Comparing of the Effects of Acceptance and Commitment Therapy and Emotion Regulation Training on Diabetes Empowerment

Background: Diabetes mellitus is a widely diffused chronic condition that affects several aspects of patients’ lives. The patient’s life in this condition depends on diabetes management ability. Therefore, this study aimed to compare the effects of Acceptance and Commitment Therapy (ACT) and Emotion Regulation Training (ERT) on the diabetes empowerment of patients with type 2 diabetes. Methods: This was a quasi-experimental study with a pre-test, post-test-follow-up and a control group design. Of the statistical population of patients referring to the Diabetes Prevention and Control Center of Mashhad Province, Iran, 45 subjects were recruited by convenience sampling method; they were randomly assigned into three groups of ACT, ERT, and control (n=15/group). The study subjects were assessed using the Diabetes Empowerment Scale (F-DES-28) in the pre-test stage, after the intervention, and 3 months later. The obtained data were analyzed by repeated-measures Analysis of Variance (ANOVA) in SPSS V. 22. Results: Both provided interventions presented a significant effect on the empowerment of the research subjects, compared to the controls (P<0.001). The effectiveness of ACT on the diabetes empowerment of patients was significantly higher than that of the ERT group (P=0.04). Conclusion: It is recommended to use ACT and ERT to empower patients with type 2 diabetes.

The Quebec Diabetes Empowerment Group Program: Program Description and Considerations Regarding Feasibility and Acceptability of Implementation in Primary Health Care Settings

Introduction: Diabetes is a highly prevalent chronic disease that frequently coexists with other medical conditions and implies a high burden for patients and the healthcare system. Clinicians currently are challenged to provide effective interventions that are both multidisciplinary and empower patient self-care. The Diabetes Empowerment Group Program (DEGP) was developed with the aims of fostering patient engagement in diabetes self-care through the lens of empowerment and to support the empowerment of patients with diabetes by providing multidisciplinary group-based care. This research's objectives were to: (1) develop a comprehensive description of the DEGP for potential adopters, and (2) explore the factors influencing the feasibility and acceptability of implementing it in other healthcare settings in Montreal.Methods: A qualitative descriptive study was conducted, following a participatory approach. Data were obtained from: (1) semi-structured interviews with 14 patients who participated in the pilot program; (2) from semi-structured group interviews with patient partners, healthcare professionals, and other stakeholders from 4 Montreal family medicine groups, and (3) discussions among the participatory research team during various knowledge translation activities. Inductive content analysis of the data was performed.Results: The DEGP identified seven key elements: medical visit, continuity of care, group-based dynamics, multi-disciplinarity, clinician facilitation, patient-centered agenda, and a theoretical framework of empowerment. The content and organization of the group visits were conceived to address each of these four domains. The empowerment framework comprises four domains of self-care: emotional (attitude), cognitive (knowledge), behavioral (skills), and relational (relatedness). Factors impacting the feasibility and acceptability of implementing the DEGP in other primary care settings were identified.Discussion: The DEGP fits within the discourse around the need for more patient-centered programs for people living with diabetes, following a more comprehensive empowerment model. This research could facilitate the development or adaptation of similar programs in other settings.

Relationship Between Diabetes, Stress, and Self-Management to Inform Chronic Disease Product Development: Retrospective Cross-Sectional Study

Background Technology is rapidly advancing our understanding of how people with diabetes mellitus experience stress. Objective The aim of this study was to explore the relationship between stress and sequelae of diabetes mellitus within a unique data set composed of adults enrolled in a digital diabetes management program, Livongo, in order to inform intervention and product development. Methods Participants included 3263 adults under age 65 who were diagnosed with diabetes mellitus and had access to Livongo through their employer between June 2015 and August 2018. Data were collected at time of enrollment and 12 months thereafter, which included demographic information, glycemic control, presence of stress, diabetes distress, diabetes empowerment, behavioral health diagnosis, and utilization of behavioral health-related medication and services. Analysis of variance and chi-square tests compared variables across groups that were based on presence of stress and behavioral health diagnosis or utilization. Results Fifty-five percent of participants (1808/3263) reported stress at the time of at least 1 blood glucose reading. Fifty-two percent of participants (940/1808) also received at least 1 behavioral health diagnosis or intervention. Compared to their peers, participants with stress reported greater diabetes distress, lower diabetes empowerment, greater insulin use, and poorer glycemic control. Participants with stress and a behavioral health diagnosis/utilization additionally had higher body mass index and duration of illness. Conclusions Stress among people with diabetes mellitus is associated with reduced emotional and physical health. Digital products that focus on the whole person by offering both diabetes mellitus self-management tools and behavioral health skills and support can help improve disease-specific and psychosocial outcomes.

