Type 1 diabetes patient experiences and management practices during the COVID-19 pandemic in rural Uganda.

Background: The COVID-19 pandemic has impacted various aspects of the lives of persons with chronic diseases, including type 1 diabetes (T1D). However, the diabetes care experiences and practices adopted by persons living with T1D after the declaration of the COVID-19 pandemic in Uganda have not been well documented. Objectives: We investigated diabetes management practices and experiences of persons with T1D during the COVID-19 pandemic lockdown in a rural district of southwestern Uganda. Methods: Using interactive sequential explanatory mixed methods, we conducted a cross-sectional study of persons with T1D aged 18-25 years, their caregivers and health workers. Quantitative data was exclusively collected from patients with T1D using Kobo Toolbox™ and analysed with SPSS™ version 26; qualitative interviews were used to elicit responses from purposively selected patients with T1D, plus caregivers and health workers that were analysed using a thematic framework approach. Results: The study enrolled 51 (24 males) patients with T1D; diabetes duration (mean ± SD) 6.6 ± 5 years. Access to insulin syringes significantly worsened in 19.6% of participants (p = 0.03). Insulin injection frequency (p = 0.01), blood glucose monitoring (p = 0.001) and meal frequency (p = 0.0001) significantly decreased. Qualitative interviews highlighted COVID-19 restriction measures had reduced household income, frequency of clinic visits, and access to food, diabetes support and social services. Conclusions: Experiences and practices were consistent with decisions to prioritise survival, even with known risks around metabolic control. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01222-4.

Primary health care nurses' knowledge, self-efficacy and performance of diabetes self-management support.

BACKGROUND: Patients living with diabetes are primarily managed and supported by nurses in primary health care (PHC). Therefore, PHC nurses require knowledge of diabetes and confidence (self-efficacy) to perform diabetes self-management support (SMS). AIM: This study evaluated the diabetes knowledge, self-efficacy and performance of diabetes SMS by PHC nurses. SETTING: Primary health care facilities in King Sabata Dalindyebo subdistrict, O.R. Tambo district, Eastern Cape. METHODS: A quantitative cross-sectional and simple correlational design was used. Registered nurses (n = 100) completed a validated self-reporting questionnaire to measure diabetes knowledge, self-efficacy and performance of SMS. RESULTS: Participants' diabetes knowledge mean scores were high (mean of 11.9, standard deviation [s.d.] 1.8, out of 14). Self-efficacy scores (mean 18.91, s.d. 3.2 out of 24) were higher than performance of SMS scores (mean 17.81, s.d. 3.3 out of 24). Knowledge was not associated with self-efficacy or performance, but self-efficacy was positively correlated with performance of SMS (r = 0.78, p 0.01). Nurses with a postgraduate qualification in primary care nursing had significantly higher diabetes knowledge scores (mean = 92.9 vs. 83.8; p = 0.03), and years of experience as a nurse were positively correlated with the performance of SMS (r = 0.21, p = 0.05). CONCLUSION: Diabetes knowledge of PHC nurses in this study does not translate into self-efficacy and the performance of SMS in practice, indicating the need for specific SMS training, support by experienced mentors, appropriate guidelines and comprehensive integrated chronic care systems.Contribution: This is the first study to report on the SMS self-efficacy and performance of PHC nurses in South Africa.

COVID: The Missing Trigger to Start a Remote FIT Course.

Type 1 diabetes management is a highly demanding task that largely falls on people with diabetes, their family, and their peers. Diabetes self-management education and support aim at increasing knowledge, skills, and confidence to take appropriate diabetes management decisions. The current evidence shows that efficient diabetes self-management relies on person-centered interventions and a team of pluri-disciplinary educators with expertise in diabetes care and education. The irruption of the COVID-19 pandemic has increased diabetes burden and the need to offer remote diabetes self-management education services. The present article offers a perspective about expectations and quality issues related to the implementation of a remote version of the FIT course, a validated structured diabetes management educational program.

