A Prospective, Non-randomized Feasibility and Preliminary Efficacy Study of a Telemedicine-Enabled Co-management Intervention for Adults With Type 2 Diabetes and Moderate Anxiety and/or Depression

2021 ◽  
Vol 47 (2) ◽  
pp. 144-152
Author(s):  
Michelle F. Magee ◽  
Stacey I. Kaltman ◽  
Mihriye Mete ◽  
Carine M. Nassar
Keyword(s):  
Mental Health ◽  
Type 2 Diabetes ◽  
Management Program ◽  
Post Intervention ◽  
Convenience Sample ◽  
Intervention Delivery ◽  
Management Intervention ◽  
Moderate Depression ◽  
Patient Health

Purpose The primary aim of this pilot study was to examine the feasibility of codelivering a mental health intervention with an evidence-based type 2 diabetes (T2DM) boot camp care management program. The preliminary impact of participation on symptom scores for depression and anxiety and A1C was also examined. Methods This was a 12-week, non-randomized pilot intervention conducted with a convenience sample of adults with uncontrolled T2DM and moderate depression and/or anxiety at an urban teaching hospital. Co-management intervention delivery was via in-person and telehealth visits. Participants were assessed at baseline and 90 days. Results Participants (n = 18) were African American, majority female (83%), and age 50.7 ± 13.4 years. Significant improvements in mental health outcomes were demonstrated, as measured by a reduction in Patient Health Questionnaire − 9 scores of 2.4 ± 2.9 ( P = .01) and in Generalized Anxiety Disorder − 7 scores of 2.3 ± 1.9 ( P = .001). The pre-post intervention mean A1C improved by 3.4 ± 2.1 units from 12% ± 1.4% to 8.5% ± 1.7% ( P < .001). Conclusion The data generated in this pilot support the feasibility of delivering a diabetes and mental health co-management intervention using a combination of in-person and telemedicine visits to engage adults with T2DM and coexisting moderate depression and/or anxiety. Further research is warranted.

scholarly journals Outcomes of a Digitally Delivered Low-Carbohydrate Type 2 Diabetes Self-Management Program: 1-Year Results of a Single-Arm Longitudinal Study (Preprint)

2017 ◽  
Author(s):  
Laura R Saslow ◽  
Charlotte Summers ◽  
James E Aikens ◽  
David J Unwin
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Body Weight ◽  
Glycemic Control ◽  
Management Program ◽  
Open Label ◽  
Post Intervention ◽  
Self Monitoring ◽  
Quasi Experimental

BACKGROUND Type 2 diabetes mellitus has serious health consequences, including blindness, amputation, stroke, and dementia, and its annual global costs are more than US $800 billion. Although typically considered a progressive, nonreversible disease, some researchers and clinicians now argue that type 2 diabetes may be effectively treated with a carbohydrate-reduced diet. OBJECTIVE Our objective was to evaluate the 1-year outcomes of the digitally delivered Low-Carb Program, a nutritionally focused, 10-session educational intervention for glycemic control and weight loss for adults with type 2 diabetes. The program reinforces carbohydrate restriction using behavioral techniques including goal setting, peer support, and behavioral self-monitoring. METHODS The study used a quasi-experimental research design comprised of an open-label, single-arm, pre-post intervention using a sample of convenience. From adults with type 2 diabetes who had joined the program and had a complete baseline dataset, we randomly selected participants to be followed for 1 year (N=1000; mean age 56.1, SD 15.7 years; 59.30% (593/1000) women; mean glycated hemoglobin A1c (HbA1c) 7.8%, SD 2.1%; mean body weight 89.6 kg, SD 23.1 kg; taking mean 1.2, SD 1.01 diabetes medications). RESULTS Of the 1000 study participants, 708 (70.80%) individuals reported outcomes at 12 months, 672 (67.20%) completed at least 40% of the lessons, and 528 (52.80%) completed all lessons of the program. Of the 743 participants with a starting HbA1c at or above the type 2 diabetes threshold of 6.5%, 195 (26.2%) reduced their HbA1c to below the threshold while taking no glucose-lowering medications or just metformin. Of the participants who were taking at least one hypoglycemic medication at baseline, 40.4% (289/714) reduced one or more of these medications. Almost half (46.40%, 464/1000) of all participants lost at least 5% of their body weight. Overall, glycemic control and weight loss improved, especially for participants who completed all 10 modules of the program. For example, participants with elevated baseline HbA1c (≥7.5%) who engaged with all 10 weekly modules reduced their HbA1c from 9.2% to 7.1% (P<.001) and lost an average of 6.9% of their body weight (P<.001). CONCLUSIONS Especially for participants who fully engage, an online program that teaches a carbohydrate-reduced diet to adults with type 2 diabetes can be effective for glycemic control, weight loss, and reducing hypoglycemic medications.

