Development of the Intercultural Diabetes Online Community Research Council: Codesign and Social Media Processes.

BACKGROUND: This case study describes the formation of the Intercultural Diabetes Online Community Research council (iDOCr) and community advisory board (CAB) to engage the diabetes community and researchers in the codesign of community-based participatory research (CBPR) to examine online peer support in type 2 diabetes (T2D). METHOD: Social media engagement was the foundation for CBPR knowledge generation. During the project, the iDOCr council and CAB (n = 27) met quarterly via video conferencing and three times in person during national diabetes meetings. Data from four Twitter chats were used to explore the usefulness and utility of Twitter data to learn about concerns and priorities of the diabetes online community (DOC) and supported the evolution of iDOCr, the development of a research question and the design of a CBPR study. RESULTS: The iDOCr project (1) created a diverse CAB; (2) raised awareness of iDOCr and online peer support, which resulted in support and trust from key opinion leaders within the DOC to enable future partnerships for research and funding; (3) engaged with English- and Spanish-speaking DOC users through social media; and (4) designed a CBPR study supported by Twitter chat data analyses. CONCLUSIONS: Integrating the voice of people with diabetes (PWD) and the DOC in designing CBPR, through use of a CAB, ensures the most important and relevant research questions are asked. Additional research focused on online peer support may increase health care provider confidence in referring PWD to this low-cost and relatively accessible resource with the potential power to advance health.

Empowerment-Based Diabetes Self-Management Education to Maintain Glycemic Targets During Ramadan Fasting in People With Diabetes Who Are on Conventional Insulin: A Feasibility Study.

OBJECTIVE: This study aims to assess the feasibility of promoting safe Ramadan fasting through diabetes self-management education (DSME) and to determine the effect of such education on hypoglycemic episodes. DESIGN AND METHODS: This prospective study included subjects attending Ramadan reinforcement sessions for participants in the Educational Program for People with Diabetes (EPPWD) at the Ain-Shams University Diabetes Center in Cairo, Egypt. The DSME sessions started 2-3 weeks before Ramadan and included one experimental fasting day during the first week and one during the second week. Participants' A1C and serum fructosamine levels were measured before and after Ramadan, and they completed weekly self-monitoring of blood glucose (SMBG) logs. RESULTS: Among 21 participants who were intending to fast for Ramadan, 14 completed the program. Their mean A1C was 6.7 ± 1.6%, and SMBG results showed a statistically nonsignificant difference in mean blood glucose levels before and after Ramadan (123.84 ± 39.96 and 123.84 ± 25.92 mg/dL, respectively; P >0.05). Serum fructosamine after Ramadan declined by 10% from pre-Ramadan levels. The mean number of hypoglycemic events before Ramadan was 3 ± 1.04, which declined to 1.4 ± 0.5 during Ramadan. Differences between group 1 (those without hypoglycemia, n = 8) and group 2 (those with hypoglycemia, n = 6) were nonsignificant for all variables, including A1C. CONCLUSION: Ramadan fasting is feasible for people with diabetes who are on a multiple daily injection insulin regimen and participate in the EPPWD. The number of hypoglycemic events per month declined with the attainment of DSME.

Evaluation of Diabetes Conversation Map™ Education Tools for Diabetes Self-Management Education.

Objective. To evaluate the efficacy of Diabetes Conversation Maps™ education tools for people with type 2 diabetes attending a diabetes self-management education program. Design and methods. This cross-sectional study was conducted with patients with type 2 diabetes who were recruited from Baqai Institute of Diabetology & Endocrinology, a tertiary care diabetes center of Karachi, Pakistan, from May 2010 to June 2011. Groups of 10-12 participants were given a pre-session questionnaire. Four sessions using Diabetes Conversation Maps™ education tools were conducted, and the same questionnaire was then completed again. Results. A total of 172 people (82 males, 90 females, mean age 60 years, average duration of diabetes 15 ± 4 years) participated in the study. Confidence in diabetes self-management: before the sessions, 52.3% of participants believed that the doctor is the most influential person in the management of their type 2 diabetes, whereas after the sessions, 97.1% acknowledged that they were responsible for diabetes self-management. Before, 15% said they knew what to do to manage their diabetes, whereas 75% indicated this after the sessions. Empowerment: before the sessions, 32% said they understood those aspects of their diabetes self-management that were in need of improvement, whereas 75.6% indicated this after the sessions. Willingness, ability, and preparedness for diabetes self-management: before the sessions, 22% said they understood the importance of diabetes self-management; this increased to 63.4% afterward. Before, 20.3% agreed that they will start making changes in their lives, whereas 65.7% agreed with this after the sessions. Satisfaction: 61% found the map sessions very effective, 72.1% found this format to be better than individual education, and 52.8% agreed that map tools helped in goal-setting. Conclusion. Diabetes Conversation Maps™ education tools are effective for diabetes self-management education and facilitating behavior change in people with type 2 diabetes. This, in turn, may improve patients' chances of attaining desirable diabetes control.