Primary health care­family partnership for better diabetes outcomes of patients: a systematic review

Background: Diabetes mellitus is a lifelong disease requiring daily self-care activities for better outcomes. Although most of these self-care activities for outpatients are taught in primary health care, their actual practice occurs at home where patients stay. Family dynamics or established cultures impact the management of the disease, hence a need for primary health care­family partnership to empower both families and patients with ways to manage the disease. This systematic review aims to describe the primary health care­family partnership. Methods: The literature was sourced using Preferred Reporting Items for Systematic Reviews and Meta-Analysis. The Scopus/ Elsevier, ScienceDirect and PubMed databases were used to source literature written in English and published between January 1, 2010 and July 31, 2022. Studies were included if focused on self-care activities, management and family-centred care (FCC); participants were diabetes patients and non-diabetic family members; and primary health care diabetes intervention. Results: A total of 62 publications that met inclusion criteria were used in this review. The included studies include quantitative, qualitative and mixed-method studies, including reports. The process of including these publications involved identification, screening and re-screening in line with set eligibility. The key search strategies resulted in the following sub-headings: diabetes self-care, diabetes self-management education and support (DSMES), family-centred care, and primary health care. Conclusion: Evidence from existing literature shows that primary health care is the source of information, yet actual diabetes management occurs at home. This review recommends the adoption of DSMES and FCC modalities to set the foundation for workable primary health care­family partnerships. The adoption of these joint modalities for partnerships will outline the dos and don'ts in managing diabetes at home. The literature further indicates that family support is critical, therefore primary health care­families partnership may lead to improved adherence to self-care activities and better outcomes

A Novel Diabetes Education Program to Improve Diabetes Knowledge, Awareness and Glycemic Control

Diabetes self-management education (DSME), an integral part of diabetes management is delivered by trained educators in well-developed countries. Unfortunately, there is a dearth of an organized, concise and easy-to-deliver diabetes education module in India. The relationship between diabetes self-care and glycemic control has been studied extensively. The present review discusses an innovative diabetes self-education training module that can be easily reciprocated by others to benefit the larger population.

Care Tips for Self-Care among Older Diabetic Patients / 임상당뇨병

With the increase in the elderly population, the number of elderly diabetics is also increasing rapidly. To educate older people with diabetes, we need to understand their characteristics and those of their main caregiver, establish careful and individualized treatment goals, and provide concrete and practical education. Diabetes educators should provide comprehensive geriatric assessment, personalized diabetes education through psychosocial assessment, practical guidance, family education, self-management skills for elderly diabetic patients and caregivers. Diabetes educators should keep in mind to consider elderly diabetic patients can support family or social resources to continue self-management.

Association of Diabetes-related emotional distress with Diabetes self-care and Glycemic Control among Adult Filipinos with Type 2 Diabetes Mellitus at a tertiary hospital in Manila, Philippines / Journal of the ASEAN Federation of Endocrine Societies

Objective@#The study aims to determine the association of diabetes-related emotional distress with reported diabetes self-care, and glycemic control of adult Filipinos with type 2 diabetes mellitus at The Medical City using 2 psychometric tests.@*Methodology@#This is a cross-sectional study conducted among 94 Filipinos diagnosed with type 2 diabetes mellitus, who answered 2 validated English questionnaires: Problem areas in diabetes (PAID-20) and Diabetes self-management questionnaire (DSMQ) that screen for diabetes-related emotional distress and diabetes reported self-care, respectively. Data were encoded and analyzed using Stata SE v.13. @*Results@#42.6% of Filipinos with type 2 diabetes mellitus had emotional distress showing moderate to severe distress in factor 1 (diabetes-related emotional distress) and factor 3 (food related problems). 51.1% had suboptimal self-care, poorly scoring in areas of health-care use and dietary control. Majority of those who had diabetes-related distress and poor self-care where young, pre-obese and had diabetes duration of ±5 years. There was no significant association between diabetes-related emotional distress with diabetes self-care and emotional distress with glycated hemoglobin, but majority of those who had diabetes distress had higher glycated hemoglobin. There was significant association between diabetes self-care and glycemic outcomes (p=0.006) with relative risk of 1.51 (95% CI 1.10-2.07). There was linear inverse weak correlation between all subdomains of DSMQ with glycated hemoglobin except Dietary Control.@*Conclusions@#Diabetes-related emotional distress and sub-optimal self-care are prevalent among Filipinos with type 2 diabetes mellitus. Those who had poor self-care were 1.5 times more likely to have poor glycemic outcomes.

