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Understanding the lived experience of the disease enables caregivers to offer people living with diabetes personalized support tailored to their needs. The discipline of nursing also enables them to draw on reference authors to guide their thinking and professional practice. Through the concepts of transition, integration of self-care, diabetes distress and empowerment, we explore certain aspects of living with diabetes., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Objectives: Our aim in this study was to develop and evaluate a tailored intervention for improving diabetes self-care among people with visual impairment (TID-VI) in South Korea., Methods: The TID-VI program was designed around the barriers, resources, and perceptual factors to promote diabetes self-care in those with visual impairment (VI). A single-arm pilot study was conducted to evaluate the feasibility and preliminary effects of the intervention. Diabetes self-efficacy, self-care behaviours, depression, health-related quality of life, and clinical outcomes (fasting blood glucose, glycated hemoglobin [A1C], lipids, and blood pressure) were measured before and up to 2 months after the 12-week intervention., Results: All 14 participants completed TID-VI. Diabetes self-efficacy, diabetes self-care behaviours, depression, and health-related quality of life showed improvement from baseline that was sustained at 2 months. Although high- and low-density lipoprotein also improved, there were no differences in blood glucose, A1C, total cholesterol, or blood pressure at 2 months., Conclusions: A theory-driven, tailored intervention specific to the needs of adults with VI can produce substantial improvements in patient-reported quality of life and health status outcomes, although the benefits are yet to be confirmed in a controlled study., (Copyright © 2024 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Objective: to evaluate the association of Orem self-care model improvement of symptoms and quality of life in patients with diabetes., Methods: A scoping review was carried on bibliographic databases: PubMed-Medline, Scopus, SID and Magiran. The inclusion criteria encompassed studies examining the impact of the Orem self-care model on diabetic patients. Studies considered for inclusion needed to have full-text availability and be written in either English or Persian, with key words including "Models", "Nursing", "Quality of Life", and "Diabetes Mellitus". CONSORT checklist and STROBE statement were selected for quality assessment., Results: A total of 9 studies were included, all using quantitative methodology and focusing on adults or older adults. The majority of articles focused on quality of life and diabetic symptoms. 8 studies showed positive outcomes after implementation of the model. The findings indicate that this model led to an enhanced level of self-efficacy, improved quality of life, and better self-care practices among diabetic patients., Conclusion: Orem self-care model can reduce the diabetic symptoms and improve the quality of life, self-efficacy and self-care in these patients., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright� by the Universidad de Antioquia.)

Background: Diabetes Mellitus (DM), a chronic metabolic disorder that caused about 4.2 million deaths and at least 760 billion dollars' expenditure in 2019, has been targeted for action by leaders of WHO member countries. In Ethiopia deaths, due to DM reached 34,262 in 2013. Studies show effective lifestyle interventions; particularly medical nutrition therapy reduces HbA1c by 0.5 to 2%. However, practicing recommended diet is reported to be difficult. Not only Knowledge and practice but also perception studies are therefore necessary to design future health programs., Objective: To assess diabetic self-care, dietary practice and associated factors among diabetes patients., Method: Institution-basedbased cross-sectional study design was employed from february15-May15, 2020 in Jimma university medical Centre (JUMC). Systematic sampling of every other patient (K = 2.7) was employed to interview 371 participants. A previously validated tool was used to collect data through a face-to-face interview. A path analysis was used to fit the structural model and tests the hypothesized Health Belief Model (HBM) relationships., Result: Response rate was 95.4% (354). Around 52% of the participants were male and 76.8% follow diabetic education at least some times. 42.4% and 48% of respondents have good dietary and general self-care practices respectively. With unstandardized coefficient (standard error) self-efficacy0.10 (0.01) being the strongest cues to action0.10 (0.02), perceived threat0.02 (0.01), and perceived barrier-0.08(0.01) constructs of HBM have a significant effect on dietary practice. Knowledge, social support and diabetes distress exert a significant indirect effect on dietary practice through health belief constructs with unstandardized path coefficient (standard error) of 0.22(0.03), 0.02(0.01), and -0.03(0.004) respectively., Conclusion: In this study, the proportion of good practice is found to be lower for both dietary as well as general self-care. HBM can best fit to explain variability in dietary self-care practice; therefore, future interventions should be designed to address the vast perception and psychosocial factors influencing dietary self-care practices., Competing Interests: The authors have declared that no competing interests exist.

Background: Self-care practice among people with diabetes is not well-implemented in Ethiopia. So far, in Ethiopia, several observational studies have been done on self-care practice and its determinants in people with diabetes. However, a comprehensive review that would have a lot of strong evidence for designing intervention is lacking. So, this review with a meta-analysis was conducted to bridge this gap., Methods: A systematic review of an observational study is conducted following the PRISMA checklist. Three reviewers have been searched and extracted from the World Health Organization's Hinari portal (SCOPUS, African Index Medicus, and African Journals Online databases), PubMed, Google Scholar and EMBASE. Articles' quality was assessed using the Newcastle-Ottawa Scale by two independent reviewers, and only studies with low and moderate risk were included in the final analysis. The review presented the pooled proportion of non-adherence to self-care practice in people with diabetes and the odds ratios of risk factors hindering to self-care practice after checking for heterogeneity and publication bias. The review has been registered in PROSPERO with protocol number CRD 42020149478., Results: We included 21 primary studies (with 7,134 participants) in this meta-analysis. The pooled proportion of non-adherence to self-care in the diabetes population was 49.91 (95% CI: 44.73-55.08, I2 = 89.8%). Male (Pooled Odds Ratio (POR): 1.84 95%CI; 1.04-2.64, I2 = 15.0%), having private glucometer (POR: 2.71; 95%CI: 1.46-3.95, I2 = 0.0%), short-term Diabetes Mellitus (DM) duration (POR: 3.69; 95%CI: 1.86-5.52, I2 = 0.0%), DM complication (POR: 2.22; 95%CI: 1.48-2.95, I2 = 0.0%), treatment satisfaction (POR: 1.8; 95% CI: 1.15-2.44, I2 = 0.0%), received diabetes self-management education (POR: 2.71; 95% CI: 1.46-3.95, I2 = 0.0%) and poor self-efficacy (POR: 3.09; 95% CI: 1.70-4.48, I2 = 0.0%) were statistically significant factors of non-adherence to self-care practice., Conclusions: The overall pooled proportion of non-adherence to self-care among adult diabetes in Ethiopia was high. Further works would be needed to improve self-care practice in the diabetes population. So, factors that were identified might help to revise the plan set by the country, and further research might be required to health facility fidelity and each domain of self-care practice according to diabetes self-management guideline., Competing Interests: The authors have declared that no competing interests exist.

