Effectiveness of Patient-centered Care for Diabetes Self-management to Improve Glycemic Control and Self-care Behaviors in Adults With Type 2 Diabetes: a Systematic Review

Abstract Background: Patient-centered care in diabetes self-management might be a significant factor in improving self-care outcomes yet the supporting evidence is inadequate. This review is aimed to assess the effectiveness of patient-centered self-management care interventions on self-care outcomes such as glycemic control (HbA1c) and self-care behaviors in adults with type-2 diabetes compared with usual care. Methods: CINAHL, PubMed, Cochrane Library, Google Scholar and the HEC Pakistan digital library were searched for English language studies that assessed patient-centered self-management educational and/or behavioral interventions in adults aged 18 years or above with type 2 diabetes from 1991 to 2020. Interventional studies comprising randomized controlled trials (RCT) and quasi experimental studies (QES) with at least three months follow up and reporting on self-care outcomes with glycemic control (HbA1c) as primary outcome and self-care behaviors including diet control, physical activity, medication adherence and foot care as secondary outcomes were included. Results: Of the 168 identified records, 25 were found eligible comprising 21 RCTs and 4 QESs with total 4,443 participants. The meta-analysis involved 23 studies that provided enough information for a pooled estimate of HbA1c. Compared with the control group, patient-centered self-management interventions significantly lowered HbA1c −0.53 (95% CI −0.73, −0.32). Stratified analysis for HbA1c with respect to various aspects of intervention showed larger effects in interventions employing both educational and behavioral components −0.59 (95% CI −0.86, −0.32), spanned over shorter (<03 months) duration −0.56 (95% CI −0.86, −0.27), administered by nurses −0.80 (95% CI −1.44, −0.16) and delivered in community setting −0.65 (95% CI −1.00, −0.29). Moreover, patient-centered self-management interventions were found effective in improving diet control, physical activity and foot care. Conclusion: This systematic review provided the evidence supporting the effectiveness of patient-centered self-management care interventions in improving glycemic control and self-care behaviors in adults with type 2 diabetes and identified key features of intervention contributing towards success.

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Patient-Centered Care, Glycemic Control, Diabetes Self-Care, and Quality of Life in Adults with Type 2 Diabetes

Diabetes Technology & Therapeutics ◽

10.1089/dia.2016.0079 ◽

2016 ◽

Vol 18 (10) ◽

pp. 644-649 ◽

Cited By ~ 16

Author(s):

Joni S. Williams ◽

Rebekah J. Walker ◽

Brittany L. Smalls ◽

Rachel Hill ◽

Leonard E. Egede

Keyword(s):

Quality Of Life ◽

Type 2 Diabetes ◽

Glycemic Control ◽

Self Care ◽

Patient Centered Care ◽

Patient Centered ◽

Centered Care ◽

Control Diabetes

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Empowerment and Social Support as Predictors of Self-Care Behaviors and Glycemic Control in Individuals With Type 2 Diabetes

Clinical Nursing Research ◽

10.1177/1054773816688940 ◽

2017 ◽

Vol 27 (4) ◽

pp. 395-413 ◽

Cited By ~ 10

Author(s):

Hamdiye Arda Sürücü ◽

Dilek Büyükkaya Besen ◽

Elif Yeter Erbil

Keyword(s):

Social Support ◽

Type 2 Diabetes ◽

Blood Glucose ◽

Glycemic Control ◽

Linear Regression Analysis ◽

Glucose Monitoring ◽

Self Care ◽

Blood Glucose Monitoring ◽

Foot Care

This study investigated empowerment, social support, and diabetes-related characteristics as predictors of self-care behaviors and glycemic control in individuals with type 2 diabetes in Turkey. Descriptive cross-sectional and relational research designs were used in this study. The study was carried out with a cohort of 220 individuals with type 2 diabetes. Linear regression analysis revealed that patient empowerment was a statistically significant predictor of diet (β = .30; p < .001), exercise (β = .19; p = .003), blood glucose monitoring (β = .27; p < .001), foot care (β = .27; p < .001), and A1c (β = −.19; p = .004). Social support was a statistically significant predictor of diet (β = .24; p < .001), exercise (β = .26; p < .001), blood glucose monitoring (β = .16; p = .011), and foot care (β = .19; p = .003). These results indicate that social support and empowerment are important for nurses to consider when planning interventions that increase the self-care behavior of individuals with type 2 diabetes and for improving glycemic control.

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Application of structural equation modeling in assessing the self-management activities of patients with type 2 diabetes

Journal of Primary Care & Community Health ◽

10.1177/2150132720974204 ◽

2020 ◽

Vol 11 ◽

pp. 215013272097420

Author(s):

Rashid M. Ansari ◽

Mark Harris ◽

Hassan Hosseinzadeh ◽

Nicholas Zwar

Keyword(s):