How has the COVID-19 Pandemic Affected Diabetes Self-Management in People With Diabetes? - A One-Year Follow-Up Study.

Background and Aim: In Denmark, the COVID-19 pandemic resulted in two lockdowns, one from March to May 2020 and another from December 2020 to April 2021, which had severe impact on everyday life. The aim of this study was to explore changes in diabetes self-management behaviors during the pandemic and to examine how specific population characteristics were associated with changes in diabetes management. Methods and Participants: In a cohort study from March 2020 to April 2021, two online questionnaires were collected from a total of 760 people with diabetes. Descriptive statistics were used to assess the proportion of participants experiencing improvements, deterioration, and status quo in diabetes self-management during the pandemic. Using logistic regressions, baseline characteristics were explored as potential predictors of change. Results: Approximately half of the participants reported that they experienced lower physical activity in April 2021 compared to before the pandemic, approximately one fifth reported diabetes self-management to be more difficult than prior to the pandemic, and one fifth reported eating more unhealthily than before the pandemic. Some participants reported higher frequency of high blood glucose levels (28%), low blood glucose levels (13%) and more frequent blood glucose variability (33%) compared to before. Easier diabetes self-management was reported by relatively few participants, however, 15% reported eating more healthily, and 20% reported being more physically active. We were largely unable to identify predictors of change in exercise activities. The few baseline characteristics identified as predictors of difficulties in diabetes self-management and adverse blood glucose levels due to the pandemic were sub-optimal psychological health, including high diabetes distress levels. Conclusion: Findings indicate that many people with diabetes changed diabetes self-management behaviors during the pandemic, mostly in a negative direction. Particularly high diabetes distress levels in the beginning of the pandemic was a predictor of both positive and negative change in diabetes self-management, indicating that people with high diabetes distress levels could potentially benefit from increased support in diabetes care during a period of crisis.

Noninferiority of Telemedicine Delivered Compared With In-person Diabetes Self-Management Education and Support (DSMES) During Covid-19 Pandemic in Thailand.

This study aimed to compare the clinical outcomes and program satisfaction of diabetes self-management education and support (DSMES) for type 2 diabetes patients delivered by telehealth during COVID-19 pandemic to in-person delivery during pre-COVID-19. A retrospective case-controlled study was conducted (95 telehealth and 95 on-site). Differences in hemoglobin A1c (HbA1c) reductions between groups were analyzed by linear mixed-effects models, and satisfaction was collected. Compared with baseline, at the three-month follow-up, the HbA1c reductions of the telehealth and on-site DSMES were 1.20 ± 0.15% and 1.21 ± 0.15%, respectively (P < .001), whereas these were 1.28 ± 0.16% and 1.18 ± 0.15% at six-month follow-up, respectively (P < .001). There were no significant differences in HbA1c reduction between the two groups (P = .967 and .674 at three- and six-month follow-up). Majority of participants in both groups had high program satisfaction (telehealth 98.7% vs on-site 95.1%, P = .269). In conclusion, DSMES delivered via telehealth is as effective in lowering HbA1c as that delivered in-person, with a high satisfaction rate.

Cultural adaptation of a diabetes self-management education and support (DSMES) programme for two low resource urban settings in Ghana, during the COVID-19 era.

BACKGROUND: Type 2 diabetes is a significant public health problem globally and associated with significant morbidity and mortality. Diabetes self-management education and support (DSMES) programmes are associated with improved psychological and clinical outcomes. There are currently no structured DSMES available in Ghana. We sought to adapt an evidence-based DSMES intervention for the Ghanaian population in collaboration with the local Ghanaian people. METHODS: We used virtual engagements with UK-based DSMES trainers, produced locally culturally and linguistically appropriate content and modified the logistics needed for the delivery of the self-management programme to suit people with low literacy and low health literacy levels. CONCLUSIONS: A respectful understanding of the socio-cultural belief systems in Ghana as well as the peculiar challenges of low resources settings and low health literacy is necessary for adaptation of any DSMES programme for Ghana. We identified key cultural, linguistic, and logistic considerations to incorporate into a DSMES programme for Ghanaians, guided by the Ecological Validity Model. These insights can be used further to scale up availability of structured DSMES in Ghana and other low- middle- income countries.

