The role of depression, stress and self-management behaviors on metabolic control in adults with type 2 diabetes

Aims: To (1) determine the contributions of depression, stress and self-management behaviors (e.g., diet, exercise) to metabolic control (hemoglobin A1c, high-density lipoprotein, low-density lipoprotein and triglyceride) and (2) examine the association among depression, stress and self-management behaviors in adults with type 2 diabetes. Background: Depression and stress are common in patients with diabetes and military families may be under high stress. However, the associations of depression, stress, and self-management behaviors, and their potential contributions to metabolic control in adults with type 2 diabetes have been limited. Design: A cross-sectional study. Methods: Adults with type 2 diabetes (N = 150) were recruited from a family medicine clinic in a military setting. Data were collected from September 2012 to April 2013, using validated questionnaires for depression, stress, and self-management behaviors. Laboratory data were collected as measures of metabolic control. Data were analyzed using a general linear model and Pearson\u27s correlation. Results: Depression, stress and self-management behaviors did not have significant contributions to metabolic biomarkers. However, depression was positively associated with stress (r = 0.72, p \u3c 0.001), whereas self-management behaviors were negatively associated with depression (r = -0.22, p = 0.006) and stress (r = -0.22, p = 0.006). Conclusion: Although there were significant associations among depression, stress and self-management behaviors, these factors failed to influence any metabolic measure in the participants of this study. However, the potential impact of psychobehavioral factors on metabolic control needs to be further explored in larger samples of underserved populations using a longitudinal biobehavioral design. Keywords: type 2 diabetes, depression, stress, metabolic control, self-management behaviors, self-care and self-monitoring

Temporo-spatial gait adaptations while walking on different surfaces in Latino-Hispanic adults with controlled type II diabetes

Those with Type 2 Diabetes with and without peripheral neuropathy (PN) display evident gait deficiencies, and kinematic alterations while stepping on various surfaces. Purpose: To verify if such modifications would emerge performing diverse tasks in the regulated stages of diabetes such as controlled type 2 diabetics without PN. Methods: We recruited and allocated 30 adult participants in two groups, 15 controlled diabetics (cDMII) and 15 controls (CoG). Gait temporospatial criteria were measured during even walkway and described concerning a ramp/slope surface, and a stair-step. Results: A Repeated measure ANOVA was employed to compare even surface gait parameters with slope and stair (ascending and descending) surfaces within each group. Our results highlight that cDMII shows distinct and initial traces of impaired gait parameters, notably on single-limb support time reduction with a double-limb time increment during ramp compared to even surface. Conclusion: Our conclusions suggest even at the early stages of diabetes, when glucose levels are regulated, adjustment while shifting and adapting to different, more challenging surfaces appear, notably in dynamic balance variables. Therefore, making this prompt detection of variations is clinically valuable for providing treatment interventions to diminish the risk of falls and trauma in those who have diabetes

A Qualitative Analysis to Understand Perception about Medication-Related Problems among Older Minority Adults in a Historically Black Community

Older adults taking multiple chronic medications experience an increased risk of adverse drug events and other medication-related problems (MRP). Most current literature on medication management involves researcher-driven intervention, yet few studies investigate patients’ understanding of MRP in a diverse community setting. This report investigates patients’ perception of MRP and patient-centered strategies among a cohort of the older adult group in a historically Black urban community. The study design is qualitative using structured open-ended questions in a multidisciplinary patient-centered focus group. Patients (age 65 years or older) taking seven or more medications were recruited. The group comprises patients, caregivers, pharmacists, health educators, a physician, and a nurse. Recordings of the group discussion are transcribed verbatim and analyzed using thematic content analysis and categorized by codes developed from the social-ecological model. The group reports patient-provider relationships, previous experience, fear of side effects played important roles in medication adherence. There is an unmet need for medication management education and tools to organize complex medication lists from multiple providers. This study provides important insights into MRP experienced by minority older adults and provided researchers with potential strategies for future interventions

Building Community-Engaged Multidisciplinary Partnerships to Improve Medication Management in Elderly Patients With Multiple Chronic Conditions

Purpose: Many studies in preventing adverse drug events have been researcher-driven, yet few have engaged patients in the development of a project. This project aims to engage minority elderly patients with multiple chronic conditions in the development of research questions and strategies to improve medication safety. Methods: Elderly patients (≥ 65 years old) who were prescribed 7 or more chronic medications were recruited through a university-based aging resource network in a historically African American community in Houston, Texas. Patients and a caregiver participated in a multidisciplinary workgroup comprised of a physician, pharmacists, a nurse, health educators, and a social worker. Patients were engaged by utilizing the 4 patient-centered outcomes research engagement principles. The workgroup created a strategic plan, completed an environmental scan, identified research problems, and reviewed current evidence-based approaches in the literature. Workgroup findings were presented to a broader audience within a community town hall setting, and input was collected from a community-wide survey. Results: From April 2018 to July 2018, 3 patients and 1 caregiver participated in 5 multidisciplinary workgroup meetings. A total of 74 seniors attended the town hall meeting, and 69 completed the surveys. The most common drug-related problems among survey participants were doubts about drug advertisements (79%) and drug interactions (70%). Most participants (88%) were more comfortable in receiving face-to-face counseling compared to an app or virtual visits. Findings aided in developing 3 grant proposals. Conclusion: This narrative provides a roadmap for conducting multidisciplinary, patient-centered participatory research to refine research strategies in minimizing drug-related problems