Glycemic excursion minimization in the management of type 2 diabetes: a novel intervention tested in a randomized clinical trial

IntroductionThis study of adults with type 2 diabetes employed a non-inferiority hypothesis to investigate whether an innovative lifestyle focused on minimizing postnutrient blood glucose (BG) excursions (glycemic excursion minimization (GEM)) would be equivalent or superior to conventional weight loss (WL) therapy in regard to reducing HbA1c, and superior to WL when investigating physical, behavioral and psychological secondary outcomes. The impact of BG feedback on GEM efficacy was also investigated.Research design and methods178 adults with type 2 diabetes for ≤10 years, HbA1c ≥6.8%, and not using insulin were randomized to WL (n=40) or one of three versions of GEM. Didactic (GEM-D, n=39) taught participants to choose low-glycemic load foods, reduce sedentary time and increase moderate routine physical activity. GEM-S (n=51) received GEM-D and systematically measured BG before and after meals and physical activity to educate and motivate food and activity choices. GEM-C (n=48) received GEM-D with continuous glucose monitoring feedback. All participants received 6 hours of group training and BG and activity monitors. Before and 3 months after treatment, participants were assessed for HbA1c, lipids, weight, routine physical activity, nutrition, depression, diabetes empowerment and distress.ResultsGEM versions did not differ in primary or secondary outcomes, so they were combined for analyses. While WL reduced body mass index (BMI) (p=0.005), GEM demonstrated a greater reduction in HbA1c (p=0.005), BMI (p=0.013), carbohydrate intake (p=0.001), BG response to a glucose challenge (p=0.02), and cardiovascular risk (p=0.003). Only GEM participants significantly improved diabetes empowerment, diabetes distress, depressive symptoms, steps/day, and active hours and reduced calories/day. Neither intervention had negative side effects.ConclusionsGEM is an effective alternative to WL with respect to physical, behavioral and psychosocial outcomes.Trial registration numberNCT03196895.

Psychosocial factors predict type 2 diabetes mastery

Background Psychosocial aspects of chronic diseases such as Type 2 diabetes (T2D) and cardiovascular disease (CVD) are increasingly recognised as impacting effective self-management. Until now, little was known regarding the moderating effects of empowerment and depression on the relationship between diabetes-specific distress and mastery. Purpose To evaluate the potential mediating role of diabetes empowerment and depression on the relationship between diabetes-specific distress and mastery. Methods Sample comprised 131 participants diagnosed with T2D, mean [SD] age 62.3 [8.8]; 59.5% male. Mean time since diagnosis was 10.4 years. Assessments included: emotional distress (Problem Areas in Diabetes Scale; PAID); depression and anxiety (Hospital Anxiety and Depression Scale; HADS); mastery (Pearlin Mastery Scale); and empowerment (Diabetes Empowerment Scale – Short Form; DES-SF). Data were examined using SPSS: PROCESS a logistic regression-based path analytical framework for multiple mediator models. Results Regression coefficients for the model identified distress (b=−0.249, t(5,112)=−3.71, p&lt;0.001), empowerment (b=0.280, t(5,112)=3.02, p&lt;0.001) and depression (b=−0.980, t(5,112)=−5.73, p&lt;0.001) were all statistically significant predictors of mastery. The PROCESS model assessed ΔR2 as a result of the interaction between distress and depression, which indicated a significant increase (ΔR2=0.08) in variance explained due to the inclusion of both moderators: F(2,112)=16.88, p&lt;0.001, ΔR2=0.14. Also identified were interaction effect sizes: at low levels of empowerment, increasing depression led to increasing levels of distress predicting overall levels of mastery. This held true at moderate and high levels of empowerment; increasing levels of depression led to increasing distress predicting mastery. Conclusions These findings elucidate the impact of empowerment and depression on the association between distress and mastery in a diabetes cohort. The evidence suggests that the psychosocial interventions likely to have greatest impact on mastery are those that target key moderators such as empowerment and depression. Funding Acknowledgement Type of funding source: None

Relationship Between Diabetes, Stress, and Self-Management to Inform Chronic Disease Product Development: Retrospective Cross-Sectional Study (Preprint)