Background and Aim: Uncontrolled diabetes has emerged as one of the major risk factors for mortality in patients with coronavirus disease (COVID-19). Physical inactivity, alterations in dietary habits, and inability to seek guidance from the physician are some of the contributing factors. This study aims to assess the self-care practices and psychological distress during the pandemic among diabetic patients visiting the institute's out patient department., Method: A convenient sampling method was used to recruit subjects from a representative clinical sample using validated scales like the Summary of Diabetes Self-Care Activities (SDSCA) and Kessler Psychological Distress Scale (K10)., Result: The study enrolled a total of 108 subjects with the mean age being 56.3 years. The everyday healthy eating plan was followed by 76.85% (N = 83) subjects and daily physical activity for at least 30 min performed by 50% (54) subjects. Only 12.04% (13) subjects tested their blood sugar and 6.48% (7) respondents checked their feet daily. There was no significant difference found between the SDSCA and psychological distress based on socio-demographic variables., Conclusion: Participants in this study typically reported a good level of self-care behavior particularly for diet followed by exercise whereas the self-care behavior was not adequate for foot care and blood-glucose testing. People were not too anxious about COVID-19. This study highlighted the fact that people with diabetes should monitor their blood sugar levels more often along with their foot care., (Copyright © 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Thirty million Americans currently have diabetes, and a substantial portion do not reach the goals of clinical treatment. This is in part due to the complex barriers to effective self-care faced by people with diabetes. This study uses a patient work perspective, focusing on the everyday, lived experience of managing diabetes. Our primary research goal was to explore how the work of self-care is embedded in the other routines of everyday living. We found that everyday objects and spaces were instrumental in the incorporation of diabetes work into daily routines. Objects anchored diabetes tasks by linking illness-specific artifacts to space and time (e.g. a morning routine), and by enabling the performance on diabetes tasks while on the move in either planned or unplanned ways., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020. Published by Elsevier Ltd.)

Objective: to assess the effectiveness of an education intervention associated with an exercise program in improving knowledge and health behaviours among diabetes patients., Methods: Diabetes and prediabetes patients were exposed to an evidence- and theoretically-based comprehensive education intervention over 24 weeks. Patients completed surveys assessing knowledge, physical activity, food intake, self-efficacy, and health literacy. Functional capacity was measured by oxygen uptake. All outcomes were assessed pre- and post-CR. Satisfaction about the education provided was assessed at post-CR. Paired t-tests, Pearson correlation coefficients, and linear regression models were computed to investigate the effectiveness of this intervention., Results: 84 patients consented to participate, of which 47(56.0%) completed post-CR assessments. There was a significant improvement in patients' overall knowledge pre- to post-CR, as well as in physical activity, food intake, self-efficacy, and health literacy (p < 0.05). Peak VO 2 has clinically significant improved. Results showed a low significant positive correlation was between post-CR knowledge and food intake(r = 0.297;p = 0.04). Linear regression analysis revealed that age(B=-0.051; p = 0.01) was influential in changing post-CR knowledge., Conclusion: The benefits of an education intervention designed for diabetes and prediabetes patients associated with an exercise program have been supported., Practice Implications: This work shows one effective education strategy taken in place that can be replicated in different settings., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Permanent compliance of self-care behaviors is a challenging issue in managing chronic diseases like diabetes. The evidence supports theory-based intervention in promoting self-care behaviors. However, no systematic review was done to monitor these interventions and compare more effective constructs. This study was conducted to investigate the studies using self-care theories and introducing the most effective theories., Methods: This is a systematic review study during which some scientific databases including Scopus, Elsevier, Google scholar and PubMed were searched by using some key words like self-care or self-management, diabetes, theory or model. English articles from the start of 2013 up to the end of November 2020 were monitored., Results: 20 articles were selected and studied based on eight theories which they used. These theories were: Social support theory, Health Belief Model, Heath Belief Model and Empowerment Theory, Empowerment Theory, Self-efficacy Theory, precede-proceed model, Self-regulation Theory, behavioral theory and Social Cognitive Theory., Conclusion: Four theories appeared to be more effective for the target behavior of present research: Social Support Theory and the combination of Empowerment Theory and Health Belief Model, Social Cognitive Theory and Self Efficacy Theory. Taken together, the findings of this systematic review suggest that interventions that go beyond individual determinants (such as changing knowledge and attitudes) to determinants of upper cognitive, motor, and social levels (such as the development of skills and competencies) they have led to raised self-care outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Diabetes self-management (DSM) is a process based on a series of complex learnings. The conceptualization of the role of the emotional dimensions that underlie and structure this process is critical to better understand why living with diabetes can become a burden. A clinical case illustrates the intertwining of the affective and cognitive dimensions of diabetes burden and its influence on DSM skills. Emotional regulation is a recognized determinant to implement effective and long-term DSM skills as well as access to DSM interventions. In order to improve DSME/S interventions efficacy, the role of emotional dimensions, new technologies and therapeutic advances needs to be considered., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Purpose: To investigate the foot care knowledge and behavior of patients with diabetes to determine effect and current challenges of foot care education, as a basis to improve education and reduce diabetic foot complications., Design: Quantitative, cross-sectional study., Methods: A convenience sampling method was used to recruit 200 patients with diabetes from the endocrinology clinic of a tertiary general hospital in Beijing between September 2014 and January 2015. Demographic and disease-related data, foot care education, foot risk stratification status, and knowledge and behavior (K&B) scores were collected using investigator-designed questionnaires., Results: Of the 200 patients, 128 (64.0%) patients received routine diabetes education, and 73 (36.5%) received foot care education. The mean ± standard deviation (SD) for K&B scores were 63.76 ± 14.85, and 59.78 ± 11.17, respectively. The K&B scores of patients who received foot care education (69.54 ± 14.32 and 65.27 ± 11.90) were significantly higher than those who received diabetic education only (60.75 ± 15.27 and 57.54 ± 10.25) and those with no diabetic education (60.21 ± 13.37 and 55.94 ± 8.74) (P < .01). The K&B scores did not differ for patients based on diabetic foot risk strata (P > .05)., Conclusion: The foot care K&B scores of patients with diabetes were low to moderate levels, particularly on items that pertained to self-foot examination, prompt treatment of foot problems, and regular foot inspection by professionals. Individuals with high risk of developing foot complications did not score higher on the K&B questionnaire. These data suggest there is need for improvement in instruction and patient uptake and application of knowledge. We recommend further study on the effectiveness of the delivery of foot care education based on foot risk stratification, and the implications of foot ulcer prevention in community settings.

