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Assessment of Barriers to Improve Diabetes Management in Older Adults: A randomized controlled study
OBJECTIVE To evaluate whether assessment of barriers to self-care and strategies to cope with these barriers in older adults with diabetes is superior to usual care with attention control. The American Diabetes Association guidelines recommend the assessment of age-specific barriers. However, the effect of such strategy on outcomes is unknown. RESEARCH DESIGN AND METHODS We randomized 100 subjects aged â„69 years with poorly controlled diabetes (A1C >8%) in two groups. A geriatric diabetes team assessed barriers and developed strategies to help patients cope with barriers for an intervention group. The control group received equal amounts of attention time. The active intervention was performed for the first 6 months, followed by a âno-contactâ period. Outcome measures included A1C, Tinetti test, 6-min walk test (6MWT), self-care frequency, and diabetes-related distress. RESULTS We assessed 100 patients (age 75 ± 5 years, duration 21 ± 13 years, 68% type 2 diabetes, 89% on insulin) over 12 months. After the active period, A1C decreased by â0.45% in the intervention group vs. â0.31% in the control group. At 12 months, A1C decreased further in the intervention group by â0.21% vs. 0% in control group (linear mixed-model, P < 0.03). The intervention group showed additional benefits in scores on measures of self-care (Self-Care Inventory-R), gait and balance (Tinetti), and endurance (6MWT) compared with the control group. Diabetes-related distress improved in both groups. CONCLUSIONS Only attention between clinic visits lowers diabetes-related distress in older adults. However, communication with an educator cognizant of patientsâ barriers improves glycemic control and self-care frequency, maintains functionality, and lowers distress in this population
Understanding the meaning of food in people with type 2 diabetes living in Northern Appalachia
© 2017 by the American Diabetes Association. Purpose. Food and eating convey memories and feelings and serve important functions in creating and maintaining relationships. Given the increasing rate of diabetes in the United States, research understanding the meaning of food may shed light on how patients negotiate everyday food choices while managing type 2 diabetes. The purpose of this qualitative study was to explore the meaning of food among adults with type 2 diabetes living in Northern Appalachia. Methods. In-depth, face-to-face interviews were conducted with type 2 diabetes patients. Interviews were coded and analyzed via thematic analysis. Results. Nineteen adults with type 2 diabetes (mean age 68.7 ± 10.6 years, mean A1C 7.4 ± 1.4%, mean diabetes duration 10.9 ± 11.9 years, 52.6% female, 100% white) participated in the study. Qualitative analysis revealed three themes: 1) Sustaining Life: Food and the Demands of Diabetes Management, in which participants described the role of food as operational and said that eating was dictated by time rather than hunger or pleasure; 2) Diabetes Feels Like a Yield Sign: Diabetes Changes Perceptions of Food, Enjoyment, and Social Relationships, in which most participants described a negative or ambivalent relationship with food after their diabetes diagnosis; and 3) Food is Everywhere; It\u27s Seducing: Struggling With Diabetes Management in a Fast-Food Culture, in which participants discussed how the American fast-food culture was in direct conflict with the demands of diabetes and described how they struggled to follow a healthful diet in a culture that advertised the opposite in many venues. Conclusion. Adults with diabetes may benefit from education that addresses both the personal and sociocultural factors that guide food choices