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Type 2 diabetes is a chronic, progressive disease, and its management results in a high emotional burden on patients. Eventually many patients require and can benefit from the use of insulin. This article reports results of a survey of patients and health care providers regarding their experiences of and challenges with the use of basal insulin. Health care providers can play a key role in helping people with type 2 diabetes overcome the challenges associated with the use of basal insulin, including connecting with their emotional needs and understanding the stressors associated with managing diabetes. [ABSTRACT FROM AUTHOR]

Aim: To explore the prevalence and related factors influencing diabetes stigma among Chinese young and middle‐aged patients with type 2 diabetes. Design: A cross‐sectional, quantitative study was conducted through questionnaires. Methods: A total of 453 young and middle‐aged patients with type 2 diabetes were recruited. Questionnaire survey was conducted with convenience sampling from September 2019 to December 2020. This included demographic questionnaire, Type 2 Diabetes Stigma Assessment Scale (DSAS‐2) and Connor–Davidson Resilience Scale (CD‐RISC). The STROBE checklist was applied as the reporting guideline for this study. Results: The scores of diabetes stigma and resilience of patients were 48.18 ± 14.52 and 66.02 ± 7.18, respectively. Diabetes stigma was negatively correlated with resilience, the correlation coefficient was −0.581. The results showed that the complications, diabetes year, monthly income and insulin treatment are important factors affecting stigma. In addition, it is resilience that was a protective factor of diabetes stigma, explaining 27.2% of the variance in diabetes stigma. [ABSTRACT FROM AUTHOR]

Background: Diabetes-related distress (DRD) is a negative emotional state related to the burden of living with diabetes mellitus. It has been associated with poor self-care and glycaemic control. This cross-sectional study aimed to examine the factors associated with DRD among urban Asian patients with poorly controlled type-2 diabetes mellitus (T2DM) in primary care in Singapore. The factors included demographics, diabetes history, medical co-morbidities, mood disorders and social history. Methods: Patients with T2DM and HbA1c of 8% or more were recruited from 2 public primary care centres in Singapore. They were administered a questionnaire survey to identify DRD based on the Problem Area In Diabetes (PAID) scale. Their anxiety and depression were screened using GAD-7 and PHQ-9, and quality of life (QOL) measured using the EQ-5D-5L. Their clinical data, including HbA1c, comorbidities and medications, were extracted from the electronic medical records. Results: Among the 356 subjects, the prevalence of DRD was 17.4%. DRD was significantly associated with younger age (AOR (95% CI) = 0.93 (0.89–0.97), p = 0.001), ex-smoker status (AOR (95% CI) = 22.30 (2.43–204.71), p = 0.006) and history of kidney disease (AOR (95% CI) = 3.41 (1.39–8.35), p = 0.007). Those who screened positive for depression (AOR (95% CI) = 4.98 (1.19–20.86), p = 0.028) were almost five times more likely to have DRD. Quality of life was lower among those with DRD (EQ5D index score AOR (95% CI) = 0.11 (0.01–0.97), p = 0.047), who also tended to feel that diabetes pharmacotherapy interfered with their normal life (AOR (95% CI) = 2.89 (1.38–6.08), p = 0.005). Conclusion: About 1 in 6 patients with poorly controlled T2DM had DRD. Younger age, ex-smoker status, history of kidney disease, and those with depressive symptoms were most at risk. [ABSTRACT FROM AUTHOR]

Although links between social relationships and health are well established, few studies have concurrently examined the effects of compositional, structural, and functional dimensions of social networks on glycemic (HbA1c) control in low- and middle-income countries such as Ghana. In these settings where informal social relationships are critical for access to resources, evaluating the links between social network characteristics, social support, and glycemic control may provide clarity about important relationships that facilitate the well-being of individuals with type 2 diabetes mellitus (T2DM). In 2018, we conducted a hospital-based, cross-sectional survey of noninstitutionalized adults with T2DM in Ghana. Using data from 247 study participants, multivariable linear regression models were used to estimate associations between: 1) HbA1c and three social network characteristics (kin composition, household composition, and network density); 2) social support and the three social network characteristics; and 3) HbA1c and social support. We also examined gender differences in these associations and applied mediation techniques to determine if network characteristics operated through social support to affect HbA1c. Findings indicated that higher kin composition and higher household composition were each significantly associated with increased social support. Neither social support nor social network characteristics were significantly related to HbA1c, and there were no gender differences in any of these associations. Although family and household members were identified as important sources of social support for diabetes management, the ways in which they influence HbA1c control among Ghanaians require further investigation. Future studies can examine whether changes in social support over time, social support satisfaction, or other dimensions of social relationships improve T2DM outcomes in countries like Ghana. [ABSTRACT FROM AUTHOR]

Introduction: Type 2 diabetes is increasing globally and particularly affects vulnerable groups in society, such as migrants. Research shows that type 2 diabetes is a risk factor for severe illness when infected with COVID‐19. Diabetes‐related complications can be prevented with good glycaemic control. In addition, good glycaemic control has been shown to be an important cornerstone for preventing severe illness in individuals infected with COVID‐19. In order to maintain good glycaemic control, self‐care is needed. The purpose of this article is to describe self‐care maintenance and possible changes in self‐care maintenance and to explore factors related to unchanged self‐care maintenance in migrant patients with type 2 diabetes during the COVID‐19 pandemic. The second aim is to describe well‐being, social support, and the need for support from healthcare services during the COVID‐19 pandemic in migrant patients with type 2 diabetes. Design/Method: A triangulation design with cross‐sectional data collection was used. Both quantitative and qualitative data were collected and interpreted together in a triangulation design. Patients were selected by a diabetes nurse from a computer system at a health center in south‐eastern Sweden and invited to participate in the study. A questionnaire was translated into the languages most commonly used at the clinic and sent out to 332 migrant patients who had been diagnosed with type 2 diabetes and treated in primary care. This questionnaire assessed self‐care maintenance for diabetes (questions inspired by the Self‐Care of Diabetes Inventory), with questions added to every item to assess changes during the pandemic. When changes occurred, we asked the participants to elaborate. Open‐ended questions asked the participants how they would like to receive information when there are changes in their healthcare. Descriptive statistical analyses were used for the quantitative data and qualitative data was analyzed using a directed approach to content analysis. Results: In total, 79 participants answered the questionnaire (mean age 69 ± 11, 51% male, 47% born in the Middle East). Of these, 76% stated a change in self‐care. More than half (58%) stated changes in maintaining an active lifestyle, 40% had changed their physical exercise, and 38% had changed their behavior to avoid getting sick. Participants said that this change was due to staying at home or canceling social activities because they feared meeting people during the pandemic. Others were more physically active than before on a regular basis during the pandemic due to taking walks to get fit, as a precaution related to COVID‐19, and having greater awareness about how to avoid getting sick. Approximately one‐quarter of the participants experienced a change in contact with healthcare due to poorer access to care, with fewer doctors' appointments and care being postponed during the pandemic. More than half (58%) would like to receive information about healthcare changes by a letter in the regular mail. Social support had changed for 35% of the participants, with less support from family and friends due to the risk of being infected with COVID‐19. Conclusion: The COVID‐19 pandemic led to societal restrictions that changed the way of life for many individuals. Migrant patients with type 2 diabetes, who are already a vulnerable group regarding self‐care, had difficulties in maintaining good living habits during the pandemic. During crises such as COVID‐19, support with self‐care, such as closer contact with healthcare providers, is vital. Clinical Relevance: Knowledge about how the COVID‐19 pandemic has affected migrants with type 2 diabetes can be used to support healthcare providers in identifying individuals who are at high risk of suffering from the consequences of their diabetes associated with the pandemic. [ABSTRACT FROM AUTHOR]