Objectives: to verify the association between knowledge and adherence to foot self-care practices performed by patients with diabetes mellitus type 2., Methods: cross-sectional, descriptive study carried out with 197 patients in basic health units located in the Northeast region of Brazil. For data collection, we used a semi-structured questionnaire that addressed issues inherent to knowledge and Diabetes Self-Care Activities., Results: we observed that patients with moderate knowledge about self-care practices were more likely to perform foot self-examination, dry the interdigital spaces, moisturize their feet with creams and oils, observe the presence of mycosis and ingrown toenail when compared to patients with insufficient knowledge., Conclusions: the patients' level of knowledge was closely related to the self-care activities carried out, which reinforces the importance of nurses working on training those on essential health care.

Purpose: Increasing attention is being given to the challenges and emotional toll of managing diabetes. This Perspectives in Practice details the specialty's guiding documents for initial and ongoing support. It also defines various types of social support, including peer support, for optimal diabetes care. Focusing on peer support, this paper provides a review of the body of evidence demonstrating the value of peer support to improve clinical and behavioral outcomes. To achieve positive outcomes, it is optimal for people with diabetes to have access to ongoing support from their health care provider, including diabetes care and education specialists. They should also be made aware of, and given referral to options and opportunities for peer support. This Perspectives in Practice concludes with a call to action for diabetes care and education specialists to deliver to integrate and promote the value of peer support in the care they provide., Conclusion: Managing diabetes during the stages and ages of life is chronically challenging and complex. Various types of support offered by health care providers, including diabetes care and education specialists and others in the person's social support milieu, can positively affect emotional well-being. Health care providers should routinely assess their client's social supports and refer the person with diabetes and/or their caregivers to evidence-based types of peer support mutually determined to be of most value. Diabetes care and education specialists should increase their awareness of opportunities to integrate the value of and referral to peer support in their counseling and to gain greater insight into the diabetes-lived experience.

Although diabetes is a nationwide epidemic, US Latinos are a particularly vulnerable population. Culturally appropriate interventions can combat this disparity, especially those that increase social support. However, these interventions face significant cost and time barriers, which mHealth (mobile health) may overcome. This trial examines the benefit of adding social support to an existing text-message based, patient-focused mHealth intervention for emergency department patients with poorly controlled diabetes. Family members and friends of patients were randomized to mHealth augmented social support training (daily text-messages that synchronize with the patient messages) or a pamphlet based training (the same content mailed to their house.) We hypothesize that patients who received mHealth augmented social support will have a larger improvement in diabetes management (glycosylated hemoglobin or A1C) than those receiving standard support at six-months, and that improvement will be sustained at twelve-months. Secondary patient outcomes are clinical (weight, blood pressure), behavioral (medication adherence, self-care activities) and psychosocial (general and diabetes-specific social support, self-efficacy, diabetes-related distress, depression, fatalism and quality of life). We screened 2004 patients and enrolled 166 patient/supporter dyads. 70% of patients are Spanish-speaking, 51% female, with a mean A1C of 10.8. We employed innovative measures to remotely enroll family members and support a bilingual population, which will assist other investigators in design of similar trials. The findings of our trial will have real-world applicability for clinicians, health system administrators, health educators and mHealth developers who aim to improve the health of this vulnerable population., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Peer-led intervention allows the patients to develop knowledge, skills and confidence in managing their own conditions. Hence this review was done to assess the effectiveness of peer-led intervention in improving the clinical outcomes of DM and HTN patients. We conducted systematic search in Medline, CENTRAL, Sciencedirect and Google-Scholar from inception till May 2018 and retrieved 3654 citations. Meta-analysis was performed using random-effects model and pooled mean difference (MD) was reported with 95% CI. Publication bias was assessed using Egger's test. 29 trials (26 DM and 3 HTN) with 6363 participants were included. There was positive effect of peer led intervention on DM and HTN with pooled MD of -0.28% [95%CI: -0.45 to -0.11] and -7.52mmHg [95%CI: -14.39 to -0.66]. There was significant heterogeneity and publication bias in both DM and HTN trials. Sensitivity analysis showed only little improvement in the final estimate. Peer support intervention is effective and causes statistically significant reduction in HbA1C and systolic blood pressure among DM and HTN patients., (Copyright © 2018 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

The objective of the present article was to evaluate the glycemic control of patients with diabetes mellitus (DM) after discharge from a pharmacotherapeutic empowerment program. The results suggest that the strategy is effective for short-term glycemic control, but the benefits are not maintained after discharge, indicating the need for the pharmacist's continuous role., (Copyright © 2019 Diabetes India. All rights reserved.)

Behavioral theory is an important factor for designing digital health tools for diabetes to increase adherence to treatment. Many digital health products have not incorporated this method for achieving behavior change. This oversight might explain the disappointing outcomes of many products in this class. Four theories reported to be capable of enhancing the performance of digital health tools for diabetes include (1) Integrate, Design, Assess, and Share (IDEAS); (2) the Behaviour Change Wheel; (3) the Information-Motivation-Behavioral skills (IMB) model; and (4) gamification. Well-designed digital health tools are most likely to be effective if they are deployed in a patient-centered care setting established upon principles of sound behavioral theory. Behavioral theory can increase the effectiveness of digital tools and promote a receptive environment for their use.

The purpose of this study was to evaluate the effects of guided reflection on self-care behaviors, confidence scores, and diabetes knowledge among adults with diabetes. A randomized controlled trial with a pre/posttest design was used to generate data from a convenience sample of 62 adults with diabetes recruited from a single site. After viewing a 30-minute video on how to manage diabetes, participants were randomized to a control group (CG) (usual care) or an intervention group (IG). The IG further engaged in a reflection educational session. For 8 weeks, the IG isolated diabetes-related events weekly, critically analyzed them using Gibbs's reflective questions, and recorded their analysis in a journal. They also shared their perspective relative to using the journal in an audiotaped interview. Main measures included baseline and 8-week clinical outcomes (self-care maintenance, monitoring, management, and confidence scores and diabetes knowledge scores) and intervention acceptability. Compared to the CG, the IG had no statistically significant difference in self-care measures over time, although scores trended in the anticipated direction. Importantly, both groups had statistically significant improvement in self-care scores. Furthermore, there was statistically significant improvement in diabetes knowledge among IG participants. Informatively, IG critically analyzed 147 diabetes-related events concentrating on blood glucose, diet, exercise, monitoring, medication, sleep pattern, and health care visits. Participants found the guided reflection activity highly acceptable. Combined educational and reflection interventions are effective approaches for improving self-care outcomes and diabetes knowledge among adults with diabetes. Research concentrating on purposeful patient reflection is warranted in a larger sample paying careful attention to study limitations.

