Effect of Diabetes Self-Management Education on Glycaemic Control in Sudanese Adults with Type 2 Diabetes

Research Background: The high prevalence of diabetes in Sudan, estimated at 16%, highlights the importance of effective health education in diabetes management. Diabetes self-management education has been identified as a crucial tool in enhancing the knowledge, attitudes, and abilities necessary for self-management among individuals with diabetes. Aim: To assess the impact of diabetes self-management education on medication adherence and glycemic control in Sudanese adults with type 2 diabetes before and 3 months after the DSME intervention. Method: The study was conducted in Sudan between September 2022 and March 2023, it was an interventional, one-group, pre- and post-test study that aimed to assess the impact of diabetes self-management education (DSME) on medication adherence and diabetes control in Sudanese adults with type 2 diabetes. The research was conducted in primary health care centers in six cities in Sudan and involved 244 participants. The data entry and statistical analysis were conducted using the Statistical Package for Social Sciences version 27.0. A paired t test was used for analysis. Results: The study included 244 participants, 67% of whom were males. The age mean ± SD was 48.6 ± 9.3 years, and 85.3% of participants were married. Age at onset of diabetes mean ± SD was 40.60 ± 7.81 years;44.6% had diabetes for less than 5 years;and 84.1% had a positive family history of diabetes mellitus. The levels of poor, low, and partial adherence to medication decreased by 8.2%, 4%, and 20.6%, respectively, after the intervention. The levels of good and high medication regime adherence increased by 13% and 19.8%, respectively;BMI decreased by 1.1 ± 0.73 kg/m2 (p = 0.005). The fasting blood sugar decreased by 69 ± 32.9 mg/dl (p = 0.049), and the glycated hemoglobin decreased by 1.21 ± 0.28% (p = 0.001). Conclusions: The findings of this study reinforce the importance of patient education in improving glycemic control and enhancing self-management behaviors. Patient education plays a critical role in enhancing glycemic control and self-management behaviors. It is essential for healthcare providers to adopt a patient-centered approach, taking into account the individual's beliefs, attitudes, and knowledge about their illness and treatment. Overcoming these challenges necessitates a comprehensive approach, including enhancing healthcare professionals’ knowledge and communication skills, offering accessible and culturally sensitive diabetes education programs, and addressing barriers to resources and support for self-management.

Self-management in patients with diabetic foot ulcer:a concept analysis

Objective:This paper presents an analysis of the concept of patient outcomes.Methods:The present study conducted searches on various databases,including Wanfang,Sinomed,CNKI,Pub Med,Cochrane Library,Embase,Web of Science,and Ovid.The paper followed the Walker and Avant concept-analysis approach.Results:Initially,899 pieces of literature were identified through the search process,and after screening,41 of them were ultimately included in the analysis.The identified attributes of the concept included(1)capability,(2)decision making,and(3)action.These antecedents were shaped by factors such as illness perception,self-efficacy,and family and social.The consequences included(1)physiological effects,(2)psychological effects,and(3)social influence.Conclusions:The concept analysis of self-management in patients with diabetic foot ulcers(DFUs)not only aids in clinical practice and suppor ts interventions,but also contributes to the development of self-management theory.The common goal of clinical medical staff is to assist DFU patients in improving cognitive ability,making correct self-management decisions,and enhancing self-management behavior.

Diabetes self-management education:Benefits and challenges

Diabetes mellitus has spread throughout many nations of the world and is now a serious threat.A lack of patient self‑management has been linked to this drain on global health.The consequences of diabetic patients’poor self‑management have increased a variety of complications and lengthened hospital stays.Poor information and skill acquisition have been linked to poor self‑management.Participating in a co‑operative approach known as diabetes self‑management education will help diabetes patients who want to successfully self‑manage their condition and any associated conditions.Information is one of the most important components of a diabetes management strategy.In conclusion,numerous studies have shown that patients with diabetes have poor self‑management skills and knowledge in all areas,making training in diabetes self‑management necessary to minimize the complications that may result from diabetes mellitus among the patients.This review discussed the severity of diabetes mellitus,diabetes self‑management,and the benefits and challenges of diabetes self‑management,which may aid individuals in understanding the significance of diabetes self‑management and how it relates to diabetes self‑care.

HHO optimized support vector machine classifier for traditional Chinese medicine syndrome differentiation of diabetic retinopathy

AIM:To develop a classifier for traditional Chinese medicine(TCM)syndrome differentiation of diabetic retinopathy(DR),using optimized machine learning algorithms,which can provide the basis for TCM objective and intelligent syndrome differentiation.METHODS:Collated data on real-world DR cases were collected.A variety of machine learning methods were used to construct TCM syndrome classification model,and the best performance was selected as the basic model.Genetic Algorithm(GA)was used for feature selection to obtain the optimal feature combination.Harris Hawk Optimization(HHO)was used for parameter optimization,and a classification model based on feature selection and parameter optimization was constructed.The performance of the model was compared with other optimization algorithms.The models were evaluated with accuracy,precision,recall,and F1 score as indicators.RESULTS:Data on 970 cases that met screening requirements were collected.Support Vector Machine(SVM)was the best basic classification model.The accuracy rate of the model was 82.05%,the precision rate was 82.34%,the recall rate was 81.81%,and the F1 value was 81.76%.After GA screening,the optimal feature combination contained 37 feature values,which was consistent with TCM clinical practice.The model based on optimal combination and SVM(GA_SVM)had an accuracy improvement of 1.92%compared to the basic classifier.SVM model based on HHO and GA optimization(HHO_GA_SVM)had the best performance and convergence speed compared with other optimization algorithms.Compared with the basic classification model,the accuracy was improved by 3.51%.CONCLUSION:HHO and GA optimization can improve the model performance of SVM in TCM syndrome differentiation of DR.It provides a new method and research idea for TCM intelligent assisted syndrome differentiation.