Background: There is growing interest in identifying factors associated with healthy aging. This cross‐sectional study evaluated associations of psychological resilience with factors associated with aging in older adults with type 2 diabetes mellitus (T2DM). Methods: Participants were 3199 adults (72.2 ± 6.2 years of age, 61% female, 61% White, body mass index [BMI] = 34.2 ± 8.2 kg/m2) with T2DM enrolled in Look AHEAD (a multi‐site randomized clinical trial comparing an intensive lifestyle intervention for weight loss to diabetes education and support). Participants were followed observationally after the 10‐year intervention was discontinued. The following items were assessed approximately 14.4 years post‐randomization in a cross‐sectional analysis: Brief Resilience Scale; overnight hospitalizations in past year; physical functioning measured objectively (gait speed, grip strength) and via self‐report (Pepper Assessment Tool for Disability; physical quality of life [QOL; SF‐36]); a measure of phenotypic frailty based on having ≥3 of unintentional weight loss, low energy, slow gait, reduced grip strength, and physical inactivity. Depressive symptoms (PHQ‐9) and mental QOL (SF‐36) were also measured. Logistic/linear/multinomial regression was used to evaluate the association of variables with resilience adjusted for age, race/ethnicity, and gender. Results: Greater psychological resilience was associated with lower BMI, fewer hospitalizations, better physical functioning (i.e., lower self‐reported disability, better physical QOL, faster gait speed, greater grip strength, lower likelihood of frailty), fewer depressive symptoms, and greater mental QOL (all p < 0.05). Psychological resilience moderated the relationship of number of hospitalizations in the past year with self‐reported disability and grip strength. Conclusions: Psychological resilience is associated with better physical function and QOL among older adults. Results should be interpreted cautiously given cross‐sectional nature of analyses. Exploring the clinical benefits of resilience is consistent with efforts to shift the narrative on aging beyond "loss and decline" to highlight opportunities to facilitate healthy aging. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes (T2D) is a burgeoning epidemic in children and adolescents. Adult T2D doubles the risk of depression and mental health comorbidity, makes it more difficult to make the lifestyle, medication adherence and health behavior changes needed to optimize outcomes. There is limited research on the impact of depression and depressive symptoms on youth T2D. Methods: A search of the literature in the last 10 years regarding youth with depression and T2D was conducted. Abstracts were screened by 2 randomly assigned authors for inclusion, and disagreement was resolved by a third author. Selected full-text articles were divided among all authors for review. Results: 13 publications from 8 studies (N=2244, age 6–17) were included. 6 of 13 publications utilized Treatment Options for Type 2 Diabetes in Youth (TODAY) study data. While studies included evaluation of depressive symptoms, most did not formally assess for major depressive disorder (MDD) and excluded participants with a previous diagnosis of MDD. Depressive symptoms were common in this population and were associated with negative T2D outcomes. Conclusions: While there is a growing body of adult literature highlighting the extensive relationship between T2D and mental health, there is a dearth of data in youth. Future studies are needed that include, 1.) youth with diagnosed MDD, 2.) treatment studies of both T2D and MDD, 3.) larger, more racially diverse samples of youth with T2D, and 4.) studies that evaluate the impact of social determinants of health, including mental health comorbidity on outcomes of T2D. [ABSTRACT FROM AUTHOR]

Background. The World Health Organization (WHO) has considered type 2 diabetes mellitus (T2DM) a major global health challenge because of its high prevalence worldwide. T2DM can affect patients' personal, social, and economic statuses. On the other hand, due to the increasing prevalence of T2DM, Quality of Life (QOL) has received more attention in recent years. Objective. The present study was conducted to investigate the relationships between QOL and physical activity level, body mass index, fasting blood sugar, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, total cholesterol, HbA1c, and systolic and diastolic blood pressure among Iranian patients with uncomplicated T2DM. Methods. This cross-sectional study was conducted on 135 participants selected through consecutive sampling. The study data were collected using International Physical Activity Questionnaire and Short-Form Health Survey Questionnaire. Then, the data were entered into the SPSS ver. 28 software, and Pearson's correlation was used to measure the correlation between the variables. Linear regression was also employed. The significance level was set at 0.05. Results. The significant association was observed between gender (p = 0.007), HDL level (p = 0.02), and gender-adjusted physical activity (p = 0.002) with QOL. Conclusions. Due to the association between physical activity and HDL level with QOL in patients with uncomplicated T2DM, they should be given the necessary training to improve their physical activity and regulate HDL level. Also, empowering them in this matter improves their QOL. [ABSTRACT FROM AUTHOR]

The purpose of this qualitative study was to gain a better understanding of the spheres of influence on engagement in recommended diabetes preventive health services among rural, working adults. Additionally, this study sought to understand the unique factors that influence diabetes self-management among rural, working adult populations. The sample included mostly African-American, low-income females with self-reported diabetes, who scored low on the Patient Activation Measure (PAM-10). Semi-structured interviews (N = 20) revealed that most participants struggled with the "ups and downs" of living with diabetes. Four major themes emerged from the data: "the struggle," "doing things together," "diabetes is not the priority," and "we're lucky to have what we have." Most participants were developing individual responsibility and motivation for a healthy future, but were overwhelmed by inconsistency in self-management, diabetes distress, lack of effective coping strategies, and lack of social and economic capital. The findings of this study indicate the need to further address psychological well-being among rural, working adults, yet rural populations often lack sufficient access to mental health care and formalized psychological support. Psychological support and resources are essential to facilitate engagement in diabetes self-management and preventive health services for rural, working adults. [ABSTRACT FROM AUTHOR]

The article presents the discussion on psychological care of youth with type 1 diabetes (T1D) as well as type 2 diabetes (T2D). Topics include professionals with expertise in the mental health of children and adolescents being essential members of interdisciplinary diabetes health care team; and mental health professionals being available to interact with youth and their families.

Latinos' type 2 diabetes (T2DM) and concurrent depression significantly lower quality of life (QoL). Patients' beliefs about their diabetes, called illness perceptions (IP), may account for the impact of depression on QoL. Using secondary data, we explored predictive and mediation relationships among IP, depression, and QoL among Mexican American adults with T2DM using hierarchical multiple regression and mediation analyses. Participants (n = 75) were predominately middle-aged, female, most scoring low on depressive-symptoms, who believed that diabetes was a chronic disease with serious consequences, controllable by treatment and personal self-management. Participants with higher acculturation and weak perceptions about negative consequences of diabetes reported better QoL. Depressive symptoms' impact on QoL were mediated by overall IP and perceptions about diabetes consequences, in particular. By eliciting patients' perceptions about disease consequences and teaching realistic ways to avoid them, clinicians may alleviate the impact of depression on QoL. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study is to identify factors associated with patient empowerment in people living with type 2 diabetes mellitus (T2DM) in the Canary Islands (Spain). Methods: Secondary cross‐sectional analysis was carried out of data obtained in the INDICA study: A 24‐month cluster randomized‐controlled trial evaluating the effectiveness of educational interventions supported by new technology decision tools for T2DM patients. Sociodemographic variables, clinical data (years since diagnosis, glycated haemoglobin level, creatine, triglycerides, waist hip index, body mass index and number of comorbidities), diabetes knowledge (DIATEK), affective outcomes (Beck Depression Inventory‐II, the State subscale of the State‐Trait Anxiety Inventory and The Diabetes Distress Scale) and diabetes‐related quality of life (The Audit of Diabetes‐Dependent Quality of life) were assessed as potential correlates of patient empowerment, assessed using the Diabetes Empowerment Scale‐Short Form. Multilevel mixed linear regression models on patient empowerment were developed. Results: The analysis included the baseline data of 2334 patients. Results showed that age (B = −0.14; p <.001), diabetes knowledge (B = 0.61; p <.001) and state‐anxiety (B = −0.09; p <.001) are significantly associated with patient empowerment. Sex, education level, living alone, employment status, country of birth, time since diagnosis, number of comorbidities, glycated haemoglobin level, depression and distress were not independently associated with patient empowerment in the multivariate analyses. Conclusion: Younger age, lower state‐anxiety and greater diabetes‐specific knowledge are important correlates of patient empowerment. In line with the results of the INDICA study, interventions based on patient‐centred care might be effective in improving patient empowerment in adults with T2DM. Understanding the factors associated with empowerment may help clinicians and policymakers to identify high‐risk groups, prioritize resources and target evidence‐based interventions to better support people with T2DM to be actively involved in their own care. Patient or Public Contribution: Patients with T2DM were actively involved in the design of the INDICA study. Two patient associations were included as part of the research team and actively participated in designing the interventions and selecting outcome measures. [ABSTRACT FROM AUTHOR]