Abstract TP190: The Effectiveness of a Person-centered Empowerment-based Self-management Intervention in Reducing Risk of Stroke Among Male Patients With Poorly Controlled Type 2 Diabetes: A Mixed-method Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Li Cheng ◽  
Janet W Sit ◽  
Sek-ying Chair
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Mixed Method ◽  
Intervention Group ◽  
Self Management ◽  
Post Intervention ◽  
Management Intervention ◽  
Male Patients ◽  
Male Subjects

Introduction: The overall incidence of stroke was higher in men than women. Type 2 diabetes is found to be a risk factor for stroke. Previous prospective studies showed each 1% increase in HbA1c would be associated with 12% increase in the risk of developing a stroke. Identifying effective strategies to optimize the glycemic control of male patients with poorly controlled type 2 diabetes would be valuable for reducing the risk of stroke. This mixed-method study aims to examine how male patients with poorly controlled type 2 diabetes responded to a person-centered empowerment-based self-management intervention. Methods: Phase I study was based on a sub-group analysis of 179 male subjects with poorly controlled type 2 diabetes [with Glycated hemoglobin (HbA1c) ≥7.5%] who received a six-week empowerment-based self-management intervention (n= 93) or attentional control (n= 86), respectively. The primary outcome was HbA1c level from baseline to three-month post-intervention. Phase II study was an in-depth individual interview with the purpose to reveal how facilitating factors or barriers become apparent in the implementation of self-management practice. Integration of quantitative and qualitative data was performed to disclose a comprehensive picture of intervention effect and mechanism. Results: The pre-post HbA1c change for male subjects in the intervention group was 1.01%, which indicated a clinical significant reduction in the risk of developing stroke. At three-month post-intervention, male participants in the intervention group showed significant improvement in glycemic control (8.99% vs. 9.68%, between-group difference: 0.69±2.64, p= 0.045). Content analysis revealed that setting personally meaningful goals, making a personalized action plan, and reflecting and solution-finding were facilitating factors perceived by male subjects with poorly controlled type 2 diabetes. Two categories for barriers to optimal glycemic control were identified, including collective culture and diabetes fatalism. Conclusions: Person-centered empowerment-based intervention could facilitate male subjects with poorly controlled type 2 diabetes to actively engage in self-management activities for stroke prevention.

Relationship between medication adherence and psychosocial adjustment in patients with type 2 diabetes: A cross-sectional study

2020 ◽  
Vol 40 (3) ◽  
pp. 116-122
Author(s):  
Duygu Kes ◽  
Feray Gökdoğan
Keyword(s):  
Type 2 Diabetes ◽  
Psychosocial Adjustment ◽  
Large City ◽  
Psychosocial Care ◽  
Self Report ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Adherence To Medication ◽  
The Relationship

Adherence to drug treatment is a multidimensional concept. It is affected by many factors, such as physiological, psychological, family, environmental and social conditions. However, relatively little is known about the relationship between adherence to medication and psychosocial adjustment. The aim was to explore the relationship between adherence to antidiabetic drugs and the psychosocial adjustment of patients with type 2 diabetes mellitus. This cross-sectional descriptive correlational study was conducted between March and June 2018. A convenience sample of participants was recruited from seven internal disease outpatient clinics at a public tertiary hospital, located in a large city that serves as a gateway to nearby rural and urban areas in the north-west region of Turkey. Data were collected using the Adherence to Refills and Medications Scale (ARMS-7), and the Psychosocial Adjustment to Illness Scale–Self Report (PAIS–SR). This study is reported in accordance with STROBE. Pearson’s correlation analysis found a significant weak positive correlation between all domains of the PAIS–SR and the total scores on the ARMS‐7. The participants’ scores on medication refill were found to be significantly and positively correlated with all of the PAIS–SR domain scores except the sexual relationships domain. Psychosocial care could play a crucial role in improving drug regimen adherence among patients with diabetes. Therefore, nurses should integrate psychosocial care into daily practice.

