Exploration of Fatalism and Religiosity by Gender and Varying Levels of Engagement Among Mexican-American Adults of a Type 2 Diabetes Management Program

Objectives: Purpose of study is to explore the roles religiosity and fatalistic beliefs play in diabetes management among newly, currently, and long-term enrolled Mexican-American participants in a Type 2 diabetes mellitus (T2DM) chronic care management program.Methods: In 2017, study participants (n = 15) completed a semi-structured interview in their preferred language (English or Spanish). Sample was stratified by amount of time individual had been enrolled as a participant of the Salud y Vida program: newly, currently, or long-term. Interviews assessed religious beliefs, beliefs concerning the cause(s) of diabetes, perceived relationship between religiosity and fatalistic beliefs with T2DM management, and the appropriateness of discussing such topics with a health professional. Interview responses were analyzed using ATLAS.ti 8.Results: Themes identified included: perceived autonomy over diabetes prognosis, motivators for self-care, discussions of personal beliefs in the healthcare setting, and the church's role in diabetes management.Conclusions: Among this sample, religiosity and religious fatalism played a complex role in coping with and managing diabetes. Long-term enrolled and male participants expressed beliefs of divine control over health, and a connection between religiosity and health behavior. Long-term enrolled participants felt religious and fatalistic beliefs may be suitable and beneficial to discuss in the healthcare setting.

Improved Glycemic Control With a Digital Health Intervention in Adults With Type 2 Diabetes: Retrospective Study (Preprint)

BACKGROUND Traditional lifestyle interventions have shown limited success in improving diabetes related outcomes. Digital interventions with continuously available support and personalized educational content may offer unique advantages for self-management and glycemic control. OBJECTIVE In the present study, we evaluate changes in glycemic control among participants with type 2 diabetes who enrolled in a digital diabetes management program. METHODS The study employed a single-arm, retrospective design. A total of 950 participants with a HbA1c baseline value of at least 7.0% enrolled in the Vida Health Diabetes Management Program. The intervention included one-to-one remote sessions with a Vida provider and structured lessons and tools related to diabetes management. Hemoglobin A1c (HbA1c) was the primary outcome measure. A total of 258 (27.2%) participants had a follow-up HbA1c completed at least 90 days from program start. Paired t-tests were utilized to evaluate changes in HbA1c between baseline and follow-up. Additionally, a cluster-robust multiple regression analysis was employed to evaluate the relationship between high and low program engagement and HbA1c change. A repeated measures ANOVA was used to evaluate difference in HbA1c as a function of measurement period (ie, pre-Vida enrollment, baseline, and post-enrollment follow-up). RESULTS We observed a significant reduction in HbA1c of -0.81 points between baseline (M = 8.68, SD = 1.7) and follow-up (M = 7.88, SD = 1.46), t(257) = 7.71, P = .00). Among participants considered high-risk (baseline HbA1c >= 8), there was an average reduction of -1.44 points between baseline (M = 9.73, SD = 1.68) and follow-up (M = 8.29, SD = 1.64), t(139) = 9.14, P = .00). Additionally, average follow-up HbA1c (M = 7.82, SD = 1.41) was significantly lower than pre-enrollment HbA1c (M = 8.12, SD = 1.46), F(2, 210) = 22.90, P = .00. There was also significant effect of engagement on HbA1c change, β = -.60, P = .00, such that high engagement was associated with a greater decrease in HbA1c (M = -1.02, SD = 1.60) compared to low-engagement, (M = -.61, SD = 1.72). CONCLUSIONS The present study revealed clinically meaningful improvements in glycemic control among participants enrolled in a digital diabetes management intervention. Higher program engagement was associated with greater improvements in HbA1c. The findings of the present study suggest that digital health intervention may represent an accessible, scalable, and effective solution to diabetes management and improved HbA1c. The study was limited by a non-randomized, observational design and limited post-enrollment follow-up data.

A1C Reduction in Patients Who Declined Pharmacist-Led Diabetes Management Services

Introduction: The purpose of this research is to assess the mean change in A1C associated with patients who declined a pharmacy-led diabetes management program and to evaluate effects of predictor variables on the odds of achieving improved A1C in these patients. Study design: Retrospective, single-center, single-group, cohort study. Methods: Patients 18 years or older with uncontrolled type 2 diabetes (defined as A1C ≥ 9%) who declined pharmacy-led diabetes management services were included in the study. The primary outcome of the study was to assess the mean change in A1C from time of phone call offering pharmacy management services (initial) to last observed A1C (final recorded A1C). Results: A total of 91 patients were included, 46 males and 45 females. The significant reduction in the mean change from baseline A1C to the final measured A1C was −0.59 (95% CI, −0.9327% to −0.2447%, P-value = 0.0010). This resulted in 8.79% of patients’ final A1C falling into the range of < 7%. Conclusion: Our study found a paradoxical reduction in A1C among patients who declined pharmacy-led diabetes management services, however, our study is limited by having no comparison group. Further research needs to be conducted to identify correlations between characteristics of patients declining diabetes management services in order to assist with identifying patient-specific methods for improving patient outcomes.

Duke University Medical Center Perioperative Diabetes Management Program

The following article describes a project at an academic tertiary-care medical center aimed at identifying surgical patients with uncontrolled diabetes early in the preoperative process to improve their perioperative glycemic control and surgical outcomes.

Duke University Medical Center Perioperative Diabetes Management Program

The following article describes a project at an academic tertiary-care medical center aimed at identifying surgical patients with uncontrolled diabetes early in the preoperative process to improve their perioperative glycemic control and surgical outcomes.