Background and Objective: This study was carried out as a validity and reliability study of the Turkish version of the Diabetes Fatalism Scale (DFS) and to investigate its psychometric properties in the Turkish society with type 2 diabetes patients. Methods: Exploratory factor analysis was conducted to assess the scale's factor structure. Confirmatory factor analysis (CFA) was performed to validate the "best fit" model. Results: The explanatory factor analysis and CFA results confirmed the three-factor structure of the scale. The Cronbach's α, item-total correlation and test–retest analyses showed high reliability. Conclusion: The results showed that DFS is a valid and reliable tool for evaluating fatalism in diabetic patients from a Turkish population. [ABSTRACT FROM AUTHOR]

Background and Aim: Each year, millions of older people experience falling which can cause serious injuries such as broken bones, head injuries, or even death. Since Diabetes Mellitus can disrupt the balance system and increase falling, and given that fear of falling and balance confidence are critical fall-related psychological concerns that can be the risk factors of falls in the diabetic elderly, this study aimed to compare fear of falling and balance confidence of diabetic and non-diabetic older adults in Iran. Methods: Participants were 63 diabetic older patients and 59 non-diabetic peers aged 60 years and over. Data were collected using the Persian versions of falling efficacy scale-international and activities-specific balance confidence-short form questionnaires. In addition, modified Romberg and timed up and go tests were performed to assess subjective balance performance. Results: The scores of falling efficacy scale-international questionnaire and timed up and go test were significantly higher in diabetic group while the scores of activities-specific balance confidence-short form questionnaire were lower (p<0.001). No significant differences were observed in the modified Romberg test scores between two groups. Conclusion: Fear of falling and low balance confidence are more common in diabetic older adults compared to non-diabetic peers. They have poor performance in timed up and go test and have more falls during the last 12 months. [ABSTRACT FROM AUTHOR]

Distress causes psychophysiological alterations that affect autonomic function. The current study explores psychophysiological modulation in diabetic distress in response to Surah Al-Rehman recitation. A single-group experimental study with before and after intervention assessments was conducted during April 2018 to February 2019 in which participants (n = 10) listened to Surah Al-Rehman recitation. Blood pressure, blood glucose, cortisol, ECG and EEG were recorded before and after recitation. Significant reduction in systolic blood pressure, increase in low frequency and absolute alpha power at Fp2 were observed. Heartbeat evoked potentials (HEP) were also significantly modulated at Fp1, Fp2 and F4. These findings suggest that Surah Al-Rehman modulated baroreflex activity thereby reducing sympathetic activity and improved heart brain coherence as reflected by HEP. [ABSTRACT FROM AUTHOR]

Introduction: The global prevalence of diabetes in 2019 in adults was estimated to be 9.3%. This study developed in Ecuador, for the first time, instruments to assess patient‐reported outcomes and experiences. Methods: The Experiences of the Person with Diabetes (EPD) Questionnaire is a diabetes‐specific instrument. A mixed‐methods study was conducted. First, a qualitative item development phase that included four focus groups and six semi‐structured interviews with patients was conducted in different rural and urban areas of Ecuador to obtain information on culture, beliefs, demographics, diet and social perspectives. A second quantitative phase for psychometric validation was carried out in primary care settings of rural and urban areas of Ecuador. Results: Forty‐two and four hundred and eighty‐nine participants were included in each phase, respectively. The item development phase resulted in a questionnaire of 44 items (23 for perceived outcomes and 21 for experiences). In the validation study, most participants were women (58%) and from urban areas (57%). Exploratory factor analysis revealed three dimensions for each instrument. Outcomes instrument dimensions were symptoms and burnout, worries and fears and social limitations. Experiences instrument dimensions were information, patient‐centred care and care delivery. Cronbach's α values of the total score and dimensions were high, ranging between.81 and.93 in both instruments. Confirmatory factor analysis showed an acceptable fit of the data. Conclusion: The EPD Questionnaire is probably the first instrument developed to assess patient‐reported experiences and perceived outcomes in a middle‐income country that included patients to capture all dimensions relevant for the intended population. Its psychometric properties are robust and could provide valuable information for clinicians and policymakers in the region. Patient or Public Contribution: The development of these instruments has taken into consideration patients and the public since their conception. A qualitative approach gathered relevant information related to the cultural, social and economic burden of different populations in Ecuador. Before validation, a pilot test was carried out with users of the National Health Services to obtain their perspectives and insights of the developed instrument. Finally, during the data analysis, we have given special consideration to social variables such as rural and urban populations. [ABSTRACT FROM AUTHOR]

Aims: To explore the lived experiences of diabetes distress (DD) in adults with type 1 and type 2 diabetes, and to identify similarities and differences in these experiences. Methods: We conducted in‐depth interviews with people with type 1 (n = 19) and type 2 diabetes (n = 29). We conducted thematic analysis using NVivo 12 software. Results: We identified three themes: (1) Experiencing Diabetes Distress as a Lack of Control – Similarities: All participants voiced a perceived lack of control with their glucose levels and other peoples' misconceptions about diabetes. Differences: Nearly all type 1 participants described a "lack of control" over emotional reactions to hypo‐ and hyperglycaemia as opposed to only one type 2 participant. (2) Experiencing Diabetes Distress as a Burden of Constant Management – Similarities: All participants emphasized the nonstop, relentless nature of diabetes management. Differences: type 1 participants described self‐care as vital, with life‐threatening consequences if not performed, while type 2 participants did not perceive such dangerous consequences. (3) Understanding the Value of Social Support in Diabetes Distress – Similarities: All participants acknowledged the importance of having others recognize the difficulties of living with diabetes. Differences: type 1 participants noted actual experiences where peers and health care professionals acknowledged that burden, whereas type 2 participants expressed a desire for this support that was not present in their lives. Conclusions: Findings revealed subtle differences in perceptions of DD among adults with type 1 and type 2 diabetes, which suggest a need to tailor treatment for people with each type of diabetes. [ABSTRACT FROM AUTHOR]

Adults with type 2 diabetes (T2D) often experience two common diabetes-related psychological distress: diabetes distress and depressive symptoms. Both are associated with adverse diabetes outcomes including poor self-management and glycemic control. However, diabetes distress and depressive symptoms differ in their associations with diabetes outcomes in T2D patients. This study proposes a hypothetical model to examine whether self-efficacy mediates the adverse effects of depressive symptoms and/or diabetes distress on self-care behaviors and glycemic control. Additionally, we examined the bi-directional relationships between diabetes distress and depressive symptoms to identify potential underlying mechanisms. This study conducted in 15 rural health clinics in Jiangsu province China. 900 adults with T2D participated in the prospective cohort study. The data Diabetes distress (the 17-item Diabetes Distress Scale, DDS17), depressive symptoms(the 10-item Center for Epidemiologic Studies Depression Scale, CESD-10), self-efficacy, self-care behaviors (diet and physical activity), metabolic variables (fasting plasma glucose, FPG) and demographic characteristics were assessed at baseline. Subsequent 12-month Hemoglobin A1C (HbA1c) were measured after baseline. Hierarchical multiple regression and bootstrap mediation analysis were used to test the effects and pathways among these associations. Of 843 participants (93.67%) of total cohort with available subsequent 12-month HbA1c levels, mean age was 66.08 years and 66.55% were women, 25.15% of them had depressive symptoms (CES-D ≥ 10), 12.20% had moderate diabetes distress (mean DDS ≥2) and 4.98% had the both two psychological distress. Hierarchical multiple regression showed higher DDS score significantly predicted unhealthy diet(β = −1.10, P < 0.001) but not physical activities, while CESD score was negatively associated with physical activity (β = −0.06, P < 0.001) but not diet. No independent effects of the two psychological distress variables on subsequent 12-month HbA 1 c were observed. Mediation analysis supported that elevated self-efficacy solely mediated the negative effect of both diabetes distress and depressive symptoms on diet (DDS score: β = −0.238, 95 BCE% CI [−0.350, −0.141]; CESD score: β = −0.010, 95 BCE% CI [−0.016, −0.005]), physical activities (DDS score: β = −0.446, 95 BCE% CI [−0.630, −0.283]; CESD score: β = −0.019, 95 BCE% CI [−0.030, −0.010]) and subsequent 12-month HbA1c (DDS score: β = 0.105, 95 BCE% CI [0.030,0.189]; CESD score: β = 0.004, 95 BCE% CI [0.001,0.009]). Additionally, the interplay of diabetes distress and depressive symptoms exerts their effects on diabetes outcomes directly and indirectly via self-efficacy. Self-efficacy may contribute to better diabetes outcomes and ameliorate negative effects of diabetes distress and depressive symptoms. [ABSTRACT FROM AUTHOR]