Type 2 Diabetes ◽

Structural Equation Modeling ◽

Glycemic Control ◽

Structural Equation ◽

Self Care ◽

The Self ◽

Self Management ◽

Equation Modeling ◽

Chi Squared

Objective This study aimed at assessing the self-management activities of type 2 diabetes patients using Structural Equation Modeling (SEM) which measures and analyzes the correlations between observed and latent variables. This statistical modeling technique explored the linear causal relationships among the variables and accounted for the measurement errors. Methods A sample of 200 patients was recruited from the middle-aged population of rural areas of Pakistan to explore the self-management activities of type 2 diabetes patients using the validated version of the Urdu Summary of Diabetes Self-care Activities (U-SDSCA) instrument. The structural modeling equations of self-management of diabetes were developed and used to analyze the variation in glycemic control (HbA1c). Results The validated version of U-SDSCA instrument showed acceptable psychometric properties throughout a consecutive reliability and validity evaluation including: split-half reliability coefficient 0.90, test-retest reliability (r = 0.918, P ≤ .001), intra-class coefficient (0.912) and Cronbach’s alpha (0.79). The results of the analysis were statistically significant (α = 0.05, P-value < .001), and showed that the model was very well fitted with the data, satisfying all the parameters of the model related to confirmatory factor analysis with chi-squared = 48.9, CFI = 0.94, TLI = 0.95, RMSEA = 0.065, SPMR = 0.068. The model was further improved once the items related to special diet were removed from the analysis, chi-squared value (30.895), model fit indices (CFI = 0.98, TLI = 0.989, RMSEA = 0.045, SPMR = 0.048). A negative correlation was observed between diabetes self-management and the variable HbA1c (r = –0.47; P < .001). Conclusions The Urdu Summary of Diabetes Self-Care Activities (U-SDSCA) instrument was used for the patients of type 2 diabetes to assess their diabetes self-management activities. The structural equation models of self-management showed a very good fit to the data and provided excellent results which may be used in future for clinical assessments of patients with suboptimal diabetes outcomes or research on factors affecting the associations between self-management activities and glycemic control

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Effectiveness of Smartphone-Based Self-Management Interventions on Self-care and Health Relevant Outcomes in Patients with Type 2 Diabetes: A Systematic Review and Meta-analysis (Preprint)

10.2196/preprints.11593 ◽

2018 ◽

Author(s):

Haziqah Binte Aminuddin ◽

Nana Jiao ◽

Ying Jiang ◽

Jingfang Hong ◽

Wenru Wang

Keyword(s):

Type 2 Diabetes ◽

Self Efficacy ◽

Meta Analysis ◽

Self Care ◽

Self Management ◽

Significant Heterogeneity ◽

Major Health Problem ◽

Management Interventions

BACKGROUND Type 2 Diabetes Mellitus (T2DM) is a major health problem worldwide. Proper self-management can improve health outcomes and reduces risk of diabetic complications. Recently, smartphone-based technology has been used for self-management programs but their effectiveness in improving self-efficacy, self-care activities, health-related quality of life (HRQoL) and clinical outcomes for patients with T2DM is not well understood. OBJECTIVE To review the evidence and determine the effectiveness of smartphone-based self-management interventions on self-efficacy, self-care activities, HRQoL, glycated haemoglobin (HbA1c), body mass index (BMI), blood pressure (BP) levels of adults with T2DM. METHODS A systematic search of five databases (PubMed, Embase, Cochrane, CINAHL and Scopus) was conducted. Study published in English, from January 2007 to January 2018, were considered. Only randomised controlled trials (RCTs) of smartphone-based self-management interventions for patients with T2DM that reported any of the study outcomes were included. Two reviewers independently screened the studies, extracted data and assessed the quality of the studies. Meta-analyses were conducted for the different study outcomes. RESULTS A total of 26 articles, consisting of 22 studies with 2645 participants were included in the review. A meta-analysis conducted on self-efficacy revealed a large improvement of 0.98 (95% confidence interval [CI] 0.42 to 1.55; P < 0.001) with smartphone-based self-management interventions. The effect size on self-care activities was also large (d = 0.90; 95% CI 0.24 to 1.57; P < 0.001). Significant heterogeneity was present among studies pooled for both outcomes and subgroup analyses were conducted for self-efficacy. Smartphone-based self-management interventions also gave a small improvement on HRQoL (d = 0.26; 95% CI 0.06 to 0.47; P = .01) and a significant reduction in HbA1c (pooled MD = -0.55; 95% CI -0.60 to -0.40; P < 0.001). The effects on BMI and BP were not statistically significant. CONCLUSIONS Smartphone-based self-management interventions appear to have beneficial effects on self-efficacy, self-care activities and health-relevant outcomes for patients with T2DM. However, more research with good study designs is needed to evaluate the effectiveness of smartphone-based self-care interventions for T2DM. CLINICALTRIAL NA

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Viewpoint: Using the patient-centred medicine clinical framework to better appreciate and explore the many barriers to care in Type 2 diabetes

Journal of Primary Health Care ◽

10.1071/hc14340 ◽

2014 ◽

Vol 6 (4) ◽

pp. 340 ◽

Cited By ~ 1

Author(s):

Ron Janes ◽

Janet Titchener

Keyword(s):

Type 2 Diabetes ◽

Diabetes Care ◽

Barriers To Care ◽

Care Patient ◽

Self Management ◽

Patient Centered ◽

Disease Outcomes ◽

Centered Care ◽

The Many

There are many barriers to diabetes care. This paper explores whether organising these barriers to Type 2 diabetes care within the clinical framework of patient-centred medicine (PCM) enables a better appreciation and conceptualisation of these barriers. The terms 'diabetes', 'barriers to care', 'self-management', 'patient-centred care' and 'outcome assessment' were used to identify 28 articles describing multiple barriers (minimum of three) to care in Type 2 diabetes. Identified barriers were organised within the clinical framework of PCM. Barriers to diabetes care were numerous and diverse, but all could be accommodated within the PCM framework, except for one, that of patient non-compliance (non-adherence). This paternalistic concept contradicts patient autonomy, a key component of the PCM paradigm. Accepting non-adherence as a plausible barrier stops providers from recognising the actual barriers to diabetes self-management. Clinicians need to stop attributing blame for poor disease outcomes on patients, and instead to become partners in identifying and addressing their patients' real barriers to better health by using the practical clinical framework of PCM. KEYWORDS: Diabetes mellitus, type 2; medication adherence; patient-centered care; patient compliance; self care

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