Objective: A good self-care practice is important for patients with diabetes to achieve the desired treatment targets and to contribute meaningfully in the management of their disease. The study aimed to assess the level of knowledge, attitude and practice of diabetes self-care and to identify the factors associated with diabetes self-care., Results: A total of 338 patients with diabetes having mean age of 45.8 years were included in the study. Among those 70.4%, 70.4% and 25.5% of the patients had a good knowledge, attitude and self-care practices, respectively. Being male (AOR = 2.7, 95% CI 1.30-5.65), living in urban (AOR = 3.37, 95% CI 1.39-8.15) and earning medium income (AOR = 2.55, 95% CI 1.15-5.65) were significantly associated with having good knowledge of self-care while being widowed (AOR = 0.15, 95% CI 0.03-0.70) was associated with having poor knowledge. Having a higher income (AOR = 7.95, 95% CI 1.54-41.12) was significantly associated with a good attitude towards diabetic self-care. However, taking both insulin and oral hypoglycemics (AOR = 0.06, 95% CI 0.01-0.67) was associated with a poor attitude. Being Muslim (AOR = 3.14, 95% CI 1.28-7.91), living in urban areas (6.47, 95% CI 1.38-30.43) and earning high income (AOR = 3.03, 95% CI 1.10-8.35) were determinant of good self-care practice. Efforts should be made to improve self-care practices of patients in closing the gap between knowledge and practice.

Objectives: Diabetes knowledge among kidney transplant recipients with posttransplant diabetes has not been exhaustively assessed. We evaluated levels of diabetes knowledge among our kidney transplant patients using a 35-item diabetes self-care management questionnaire., Materials and Methods: The study comprised renal transplant patients with posttransplant diabetes mellitus who were referred from Hamed Al-Essa Organ Transplant Center of Kuwait to the Dasman Diabetes Institute. Patient data were collected through patient identification forms, metabolic control parameters forms, and diabetes self-care scale questionnaires (with score from 0-7)., Results: Of 356 (25.6%) kidney transplant recipients with posttransplant diabetes, 210 patients were enrolled in this study. Most were Kuwaiti (60%), men (48.8%), and with high school education level (43.8%). Some were smokers (11.9%), and the original kidney disease was glomerulonephritis in 37.6% of patients. Most patients (71.9%) received hemodialysis pretransplant. Most patients (> 88%) reported low mean score of healthy diet (0-3), with > 93% reporting low mean score of practicing exercise (0-3), > 62% not checking blood sugar at home, 85% not following the recommended frequency, and > 72% not caring for their feet (except washing in 86.7%). Moreover, most patients lacked information about sharp disposal, diet regimen, using logbooks, hypoglycemia and hyperglycemia, sick day management, and the importance of hemoglobin A1c and regular fundus examination. Mean score of practicing exercise was significantly higher in men (especially non-Kuwaiti; P < .05); otherwise, other mean scores were comparable between sexes and different nationalities (P > .05)., Conclusions: Diabetes knowledge is deficient in patients with posttransplant diabetes. Seminars, counseling sessions, and workshops should be arranged periodically for renal transplant recipients to improve their low level of diabetes knowledge. This is a preliminary report of our randomized controlled study evaluating the impact of structured diabetes education on self-care activities and metabolic control variables.

This study aimed to assess the knowledge about diabetes, the attitude for self-care and associated factors through a cross-sectional study, the baseline of a randomized clinical trial with elderly diabetic in primary health care in Recife, Northeastern Brazil. We used the Diabetes Knowledge Scale (DKN-A) and Diabetes Attitudes Questionnaire (ATT-19). Of the 202 elderly, 77.7% had insufficient knowledge of the disease, especially for ketonuria, food replacement and were unaware of the causes and care of hypoglycemia. As for attitude, 85.6% had a negative psychological adjustment for diabetes. The logistic regression model showed that living alone was a protective factor (OR = 0.24; 95% CI 0.09-0.65; OR = 0.22; 95% CI 0.07 to 0.71), and low education, a risk factor (OR = 7.78; 95% CI 3.36-18.01; OR = 13.05; 95% CI 4.63-36.82) for the insufficient knowledge and the negative attitude for self-care, respectively. The findings reinforce the need for interdisciplinary educational actions that include socioeconomic, psycho-emotional and educational aspects in diabetes management to maintain elderly autonomy and functionality.

Aim: To examine the relationships of health literacy to diabetes self-care behaviors (diet, physical exercise, foot care and blood glucose monitoring) through empowerment controlling for diabetes education., Background: Potential mechanisms of how health literacy links to health outcomes have not clearly elucidated., Design: A cross-sectional study design was used., Methods: Participants were recruited from three community health centers in South Korea from September 2016 to April 2017 using a convenience sampling method. A total of 136 people with diabetes aged 60 and above were participated in this study. The main study variables of health literacy, empowerment and diabetes self-care activities were assessed using self-reported questionnaires. This study applied a simple mediation analysis with a single covariate using the PROCESS macro, with health literacy entered as an antecedent variable, empowerment as a mediator, diabetes self-care behaviors as outcome variables and diabetes education as a covariate., Results: After controlling for diabetes education, the indirect effects of health literacy to self-care behaviors through empowerment were significant when the self-care behaviors were particularly diet and physical exercise. Whereas, the indirect effects were not significant when the self-care behaviors were foot care and blood glucose monitoring., Conclusions: This study indicates that the people with higher health literacy were more empowered and those with higher empowerment were more likely to eat healthy foods and exercise. In the light of these findings, a health literacy-tailored empowerment enhancing program may be important targets for interventions promoting diabetes self-care behaviors of diet and physical exercise., (© 2018 John Wiley & Sons Ltd.)

Purpose: Diabetes education for those patients at risk of diabetes complications remains a mainstay of diabetes treatment. This study aimed primarily to determine the retention of foot health information 6 months post delivery of education. The secondary aim was to determine the type and delivery method of diabetes-specific foot health information during a podiatry consultation., Methods: This study was a prospective cohort study with two groups: patients with diabetes and their treating podiatrist. Baseline data collection included educational topics and delivery methods discussed during the consultation. The Problem Areas in Diabetes Questionnaire (PAID) and perceived key educational message were collected from each group's perspective at baseline and 6 months afterwards., Results: Three podiatrists and 24 participants with diabetes provided information at the two time points. At baseline, the key messages of 14 (58%) patient participant responses differed from their podiatrists and 15 (63%) differed 6 months later. Education covered up to seven separate topics, including neurological impact of diabetes, vascular supply and general foot care. The majority of consultations (n = 23, 96%) covered three or more topics., Conclusions: Education is vital to effective treatment of people with diabetes. Current common approaches used in individual consultations such as verbal explanations appear ineffective in aiding the learning and retention of podiatry-specific diabetes education. This study highlights the need for research investigating more effective methods to deliver key education to this population to aid retention and therefore assist behaviour change.