Participation in regular physical activity has significant physical, psychological, and social benefits, including the prevention and treatment of Type 2 Diabetes (T2D). The primary aim of this paper was to evaluate the impact of theeCoFit physical activity intervention on depression and anxiety symptoms among adults at risk of, or diagnosed with, T2D. The primary outcomes were assessed using Patient Health Questionnaire-9, and Generalised Anxiety Disorder-7. The secondary aim was to test for the potential mediators for the intervention effect on mental health. The 20-week intervention was evaluated using a two-arm randomised controlled trial with await list control group. The intervention included two phases: Phase 1 integrated group face-to-face sessions and the use of the eCoFit smartphone application (app); and Phase 2 that included the use of the app only. Participants (n = 84) were assessed at baseline and 10- and 20-weeks post-baseline. Social support, self-efficacy, nature-relatedness, and perceived sleep quality were examined as potential mechanisms for the intervention effects on mental health. A significant interaction for depression severity was observed at 20-weeks (−1.76, CI −3.48, −05, p=.044, d= −0.35). There were no significant intervention effects for anxiety or any of the potential mechanisms. [ABSTRACT FROM AUTHOR]

Aims: To examine whether the incidence rates of diagnosed depression, anxiety disorders and stress reactions, as well as prescription rates of antidepressants and anxiolytics were higher during the COVID‐19 pandemic than before in persons with type 2 diabetes in Germany. Contrary to earlier studies, clinical diagnoses of psychiatric disorders (ICD classification) were used. Methods: The German Disease Analyzer (DA) database is an outpatient database containing routine data on patients´ diseases and treatments provided by a representative panel of physician practices selected from across Germany. We assessed incidence rates of depressive disorders (ICD‐10: F32, F33), anxiety disorders (F41) and stress reactions (F43) in quarters from January 2019 to March 2021 in 95,765 people with type 2 diabetes included in the DA in 2019 (mean age 68.9 years, 58% men). Prescription rates of antidepressants and anxiolytics in quarters from January 2020 to March 2021 were compared with prescription rates from 1 year earlier. Results: During the study period, the incidence rate of newly diagnosed depressive disorders in persons with type 2 diabetes declined slightly, while the incidence rates of anxiety and stress disorders remained largely constant. The rates of new prescriptions for antidepressants and anxiolytics were lower in all quarters of 2020 and in the first quarter of 2021 than in the quarters 1 year earlier. Diabetes‐related complications were more prevalent in persons with incident psychiatric disorders than in those without. Conclusions: No increase in the incidence rates of clinically diagnosed psychiatric disorders was observed during the COVID‐19 pandemic in Germany in persons with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: Diabetes-related guidelines recommend lifestyle changes for people living with type 2 diabetes (PLwD). In South Asian (SA) families, cultural and contextual expectations often influence people's decisions. However, broad explanations provided in the existing literature and theories concerning family involvement can increase the chance of health professionals overlooking the complexities of family roles within SA communities. Previous literature has identified the need to examine the perspectives of PLwD and their family members in Pakistan to shed light on factors perceived to support and hinder recommended physical activity (PA) to manage type 2 diabetes. This study explored (1) the enablers of and barriers to PA in the context of PLwD in Pakistan and (2) family involvement regarding PLwD's engagement with PA. Methods: Semi-structured interviews were conducted with 30 PLwD and 17 family members of PLwD who were recruited in metropolitan Lahore (Pakistan) and primarily used state health services available to relatively disadvantaged populations. Interviews were transcribed and analysed using thematic analysis. Results: Three themes were identified: (1) Going for a walk as a feasible PA; (2) the role of family members in influencing PA; and (3) gender differences and cultural acceptability of an activity. PA enablers for PLwD consist of gender-specific opportunities for activity facilitated by peers and family members. Culturally acceptable opportunities for PA in Pakistan for specific genders and age groups within the socio-cultural context constituted an essential factor. In this study, all women with diabetes described walking as the only acceptable form of PA, whereas some men mentioned other activities such as running, playing cricket, and cycling. Conclusions: Medical guidelines must consider patients' daily routines, account for cultural and familial expectations of different genders and age groups, and address social and physical barriers encountered by these different groups to encourage PA among PLwD in SA cultures. [ABSTRACT FROM AUTHOR]

Objective: The present study aims to evaluate the association between sociodemographic characteristics and health-related quality of life (HRQoL) among diabetic patients attending a clinic situated in the Warangal region of Telangana, India. Materials and Methods: A cross-sectional study was conducted for 8 months in the diabetes outpatients' clinic in the Warangal region, Telangana, India. A total of 402 patients were included in that study. The patients were assessed for QoL using the HRQoL-8-dimensional scale, which covers mainly Role Restriction Due to Physical Illness (6 items), Strength and Stamina (6 items), Health in General (3 items), Satisfaction with the Treatment (4 items), Symptoms Botherless (3 items), Financial Worries (3 items), Mental Health (5-items), and Satisfaction with Diet (2 items). All the items were assessed on a five-point Likert scale. Results: The mean age of the patients was 52.39 ± 11.01 (mean±SD). There was a statistically significant association between education and physical health (P=0.015), treatment satisfaction (P=0.006), emotional health (P=0.038), and diet satisfaction domain of HRQoL (P=0.006). The type of medication is associated with treatment satisfaction, financial worry, emotional health, and diet satisfaction (P=0.001). The patient's employment status is significantly different from the general health, financial, and emotional health of HRQoL (P=0.001). However, treatment satisfaction (P=0.044) alone was significantly associated with years of having diabetes. Conclusion: Adhering to treatment guidelines and provider recommendations helps patients to lead a healthy lifestyle. [ABSTRACT FROM AUTHOR]

It has been suggested that gain-framed messages are more effective than loss-framed messages in promoting low-risk health behaviors such as physical activity. Because of a heightened health concern and possible medical complications, older adults with type 2 diabetes (T2D) may consider physical activity to be risky. This study examined whether a reverse message-framing effect would be found among older adults with T2D. The participants included 211 sedentary and older adults with T2D recruited from an outpatient clinic. The participants were randomly assigned to receive either gain-framed or loss-framed messages and wore an accelerometer to monitor their physical activity for 2 weeks. The participants who received loss-framed messages were more physically active than those who received gain-framed messages (β = 0.13, p = .033). This loss-frame advantage might be attributable to the heightened perceived risks among older outpatients with T2D and the temporarily activated prevention-focused orientation in a clinical setting. [ABSTRACT FROM AUTHOR]

Religious coping is considered an important factor for assisting with the management of chronic diseases. This study was conducted to determine the relationship between religious coping and disease acceptance and management among patients with diabetes. A total of 504 individuals with type 2 diabetes were included in this descriptive-correlational study. In this study, individuals who did not use their medications regularly, those who did not pay attention to their diet and those who did not exercise regularly had higher levels of positive religious coping. No significant relationship was found between the level of acceptance of illness and religious coping styles among participants with diabetes. However, it was found out that there was a positive relationship between HbA1C levels and the mean score of positive religious coping and positive religious coping accounted for 7% of the total variance in the glycemic control parameter. [ABSTRACT FROM AUTHOR]