Diabetes Self-management Apps: Systematic Review of Adoption Determinants and Future Research Agenda.

BACKGROUND: Most diabetes management involves self-management. Effective self-management of the condition improves diabetes control, reduces the risk of complications, and improves patient outcomes. Mobile apps for diabetes self-management (DSM) can enhance patients' self-management activities. However, they are only effective if clinicians recommend them, and patients use them. OBJECTIVE: This study aimed to explore the determinants of DSM apps' use by patients and their recommendations by health care professionals (HCPs). It also outlines the future research agenda for using DSM apps in diabetes care. METHODS: We systematically reviewed the factors affecting the adoption of DSM apps by both patients and HCPs. Searches were performed using PubMed, Scopus, CINAHL, Cochrane Central, ACM, and Xplore digital libraries for articles published from 2008 to 2020. The search terms were diabetes, mobile apps, and self-management. Relevant data were extracted from the included studies and analyzed using a thematic synthesis approach. RESULTS: A total of 28 studies met the inclusion criteria. We identified a range of determinants related to patients' and HCPs' characteristics, experiences, and preferences. Young female patients were more likely to adopt DSM apps. Patients' perceptions of the benefits of apps, ease of use, and recommendations by patients and other HCPs strongly affect their intention to use DSM apps. HCPs are less likely to recommend these apps if they do not perceive their benefits and may not recommend their use if they are unaware of their existence or credibility. Young and technology-savvy HCPs were more likely to recommend DSM apps. CONCLUSIONS: Despite the potential of DSM apps to improve patients' self-care activities and diabetes outcomes, HCPs and patients remain hesitant to use them. However, the COVID-19 pandemic may hasten the integration of technology into diabetes care. The use of DSM apps may become a part of the new normal.

Association of the Coronavirus Disease 2019 Outbreak on the Diabetes Self-Management in Chinese Patients: An Analytical Cross-Sectional Study.

Background: The coronavirus disease 2019 (COVID-19) outbreak has seriously affected people's lives, especially those with chronic diseases. Diabetes self-management, which plays an important role in glycaemic control and reducing the risk of acute and long-term complications, may be discouraged by social distancing. Purpose: To evaluate the level of self-management activities in Chinese patients with type 2 diabetes mellitus (T2DM) during the COVID-19 pandemic. Patients and Methods: A survey of with 872 patients with T2DM in the inpatient and outpatient departments through face-to-face interviews was conducted from 1 July, 2020 to 30 September, 2020. The main outcome measures were glycaemic control status and level of self-management activities during the pandemic. Results: In terms of glycaemic control, the data showed that patients with fasting plasma glucose (FPG) < 7.0 mmol/L (36.4%), postprandial plasma glucose (PPG) < 10.0 mmol/L (26.3%), or glycosylated haemoglobin (HbA1c) < 7.0% (18.6%) in our investigation has well-controlled blood glucose level, and 11.9% of patients experienced blood glucose <3.9 mmol/L during the outbreak. The diabetes self-management of Chinese patients decreased and the final diabetes self-management score of the Chinese patients was 3.4 ± 1.45. Patients with higher education, diabetes education, comorbidities, and online consultations had higher diabetes self-management scores (P <0.05). Adherence to diabetes self-management in the normal glycaemic control group was higher than that in the substandard glycaemic control group (P<0.05). Among all participants, 72.1% of the patients reduced the frequency of hospital visits, and 44.8% considered that they had diabetes-related stress during the pandemic. The mean anxiety level score rated by 286 patients was 5.3±2.8. Conclusion: The COVID-19 pandemic has affected diabetes self-management, including substandard glycemic control, increased diabetes-related stress, limited exercise range and medical visits. Therefore, future interventions should focus on the online management of chronic diseases and support online consultation' development and promotion, which can overcome physical distance and provide personalized services conveniently.