Self-management is integral to effective chronic disease management. Cognitive impairments (CogImp) associated with dementia have not previously been reviewed in diabetes mellitus (DM) self-care. The aims of this study are to know (1) whether CogImp associated with dementia impact self-care and (2) whether specific CogImp affects key DM self-care processes. A systematic literature search with a narrative review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This review examined studies published from January, 2000 to February, 2016 describing the relationship between cognition and DM self-care domains in community dwelling older adults with dementia/CogImp. Eight studies met inclusion criteria. Decrements in all self-care domains were associated with CogImp. Problem solving was related to reduced disease knowledge (OR 0.87, 95% CI = 0.49-1.55), resulting in poorer glycemic control. Decision-making impairments manifested as difficulties in adjusting insulin doses, leading to more hospital admissions. People without CogImp were better able to find/utilize resources by adhering to recommended management (OR 1.03, 95% CI = 1.02-1.05). A lack of interaction with health care providers was demonstrated through reduced receipt of important routine investigation including eye examinations (ARR = 0.85, 95% CI = 0.85-0.86), HbA1c testing (ARR = 0.96, 95% CI = 0.96-0.97), and LDL-C testing (ARR = 0.91, 95% CI = 0.901-0.914). People without CogImp had better clinic attendance (OR 2.17, 95% CI = 1.30-3.70). Action taking deficits were apparent through less self-testing of blood sugar levels (20.2% vs 24.4%, P = 0.1) resulting in poorer glycemic control, self-care, and more frequent micro/macrovascular complications. Persons with diabetes and CogImp, particularly in domains of learning, memory and executive function, were significantly impaired in all self-care tasks., (Copyright © 2018 John Wiley & Sons, Ltd.)

Patients with diabetes are sometimes overwhelmed with the burden of self-care associated with the disease. Although it may seem appropriate to diagnose patients experiencing such emotional burdens with depression, the literature over the past 20 years has matured the concept of diabetes distress, which may more accurately describe the phenomenon.

Background: Most adults with diabetes who are at high risk for complications have family or friends who are involved in their medical and self-care ("family supporters"). These family supporters are an important resource who could be leveraged to improve patients' engagement in their care and patient health outcomes. However, healthcare teams lack structured and feasible approaches to effectively engage family supporters in patient self-management support. This trial tests a strategy to strengthen the capacity of family supporters to help adults with high-risk diabetes engage in healthcare, successfully enact care plans, and lower risk of diabetes complications., Methods/design: We will conduct a randomized trial evaluating the CO-IMPACT (Caring Others Increasing EnageMent in Patient Aligned Care Teams) intervention. Two hunded forty adults with diabetes who are at high risk for diabetes complications due to poor glycemic control or high blood pressure will be randomized, along with a family supporter (living either with the patient or remotely), to CO-IMPACT or enhanced usual primary care for 12 months. CO-IMPACT provides patient-supporter dyads: it provides one coaching session addressing supporter techniques for helping patients with behavior change motivation, action planning, and proactive communication with healthcare providers; biweekly automated phone calls to prompt dyad action on new patient health concerns; phone calls to prompt preparation for patients' primary care visits; and primary care visit summaries sent to both patient and supporter. Primary outcomes are changes in patient activation, as measured by the Patient Activation Measure-13, and change in 5-year cardiac event risk, as measured by the United Kingdom Prospective Diabetes Study cardiac risk score for people with diabetes. Secondary outcomes include patients' diabetes self-management behaviors, diabetes distress, and glycemic and blood pressure control. Measures among supporters will include use of effective support techniques, burden, and distress about patient's diabetes care., Discussion: If effective in improving patient activation and diabetes management, CO-IMPACT will provide healthcare teams with evidence-based tools and techniques to engage patients' available family or friends in supporting patient self-management, even if they live remotely. The core skills addressed by CO-IMPACT can be used by patients and their supporters over time to respond to changing patient health needs and priorities., Trial Registration: ClinicalTrials.gov, NCT02328326 . Registered on 31 December 2014.

Health 360x is a mobile health application and social platform that integrates self-monitoring and decision support for preventive health. We studied 240 diabetic patients in primary care practices and a church community in metropolitan Atlanta. Health coaches were trained on the Health 360x curriculum, which was adapted from the American Association of Diabetes Educators. Participants worked with the health coaches to set goals for diabetes self-management. The intervention included weekly coaching for 12 weeks and online peer networking. Outcome variables included blood pressure, physical activity, and blood glucose that showed significant improvement at 12 weeks and 12 months compared to baseline. Focus group testing revealed that references for empowerment and engagement were associated with positive clinical outcomes. Barriers to adoption and use of the technology were inability to use the internet and concern about privacy and security of health data. Future efforts will integrate a multidisciplinary training dashboard with considerable attention to education on security features including data encryption and sign-on verification., Competing Interests: Potential Conflicts of Interest: Dr. Ofili is the lead Inventor of the patented technology that supports Health 360x. She is also the Founder and Chief Scientific Officer of AccuHealth Technologies Inc., a Morehouse School of Medicine Technology Transfer Faculty Start Up.

Aims: To evaluate the health-related quality of life (HRQoL) and functional capacity in relation to glycemic control among older home-dwelling primary care patients., Methods: Electronic patient records were used to identify 527 people over 65 years with diabetes. Of these, 259 randomly selected subjects were invited to a health examination and 172 of them attended and provided complete data. The participants were divided into three groups based on the HbA1c: good (HbA1c<48mmol/mol (N=95)), intermediate (HbA1c 48-57mmol/mol (N=48)) and poor (HbA1c>57mmol/mol (N=29)) glycemic control. HRQoL was measured with the EuroQol EQ-5D questionnaire. Functional and cognitive capacity and mental well-being were assessed with the Lawton Instrumental Activities of Daily Living (IADL) scale, Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-15)., Results: EQ-5D scores for good, intermediate and poor glycemic control were 0.78; 0.74 and 0.70, p=0.037. Sub-items of mobility (p=0.002) and self-care were the most affected (p=0.031). Corresponding trend was found for IADL, p=0.008. A significant correlation was found between MMSE scores and HbA1c., Conclusion: Older primary care home-dwelling patients with diabetes and poorer glycemic control have lower functional capacity and HRQoL, especially in regard to mobility and self-care., (Copyright © 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Background: Camp offers a safe and fun environment for learning new information about diabetes care and for trying new self-care skills. It is a place where children and teens are able to meet with others who also have diabetes and who share their experiences., Materials and Methods: This study assessed self-reports before and after attending diabetes camp on diabetes-specific emotional distress, diabetes-specific quality of life, and self-care behaviors by surveying campers and their parents from over 42 diabetes-specific summer camps across the United States. Parents (N = 413), Teenagers (N = 154), and Children (N = 116) completed both pre- and post-camp surveys., Results: Parents reported higher levels of diabetes-specific emotional distress than their campers did. Both parents and children reported significant improvements in their own distress after camp. Teens reported improvements in distress but they were not statistically significant. Youth report higher levels of self-care skills than parents believe their children possess. Parents, Teens, and Children all reported significant improvements in the camper's self-care skills after camp. First time campers' and their parents' perspectives regarding self-care skills are consistent with veteran campers after attending camp. Self-reports post-camp reveals that campers and their parents see camp as a place where youth feel they are with others who really understand what it is like to live with diabetes. Respondents also report that camp is a place where youth are exposed to new technologies and where campers can try new self-care tasks., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

