Serious Complications for Patients, Care Providers and Policy Makers: Tackling the Structural Violence of First Nations People Living with Diabetes in Canada

Type 2 diabetes mellitus is a progressive metabolic disorder that affects Aboriginal people disproportionately around the world. Evidence shows that diabetes treatment strategies can effectively reduce complications related to the disease; in contrast many Aboriginal people develop these rapidly and at a young age. We conducted qualitative research on the barriers to evidence-based self-management behaviours and education from the perspectives of Aboriginal people living with type 2 diabetes and their health care providers on Manitoulin Island in Ontario, Canada. Applying the concept of structural violence, we analyzed the social and political arrangements that can put Aboriginal people with diabetes “in harm’s way” by interfering with diabetes management. Lastly, we provide recommendations for structural interventions.

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Contextually Appropriate Tools and Solutions to Facilitate Healthy Eating Identified by People with Type 2 Diabetes

Nutrients ◽

10.3390/nu13072301 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2301

Author(s):

M. Carolina Archundia Herrera ◽

Denise L. Campbell-Scherer ◽

Rhonda C. Bell ◽

Catherine B. Chan

Keyword(s):

Type 2 Diabetes ◽

Health Care Providers ◽

Healthy Eating ◽

Eating Behaviors ◽

Diabetes Management ◽

Relevant Information ◽

Care Providers ◽

Foot Care ◽

The Individual

Type 2 diabetes (T2D) is a complex, multifaceted disease and its treatment involves lifestyle intervention (LI) programs that participants may find difficult to adopt and maintain. The objective of this study is to understand the lived experiences of participants with T2D regarding healthy eating behavior change, in order to identify and incorporate relevant information, skills, and educational approaches into LI programs. An explorative qualitative study was undertaken. Purposeful sampling was used to recruit 15 participants. One-on-one, semi-structured, open-ended, and in-depth interviews were conducted. An essentialist paradigm was adopted to accurately report the experiences, meaning, and reality of participants. An inductive approach was used to analyze the data. Participants reported that being diagnosed and living with T2D could be overwhelming, and their ability to manage was influenced by health care providers (HCP), family, and individual context. Many experienced a loop of “good–bad” eating behaviors. Participants expressed desires for future diabetes management that would include program content (nutrition, physical activity, mental health, foot care, and consequences of T2D), program features (understand context, explicit information, individualized, hands-on learning, applicable, realistic, incremental, and practical), program components (access to multidisciplinary team, set goals, track progress and be held accountable, one-on-one sessions, group support, maintenance/follow-up), and policy change. In conclusion, the results of this study indicate that T2D management requires more extensive, comprehensive, and ongoing support, guided by the individual participant.

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Disclosure of Herbal Medicine Usage in Diabetes Management: A Qualitative Study amongst Type 2 Diabetes Mellitus Patients and Health Care Providers in Negeri Sembilan, Malaysia

Malaysian Journal of Social Sciences and Humanities (MJSSH) ◽

10.47405/mjssh.v6i1.617 ◽

2021 ◽

Vol 6 (1) ◽

pp. 279-288

Author(s):

Nadia Amirudin ◽

Albeny Joslyn Panting ◽

Rosnani Kassim ◽

Norbaidurah Ithnain

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Herbal Medicine ◽

Qualitative Study ◽

Health Care Providers ◽

Diabetes Management ◽

Communication Process ◽

Care Providers

The use of herbal medicine (HM) and its products has significantly increased in the past decade. Type 2 Diabetes mellitus patients (T2DM) are always rendering herbal medicine as an alternative to the current option of treatment to manage their disease. This article is aimed to explore the extent of communication process of patients who disclose their HM usage to healthcare providers (HCPs) and HCP’s experiences in managing these patients. Purposive sampling method was applied in this qualitative study, which involved 28 respondents from four government clinics in Negeri Sembilan, Malaysia. A semi-structured interview was developed for the in-depth interview (IDI) and focus group interview (FGD). Both IDIs and FGDs were audio-recorded and conducted for approximately (40–60) minutes. The contents were transcribed verbatim and thematically analysed. The majority of T2DM patients did not reveal their HM usage due to fear of negative feedback, never been inquired by HCP and bad experiences after disclosure. Whereas, patients will disclose if they have a good rapport with HCPs and HCP asked patients courteously. However, HCPs reported that they did not discuss HM usage with patients due to limited knowledge, patients refuse to admit and time constraint to consult patients. Communication between T2DM patients and HCPs during consultation concerning the proper use of HM alongside modern medicine needs to be improved. Therefore, a better understanding factor of HM usage and its disclosure would make patients more open-minded to discuss and encourage HCPs to be attentive to avoid any potential adverse effects in HM usage.