Informing a Randomized Control Trial in Rural Populations: Adaptation of a Diabetes Self-Management Education and Support Intervention.

BACKGROUND: Over 34 million people in the United States have diabetes, with 1.5 million diagnosed every year. Diabetes self-management education and support (DSMES) is a crucial component of treatment to delay or prevent complications. Rural communities face many unique challenges in accessing DSMES, including geographic barriers and availability of DSMES programs that are culturally adapted to rural context. OBJECTIVE: Boot Camp Translation (BCT) is an established approach to community-based participatory research used to translate complex clinical and scientific information into concepts, messages, and materials that are understandable, meaningful, and relevant to community members and patients. This study aimed to utilize BCT to adapt an existing DSMES program for delivery in rural primary care for English- and Spanish-speaking people with diabetes. METHODS: The High Plains Research Network (HPRN) Community Advisory Council (C.A.C.) partnered with researchers at the University of Colorado and University of Utah to use BCT to aid in translating medical jargon and materials from an existing DSMES program, called "Diabetes One Day (D1D)." BCT consisted of 10 virtual meetings over a 6-month period among the C.A.C., which included 15 diverse community stakeholders. Both English-speaking and bilingual Spanish-English-speaking C.A.C. members were recruited to reflect the diversity of the rural communities in which the adapted program would be delivered. RESULTS: The BCT process guided adaptations to D1D for use in rural settings (R-D1D). R-D1D adaptations reflect both content and delivery to assure that the intervention is appropriate and likely to be accepted by rural English- and Spanish-speaking people with diabetes. Additionally, BCT informed the design of recruitment and program materials and identification of recruitment venues. During the BCT process, the importance of tailoring materials to reflect culture differences in English- and Spanish-speaking patients was identified. CONCLUSIONS: BCT was an effective strategy for academic researchers to partner with rural community members to adapt an existing DSMES intervention for delivery in rural areas to both English- and Spanish-speaking patients with diabetes. Through BCT, adaptations to recruitment materials and methods, program content and delivery, and supplemental materials were developed. The need to culturally adapt Spanish materials with input from stakeholders rather than simply translate materials into Spanish was highlighted. The importance of increasing awareness of the connection between diabetes and depression or diabetes distress, adaptations to include local foods, and the importance of the relationship between people with diabetes and their primary care practices were identified.

Evaluation of Self-care Activities and Quality of Life in Patients With Type 2 Diabetes Treated With Metformin Using the 2D Matrix Code of Outer Drug Packages as Patient Identifier: the DePRO Proof-of-Concept Observational Study

