◽

José A. Sacristán

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Type 2 Diabetes ◽

Decision Making ◽

Type 2 Diabetes Mellitus ◽

Economic Outcomes ◽

Decision Making Process ◽

Patient Reported

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A Self-Report Measure of Diabetes Self-Management for Type 1 and Type 2 Diabetes: The Diabetes Self-Management Questionnaire-Revised (DSMQ-R) – Clinimetric Evidence From Five Studies

Frontiers in Clinical Diabetes and Healthcare ◽

10.3389/fcdhc.2021.823046 ◽

2022 ◽

Vol 2 ◽

Author(s):

Andreas Schmitt ◽

Bernhard Kulzer ◽

Dominic Ehrmann ◽

Thomas Haak ◽

Norbert Hermanns

Keyword(s):

Type 2 Diabetes ◽

Clinical Practice ◽

Management Practices ◽

Self Report ◽

Self Management ◽

Diabetes Research ◽

Glucose Testing ◽

Reliability Coefficients

AimsMeasurement tools to evaluate self-management behavior are useful for diabetes research and clinical practice. The Diabetes Self-Management Questionnaire (DSMQ) was introduced in 2013 and has become a widely used tool. This article presents a revised and updated version, DSMQ-R, and evaluates its properties in assessing self-management practices in type 1 diabetes (T1D) and type 2 diabetes (T2D).MethodsThe DSMQ-R is a multidimensional questionnaire with 27 items regarding essential self-management practices for T1D and T2D (including diabetes-adjusted eating, glucose testing/monitoring, medication taking, physical activity and cooperation with the diabetes team). For the revised form, the original items were partially amended and the wording was updated; eleven items were newly added. The tool was applied as part of health-related surveys in five clinical studies (two cross-sectional, three prospective) including a total of 1,447 people with T1D and T2D. Using this data base, clinimetric properties were rigorously tested.ResultsThe analyses showed high internal and retest reliability coefficients for the total scale and moderate to high coefficients for the subscales. Reliability coefficients for scales including the new items were consistently higher. Correlations with convergent criteria and related variables supported validity. Responsiveness was supported by significant short to medium term changes in prospective studies. Significant associations with glycemic outcomes were observed for DSMQ-R-assessed medication taking, glucose monitoring and eating behaviors.ConclusionsThe results support good clinimetric properties of the DSMQ-R. The tool can be useful for research and clinical practice and may facilitate the identification of improvable self-management practices in individuals.

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A qualitative inquiry on self-management decision making among rural African Americans with type 2 diabetes

Innovation in Aging ◽

10.1093/geroni/igab046.2580 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 693-693

Author(s):

Idethia Shevon Harvey

Keyword(s):

Type 2 Diabetes ◽

Decision Making ◽

African Americans ◽

Disease Management ◽

Developmental Process ◽

Qualitative Inquiry ◽

Self Management ◽

Management Decision ◽

Management Decision Making

Abstract Living in a rural area has been recognized as a unique health disparity associated with higher rates of chronic disease. It is further compounded for those who are the most structurally vulnerable complicating access to care and negatively affecting health outcomes. Barriers to type 2 diabetes (T2DM) self-management remain a growing concern, particularly among minority communities living in underserved geographical areas. Much of the self-management research focused on compliance with medication regimens and modification of lifestyle choices. A less well-understood but arguably more critical aspect is the social factors in disease management decision-making. Purposive sampling was used to identify rural African Americans (n = 34). The mean age of participants was 65.9 years (SD = 12.3), and T2DM diagnosis was 15 years (SD = 12.4). The study utilized the consensual qualitative research methodology and the "Sort and Sift, Think and Shift" approach to identify themes. The participants reported an alternative way of integrating glucose monitoring through a "feedback loop" of body sensing. The longer they live with the condition (i.e., knowing my body), the more they can interpret whether they are hypoglycemic or hyperglycemic (i.e., deciphering the cues) to create and navigate their disease management strategy (i.e., body sensing). Self-management decision-making is a complex developmental process that includes disease trajectory and cultural and environmental factors. Findings from this study may provide a conceptual framework for ongoing inquiry and may provide insights to help T2DM educators and clinicians fully understand the complexity of long-term disease management among rural African Americans.

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