Patient–provider perceptions of diabetes and its impact on self-management: a comparison of African-American and White patients

Aims  To compare patient–provider differences in diabetes-related perceptions between African-American and White patients and to examine its association with self-care behaviours. Methods  One hundred and thirty patient–provider pairs were recruited from the greater Detroit area. Patients and providers completed a survey assessing perceptions about diabetes-related concepts and demographic background. The Diabetes Semantic Differential Scale was used to measure diabetes-related perceptions. Patients also reported the frequency of performing self-care behaviours, including following a healthy eating plan, engaging in physical activity, blood glucose monitoring, and taking medication and/or insulin. Results  There were a greater number of patient–provider differences in diabetes-related perceptions for the African-American patients (nine of 18 concepts) compared with the White patients (four of 18 concepts). Stepwise regression analyses found patients’ semantic differential scores to be significantly associated with five self-care behaviours for African-American patients and two self-care behaviours for White patients. Providers’ semantic differential scores emerged as predictors of self-care behaviours for African-American patients, but not for White patients. Conclusions  Our findings suggest that compared with White patients, African-Americans differ in a greater number of diabetes-related perceptions than their providers. Patients’ and providers’ perceptions of diabetes care concepts have a significant impact on a greater number of self-care behaviours for African-American patients than White patients. Diabet. Med. 25, 341–348 (2008)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72171/1/j.1464-5491.2007.02371.x.pd

Validity and reliability of the DMSES UK : a measure of self-efficacy for type 2 diabetes self-management

Objectives Self-efficacy is an important outcome measure of self-management interventions. We aimed to establish UK validity and reliability of the diabetes management self-efficacy scale (DMSES). Methods The 20 item DMSES was available for Dutch and US populations. Consultation with people with type 2 diabetes and health professionals established UK content and face validity resulting in item reduction to 15. Participants were adults with type 2 diabetes enrolled in a randomised controlled trial (RCT) of the diabetes manual, a self-management education intervention, with an HbA1c over 7% and who understood English. Baseline trial data and follow-up control group data were used. Results A total of 175 participants completed all 15 items. Pearson’s correlation coefficient of −0.46 (P 0.30. Cronbach’s alpha was 0.89 over all items. Conclusion This evaluation demonstrates that the scale has good internal reliability, internal consistency, construct validity, criterion validity, and test-retest reliability. Practice Implications The 15 item DMSES UK is suitable for use in research and clinical settings to measure the self-efficacy of people living with type 2 diabetes in managing their diabetes

Psychosocial Effects of a Holistic Ayurvedic Approach to Well-being in Health and Wellness Courses.

BackgroundAs individuals are increasingly attending health and wellness courses outside of the conventional medical system, there is a need to obtain objective data on the effects of those programs on well-being.MethodsIn total, 154 men and women (mean age 54.7 years; range 25-83) participated in 3 different holistic wellness programs based on Ayurvedic Medicine principles (Seduction of Spirit, Journey into Healing, and Perfect Health) or a vacation control group. Psychosocial outcomes included spirituality (Delaney Spirituality Scale), mindful awareness (Mindful Attention Awareness Scale), psychological flexibility (Acceptance and Action Questionnaire), mood (Center for Epidemiology Studies-Depression), and anxiety (Patient-Reported Outcomes Measurement System Anxiety Scale).ResultsParticipants in the Seduction of Spirit (P < .004), Journey into Healing (P < .05), and Perfect Health (P < .004) courses showed significant increases in spirituality as compared to vacation controls. Participants in Seduction of Spirit (P < .007) also showed significant increases in mindfulness as compared to vacation controls. Participants in the Seduction of Spirit (P < .001) and Journey into Healing (P < .05) courses showed significant decreases in depressed mood as compared to those in the Perfect Health and vacation control groups. All study participants showed similar increases in psychological flexibility (P < .01) and decreases in anxiety (P < .01).ConclusionParticipation in wellness courses that incorporate a mind-body-spirit approach to health improves multiple domains of psychosocial well-being, which persists even after course participation

Effect of the Conversation Map That People with Type-2 Diabetes Experienced: Effect Measurement by a New Questionnaire Method

本論文の目的は糖尿病の療養指導の方法として開発されたグループ体験学習「カンバセーションマップ」の効果測定およびその信頼性、妥当性に関する検討である。グループ体験学習にカウンセリング的配慮を組み込み、医療従事者によるファシリテーターと患者数名によるグループの実施の前後に客観的データとしてのエビデンスを得るための第一歩として質問紙による効果測定を試行し、グループ体験マップの参加による効果として、糖尿病に関する知識の向上と人間関係の深まりと広がりが得られるという結果が得られた。その効果要因として＜知識、理解の深まり＞＜関係性の意識＞＜心理的意識の変化＞の3 要因が抽出された。　質問紙の構成上の課題の改良と抽出された3 要因についての輻輳関係の測定の可能性を含めた総括的な測定尺度の作成が必要であることが指摘された。糖尿病カンバセーションマップ効果測定質問紙信頼性妥当