Background: The use of digital technology to assess patients remotely can reduce clinical study costs. In the European Union, the 2D matrix code on prescription drug packaging serves as a unique identifier of a given package of medication, and thus, also of the patient receiving that medication. Scanning of the 2D matrix code may therefore allow remote patient authentication in clinical studies. Objective: The aim of the DePRO study was to assess the feasibility of a fully digital data-capture workflow, the authentication of participants via drug packaging 2D matrix codes, in patients with type 2 diabetes mellitus (T2DM) who use metformin. The primary objective was to describe the self-care activities of these patients. Secondary objectives were to evaluate (1) the self-reported health status of these patients, (2) the association of self-care activities with demographics and disease characteristics, and (3) the usability of the my ePRO app. Methods: DePRO was an observational, multicenter, cross-sectional, digital, and patient-driven study conducted in Germany from June to December 2020. Adult patients prescribed metformin were invited to participate via their pharmacist or a medication tracker app. Participants downloaded the my ePRO app onto their own mobile device, scanned the 2D matrix code on their metformin package for registration and authentication, and provided informed consent via an electronic form. They were then able to complete a study-specific questionnaire on demographics and clinical characteristics, the German version of the Summary of Diabetes Self-Care Activities measure (SDSCA-G), the Diabetes Treatment Satisfaction Questionnaire (DTSQ), and the EQ-5D-5L. The patients conducted the study without support from a health care professional. Statistical analyses were exploratory and descriptive. Results: In total, 3219 patients were invited to participate. The proportion of patients giving consent was greater among those invited by pharmacists (19/217, 8.8%) than among those invited via the medication tracker app (13/3002, 0.4%). Of the 29 patients eligible for analysis, 28 (97%) completed all study questionnaires. Most of the patients (23/29, 79%) were aged <60 years, and 59% (17/29) were male. The patients spent a mean total of 3.5 (SD 1.3) days out of 7 days on self-care activities (SDSCA-G). Most patients (24/29, 83%) were satisfied to extremely satisfied with their current treatment (DTSQ). Events of perceived hyperglycemia or hypoglycemia were reported by 20 of 29 (69%) patients. The best possible health status (EQ-5D-5L) was reported by 18 of 28 (64%) patients. Age was positively correlated with time spent on general and specific diet (Spearman coefficient 0.390 and 0.434, respectively). Conclusions: The DePRO study demonstrates the feasibility of fully digital authentication (via 2D matrix codes on drug packaging) and data capture in patients with T2DM. Personal invitations yielded higher recruitment rates than remote invitations via the medication tracker app. A high questionnaire completion rate was realized, based on completion by 28 out of 29 patients. Trial Registration: ClinicalTrials.gov NCT04383041;https://clinicaltrials.gov/ct2/show/NCT04383041 International Registered Report Identifier (IRRID): RR2-10.2196/21727

Diabetes self-management of adults with diabetes in Grenada during the COVID-19 pandemic

Diabetes self-management involves several behaviors to prevent complications and ensure a good quality of life. Several studies addressed how the COVID-19 lockdown impacted diabetes self-management practices worldwide, yet little was known about self-management experiences in Grenada and the Caribbean region. The purpose of this phenomenological and directed content analysis study was to gain insight into the lived diabetes self-management experiences during the COVID-19 lockdown in Grenada. The theory of planned behavior was used as the theoretical framework for this study. The research questions addressed lived self-management experiences and attitudes, subjective norms, and perceived behavioral control toward diabetes self-management. Semistructured interviews were conducted with 13 Grenadian adults, age 35 to 65. Results were analyzed using descriptive coding and predetermined categories using the theory's constructs (directed content analysis). Three overarching themes emerged: (a) diabetes self-management activities, (b) barriers, and (c) intentions to perform self-management behaviors. Results indicated that although participants had adequate social support, there was significant nonadherence toward exercise and diabetes foot care. Findings may be used to develop a multidisciplinary approach, especially from the government of Grenada, to improve self-management skills and attitudes, and to promote appropriate diabetes disaster planning for a future pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Self- management of diabetes mellitus during the Covid-19 pandemic: Recommendations for a resource limited setting.

BACKGROUND AND AIMS: The COVID-19 pandemic has challenged both institutional and self-management of diabetes. The ongoing social distancing and lock downs have negatively impacted to access to care and self-management. METHODS: This is a narrative review of diabetes management in a resource limited setting during the ongoing COVID-19 pandemic. Electronic databases, namely; Pubmed, CINAHL, EMBASE and Google Scholar were searched for literature. Search terms were "corona virus", "COVID-19", "diabetes self-care", "diabetes self-management education", "DSME", "diabetes self-management", "diabetes self-care in low income countries" and "diabetes management in Zimbabwe". RESULTS: This paper suggests a culturally tailored educational plan on diabetes self-management of diabetes in a limited resource country, Zimbabwe, amid the ongoing COVID-19 pandemic. Components of health education comprised general preventive measures, medications, diet, physical activity, self-monitoring of blood glucose, stress management, foot care, smoking and drinking and preventing complications of diabetes mellitus. CONCLUSIONS: We have reemphasized the need for self-care, social support and a collaborative, patient-centered approach to care amid the ongoing COVID-19 pandemic.