A wide range of diabetes-directed interventions - including novel medications, devices and comprehensive education programmes - have been shown to be effective in clinical trials. But in the real world of diabetes care their efficacy is often dependent upon on how well a clinician is able to support personal engagement and motivation of the person with diabetes to use these new tools and knowledge consistently, and as directed. Although many person-centred motivational and behavioural strategies have been developed, for example, action planning, motivational interviewing and empowerment-based communication, the sheer number and apparent lack of clear differences among them have led to considerable confusion. The primary goal of this review, therefore, is to provide a practical framework that organizes and structures these programmes to enhance their more systematic use in clinical care. Its purpose is to enhance clinician efforts to respectfully encourage and support engagement and motivation for behaviour change in people with diabetes. The three-step framework for organizing and describing the specific clinical processes involved is based on self-determination theory and includes: clinician preparation for a different type of clinical encounter, clinician/person with diabetes relationship building, and clinician utilization of specific behavioural tools. We conclude with practical considerations for application of this framework to the real world of clinical care., (© 2017 Diabetes UK.)

Diabetes self-management education (DSME) is generally considered as an integral part of diabetes care. The availability of different types of self-management in the European Union Member States (EUMS) remains uncertain. The aim of this study is to perform a comparative analysis of existing DSME programs (DSMEP) implemented in EUMS. Unpublished data regarding DSME in the EUMS was assessed with Diabetes Literacy Survey using wiki tool (WT) targeting patients and different stakeholders. An additional literature review (LR) was performed in PubMed to identify published studies regarding DSMEP in the EUMS from 2004 to 2014. A total of 102 DSMEP implemented in EUMS were reported in the WT and 154 programs were identified from the LR. Comparative analysis of the data indicated that a majority of programs are aimed at adults and only a minority at children and elderly. Only a small percentage of the programs utilize information technology for teaching and learning, and only one out of five programs pay attention to depression. The identified DSMEP aimed primarily to empower patients through increasing knowledge and changing attitudes and beliefs towards diabetes. This study provides an overview of the present state-of-the-art on diabetes self-management education programs in the 28 EUMS. To increase participation, existing DSMEP should be made more accessible to the patients as well as tailored to specific patient groups., (Copyright © 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Aim: To investigate the role of self-compassion in diabetes outcomes. Self-compassion is a construct which may be relevant to chronic conditions, given its focus on compassion toward oneself, especially in times of difficulty., Methods: In this cross-sectional study we collected data online from 310 adults diagnosed with diabetes. The questionnaire measured three primary outcomes: self-management behaviours; HbA 1c levels and psychological well-being. Potential predictors were also assessed, including self-compassion, locus of control, social support and demographics., Results: Multiple regression analyses showed that self-compassion had the most consistent association with better outcomes, including all forms of self-management behaviour, HbA 1c levels and psychological well-being. Self-compassion was independently associated with 55.1% of the variance in well-being. Internal locus of control was also significantly associated with better well-being and HbA 1c outcomes. Chance and external locus of control and social support were generally associated with poorer outcomes., Conclusions: Higher levels of self-compassion are typically associated with improved self-management behaviour, medical outcomes and psychological well-being in adults with diabetes mellitus. The present findings suggest that self-compassion may be a parsimonious and suitable intervention target. Future interventions and consultations with medical professionals may benefit from fostering self-compassion in adults with diabetes mellitus., (© 2017 Diabetes UK.)

Review Objectives: The aim of this umbrella review is to identify and describe factors influencing diabetes self-management (DSM) in adults with diabetes. More specifically, we will address DSM-related factors and their relationships, considering both qualitative and quantitative components of available literature.The review question for the qualitative component of the umbrella review is:The review questions for the quantitative component of the umbrella review are:An additional question will be applied to both the qualitative and quantitative components of the overview.

Background: Self-care is essential for patients with diabetes mellitus. Both clinicians and researchers must be able to assess the quality of that self-care. Available tools have various limitations and none are theoretically based. The aims of this study were to develop and to test the psychometric properties of a new instrument based on the middle range-theory of self-care of chronic illness: the Self-Care of Diabetes Inventory (SCODI)., Methods: Forty SCODI items (5 point Likert type scale) were developed based on clinical recommendations and grouped into 4 dimensions: self-care maintenance, self-care monitoring, self-care management and self-care confidence based on the theory. Content validity was assessed by a multidisciplinary panel of experts. A multi-centre cross-sectional study was conducted in a consecutive sample of 200 type 1 and type 2 diabetes patients. Dimensionality was evaluated by exploratory factor analyses. Multidimensional model based reliability was estimated for each scale. Multiple regression models estimating associations between SCODI scores and glycated haemoglobin (HbA1c), body mass index, and diabetes complications, were used for construct validity., Results: Content validity ratio was 100%. A multidimensional structure emerged for the 4 scales. Multidimensional model-based reliabilities were between 0.81 (maintenance) and 0.89 (confidence). Significant associations were found between self-care maintenance and HbA1c (p = 0.02) and between self-care monitoring and diabetes complications (p = 0.04). Self-care management was associated with BMI (p = 0.004) and diabetes complications (p = 0.03). Self-care confidence was a significant predictor of self-care maintenance, monitoring and management (all p < 0.0001)., Conclusion: The SCODI is a valid and reliable theoretically-grounded tool to measure self-care in type 1 and type 2 DM patients.

An integrative review was conducted using PubMed and CINAHL databases to answer: What is known about adult attrition from community health worker (CHW) programs on diabetes self-care? The 14 articles described patients of multiple races who were mainly of lower socioeconomic status. CHW interventions were given in individual meetings and/or group sessions. Incentives to reduce attrition came in different forms. Barriers involved transportation, family obligations, and scheduling conflicts. Attrition from these programs is a multifactorial problem. Alleviating transportation barrier appears to be protective. Program planners should consider these barriers when planning CHW programs.