BACKGROUND Technology is rapidly advancing our understanding of how people with diabetes mellitus experience stress. OBJECTIVE The aim of this study was to explore the relationship between stress and sequelae of diabetes mellitus within a unique data set composed of adults enrolled in a digital diabetes management program, Livongo, in order to inform intervention and product development. METHODS Participants included 3263 adults under age 65 who were diagnosed with diabetes mellitus and had access to Livongo through their employer between June 2015 and August 2018. Data were collected at time of enrollment and 12 months thereafter, which included demographic information, glycemic control, presence of stress, diabetes distress, diabetes empowerment, behavioral health diagnosis, and utilization of behavioral health-related medication and services. Analysis of variance and chi-square tests compared variables across groups that were based on presence of stress and behavioral health diagnosis or utilization. RESULTS Fifty-five percent of participants (1808/3263) reported stress at the time of at least 1 blood glucose reading. Fifty-two percent of participants (940/1808) also received at least 1 behavioral health diagnosis or intervention. Compared to their peers, participants with stress reported greater diabetes distress, lower diabetes empowerment, greater insulin use, and poorer glycemic control. Participants with stress and a behavioral health diagnosis/utilization additionally had higher body mass index and duration of illness. CONCLUSIONS Stress among people with diabetes mellitus is associated with reduced emotional and physical health. Digital products that focus on the whole person by offering both diabetes mellitus self-management tools and behavioral health skills and support can help improve disease-specific and psychosocial outcomes.

Peningkatan Self Empowerment Klien Diabetes Militus Tipe 2 dengan Pendekatan Health Action Proces Approach

Diabetes mellitus is a chronic disease that requires the individual ability of patients to approve the process of disease management. Individuals with DM must take great responsibility for the care of themselves in the treatment of their illness. Empowerment of individuals to control independent life and make choices about self empowerment. Self empowerment in DM patients can be improved through the approach of the health action process approach which is a concept of a patient that is believed to be done by increasing the intention through the motivational phase to realize the intention to action. The purpose of this study was to determine the increase in self empowerment of people with type II diabetes mellitus with a health action approach. This study used a pre-experimental study using a control-group pre-test-post-test design. The population was 64 with type 2 diabetes mellitus patients. The sample were 32 people in the experimental group and 32 people in the control group, selected by purposive sampling. Self empowerment using diabetes empowerment scale (DES) questionnaire in accordance with the characteristics of the research subjects. Data analysis was performed with the Wilcoxon statistical test signing the rank test and Mann-Whitney with the result of p value of 0.000 < 0.05 so that there were differences between the experimental and control groups. The results in this study were DM clients who have a good increase in self empowerment are clients who have the motivation and ability to recover from illness. Keywords: diabetes mellitus; self empowerment; health action process approach ABSTRAK Diabetes mellitus merupakan salah satu penyakit kronis yang memerlukan kemampuan individu dari klien untuk mematuhi penatalaksanaan proses penyakit. Individu dengan penyakit DM mempunyai tanggung jawab yang besar untuk mengatur dirinya sendiri dalam melakukan perawatan pada penyakitnya. Kemampuan individu untuk mempunyai kontrol atas hidup mereka sendiri dan menentukan pilihan mengenai kesehatan disebut self empowerment. Self empowerment pada klien DM dapat ditingkatkan melalui pendektan Health Action Process Approach yang merupakan suatu konsep pendekatan terhadap klien yang meyakini bahwa untuk mengubah perilaku seseorang dapat dilakukan dengan cara meningkatkan niat melalui motivational phase untuk membentuk niat menjadi action. Tujuan penelitian ini adalah untuk mengetahui peningkatan self empowerment klien diabetes militus tipe II dengan pendekatan Health action proces approach. Penelitian ini menggunakan pre-eksperiment dengan pendekatan control-group pre-test-post-test design. Populasinya adalah klien diabetes mellitus tipe 2 dengan jumlah 64 responden. Ukuran sampel adalah 32 orang pada kelompok eksperimen dan 32 orang pada kelompok kontrol dengan pengambilan sampel menggunan teknik purposive sampling. Self empowerment diukur menggunakan kuesioner Diabetes Empowerment Scale (DES) yang dimodifikasi sesuai dengan karakteristik subjek penelitian. Analisis data dilakukan dengan uji statistik Wilcoxon signed rank test dan Mann-Whitney dengan hasil p value signifikansi 0,00 < 0,05 sehingga ada perbedaan antara kelompok eksperimen dan kelompok kontrol. Hasil dalam penelitian ini adalah bahwa klien DM yang memiliki peningkatan self empowerment yang baik adalah klien yang memiliki motivasi dan kemaun untuk sembuh dari penyakit. Kata Kunci: diabetes mellitus; self empowerment; health action proces approach