Factors contributing to glycemic control in diabetes mellitus patients complying with home quarantine during the coronavirus disease 2019 (COVID-19) epidemic.

AIMS: This study assessed factors contributing to glycemic control among diabetes mellitus patients complying with home quarantine during the epidemic of coronavirus disease 2019 (COVID-19). METHODS: We conducted an analytical cross-sectional study by telephone with 1159 patients with type 2 diabetes mellitus (T2DM) and 96 patients with type 1 diabetes mellitus (T1DM) who were discharged from the endocrinology department of a hospital from January 1, 2019, to January 24, 2020. According to their fasting blood glucose (FBG) and 2-h postprandial BG (2hPBG) values, the patients were divided into the well-controlled BG group and the poorly controlled BG group. The main evaluation indicators included sociodemographic variables, health risk variables and adherence to self-management behaviors. RESULTS: In total, 74.46% of the T2DM patients and 64.89% of the T1DM patients had poor glycemic control. T2DM patients with poor glycemic control were more likely to be older (odds ratio (OR): 1.017 [95% confidence interval (CI) 1.003-1.030]; P = 0.013), have fewer than 12 years of education (OR: 1.646 [95% CI 1.202-2.255]; P = 0.002), lack a BG meter at home (OR: 2.728 [95% CI 1.205-6.179]; P = 0.016), have a lower degree of medicationcompliance (OR: 1.627 [95% CI 1.076-2.460]; P = 0.021), and engage in less self-monitoring of BG (SMBG) per week (OR: 10.884 [95% CI 5.883-20.139]; P < 0.001). Fewer than 12 years of education (OR: 3.031 [95% CI 1.112-8.263]; P = 0.030) was a risk factor for glycemic control in T1DM. CONCLUSIONS: Glycemic control among patients with T1DM and T2DM during home quarantine amid the COVID-19 pandemic is poor. Our results showed that more eduction, a higher frequency of SMBG, and improved medication compliance may contribute to glycemic control. Therefore, diabetic patients should be advised to increase the frequency of blood glucose measurements during home quarantine and be re-educated regarding the importance of medication compliance.

The COVID19 pandemic - Perspectives from people living with diabetes.

During the unprecedented times of the COVID 19 pandemic, the lives of people with diabetes have been severely impacted. This article discusses the extent of this impact presenting the obstacles and challenges from the perspective of the patient, including specifics of practical day-to-day diabetes self-management routines. Since the COVID19 outbreak, certain psychosocial factors have been amplifieddue tothe manner in whichmainstream media and policy makers have carelessly emphasized the vulnerability of people with diabetes. The authors discuss the increased importance of support networksdue to people living in isolation and quarantine. Anewlayer of complexity has been added to the already difficult task of managing one's diabetes and ithasincreasedanxiety and stress levels. Guidelines and tips for people living with diabetes are discussed based on theauthors' personalexperiences as well as those ofthe diabetes associations they work with.

Diabetes self-management amid COVID-19 pandemic.

BACKGROUND AND AIMS: COVID-19 pandemic has challenged the physician-centered approach of diabetes care in India that is primarily based on routine clinic visits. We aim to review the various aspects of patient-centered care via diabetes self-management education based on available literature. METHODS: This is a narrative review using Pubmed, EMBASE and Google Scholar search till March 29, 2020. Search terms were "COVID-19", "diabetes self-care", "diabetes self-management education", "DSME", "diabetes self-management in India", "diabetes self-care in India" and "DSME in India". RESULTS: We have discussed an educational plan on diabetes self-management that can be adopted for people with diabetes mellitus in our country amid the ongoing pandemic. We have also identified the barriers to diabetes self-management in the current scenario and suggested possible solutions to overcome those. CONCLUSIONS: We have reemphasized the need for a simultaneous patient-centered approach in routine diabetes care that has to be coordinated by a multidisciplinary team amid the ongoing COVID-19 pandemic.