Effectiveness of a Cluster Randomized Controlled Trial Involving Community-Based Intervention for Older Adults With Type 2 Diabetes Mellitus in Singapore.

PURPOSE: The purpose of the study was to investigate the effectiveness of a community-based intervention on improving knowledge about diabetes, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus (T2DM) in Singapore, a country in Asia with a high prevalence of diabetes. METHODS: A 3-arm cluster randomized controlled trial involving community-dwelling older adults ages 55 to 99 with T2DM was conducted. Intervention group 1 and 2 participants received a 12-session intervention program designed to teach knowledge and practical skills in diabetes self-care with psychological techniques for behavioral change like problem solving, goal setting, and motivational interviewing. In addition, intervention group 2 participants received a glucometer and a supply of accessories each. The control group received routine care from their health care providers. RESULTS: Compared to the control group, intervention group 2 reported an increase in medication adherence and self-monitoring of blood glucose (SMBG) at 3-month follow-up and increased knowledge about diabetes and self-care behavior in general diet control at 6-month follow-up. CONCLUSIONS: The community-based intervention should be extended to more older adults with T2DM in the community. Glucometers and accessories could be provided at subsidized rates or be made free contingent on older adults' income status to overcome the barrier of performing SMBG.

Exploring the Perspective of Diabetes, Diabetes Self-Management, and Quality of Life Among Older Adults With Type 2 Diabetes: A Qualitative Study Before and During the COVID-19 Pandemic.

PURPOSE: The purpose of the study was to explore the perspective and impact of diabetes, diabetes self-management, and quality of life (QoL) among older adults with Type 2 diabetes (T2DM) before and during the COVID-19 pandemic to better inform T2DM self-management interventions. METHODS: A qualitative descriptive approach with focus group discussions (n = 5 sessions with 5-6 older adults per session) and in-depth interviews (n = 15) was conducted with community-dwelling older adults with T2DM. RESULTS: Five themes emerged. The definition of diabetes carries negative connotations, QoL is defined in terms of biopsychosocial health, diabetes self-management refers to the ability to adhere to medical advice and lifestyle changes, the QoL of older adults is differentially affected by COVID-19 measures, and important aspects of diabetes self-management activities are impacted by COVID-19 measures. CONCLUSIONS: Understanding older adults' perspectives on diabetes, diabetes self-management, and QoL provided insights into the facilitators and barriers to diabetes self-management practices before and during the COVID-19 pandemic. Findings inform the need for greater bottom-up initiatives and the need for a multipronged approach that considers the intra- and interpersonal and current policy factors to encourage diabetes self-management behaviors, especially during the COVID-19 era.

Sociodemographic characteristics associated with self-care and quality of life among community-dwelling older adults with type 2 diabetes.

AIMS: To assess how well community-dwelling older adults in Singapore were coping with their diabetes, and the sociodemographic characteristics that were associated with their level of coping. METHODS: This was a cross-sectional study involving 257 older adults. Multiple regression was used to assess the associations between various sociodemographic characteristics and coping measures of present quality of life and level of self-care. RESULTS: Older adults mainly sought care in the primary care setting. They were not coping well given their mean scores for diabetes-dependent quality of life and the self-care index were -3.57 and 3.55 respectively. Compared to those with post-secondary education, individuals who had no formal (adjusted B -0.92, p 0.003), primary level (adjusted B -0.76, p < 0.001) and secondary level (adjusted B -0.50, p < 0.02) education reported lower present quality of life. Those with prior lowest skill level occupations were less likely to consume a healthy diet per week than those with prior highest skill level occupations (adjusted B -1.48, p 0.004). CONCLUSIONS: There should be provision of diabetes self-care interventions targeting older adults in Singapore especially for those with lower education and work skill levels. As the first line of contacts, primary care providers should advocate for diabetes self-care and develop community-based interventions for these priority groups.

Efficacy of community-based self-care interventions to improve biophysical, psychosocial or behavioural outcomes among community-dwelling older adults with type 2 diabetes: A systematic review and meta-analysis.

AIMS: This review assessed the efficacy of self-care interventions to improve biophysical, psychosocial or behavioural outcomes among older adults with diabetes. METHODS: Computerised and manual searches were performed. A total of 18 randomised control trials were included in the review, of which eight were subsequently included in the meta-analysis. RESULTS: Most studies were from the United States of America and adopted a collaborative approach with participants. The specific needs of older adults were often not considered, and there was a predominance of biophysical measures. Meta-analysis revealed that among intervention condition participants, there were improvements in HbA1c (pooled weighted mean difference (WMD) -0.33, 95%CI -0.48 to -0.17), systolic blood pressure (WMD -1.55, 95%CI -2.93 to -0.18), diastolic blood pressure (WMD -1.41 95%CI -2.08 to -0.20), triglyceride (WMD -13.25, 95%CI -23.31 to -3.20), high-density lipoprotein (WMD 2.05, 95%CI 1.04 to 3.06) and Diabetes Self-Care Activities score (mean 4.10, 95%CI 3.11 to 5.10) compared to the control group. There was no significant change for low-density lipoprotein (WMD -5.93, 95%CI -12.08 to 0.22). CONCLUSIONS: While continuing to adopt a collaborative approach, future self-care interventions should incorporate psychosocial and behavioural outcomes, consider the specific needs of older adults, and focus on more ethnically diverse populations.

Efficacy and challenges of a culturally relevant intervention to improve attitudes to aging.

OBJECTIVES: Attitudes to aging have been linked with important health outcomes. It is unclear whether interventions to improve attitudes to aging are effective across cultural contexts. This study investigated the efficacy of an intervention among women of either Australian or Chinese backgrounds. METHODS: Among 96 women who provided baseline measures, 86 attended a single, 90-min group session on either healthy aging or healthy diet. Measures of three domains of attitudes to aging were collected at baseline, then immediately and 8 weeks after the intervention. RESULTS: The intervention improved attitudes in the psychological growth domain, but not the physical change or psychosocial loss domains. Cultural identification did not moderate intervention efficacy. DISCUSSION: The findings suggest that brief, culturally inclusive interventions may be partially effective at improving attitudes to aging. Furthermore, research is needed to investigate if the intervention would be more effective when baseline attitudes to aging are less positive.