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Assessment of Ramadan Education and Knowledge Among Diabetic Patients

Clinical Medicine Insights Endocrinology and Diabetes ◽

10.1177/1179551417751611 ◽

2018 ◽

Vol 11 ◽

pp. 117955141775161 ◽

Cited By ~ 7

Author(s):

Mussa Hussain Almalki ◽

Ibtihal Hussen ◽

Shawana A. Khan ◽

Abdulrahman Almaghamsi ◽

Fahad Alshahrani

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Health Care Providers ◽

Diabetes Management ◽

Cross Sectional Study ◽

Diabetic Patients ◽

Care Providers ◽

Cross Sectional

Background: During Ramadan, Muslims fast from dawn until dusk for one lunar month every year. Most of the Muslim patients with diabetes are unaware of the potential complications that can occur while fasting, such as hypoglycemia. The aim of this study is to assess the the patient education level and patients’ overall awareness of any possible complications that could occur while fasting during Ramadan and to determine how these patients deal with these complications. Methods: We conducted a cross-sectional study and surveyed diabetic patients about their diabetes-related knowledge over a period of 4 months from the outpatient clinic at the Obesity, Endocrine, and Metabolism Center at King Fahad Medical City. Patients were included if they were ≥16 years and if they had been receiving treatment for at least 1 year before the study, irrespective of the medications used; patients were also asked about the presence or absence of complications. Results: This study included 477 patients (325 women and 152 men). Most patients (297; 62.3%) had type 2 diabetes. The patients’ mean age was 39.72 ± 15.29 years, and the mean duration of diabetes was 10.80 ± 5.88 years. During the preceding Ramadan, 76% of patients reported fasting, whereas 58% said that they monitored their blood glucose levels once per day. Hypoglycemic episodes were reported in 60.3% of cases with type 2 diabetes and in 8.3% of cases with type 1 diabetes. Among those who had hypoglycemia, 2.8% of patients with type 1 diabetes and 17.8% with type 2 diabetes broke their fast. Finally, 54% of patients reported that their health care providers offered them instructions on diabetes management during Ramadan. Conclusions: Ramadan health education in diabetes can encourage, improve, and guide patients to change their lifestyles during Ramadan while minimizing the risk of acute complications.

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Incorporating Aboriginal women’s voices in improving care and reducing risk for women with diabetes in pregnancy - A phenomenological study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04055-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anna J Wood ◽

Sian Graham ◽

Jacqueline A Boyle ◽

Beverley Marcusson-Rababi ◽

Shonada Anderson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Health Care Providers ◽

Phenomenological Study ◽

Aboriginal People ◽

Lifestyle Change ◽

Care Providers ◽

Diabetes In Pregnancy ◽

Health Lifestyle ◽

In Pregnancy

Abstract Background There is a high burden of gestational diabetes (GDM) and type 2 diabetes in pregnancy for Aboriginal and Torres Strait Islander women. Postpartum diabetes programs have the potential to prevent recurrent GDM and improve management of type 2 diabetes. However, data on such programs are limited, particularly in the Indigenous context. We aimed to explore Aboriginal Australian women’s and health providers’ preferences for a program to prevent and improve diabetes after pregnancy. Methods A phenomenological methodology underpinned semi-structured in-depth interviews with eleven Aboriginal women and seven health professionals across the Northern Territory from October 2019- February 2020. Interviews were analysed using an inductive analysis framework to address the barriers and enablers of proposed diabetes prevention programs identified by participants. Results Identified structural barriers to lifestyle change included: food insecurity, persuasive marketing of unhealthy food options, lack of facilities and cultural inappropriateness of previous programs. Enablers to lifestyle change included: a strong link between a healthy lifestyle and connection with Country, family and community. Suggested strategies to improve lifestyle included: co-designed cooking classes or a community kitchen, team sports and structural change (targeting the social determinants of health). Lifestyle change was preferred over metformin to prevent and manage diabetes after pregnancy by participants and health care providers. Conclusions We recommend individual level programs be designed alongside policies that address systemic inequalities. A postpartum lifestyle program should be co-designed with community members and grounded in Aboriginal conceptions of health to adequality address the health disparities experienced by Aboriginal people in remote communities.