Exercise Improves Quality of Life in Indigenous Polynesian Peoples With Type 2 Diabetes and Visceral Obesity

2013 ◽  
Vol 10 (5) ◽  
pp. 699-707 ◽  
Author(s):  
William R. Sukala ◽  
Rachel Page ◽  
Chris Lonsdale ◽  
Isabelle Lys ◽  
David Rowlands ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Type 2 Diabetes ◽  
Short Form ◽  
Bodily Pain ◽  
Visceral Obesity ◽  
Indigenous Populations ◽  
Post Intervention ◽  
Group Post

Background:To evaluate the differential effect of 2, group-based exercise modalities on quality of life (QoL) in indigenous Polynesian peoples with type 2 diabetes (T2DM) and visceral obesity.Methods:Participants were randomized to resistance training or aerobic training performed 3 times per for 16 weeks. The Short-Form 36 was administered at baseline and post intervention to assess 8 domains and physical and mental component scales (PCS and MCS) of QoL.Results:With the exception of Mental Health and MCS, all scores were lower at baseline than general population norms. Significant improvements were documented in several QoL scores in each group post intervention. No group × time interactions were noted. Pooled analyses of the total cohort indicated significantly improved Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Role-Emotional, PCS and MCS. Adaptation ranged from 5%−22%, and demonstrated a moderate-to-large effect (Cohen’s d = 0.64−1.29). All measures of QoL increased to near equivalent, or greater than general norms.Conclusion:Exercise, regardless of specific modality, can improve many aspects of QoL in this population. Robust trials are required to investigate factors mediating improvements in QoL, and create greater advocacy for exercise as a QoL intervention in this and other indigenous populations with T2DM.

scholarly journals Caregiving Stress Among American Indians With Type 2 Diabetes: The Importance of Awareness of Connectedness and Family Support

2018 ◽  
Vol 24 (4) ◽  
pp. 621-639 ◽  
Author(s):  
Ashleigh Coser ◽  
Kelley J. Sittner ◽  
Melissa L. Walls ◽  
Tina Handeland
Keyword(s):  
Mental Health ◽  
Type 2 Diabetes ◽  
Physical Health ◽  
Family Support ◽  
American Indians ◽  
Diabetes Management ◽  
Cumulative Exposure ◽  
Physical And Mental Health ◽  
Community Connectedness

American Indian (AI) communities experience a disproportionate rate of Type 2 diabetes (T2D) and cumulative exposure to stress. Although this link is well researched among various populations, it has not been examined among AI communities. Path analysis was used to examine a multiple-mediator model to explain how caregiver stress influences self-reported mental and physical health among 100 AI participants with T2D. Caregiver stress was negatively associated with physical and mental health. Physical health was positively associated with family/community connectedness and mental health was positively associated with both family support and connectedness. The relationship between caregiver stress and mental health was partially mediated by family/community connectedness; caregiver stress had no indirect effects on physical health via either hypothesized mediator. Findings demonstrate the importance of integrating individuals’ connection to family and community and its influence on caregiver stress and mental health in intervention programs targeting diabetes management and care among AI communities.

Measuring Outcomes of Type 2 Diabetes Disease Management Program in an HMO Setting

2002 ◽  
Vol 95 (1) ◽  
pp. 78-87 ◽  
Author(s):  
IBRAHIM AWAD IBRAHIM ◽  
JEFF BEICH ◽  
JAAN SIDOROV ◽  
ROBERT GABBAY ◽  
LUCY YU
Keyword(s):  
Type 2 Diabetes ◽  
Disease Management ◽  
Disease Management Program ◽  
Management Program ◽  
Diabetes Disease Management Program ◽  
Measuring Outcomes

scholarly journals Improving Type 2 Diabetes Patient Health Outcomes with Individualized Continuing Medical Education for Primary Care

2016 ◽  
Vol 7 (3) ◽  
pp. 473-481 ◽  
Author(s):  
Brian Lee ◽  
Dace Trence ◽  
Silvio Inzucchi ◽  
Jay Lin ◽  
Steven Haimowitz ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Medical Education ◽  
Health Outcomes ◽  
Continuing Medical Education ◽  
Diabetes Patient ◽  
Patient Health
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