A critical goal in the management of elderly patients with diabetes is to improve their health-related quality of life (HRQOL). This study aimed to identify the factors affecting HRQOL in elderly Korean patients with diabetes. Participants were 365 elderly patients with diabetes who were treated in a general hospital in Korea. The data were analysed using independent t-tests, Pearson correlations, and stepwise multiple regression. The mean total HRQOL score was 74.77, and HRQOL showed positive correlations with activities of daily living (ADL), instrumental activities of daily living (IADL), and the Summary of Diabetes Self-care Activities (SDSA). There was a negative correlation between HRQOL and Short Geriatric Depression Scale (SGDS). Lower SGDS scores, higher SDSA scores, and being male were associated with higher HRQOL, with these variables explaining 57.5% of the variance in participants' HRQOL. Improvement in the HRQOL of elderly patients with diabetes requires the development of interventions for depression, and improvements in methods of diabetes self-care and gender-dependent managerial measures.

Background: Diabetes shared medical appointments (SMAs) and reciprocal peer support programs have been found in efficacy trials to help adults with diabetes improve their self-management and achieve short-term gains in clinical and patient-centered outcomes. In order to translate this evidence to system-level interventions, there is a need for large-scale, pragmatic trials that examine the effectiveness, implementation, and costs of SMAs and reciprocal peer support across diverse settings., Methods: The Shared Health Appointments and Reciprocal Enhanced Support (SHARES) study is a multisite, cluster randomized trial that is evaluating the effectiveness and implementation of SMAs with and without an additional reciprocal Peer-to-Peer (P2P) support program, when compared to usual care. The P2P program comprises periodic peer support group sessions and telephone contact between SMA participant pairs to promote more effective diabetes self-management. We will examine outcomes across three different treatment groups: (1) SMAs, (2) SMAs plus P2P, and (3) usual care. We will collect and analyze data over a 2.5-year implementation period at five geographically diverse Veterans Affairs (VA) health systems. The primary outcome is the relative change in hemoglobin A1c over time. Secondary outcomes are changes in systolic blood pressure, antihypertensive medication use, statin use, and insulin initiation over the study period. The unit of analysis is the individual, adjusted by the individual's SMA group (the cluster). We will use mixed methods to rigorously evaluate processes and costs of implementing these programs in each of the clinic settings., Discussion: We hypothesize that patients will experience improved outcomes immediately following participation in SMAs and that augmenting SMAs with reciprocal peer support will help to maintain these gains over time. The results of this study will be among the first to examine the effects of diabetes SMAs alone and in conjunction with P2P in a range of real-life clinical settings. In addition, the study will provide important information on contextual factors associated with successful program implementation., Trial Registration: ClinicalTrials.gov, ID: NCT02132676 . Registered on 21 August 2013.

Aims: To determine predictors associated with the diabetes self-management education and training (DSME) venue and its impact on oral antidiabetic (OAD) medication adherence., Methods: The Medical Expenditure Panel Survey household component (MEPS-HC) data (2010-2012) identified adults with diabetes prescribed OAD medication(s) who completed a supplemental Diabetes Care Survey (DCS). Based on the DCS responses to questions about the number and type of DSME venue(s), two groups were created: (1) multiple venues (a physician or health professional plus internet and/or group classes) vs (2) single venue (physician or health professional only). The medication possession ratio (MPR) measured medication adherence, with 0.80 the cut-point defining adherent. Logistic regression examined factors associated with the DSME venue and its effect on OAD medication adherence., Results: Of the 2119 respondents, 41.6% received DSME from multiple venues. Age (<65years), education-level (college or higher), high-income, and diet modification were significantly more likely associated with receiving DSME from multiple venues. In single vs multiple venues, medication adherence was suboptimal (mean MPR 0.66 vs 0.64, p=0.245), and venue showed no influence on adherence (OR: 0.92, 95% CI, 0.73-1.16)., Conclusion: Sociodemographic characteristics influence where adults with diabetes receive DSME. Adding different DSME venues may not address suboptimal OAD medication adherence., (Copyright © 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Objective: To examine provider- and patient-related factors associated with diabetes self-management among recent immigrants., Design: Demographic and experiential data were collected using an international survey instrument and adapted to the Canadian context. The final questionnaire was pretested and translated into 4 languages: Mandarin, Tamil, Bengali, and Urdu., Setting: Toronto, Ont., Participants: A total of 130 recent immigrants with a self-reported diagnosis of type 2 diabetes mellitus who had resided in Canada for 10 years or less., Main Outcome Measures: Diabetes self-management practices (based on a composite of 5 diabetes self-management practices, and participants achieved a score for each adopted practice); and the quality of the provider-patient interaction (measured with a 5-point Likert-type scale that consisted of questions addressing participants' perceptions of discrimination and equitable care)., Results: A total of 130 participants in this study were recent immigrants to Canada from 4 countries of origin-Sri Lanka, Bangladesh, Pakistan, and China. Two factors were significant in predicting diabetes self-management among recent immigrants: financial barriers, specifically, not having enough money to manage diabetes expenses ( P  = .0233), and the quality of the provider-patient relationship ( P = .0016). Participants who did not have enough money to manage diabetes were 9% less likely to engage in self-management practices; and participants who rated the quality of their interactions with providers as poor were 16% less likely to engage in self-management practices., Conclusion: Financial barriers can undermine effective diabetes self-management among recent immigrants. Ensuring that patients feel comfortable and respected and that they are treated in culturally sensitive ways is also critical to good diabetes self-management., (Copyright© the College of Family Physicians of Canada.)

Cardiovascular disease is the leading cause of morbidity and mortality globally, with diabetes being an independent risk factor. Adequate diabetes management has proven to be resource-intensive, requiring frequent lab work, primary care and specialist visits, and time-consuming record-keeping by the patient and care team. New mobile health (mHealth) technologies have enhanced how diabetes is managed and care is delivered. While more recent work has investigated mHealth devices as complementary tools in behavioral interventions for diabetes prevention and management, little is still known about the effectiveness of mHealth technology as stand-alone intervention tools for reducing diabetes risk. In addition, more work is needed to identify the role of mHealth technology in treating vulnerable populations to ameliorate cardiovascular health disparities. With advances in mobile health technology development for diabetes prevention and management, these modalities will likely play an increasingly prominent role in reducing cardiometabolic risk for the US population.