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‘Working with the team’: an exploratory study of improved type 2 diabetes management in a new model of integrated primary/secondary care

Australian Journal of Primary Health ◽

10.1071/py12087 ◽

2013 ◽

Vol 19 (3) ◽

pp. 207 ◽

Cited By ~ 14

Author(s):

Julie Hepworth ◽

Deborah Askew ◽

Claire Jackson ◽

Anthony Russell

Keyword(s):

Type 2 Diabetes ◽

Health Care ◽

Health Care Providers ◽

Secondary Care ◽

Diabetes Management ◽

Care Providers ◽

Positive Health ◽

New Model ◽

Patient Centred Care

This study aimed to explore how a new model of integrated primary/secondary care for type 2 diabetes management, the Brisbane South Complex Diabetes Service (BSCDS), related to improved diabetes management in a selected group of patients. We used a qualitative research design to obtain detailed accounts from the BSCDS via semi-structured interviews with 10 patients. The interviews were fully transcribed and systematically coded using a form of thematic analysis. Participants’ responses were grouped in relation to: (1) Patient-centred care; (2) Effective multiprofessional teamwork; and (3) Empowering patients. The key features of this integrated primary/secondary care model were accessibility and its delivery within a positive health care environment, clear and supportive interpersonal communication between patients and health care providers, and patients seeing themselves as being part of the team-based care. The BSCDS delivered patient-centred care and achieved patient engagement in ways that may have contributed to improved type 2 diabetes management in these participants.

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Understanding Gestational Diabetes, Future Diabetes Risk, and Diabetes Prevention: A Qualitative Study of Patient, Provider and Staff Perspectives

10.2337/figshare.15031746 ◽

2021 ◽

Author(s):

Hannah R. Lucas ◽

Roxann C. Williams ◽

Laura N. Hollar ◽

Bethany Johnson-Javois ◽

Heidi B. Miller ◽

...

Keyword(s):

Type 2 Diabetes ◽

Gestational Diabetes ◽

Health Care Providers ◽

Diabetes Prevention ◽

Diabetes Risk ◽

Care Providers ◽

Diabetes Screening ◽

Structured Interviews ◽

Future Diabetes

Gestational diabetes mellitus (GDM) increases type 2 diabetes risk; however, postpartum diabetes screening rates are low. Using semi-structured interviews and focus groups, this study investigates the understanding of GDM and its relationship to future diabetes risk and diabetes prevention among patients with public or no insurance (n = 36), health care providers (n = 21), and clinic staff (n = 9) from Federally Qualified Health Centers. Five main themes emerged: 1) general understanding of GDM diagnosis with focus on neonatal complications; 2) variable recall of diet, exercise, and weight recommendations; 3) overwhelming medication and self-monitoring routines; 4) short-term focus of type 2 diabetes risk and screening; and 5) limited understanding of all options for diabetes prevention. The results may inform diabetes screening and prevention interventions in primary care settings.

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Sociocultural Influences on African Americans’ Representations of Type 2 Diabetes: A Qualitative Study

Ethnicity & Disease ◽

10.18865/ed.28.1.25 ◽

2018 ◽

Vol 28 (1) ◽

pp. 25 ◽

Cited By ~ 6

Author(s):

Olayinka O. Shiyanbola ◽

Earlise Ward ◽

Carolyn Brown

Keyword(s):

Type 2 Diabetes ◽

African Americans ◽

Racial Discrimination ◽

Health Care Providers ◽

Eating Habits ◽

Cultural Beliefs ◽

Sociocultural Factors ◽

Diabetes Diagnosis ◽

Care Providers

Objective: Illness representations, known as patients’ beliefs and expectations about an illness, may be influenced by cultural beliefs and personal experiences. This study explored African Americans’ perceptions of the sociocultural factors that influence their representations of diabetes.Design: Six semi-structured focus groups.Setting: Private space at a convenient site.Participants: Forty African Americans, aged 45-60 years with type 2 diabetes for at least one year prior.Results: Participants perceived that there was a race-mediated effect of how they developed diabetes because of poverty due to past slavery, racial discrimination by health care providers, and the stigma associated with diabetes within the African American community. Participants perceived that poverty influenced African Americans’ unhealthy eating habits, which led to diabetes diagnosis among their ancestors and their development of the disease since it was hereditary. Participants also perceived that there was provider ill intention, ie, providers were purposefully making people sick, and their lack of education on diabetes from providers was done on purpose, as information on diabetes was withheld and not shared due to racial discrimination. Perceived stigma by the community led to African Americans’ avoidance and denial of the disease, and subsequently the development of diabetes.Conclusions: To enhance disease management for African Americans with diabetes, it is important to focus on the sociocultural context of how African Americans view their world that may be influenced by their knowledge of negative historical circumstances and their current provider relationship, which, in turn, may be reflected in their perceptions of diabetes.Ethn Dis. 2018;28(1):25-32; doi:10.18865/ed.28.1.25.