Predictors of Glycaemic Control among Ghanaian Type 2 Diabetic Patients Using Diabetes Self-management Approach

Aims: Management of a complex metabolic disease like diabetes can be very challenging since it involves a careful combination of medication, exercise, diet and regular monitoring of blood glucose in order to achieve good glucose control. The study aimed at determining predictors of glycaemic control of type 2 diabeticpatients using diabetes self-management approach.Study Design: A Cross-sectional study.Place and Duration of study: Diabetes clinic at two selected district hospitals in Ashanti region of Ghana.Methodology:A structured questionnaire was used to collect demographic, medical history and dietary information. A validated Diabetes Self-Management Questionnaire was alsoused. Serum glycated haemoglobin (HbA1c) was used as the standard for glycaemic control.Results:Mean glycated haemoglobin level for study participants was 7.2%±0.2. Optimal glycaemic control was significantly associated with diabetes self-management (r= -0.428), diabetes-related distress (r= 0.381) and acceptance and action on diabetes (r= 0.316). In. addition to the above associations, diabetes self-management (?= -0.297, p=0.007) and diabetes-related distress (?= 0.219, p=0.028) could significantly predict glycated haemoglobin but not acceptance and action on diabetes (?= 0.046, p=0.665). Conclusions:All the three study variables correlated with glycated haemoglobin of study participants but only diabetes self-management and diabetes-related distress had predictive value. Further, an epidemiological study is needed to ascertain the strength of the effects. Various health stakeholders should encourage diabeticpatients to understand the importance of diabetes self-management which may help in better glycaemic control, disease management and better quality of life

To Assess Medication Compliance and Self Care Practices in Patients with Diabetes Mellitus

Background: The global rise in the prevalence of diabetes mellitus and a wide variation in compliance to self-management of diabetes has become a challenging health care problem. Poor glycaemic control can lead to treatment failures and accelerated development of various diabetes-related complications. Our study aims to find out the compliance rate of the patients with type 2 diabetes to the prescribed medications and to find out its comparison across various socio-demographic variables. Methods: This is a cross sectional questionnaire based study that was conducted amongst patients with type 2 diabetes mellitus. A total of 136 patients were included in the study and interviewed by using a pre tested, structured interview schedule which captured socio-demographic variables and Diabetes Self-Management Questionnaire covering different aspects of diabetes self-management. Participants rate the extent to which each description applies to them on a four-point Likert scale. Results: Mean age of the participants was 44.53 ± 8.13. The mean duration of diabetes was 7.63 ± 6.49 years. The overall compliance score in our participants was 23.44 ± 4.17. None of the participants stated that they check their blood sugar levels regularly. Of self-care activities, 69.1% of the patients agree that they do not skip their diabetes medication. Compliance to the diabetes self-care decreased significantly with an increase in age (p<0.001) and duration of disease (p<0.01). The mean compliance score was also significantly lower among those who were illiterate (p<0.001) and unskilled workers (p=0.02). Conclusion: It can be concluded that the compliance score was not good among the participants. Significant association have been found between mean compliance scores and increasing age, illiteracy, unskilled occupation and longer duration of disease.