Use of technology in diabetes management is rapidly advancing and has the potential to help individuals with diabetes achieve optimal glycemic control. Over the past 40 years, several devices have been developed and refined, including the blood glucose meter, insulin pump, and continuous glucose monitor. When used in tandem, the insulin pump and continuous glucose monitor have prompted the Artificial Pancreas initiative, aimed at developing control system for fully automating glucose monitoring and insulin delivery. In addition to devices, modern technology, such as the Internet and mobile phone applications, have been used to promote patient education, support, and intervention to address the behavioral and emotional challenges of diabetes management. These state-of-the-art technologies not only have the potential to improve clinical outcomes, but there are possible psychological benefits, such as improved quality of life, as well. However, practical and psychosocial limitations related to advanced technology exist and, in the context of several technology-related theoretical frameworks, can influence patient adoption and continued use. It is essential for future diabetes technology research to address these barriers given that the clinical benefits appear to largely depend on patient engagement and consistence of technology use. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Introduction: The prevalence of diabetes mellitus is rapidly increasing particularly in developing countries. The aim of this study was to assess the knowledge and self-care practices of diabetes patients and to assess the contribution of the education to this knowledge level and glycemic control., Methods: We formed patient groups consisting of 15-30 diabetic patients. First, patients were surveyed using a diabetes self-care knowledge questionnaire (DSCKQ-30). Sunsequently, a standard PowerPoint presentation about diabetes self-management was made to the patients who were then surveyed again using DSCKQ-30. All patients were invited to hospital to measure their control glycated hemoglobin (HbA1c) level 3 months later., Results: Of the total 364 participants, 62.9% were females. Significant increases in the percentage of correct responses were determined in all components between, before and after education. There was a significant decline of 1.1 in HbA1c levels after 3 months of education. Married or active working patients had a better understanding of the education about diabetes and had a greater knowledge of self-care management regardless of their level of education or income., Conclusion: Education about diabetes can significantly improve knowledge of self-care management and can help in achieving glycemic control. Continuing education about self-care management and complications is crucial and this should be accompanied by a regular assessment of pateients' diabetic knowledge.

Background: Depression is prevalent among individuals with diabetes and associated with suboptimal self-management. Little is known about the feasibility and potential impact of tele-behavioral therapy to improve depressive symptoms and self-management among diabetes patients., Methods: This was a retrospective observational study of consecutive graduates enrolled in a national 8-week diabetes behavioral telehealth program between August 1, 2014, and January 31, 2015 (N = 466; mean age 56.8 ± 5.0 years; 56% female). Participant characteristics (demographics, comorbidities) were obtained by standardized questionnaire. Depression, anxiety, and stress symptoms (DASS; validated Depression Anxiety and Stress Scale 21 survey), and glucose self-testing frequency and values (point-of-care monitor) were measured at program start and completion. Changes in DASS severity and glucose self-testing frequency were assessed by chi-square tests. Changes in DASS and blood glucose levels were evaluated by paired t-tests., Results: At baseline, approximately one in three participants had elevated depression (32%), anxiety (33%), or stress (31%) scores. Significant reductions in average DASS, depression (-8.8), anxiety (-6.9), and stress (-9.9), scores were observed at graduation among those with elevated baseline scores (p < 0.0001); most (≥80%) improved to less severe depression, anxiety, or stress categories. Improved glucose self-testing frequency (69% vs. 60% tested ≥once per week; p = 0.0005) and significant reductions in mean morning glucose levels (-12.3 mg/dL; p = 0.0002) were observed from baseline to graduation. Participants with normal versus non-normal depression scores were more likely to have lower (

Background: Psychological problems are frequently comorbid with diabetes and can be complex and time consuming to manage in general practice. They can also complicate diabetes management., Objective: This pre-post, mixed-methods study examined whether a diabetes-specific online module, integrated into an existing e-mental health program, is acceptable to patients and helps to improve psychological wellbeing., Methods: The study was conducted in three stages. First, qualitative information was obtained from consumers and practitioners to inform module content. Second, clinical content for the module was developed, including psychoeducational material and clinical content. In the final stage, acceptability and feasibility was evaluated in a group of patients with diabetes., Results: Patients' satisfaction with and acceptance of the module was high. Significant improvement in mental health and diabetes outcomes was also observed., Discussion: Preliminary evidence suggests that the online diabetes module may be a useful psychological support for patients with diabetes. Further controlled investigation is warranted.

Objective: To evaluate the efficacy of an Urdu translation of Self Care Inventory for measuring adherence to diabetes treatment., Methods: The correlational cross-sectional study was conducted in October and November, 2011, and data was collected from outpatient department of public-sector hospitals of Rawalpindi and Islamabad, Pakistan. Patients included had diabetes type1 or type 2, while those with severe diabetic complications, including nephropathy, neuropathy, diabetic foot, and renal disease or any psychiatric comorbidity, were excluded., Results: Of the 300 patients, 165(55%) were women. The overall age of the sample ranged between 19 and 72 years. The translated version of Self Care Inventory showed Chronbach's alpha ranging from 0.73 to 0.80 for four sub-scales, and 0.78 for the overall measure of adherence. In support of predictive validity, the inventory correlated negatively with fasting blood glucose level (r = -0.12 to -0.17; p<0.05) and positively with the problem areas in diabetes score (r= 0.15 to 0.24; p<0.01). Confirmatory factor analysis presented a good fit of the model to the data with all recommended items loading well on respective scales (lambda ranging from 0.42 to 0.86)., Conclusions: The self care inventory is an effective measure for assessing adherence to diabetes treatment. The Urdu version of the inventory appeared to be a valid and reliable instrument and is ready to be used in clinical and research setting.

Objective: This study explored whether depression remission and problem-solving therapy (PST) receipt are associated with more frequent self-care behaviors via cross-sectional and prospective analyses., Method: We analyzed data from a randomized clinical trial (N=387) that tested collaborative depression care among predominantly Hispanic patients with diabetes in safety-net clinics. Data at 12-month follow-up, measured with the Patient Health Questionnaire-9 and Hopkins Symptom Checklist-20, were used to define depression remission. PST was provided by a bilingual social worker. Multivariate regression analysis was used to examine associations between predictors and frequency change of each self-care behavior (healthy diet, exercise, self-blood glucose monitoring, and foot care between baseline and 12-month (N=281), 18-month (N=249), and 24-month (N=235) follow-up surveys., Results: Inconsistent relationships were observed depending on the instrument to identify depression remission, type of self-care behaviors, and time when self-care behavior was measured. Significant associations were more likely to be observed in cross-sectional analyses. PST receipt was not associated with self-care behaviors., Conclusions: Depression remission or the receipt of PST may not be a reliable antecedent for more frequent self-care behaviors among this group. A few recommendations for studies were offered to enhance existing depression care for diabetes patients., (Copyright © 2016 Elsevier Inc. All rights reserved.)