Aims and objectives: To synthesise empirical studies on factors related to fatigue and its impact on diabetes self‐management (DSM) and quality of life (QOL) in adults with type 2 diabetes mellitus (T2DM). Background: Fatigue is commonly reported in people with T2DM, a chronic condition that is highly prevalent worldwide. However, a holistic understanding of the consequences and factors related to fatigue in adults with T2DM is not well synthesised. Design: This integrative review used Whittemore and Knafl's methodology and was reported according to the Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and checklist. Methods: The theory of unpleasant symptoms (TOUS) was used as a conceptual model to guide the review. The PubMed, PsychINFO and CINAHL databases were searched to identify studies that recruited adults with T2DM, were peer‐reviewed, written in English and investigated fatigue as a primary or secondary outcome. Two investigators independently appraised the quality of the studies and extracted the data. Results: Twenty‐nine articles met the inclusion criteria: 23 observational studies, two randomised controlled trials, one quasi‐experimental study and three qualitative studies. All articles were of high quality. Physiological (e.g. T2DM duration, complications and inflammatory biomarkers), psychological (e.g. diabetes distress, depression and sleep quality) and situational factors (e.g. race/ethnicity, education and social support) were related to fatigue. Studies reported fatigue as a barrier to physical activity, healthy eating behaviours and the physical aspect of QOL. Conclusions: Multiple factors are related to fatigue in adults with T2DM. Gaps in the literature include the multiple dimensions of fatigue, the effectiveness of interventions to alleviate fatigue and fatigue experiences in under‐represented populations. Relevance to clinical practice: This integrative review supports the complex origin of fatigue and its impact on adults with T2DM. Nurses should evaluate modifiable factors related to fatigue and provide support to help improve DSM and QOL in this population. [ABSTRACT FROM AUTHOR]

Aims and objectives: To validate a hypothetical path model estimating the health status of patients with insulin‐treated type 2 diabetes and to verify the mediating effects of diabetes management self‐efficacy, diabetes self‐management behaviour and haemoglobin A1c using a multi‐mediation model. Background: Diabetes knowledge, personal and social motivations, diabetes management self‐efficacy and health behaviours may be interrelated and may directly or indirectly affect the objective and subjective health outcomes of patients with type 2 diabetes mellitus receiving insulin treatments. Design: Model testing correlational design. Methods: The participants were 193 outpatients with insulin‐treated type 2 diabetes. Data were collected between July and November 2019. The collected data were analysed using SPSS version 25.0® and AMOS 23.0. This study is based on STROBE guidelines. Results: The model's fit indices were adequate. Diabetes‐related knowledge, psychological insulin resistance, family support for diabetes management, diabetes self‐care activities and haemoglobin A1c had significant direct effects on subjective health status. Diabetes management self‐efficacy had significant indirect effects on subjective health status via diabetes self‐care activities and haemoglobin A1c, and mediated the path through which diabetes knowledge, psychological insulin resistance and family support for diabetes management indirectly affect subjective health status. These variables explained 55.0% of the total variance of subjective health status. Conclusion: Diabetes knowledge, psychological insulin resistance, diabetes management family support, diabetes management self‐efficacy and diabetes self‐care activities were found to be related to the subjective and objective health status. Relevance to clinical practice: The findings can help health professionals improve diabetes self‐care activities and haemoglobin A1c, which will influence subjective health status in patients with type 2 diabetes mellitus, receiving insulin treatments. [ABSTRACT FROM AUTHOR]

Type 2 diabetes is a chronic condition primarily self-managed by the individual. Mastery is a protective factor linked to better control of chronic conditions, effective self-management and improved medication adherence. Mastery appears increasingly important as treatment regimens and self-management demands become more complex and burdensome. Diabetes distress negatively impacts self-management, glycaemic control and treatment adherence. Understanding the relationship between diabetes distress and mastery may provide opportunities to improve condition management and adherence. This relationship may be impacted by other factors affecting the individual's perceived sense of control over their condition. This study examined the role of diabetes empowerment and depression in the relationship between diabetes distress and mastery. Data were drawn from a randomised controlled trial of 131 adults with type 2 diabetes transitioning to injection therapy. Participants completed measures of diabetes distress , mastery , depression and empowerment. Diabetes distress and depression were negatively associated with mastery, whilst diabetes empowerment was positively associated. A significant interaction effect (b =.024, t(112) = 3.79, p = <.005) confirmed the relationship between diabetes distress and mastery was moderated by depression. Findings highlight the additive deleterious effects of depression. Interventions to improve mastery among those living with type 2 diabetes should address diabetes distress and depression to optimise outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Considering the prevalence of the symptoms of type 2 diabetes, to prevent its chronicity and recurrence, it seems that measures should be taken in this regard. This study aimed to evaluate the effectiveness of time perspective therapy on mental well-being, functional flexibility, and mental cohesion in patients with type 2 diabetes. Method: This quasi-experimental study was a pre-test, post-test, and follow-up after two months. The statistical population included people with type 2 diabetes who were referred to Mashhad Diabetes Center in 2020. Among them, 30 individuals with type 2 diabetes were selected by convenience sampling and were randomly assigned to an experimental and control group awaiting treatment. To collect data, the Mental Well-Being, Mental Cohesion, and Functional Flexibility Questionnaire scales were used. Results: The results of repeated measures analysis of variance showed that time perspective treatment is effective on mental well-being, psychological cohesion, and functional flexibility in people with type 2 diabetes. Conclusion: It can be concluded that time perspective therapy can be effective on mental well-being, psychological cohesion and functional flexibility in people with type 2 diabetes. It is suggested that by using these variables by medical centers, other relevant organs and organizations, an effective step can be taken to improve the mental health status of women. [ABSTRACT FROM AUTHOR]

Purpose: Diabetes Mellitus Type II is a condition where the patients present with increased receptor resistance to adequately or normal amount of insulin production and reduced or inadequate amount of insulin produced. Worldwide the approximated burden of DM Type II is at 366 million people in 2011. The objective of the study is to determine the level of social support received by Diabetes Mellitus Type II patients attending a County Referral Hospital in Kenya. Methodology: This was a descriptive cross-sectional study conducted at a County Referral Hospital Outpatient Diabetic Clinic. Researcher administered questionnaires were used to collect data. Data analysis was manual for qualitative data and for quantitative data, descriptive statistics were used to analyze aided by the statistical package for social scientists (SPSS) version 22. Results: Majority 67.91% of the total participants reported not to be socially supported by their family and peers in specific aspects of their self-care management of Diabetes Mellitus Type II that contributed to the sub-optimal self-care practices attributed to the participants. Unique contribution to theory, practice and policy: Study found close relationship between adequate Diabetes Mellitus Type II self-care by DM Type II patients and social support. The researcher recommends in-cooperation of the patient's social circles in Diabetes Mellitus Type II self-care patients' education so as to promote understanding which will enhance social support hence optimal practice and adherence. [ABSTRACT FROM AUTHOR]

Objective: To compare exclusive breastfeeding (BF) and BF initiation among 185 women with Type 1 and 212 women with Type 2 pregestational diabetes who intended exclusive or partial BF and delivered at ≥34 weeks of gestation.Methods: Retrospective cohort study. At discharge, exclusive BF is direct BF or BF complemented with expressed breast milk. BF initiation is defined by exclusive or partial BF.Results: Type 1 and Type 2 groups were similar in prior BF experience (69 vs 67%) but were different in intention to BF exclusively (92 vs 78%) and partially (8 vs 22%). Women in the Type 1 group were younger (median age 30 vs 33y), likely to be primiparous (47 vs 25%), have a lower median BMI (32 vs 36 kg/m2) and deliver by primary cesarean (37 vs 26%). Infants born to Type 1 women were more likely to be admitted to the NICU (44 vs 18%) and to have hypoglycemia (59 vs 41%). At discharge, exclusive BF among Type 1 was higher (34 vs 23%), partial BF was similar (47 vs 46%) while FF (formula feeding) was lower (19 vs 31%) than in the Type 2 group. BF initiation occurred in 81% of Type 1 and 69% of Type 2 women.Conclusion: Intention to BF exclusively was higher in Type 1 women compared to Type 2. At discharge, exclusive BF and BF initiation were lower and FF higher in the Type 2 group highlighting the need for different strategies if lactation in this special population is to be improved. [ABSTRACT FROM AUTHOR]