Managing periodontitis in type 1 diabetic patients improves glycemic control: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#<p style="text-align: justify;">This case report describes the long-term follow-up of a 22-year-old, female patient with type 1 diabetes managed by conservative oral care and glycemic control measures. She is on a twice a day insulin regimen. Tooth numbers 13 and 37 had pockets less than 6 mm while all remaining teeth had greater than 6 mm. Periodontal management consisted of root planing combined with instructions on diabetes self-management skills at home. Nine weeks after the first sextant was treated, pocket depth measurements in 93 (81.6%) out of 114 sites and bleeding on probing (BOP) scores in 11 (57.9%) out of 19 teeth decreased. There was a 50% reduction in the C reactive Protein and a 46.7% decrease in the fructosamine assay levels. Initial glycohemoglobin level of 8.3% decreased substantially to 7.1%. The goal of the dentist is no longer just the improvement of oral health but ultimately the overall health of the patient and the physician's goal is to include oral health in the promotion of overall health.</p>

Associations between diabetes self-management and microvascular complications in patients with type 2 diabetes / 한국역학회지

OBJECTIVES: Diabetes is a major public health problem that is approaching epidemic proportions globally. Diabetes self-management can reduce complications and mortality in type 2 diabetic patients. The purpose of this study was to examine associations between diabetes self-management and microvascular complications in patients with type 2 diabetes. METHODS: In this cross-sectional study, 562 Iranian patients older than 30 years of age with type 2 diabetes who received treatment at the Diabetes Research Center of the Endocrinology and Metabolism Research Institute of the Tehran University of Medical Sciences were identified. The participants were enrolled and completed questionnaires between January and April 2014. Patients' diabetes self-management was assessed as an independent variable by using the Diabetes Self-Management Questionnaire translated into Persian. The outcomes were the microvascular complications of diabetes (retinopathy, nephropathy, and neuropathy), identified from the clinical records of each patient. A multiple logistic regression model was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) between diabetes self-management and the microvascular complications of type 2 diabetes, adjusting for potential confounders. RESULTS: After adjusting for potential confounders, a significant association was found between the diabetes self-management sum scale and neuropathy (adjusted OR, 0.64; 95% CI, 0.45 to 0.92, p=0.01). Additionally, weak evidence was found of an association between the sum scale score of diabetes self-management and nephropathy (adjusted OR, 0.71; 95% CI, 0.47 to 1.05, p=0.09). CONCLUSIONS: Among patients with type 2 diabetes, a lower diabetes self-management score was associated with higher rates of nephropathy and neuropathy.

Oral health status of children attending a summer camp for diabetes children / Journal of the ASEAN Federation of Endocrine Societies

@#<b>OBJECTIVE</b>: The aim of this paper is to examine the oral health of children attending a diabetes camp. Despite studies showing diabetes to be a risk factor for periodontitis on the one hand and periodontitis having been shown to affect glycemic control and increase the risk for developing complications among diabetic patients, oral health is only beginning to receive much needed attention as an important aspect of general health in diabetic patients. <br /><br /><b>METHODOLOGY</b>: A simple count of the number of decayed, missing, and filled teeth was performed and added to come up with the Decayed Missing and Filled Teeth index (DMFT). Periodontal examination was performed using a Community Periodontal Index of Treatment Needs (CPITN) probe. Pocket probing was performed on six sites (mesiobuccal, midbuccal, distobuccal, mesiolingual, mid-lingual, and distolingual) on each tooth. The teeth were then scored on a scale of 0–4 similar to the CPITN method of the World Health Organization. <br /><br /><b>RESULTS</b>: The proportion of participants with dental caries was 72% (18) with a mean number of decayed, missing and filled teeth (DMFT) of 4.6. 5 (20%) of the participants had a DMFT score of 0, meaning that they have no decayed missing or filled teeth while 10 (40%) either already had permanent teeth extracted. or required tooth extraction for nonrestorable, severely decayed permanent teeth. Periodontitis (Pockets > 3.5 mm; CPITN = 4) was found in only 1 (4%) patient. 21 (84%) of the participants either had a CPITN score of 1 or 2, meaning bleeding upon probing or calcular deposits were observed. 3 (12%) had a CPITN score of 0. <br /><br /><b>CONCLUSIONS</b>. Diabetes camps are a good place to screen oral health problems among type 1 diabetic patients given the different socio-economic factors, levels of concern for oral health, and availability of dental care providers among families of with type 1 diabetic children. Physicians managing type 1 diabetics should motivate their patients to see the dentist twice a year for preventive visits and strongly encourage them to have treatment when dental diseases are present. An oral exam should be part of the cursory examination performed by physicians handling these patients.