Depression in diabetic patients presenting to the emergency department in Trinidad and Tobago – a hidden epidemic

The likelihood of depression in diabetics presenting to the Emergency Department in developing countries is unknown. The aim of this study was to determine the prevalence of undiagnosed depression among diabetic patients presenting to the Emergency Department in Trinidad and Tobago, and to determine the risk factors associated with depression in these patients. The prevalence of depression was 46.2%, of which 76.1% had mild depression, 20.6% moderate depression and 3.3% severe depression. Depressed patients were more likely to be Indo Trinidadian (69.7%), married (61.8%) and working in the public sector (42.3%). Factors independently associated with depression included lower education level (p=0.003), and a history of co-existing heart disease (p=0.048), myocardial infarction (p=0.04) or other co-morbidities (p=0.010). Depressed patients had higher HbA1c% values (p<0.0001), and were less likely to adhere to meal plans (p=0.015) and exercise regimes (p=0.028). Depression is an unrecognised epidemic among diabetics in the Trinidad and Tobago. This study suggests that screening for depression among diabetics in the Emergency Department may be a useful method of identifying these patients. Additionally, the association between poor diabetic control and depression in these patients suggests the need for more research into this phenomenon

The effectiveness of cognitive-function stress management training in glycemic control in children and in mental health of mother caring for child with type 1 diabetes mellitus

Aim: The study was aimed to evaluate the effectiveness of a training course of cognitive-behavioral stress managementin glycaemia regulation in children with type 1 diabetes mellitus as well as in mental health status of their mothers. Materials and methods: Fifty children with type 1 diabetes mellitus and their mothers were selected and randomly assigned into two groups. A group of mothers (n = 25; as experimental one besides their children) passed a course, eight 2-h sessions, on the cognitive-behavioral and stress management, and the control group received the usual care. To evaluate the effectiveness of the intervention, before and after holding the course, glycosylated hemoglobin (HbA1C) test was done on both groups of children, and also some information was collected from the mothers through interview and the DASS (depression, anxiety, stress scale) and PSI (parenting stress index) questionnaires. Results: After the intervention, HbA1c level decreased in the experimental group. Feeling of depression, anxiety and stress was significantly lower than the control group. Furthermore, training for parenting stress management positively affected on the sense of demanding, reinforcement, and adaptability in child domain and also on attachment, competence, depression, relationship with spouse and family health in parent domain. Conclusion: The intervention program was significantly effective in reducing the amount of HbA1c in diabetic children, and also reduced the intensity of psychosocial problems such as depression, anxiety and stress in the mothers caring for children with type 1 diabetes

糖尿病における口腔粘膜の創傷治癒遅延のメカニズムについて

糖尿病患者における口腔粘膜の創傷治癒が遅延するメカニズムについて、口腔粘膜の創傷治癒とそれに影響を及ぼす因子、糖尿病での血流・血管新生、免疫能の変化、糖尿病での唾液量と成分の変化、糖尿病での成長因子の変化、糖尿病患者の心理的ストレスに分けて考察した。創傷治癒遅延には様々な現象が関わると考えられ、これらの現象が影響しあい遅延を引き起こしているものと考えられる

Prevalence of diabetes distress and associated factors among patients with diabetes using antihypertensive medications in community health centres in Bandung City, Indonesia

Diabetes distress is common among patients with type 2 diabetes mellitus (T2DM), which remains unrecognized in primary care settings. A higher level of diabetes distress was found among T2DM patients with comorbidities. The objectives of this study are to assess the prevalence rate of diabetes distress and its association with sociodemographic factors among T2DM patients using antihypertensive medication in Bandung City, Indonesia. An observational cross-sectional survey was performed in six community health centres in Bandung City, Indonesia, among T2DM patients aged at least 18 years who were using antihypertensive medications. Diabetes distress subscales (emotional, regimen, interpersonal, and physician-related distress) were evaluated using the validated Diabetes Distress Scale. Pearson χ2 and Mann–Whitney tests were performed to assess the associations of patients’ sociodemographic factors (age, gender, insurance type, education, and duration since diagnosed with diabetes and hypertension) with diabetes distress. Of 105 patients who participated and completed the survey (response rate 93.8%), most of them were female and were aged 60-69 years. A total of 38 patients (36.2%) had moderate-high diabetes distress with emotional (56.2%) and regimen (53.3%) distress as the most commonly reported distress. Moderate-high emotional and regimen diabetes distress were significantly higher among the elderly (p 0.014) and patients who could not afford to pay the health insurance premium (p 0.012). Emotional and regimen distress as dominant forms of diabetes distress was observed among T2DM patients using antihypertensive medications. A routine diabetes distress assessment is needed in T2DM patients with comorbidity in primary care settings