Aims: This qualitative study aims to explore beliefs, attitudes and experiences of injectable glucagon‐like‐peptide‐1 receptor agonists (GLP‐1RAs) use and discontinuation, as well as attitudes to further injectable treatment intensification, among adults with type 2 diabetes (T2D). Methods: Nineteen in‐depth semi‐structured interviews lasting (mean ± standard deviation) 45 ± 18 min were conducted, face‐to‐face (n = 14) or via telephone (n = 5). Transcripts were analysed using inductive template analyses. Eligible participants were English‐speaking adults with T2D who had recently initiated (≤3 years) GLP‐1RA treatment. Results: Participants were aged 28–72 years, who predominantly lived in metropolitan areas (n = 15), and had an experience of daily (n = 11) and/or once‐weekly (n = 13) GLP‐1RA formulations. Six participants had discontinued treatment and seven had trialled two or more formulations. Expectations and experiences of GLP‐1RA were related to the perceived: (1) symbolism and stigma of injectable diabetes treatment; (2) ease of injectable administration and device preferences; (3) treatment convenience and social impact; (4) treatment efficacy and benefits, and; (5) negative treatment side effects. Some participants reported increased receptiveness to insulin therapy following their GLP‐1RA experience, others emphasised unique concerns about insulin beyond injectable administration. Conclusions: This study provides a novel understanding of expectations and experience of non‐insulin injectables among Australian adults with T2D. Our data suggest expectations may be informed by attitudes to insulin therapy, while perceived treatment benefits (e.g. weight‐related benefits, administration frequency) may motivate uptake and ongoing use despite concerns. Experience of GLP‐1RA injections may impact receptiveness to future insulin use. [ABSTRACT FROM AUTHOR]

People with diabetes frequently have elevated diabetes distress. Although mindfulness‐based stress reduction (MBSR) therapy has been shown effective in reducing diabetes distress, it has only been delivered by psychologists or a multidisciplinary team with an attrition rate of up to 39%, which limits its dissemination to a broader audience. This study was aimed to pilot evaluate the feasibility of a nurse‐led MBSR therapy and explore its potential efficacy amongst people with type 2 diabetes mellitus. A total of 100 participants were randomly allocated either to the intervention group (nurse‐led MBSR therapy + regular diabetes education) or the control group (regular diabetes education). Data on diabetes distress, diabetes self‐efficacy, and diabetes self‐management were collected at baseline, 8 and 12 weeks. Hemoglobin A1c (HbA1c) was collected at baseline and 12 weeks. A generalized estimating equation analysis for repeated measures was used to determine intervention and time effects. As predicted, the nurse‐led MBSR therapy had a significant time‐by‐group interaction effect on diabetes distress total score (95% confidence interval [CI]: 0.58–0.77, p < 0.001), diabetes self‐efficacy (95% CI: −0.93 to −0.74, p < 0.001), diabetes self‐management (95% CI: −10.80 to −7.83, p < 0.001), and HbA1c levels (95% CI: 0.04–1.14, p = 0.03) in the intervention group compared with the control group over 12 weeks. This is the first nurse‐led MBSR therapy in a hospital setting that is feasible and has the potential to improve health outcomes. This approach may offer an innovative model to deliver MBSR therapy. A randomized controlled trial comparing the nurse‐led MBSR plus usual diabetes education with usual diabetes education along with a mechanism to equalize intervention attention between the groups is indicated. [ABSTRACT FROM AUTHOR]

Background and aims: The prevalence of sexual dysfunctions in people with diabetes is still debated and understudied in women. This study examines the prevalence of sexual dysfunction in men and women with type 1 or type 2 diabetes (T1D or T2D) and the associations with clinical and psychological variables. Methods: Adults with diabetes (n = 756) completed an online survey including questions on sexual functioning (adapted Short Sexual Functional Scale), general emotional well‐being (WHO‐5), symptoms of anxiety (GAD‐7) and diabetes distress (PAID‐20). Results: One third of participants reported a sexual dysfunction. Men reported erectile dysfunction (T1D: 20%; T2D: 33%), and orgasmic dysfunction (T1D: 22%; T2D: 27%). In men, sexual dysfunction was independently associated with, older age (OR = 1.05, p = 0.022), higher waist circumference (OR = 1.04; p < 0.001) and longer duration of diabetes (OR = 1.04; p = 0.007). More men with sexual dysfunction reported diabetes distress (20% vs. 12%, p = 0.026). Women reported decreased desire (T1D: 22%; T2D: 15%) and decreased arousal (T1D: 9%; T2D: 11%). More women with sexual dysfunction reported diabetes distress (36% vs. 21%, p = 0.003), impaired emotional well‐being (36% vs. 25%, p = 0.036) and anxiety symptoms (20% vs. 11%, p = 0.026). Conclusion: Sexual dysfunctions are common in both men and women with diabetes. In men, sexual dysfunctions were associated with clinical factors. More women with sexual dysfunction reported low emotional well‐being and anxiety symptoms compared to women without sexual dysfunction. For both men and women, sexual dysfunctions were associated with diabetes distress. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM) is a serious chronic illness which has a major impact on the psychological well-being of the individuals. Aim: This case--control study compared the optimism, quality of life (QOL), and psychological distress between T2DM persons and healthy controls and examined the relationship of optimism with QOL and psychological distress among T2DM persons. Materials and Methods: Using a purposive sampling technique, this study was conducted in the General Medicine Outpatient department of a tertiary care hospital between January and March 2020. Fifty participants (25 cases and 25 healthy controls) in the age range of 30--60 years took part in the study. Both groups were assessed by the following instruments: Life Orientation Test-Revised, WHOQOL-BREF, and Depression Anxiety and Stress Scale. Results: T2DM persons are experiencing significant psychological distress with a pessimistic disposition and reduced QOL. Furthermore, optimism was positively correlated with psychological health among T2DM persons. Conclusions: T2DM persons are found to be pessimistic and distressed with significant reductions in their QOL. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus is both prevalent and profoundly impactful, and how people cope with the illness is related to a variety of individual and relational outcomes. The goal of this investigation was to test the logic of the recently extended Theoretical Model of Communal Coping (TMCC), a communication theory that argues that race (in this study, Black and White) moderates the relationship between communal coping and disease-related outcomes (i.e., glucose, diet, and exercise self-care). In general, survey data from 348 participants (n = 224 Black participants, n = 124 White participants) revealed that although communal coping was directly and positively related to self-care, the relationship between communal coping and self-care was stronger for Black participants than White participants. The results of the study have implications for the TMCC and for researchers, families managing type 2 diabetes, and healthcare practitioners. [ABSTRACT FROM AUTHOR]

Introduction: Latino populations, particularly those living in rural areas, experience a disproportionately high prevalence and poorer outcomes of type 2 diabetes mellitus (T2DM). The purpose of this study was to test the acceptability and perceived effectiveness of a group-based, facilitated digital storytelling intervention for T2DM self-management among rural Latino patients. Method: Twenty Latino adults with T2DM participated in facilitated storytelling discussions at two primary clinics. Participants viewed a 12-minute T2DM self-management digital storytelling intervention, followed by a facilitated group discussion. Surveys, observations, and focus groups were used to assess for acceptability and perceived effectiveness of the intervention through descriptive and qualitative analysis, informed by narrative and social cognitive theory. Results: All participants found the intervention interesting and useful and reported improvement in confidence, motivation, and behavioral intentions for T2DM self-management. Themes mapped closely with narrative theory models, further suggestive of the behavior change potential. Discussion: Facilitated discussions may add value to viewing of digital stories and represent a scalable approach to provide culturally congruent health care for Latino patients with diabetes in rural settings. Within the paradigm of group-based diabetes educational programs, this lends itself well to critical transcultural nursing care. [ABSTRACT FROM AUTHOR]