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Health Care Providers’ Perceptions of Responsibilities and Resources to Reduce Type 2 Diabetes Risk After Gestational Diabetes Mellitus

Clinical Diabetes ◽

10.2337/cd17-0063 ◽

2018 ◽

Vol 36 (2) ◽

pp. 160-167

Author(s):

Sumali S. Hewage ◽

Shweta R. Singh ◽

Claudia Chi ◽

Jerry K.Y. Chan ◽

Tong Wei Yew ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Health Care ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Health Care Providers ◽

Diabetes Risk ◽

Care Providers

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The Emerging Role of SGLT2 Inhibitors in the Treatment of Type 2 Diabetes. Focus on Dapagliflozin

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.1515/rjdnmd-2016-0014 ◽

2016 ◽

Vol 23 (1) ◽

pp. 113-120

Author(s):

Bogdan Timar ◽

Cristian Serafinceanu ◽

Adrian Vlad ◽

Romulus Timar

Keyword(s):

Type 2 Diabetes ◽

Glucose Transporter ◽

Diabetes Management ◽

Treatment Strategies ◽

Signs And Symptoms ◽

Sglt2 Inhibitors ◽

Glucose Transporter 2 ◽

Target Blood Glucose ◽

Attractive Therapeutic Target

AbstractType 2 diabetes is a progressive metabolic disorder, accounting for more than 90% of all cases of diabetes. Treatment strategies target blood glucose reduction and non-glycemic effects that can reduce long-term complications, such as cardiovascular disease. Although metformin is often initially effective as monotherapy, the progressive nature of diabetes frequently requires additional therapies. Sodium-glucose transporter 2 (SGLT2) became a very attractive therapeutic target in diabetes management. The mechanism of action of SGLT2 inhibitors is not dependent on insulin, thus making them attractive options anytime over the course of the disease. Dapagliflozin is a stable and highly selective inhibitor of SGLT2. The reductions in fasting plasma glucose concentration and bodyweight recorded during the first week of treatment in the dapagliflozin groups continued over weeks and years of treatment. Early weight loss with dapagliflozin might be partly due to a mild osmotic diuresis, while the gradual progressive reduction in bodyweight is consistent with a reduction of fat mass. Although dapagliflozin is well tolerated, signs and symptoms suggestive for urinary and/or genital infections were reported during clinical trials in more patients assigned to the drug than in placebo groups.

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A socioecological perspective : the "ups and downs" of living with type 2 diabetes among working adults in the rural south

10.32469/10355/79563 ◽

2019 ◽

Author(s):

◽

Lynn E. Glenn

Keyword(s):

Type 2 Diabetes ◽

Health Services ◽

Health Care Providers ◽

Preventive Health Services ◽

Patient Activation ◽

Preventive Health ◽

Self Management ◽

Care Providers ◽

Working Adults

Persons with higher patient activation levels are more likely to engage in preventive health behaviors. This qualitative study addressed a population that may be particularly vulnerable to poor diabetes outcomes: rural, working adults with type 2 diabetes (T2 DM) with low levels of patient activation. This study sought to gain a better understanding of the individual, interpersonal, health system, and community spheres of influence on engagement in diabetes self-management and recommended preventive health services among rural, working adults. A socioecological approach, based on Fisher's (2005) Resources and Supports for Self-Management Model, guided the study. The Patient Activation Measure (PAM-10) was used to identify individuals with low patient activation. Participants (N = 20) had PAM-10 scores less than 75 (M = 59.4) and were predominately African American (n = 12) and female (n = 14), earning incomes less than $50,000 (n = 13). The overarching theme, "ups and downs" of living with diabetes, emerged from the data. Four other major themes emerged: "the struggle", "you don't talk about it", "diabetes is not the priority", and "we're lucky to have what we have". Most participants had social support, employer health benefits, and a trusting, satisfactory relationship with health care providers. However, a lack of equitable workplace and community resources may have contributed to lack of engagement in diabetes self-management and preventive health services.

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