Improvement in periodontitis following conservative periodontal treatment in a Type 1 Diabetic patient / Journal of the ASEAN Federation of Endocrine Societies

@#We report a case of severe gingival bleeding in a 15-year old, type 1 diabetic female. Examination revealed severe gingival inflammation with periodontal pockets (<6 mm), indicating mild-moderate periodontitis. Periodontal therapy resulted in reduction of fructosamine level (-72.98) after four weeks, but HbA1c level checked 3 months after treatmentincreased (+0.7). Reduction in gingival bleeding and periodontal pockets improved the patient’s quality of life. Insulin resistance is offered as a possible reason for non-improvement in HbA1c levels.

Estudio piloto de dos diferentes estrategias para reforzar conductas de autocuidado y adherencia al tratamiento en pacientes de bajos recursos económicos con diabetes tipo 2 / Pilot study of two different strategies to reinforce self care behaviors and treatment compliance among type 2 diabetes patients from low income strata

Antecedentes: Es difícil establecer conductas apropiadas de autocuidado y cumplir los objetivos terapéuticos en pacientes con diabetes tipo 2. El objetivo de esta investigación fue evaluar el impacto de dos estrategias de reforzamiento en el autocuidado de la diabetes, variables psicosociales y control glucémico a un año de seguimiento. Métodos: Se incluyeron 70 pacientes con diabetes tipo 2 asignados en forma aleatoria a tres grupos de estudio: grupo control (GC) que continuó con el programa habitual de tratamiento; un segundo grupo (GCR), que recibió un curso educativo después de seis meses; un tercer grupo (GRT), asignado a recibir llamadas telefónicas mensuales para promover conductas de autocuidado e intentar detectar y solucionar problemas. Se practicaron diversos cuestionarios y análisis de laboratorio al inicio y un año después. Resultados: Al año de seguimiento, los tres grupos mejoraron en forma significativa sus conocimientos en diabetes. Ambos grupos experimentales mejoraron su adherencia al plan de alimentación (p=0.06 y 0.003). El GRT también mejoró su adherencia al tratamiento farmacológico (p<0.0001). No se observaron cambios significativos en el control glucémico, prevalencia de depresión o disfunción emocional asociada a la diabetes. Conclusiones: Las estrategias de reforzamiento mejoran el autocuidado de la diabetes. Se requieren estudios a largo plazo para demostrar el impacto de estos beneficios en la calidad de vida y el logro de los objetivos terapéuticos.

Long term diabetes self-management behaviors, and strict glycemic control are difficult to achieve in clinical practice. OBJECTIVE: Asesss two different reinforcement strategies for diabetes selfcare management, psychological distress and glycemic control in a one year follow up study. METHODS: 70 consecutive type 2 diabetic patients, were recruited and randomly assigned to three study groups. Subjects in the control group (CG) continued with their normal treatment schedule. The second group received a reinforcement course at 6 months (RCG) and in the third group, patients were contacted monthly by phone (PHCG) to promote self-management attitudes and address problems as they arose. A battery of questions and laboratory work-up were obtained at baseline and at one year follow-up. RESULTS: At one year follow-up, the three groups significantly increased their diabetes-related knowledge. Both experimental groups displayed improved treatment compliance and had better adherence to the recommended meal plan (p=0.06 and 0.003). In addition, the PHCG significantly increased (p<0.0001) their adherence to pharmacological treatment. No significant differences were observed in glycemic control, prevalence of depression or diabetes related distress. CONCLUSIONS: Follow-up patient reinforcement strategies improve strategic diabetes self-care management behaviors. Further studies are needed to demonstrate the positive impact of these benefits on diabetes related outcomes.