Introduction: Complications and problems of diabetes can be controlled by following the treatment. This study aimed to evaluate the effectiveness of stress inoculation treatment on adherence to the treatment among type II diabetic patients with glycated hemoglobin index. Materials and Methods: This quasi-experimental study was conducted based on a pretest-posttest control group design. The statistical population of the present study included patients with type 2 diabetes having a record in the Imam Khomeini Hospital, Mahallat, Iran, in 2009-2010. The samples (n=50) were selected by convenience sampling method and matched in experimental and control groups. The research instruments included a questionnaire of adherence to treatment and a glycated hemoglobin test for both groups. Stress inoculation training techniques were performed in ten 90-minute sessions for the experimental group. After the administration of treatment in both groups, the questionnaire and blood test were performed again to evaluate glycated hemoglobin. The collected data were analyzed using a one-way analysis of covariance. Results: The results of the study showed that the mean scores of adherence to medication treatment (P=0.0001) and adherence to diet (P=0.0001) in the intervention group were increased, compared to the control group, which was statistically significant. Based on the results, a significant decrease was observed in the mean of glycosylated hemoglobin in the intervention group, compared to the control group (P=0.0001). However, the decrease in the mean of adherence to treatment in physical activity was not significant (P=0.062). Conclusion: According to the findings of the present study, stress inoculation training can be used to control glycosylated hemoglobin. [ABSTRACT FROM AUTHOR]

Purpose: To assess the correlation between toothbrushing (TB) and the common biological (HDL) and quality-of-life-related risk factors for noncommunicable diseases (NCDs) and communicable diseases among patients with diabetes mellitus type 2 (DM2).Materials and Methods: The present study is part of a prospective intervention study among DM2 patients (n=200), randomly selected from the outpatient clinics, Istanbul, Turkey. The assessed variables were: TB, self-reported gingival bleeding (SRGB), HDL, BMI, body-fat proportion, modified quality of life scale (WHOQOL-BrefPhPs). Descriptive statistics, frequency distributions, Spearman rank correlation, the chi-square test and factor analysis were applied.Results: A minority of the patients brushed their teeth twice a day or more (27%) and reported no gingival bleeding (37%). Favourable HDL and high WHOQOL-BrefPhPs were 77% and 57%, respectively. A majority of patients had unhealthy BMI (83%) and body-fat proportions (63%). SRGB was negatively correlated with WHOQOL-BrefPhPs (rs=-0.24, p<0.05) and TB (rs=-0.25, p<0.01). The patients who reported less than daily TB were more likely to have unfavourable HDL and low WHOQOL-BrefPhPs (32% vs 54%) than those brushing their teeth daily (17% vs 35%, p<0.05). Principal component analysis revealed two clusters: 'healthy weight' (WHOQOL-BrefPhPs, TB, BMI) and 'oral health' (SRGB, HDL).Conclusion: The present results demonstrate a correlation between TB and biological and quality-of-life-related risk markers of NCDs and communicable diseases. There seems to be a need to increase the awareness of the significance TB's potential intermediatory role between NCDs and communicable diseases. [ABSTRACT FROM AUTHOR]

Aims: To identify the views of people with Type 2 diabetes (PWD) and healthcare professionals (HCP) about diabetes care. Methods: A systematic review of qualitative studies reporting both groups' views using thematic synthesis frameworked by the eHealth Enhanced Chronic Care Model was conducted. Results: We searched six electronic databases between 2010 and 2020, identified 6999 studies and included 21. Thirty themes were identified with in general complementary views between PWD and HCP. PWD and HCP find lifestyle changes challenging and get frustrated when PWD struggle to achieve it. Good self‐management requires a trustful PWD–HCP relationship. Diabetes causes distress and often HCP focus on clinical aspects. They value diabetes education. PWD require broader, tailored, consistent and ongoing information, but HCPs do not have enough time for providing it. There is need for diabetes training for primary HCP. Shared decision making can mitigate PWD's fears. Different sources of social support can influence PWD's ability to self‐manage and PWD/HCP suggest online peer groups. PWD/HCP indicate lack of communication and collaboration between HCP. PWD's and HCP's views about quality in diabetes care differ. They believe that comprehensive, multidisciplinary and locally provided care can help to achieve better outcomes. They recognise digital health benefits, with room for personal interaction (PWD) and eHealth literacy improvements (HCP). Evidence‐based guidelines are important but can detract from personalised care. Conclusion: We hypothesise that including PWD's and HCP's complementary views, multidisciplinary teams and digital tools in the redesign of Type 2 diabetes care can help with overcoming some of the challenges and achieving common goals. [ABSTRACT FROM AUTHOR]

Background: Periodontal disease(s) and metabolic illnesses negatively impact the quality of life and, eventually mental health.Objective: This study investigated the effect of Porphyromonas gingivalis (W83) oral infection on the development of Alzheimer's disease (AD) pathophysiology in a wild-type obese, diabetic (db/db) mouse model.Methods: The db/db mice were either orally infected with P. gingivalis and Fusobacterium nucleatum or sham infected for 16 weeks. The presence of amyloid-β (Aβ) and neurofibrillary tangles (NFTs) were assessed using a silver impregnation technique and subsequently by immunohistochemistry for tau and neuroinflammation. The mRNA abundance of a panel of 184 genes was performed using quantitative real-time PCR, and the differentially expressed genes were analyzed by Ingenuity Pathway Analysis.Results: While no Aβ plaques and NFTs were evident by silver impregnation, immunohistochemistry (glial cell markers) of the P. gingivalis-infected mice tissue sections exhibited neuroinflammation in the form of reactive microglia and astrocytes. Anti-tau immunopositivity, in addition to cells, was prominent in thickened axons of hippocampal CA neurons. The mRNA abundance of crucial genes in the insulin signaling pathway (INSR, IGF1, IRS, IDE, PIK3R, SGK1, GYS, GSK3B, AKT1) were upregulated, potentially exacerbating insulin resistance in the brain by P. gingivalis oral infection. Increased mRNA abundance of several kinases, membrane receptors, transcription factors, and pro-inflammatory mediators indicated hyperactivation of intracellular cascades with potential for tau phosphorylation and Aβ release in the same infection group.Conclusion: P. gingivalis W83 infection of db/db mice provides a disease co-morbidity model with the potential to reproduce AD pathophysiology with induced periodontal disease. [ABSTRACT FROM AUTHOR]

We suggest a reconsideration of the role of 'attachment orientation' in the context of eating disorders and paediatric diabetes. Attachment orientation is a psychological construct that describes a relatively stable set of expectations and behaviours an individual relies upon in managing relationships. There is considerable evidence of an association between attachment orientation and the development and maintenance of disordered eating in individuals without diabetes, though evidence is more scant in populations with diabetes. We discuss the underpinning theory and critically examine the existing literature for the relationship between attachment orientation and disordered eating in paediatric diabetes. Finally, we draw on adjacent literatures to highlight potential future directions for research should this area be revisited. Overall, we contextualise our discussion in terms of patient-centred, holistic care that addresses the mind and body (i.e., our discussion of attachment orientation assumes a psycho-biological approach). [ABSTRACT FROM AUTHOR]

Introduction: Diabetes mellitus is a chronic disorder that is increasing rapidly worldwide. Appropriate management of this chronic disease can improve patient's quality of life, increase life expectancy and relieve society of the huge financial burden. Purpose: The aim of this study was to measure the quality of life of patients with type 2 diabetes and to investigate the role of rehabilitation. Methodology: Data were collected with the use of a questionnaire that consisted of three (3) sections: The Short Form 36 Health Survey Questionnaire, (17) questions adapted from the Diabetes Satisfaction Questionnaire (DTSQs) and the Problem Areas In Diabetes (PAID) scale and questions regarding medical data and demographic information. The sample included a total of n = 122 individuals suffering from type 2 diabetes. The research was carried out in outpatient clinics of two general hospitals and private practices within the region of Western Greece. The results of the study were analyzed using the statistical program SPSS v.25.0. Results: Age and the existence of another health problem besides diabetes have a negative impact on the quality of life of these patients on their physical and emotional health. As patients age, their quality of life decreases affecting all eight scales of the SF-36 Questionnaire. In contrast, patients who had several hours of professional work managed to have a positive outcome on all eight scales. Regarding these patient's rehabilitation, the results showed that the more satisfied the patients were regarding their treatment plan, doctor and nursing staff, their family's support, and their diabetic diet, the grater their functionality on all scales. Conclusions: The results showed that it is important for patients with type 2 diabetes to have an active professional life and follow an appropriate rehabilitation program, in order to improve their quality of life. [ABSTRACT FROM AUTHOR]

Background Previous reports about health-related quality of life (HRQoL) of type 2 diabetes mellitus (T2DM) concentrated on general patients rather than patients in rural areas with poor infrastructure and limited resources. Thus, the aims of this study were to evaluate the HRQoL of diabetics in the countryside and explore its influencing factors. Methods A total of 23 053 participants aged from 18 to 79 years were drawn from the Henan Rural Cohort Study for this cross-sectional study. The HRQoL of participants were assessed by utility index and VAS-score of European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) instrument. Binary logistic regression, generalized linear and tobit regression models were used to estimate the potential influencing factors on HRQoL. Results This study (23 053 participants) included 2231 T2DM patients with a crude prevalence of 9.68%. The utility index and VAS-score in health group were 0.96 ± 0.10 and 78.85 ± 14.53, while in T2DM group were 0.93 ± 0.15 and 74.09 ± 16.09, respectively. In total, most diabetics reported problem about pain/discomfort dimension. Being old, poverty, low physical activity, and with comorbidities was negatively related to HRQoL of diabetics, while high educational level was positively related to HRQoL. Conclusion HRQoL of rural T2DM patients depended on several sociodemographic factors. More attention should be paid to diabetics with poor socioeconomic status in rural areas. Clinical trial registration The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699) http://www.chictr.org.cn/showproj.aspx?proj=11375. [ABSTRACT FROM AUTHOR]

Introduction: Although science has discovered several factors involved in diabetes self-care, there are still some gaps especially regarding self-care behaviors among people with different socioeconomic statuses. The objective of this study is to identify adherence to diabetes self-care and its correlation with sociodemographic, clinical and psychosocial factors among users of the supplementary health system in Sao Paulo. Materials and Methods: A cross-sectional study was conducted with 214 participants who had type 2 diabetes by using the Brazilian versions of the Summary of Diabetes Self-Care Activities Measure, Diabetes Attitudes Scale and Diabetes Empowerment Scale. A multiple linear regression model (backward stepwise regression) was used to delineate the correlations between variables. Results: Participants showed moderate adherence to general self-care. Factors such as being a woman, being married/in a stable union, being retired, having been diagnosed for a longer time and showing a more positive attitude towards diabetes explained 93.0% of the variance in general self-care. Discussion: This is an unprecedented study in the characterization of diabetes self-care among users of the supplementary health system in Brazil. Although the results are similar to those of national and international studies, they suggest that, given the complexity of the disease, diabetes self-care is constantly neglected and more training is required among healthcare professionals to address related psychosocial factors. Conclusions: The results suggest that educational interventions for the promotion of diabetes self-care should be developed taking into account the sociodemographic and clinical profile of the participants, as well as the promotion of self-efficacy to decrease negative attitudes towards diabetes. [ABSTRACT FROM AUTHOR]

Introduction: Type 2 diabetes mellitus (T2DM) incidence is rising among Asian Americans, including Vietnamese, and is associated with increasing rates of urbanization, population aging, and overweight/obesity. We examined literature targeting diabetes self-management (DSM) beliefs, practices, and culturally informed interventions specific to Vietnamese adults. Methods: Using PRISMA systematic review guidelines, we searched CINAHL, Ovid, and Medline databases for research articles published from 2001 to 2019 examining DSM beliefs, practices, and/or interventions among Vietnamese adults with T2DM and/or family members. Results: Of the 971 articles identified, 12 articles representing 11 studies (N = 2,628) met inclusion criteria. Cultural knowledge and beliefs influence Vietnamese health practices and nutrition-based interventions that infuse traditional dietary norms are common. Two studies incorporated digital technology and community health workers in interventions. Discussion: Appreciating unique health beliefs and practices of Vietnamese adults is critical to designing and testing culturally congruent interventions. Further research involving community-centered approaches to enhance DSM is warranted. [ABSTRACT FROM AUTHOR]

Glycemic control has become a focus of concern among diabetic patients. However, only 26.71% of patients achieved better glycemic control in China. Given the complexity of glycemic control, it is worth investigating the potential mechanisms between negative emotions and glycemic control. A total of 428 participants were recruited from a tertiary hospital (the number of hospital beds>500). They completed questionnaires consisting of demographics, Zung Self-Assessed Anxiety Scale(SAS), Zung Self-Assessed Depression Scale(SDS), and the Summary of Diabetes Self-Care Activities (SDSCA). HbA1 c was used to measure glycemic control. Descriptive analysis, Pearson correlation analysis, and Bootstrap analysis were conducted to analyze data. A total of 428 questionnaires were distributed, with 28 invalid questionnaires (93.46% were valid). Depression and self-care activities (exercise, medication) were associated with glycemic control. At the same time, the Bootstrap analysis revealed that self-care activities (exercise: standardized coefficient β = 0.0181, p < 0.05, medication: standardized coefficient β = 0.0211, p < 0.05) mediated the relationship between depression and glycemic control. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify positive experiences associated with diabetes from the perspective of adults diagnosed with type 1 or type 2 diabetes. We conducted in-depth face-to-face and telephone interviews with adults with diabetes. Participants focused on positive and supportive experiences with their peers and community, improved health behaviors, personal growth, and engagement in diabetes advocacy. Communicating positive experiences about diabetes may help clinicians and educators reframe the negative messages commonly shared with people with diabetes. [ABSTRACT FROM AUTHOR]

Aims: Diabetes distress affects approximately 36% of adults with diabetes and is associated with worse diabetes self‐management and poor glycaemic control. We characterized participants' diabetes distress and studied the relationship between social support and diabetes distress. Methods: In this cross‐sectional study, we surveyed a population‐based sample of adults with type 2 diabetes covered by Alabama Medicaid. We used the Diabetes Distress Scale assessing emotional burden, physician‐related, regimen‐related and interpersonal distress. We assessed participants' level of diabetes‐specific social support and satisfaction with this support, categorized as low or moderate–high. We performed multivariable logistic regression of diabetes distress by level of and satisfaction with social support, adjusting for demographics, disease severity, self‐efficacy and depressive symptoms. Results: In all, 1147 individuals participated; 73% were women, 41% White, 58% Black and 3% Hispanic. Low level of or satisfaction with social support was reported by 11% of participants; 7% of participants had severe diabetes distress. Participants with low satisfaction with social support were statistically significantly more likely to have severe diabetes distress than those with moderate–high satisfaction, adjusted odds ratio 2.43 (95% CI 1.30, 4.54). Conclusions: Interventions addressing diabetes distress in adults with type 2 diabetes may benefit from a focus on improving diabetes‐specific social support. [ABSTRACT FROM AUTHOR]

A relationship between anxious depression has been proposed in patients with diabetes, which may contribute to the lack of medication adherence. The aim of this study was to investigate if there is a relationship between depression and / or anxiety with medication adherence and glycemic control in patients with type 2 Diabetes Mellitus (DM2). An analytical, cross-sectional study was carried out in the internal medicine outpatient clinic of a Hospital in Mexico. Patients with DM2 participated over a period from November 2015 to January 2016. The Morisky scale for medication adherence, and the Goldberg anxiety and depression scale were conducted for each patient. Data was collected from a total of 179 patients. There was a significant difference between anxious depression and medication adherence (p < 0.001) using logistic regression with an R2 of 0.136. There was also a significant difference between anxiety and glycemic control (p < 0.001) with an R2 of 0.175, however no significant difference was found between glycemic control and anxious depression. Our findings demonstrate that patients who suffer from anxious depression also tend to have reduced medication adherence, and anxiety was associated with poor glycemic control in patients with DM2 within the Mexican population. [ABSTRACT FROM AUTHOR]