Patient-centered care in diabetes care-concepts,relationships and practice

We still do not have comprehensive knowledge of which framework of patientcentered care(PCC)is appropriate for diabetes care,which elements of PCC are evidence-based,and the mechanism by which PCC elements are associated with outcomes through mediators.In this review,we elaborate on these issues.We found that for diabetes care,PCC elements such as autonomy support(patient individuality),cooperation and collaboration(system-level approach),communication and education(behavior change techniques),emotional support(biopsychosocial approach),and family/other involvement and support are critically important.All of these factors are directly associated with different patient outcomes and indirectly associated with outcomes through patient activation.We present the practical implications of these PCC elements.

Technology and diabetes self-management: An integrative review

Technology can be used to supplement healthcare provider diabetes care by providing both educational and motivational support. Education can be provided using technology allowing patients to learn new practices and routines related to diabetes management. Technology can support daily diabetes self-management activities including blood glucose monitoring, exercising, healthy eating, taking medication, monitoring for complications, and problem-solving. This article describes an integrative review conducted to evaluate the types of technology being used to facilitate diabetes self-management and the effect of that technology on self-management and diabetes outcomes for adults living with type 2 diabetes mellitus. A literature review was conducted by searching Medline, Pub Med, and Psych INFO databases using the search terms: diabetes self-management, technology, type 2 diabetes, smartphones, cell phones, and diabetes mellitus covering the years from 2008-2013. Articles relying on secondary data(editorials, systematic reviews) and articles describing study protocol only were excluded. Fourteen studies including qualitative, quasiexperimental, and randomized controlled trial designs were identified and included in the review. The review found that technological interventions had positive impacts on diabetes outcomes including improvements in hemoglobin A1 C levels, diabetes self-management behaviors, and diabetes self-efficacy. Results indicate that technological interventions can benefit people living with diabetes when used in conjunction with diabetes care delivered by healthcare providers.

Impact of chronic disease self-management programs on type 2 diabetes management in primary care

AIM: To assess the effectiveness of the Chronic Disease Self-Management Program(CDSMP) on glycated hemoglobin A1c(HbA1c) and selected self-reported measures.METHODS: We compared patients who received a diabetes self-care behavioral intervention, the CDSMP developed at the Stanford University, with controls whoreceived usual care on their HbA1c and selected self-reported measures, including diabetes self-care activities, health-related quality of life(HRQOL), pain and fatigue. The subjects were a subset of participants enrolled in a randomized controlled trial that took place at seven regional clinics of a university-affiliated integrated healthcare system of a multi-specialty group practice between January 2009 and June 2011. The primary outcome was change in HbA1c from randomization to 12 mo. Data were analyzed using multilevel statistical models and linear mixed models to provide unbiased estimates of intervention effects.RESULTS: Demographic and baseline clinical characteristics were generally comparable between the two groups. The average baseline HbA1c values in the CDSMP and control groups were 9.4% and 9.2%, respectively. Significant reductions in HbA1c were seen at 12 mo for the two groups, with adjusted changes around 0.6%(P < 0.0001), but the reductions did not differ significantly between the two groups(P = 0.885). Few significant differences were observed in participants' diabetes self-care activities. No significant differences were observed in the participants' HRQOL, pain, or fatigue measures.CONCLUSION: The CDSMP intervention may not lower HbA1c any better than good routine care in an integrated healthcare system. More research is needed to understand the benefits of self-management programs in primary care in different settings and populations.

What are the self-management experiences of the elderly with diabetes?A systematic review of qualitative research

BACKGROUND The number of elderly individuals with diabetes is dramatically increasing.Diabetes is a long-term condition and a noncommunicable disease and requires intensive daily self-management.Understanding of self-management from the patients’perspectives is important to nurses,healthcare providers,and researchers and benefits people by improving their self-management skills.AIM To examine and synthesize qualitative studies that explore the experiences of elderly people in self-managing diabetes.METHODS Electronic databases were searched,including MEDLINE,CINAH,PsycINFO,PubMed,CNKI,and WANFADATA.Relevant research was identified by manually searching reference lists and gray literature.Only English and Chinese publications were included.The Critical Appraisal Skills Program was used to assess the quality of the research.The Confidence in the Evidence from Reviews of Qualitative research approach was used to assess the confidence of the findings.RESULTS A total of 10 qualitative studies were included,and content analysis was performed.Five themes were identified:The need for knowledge about diabetes care,support systems,functional decline,attitudes toward diabetes,and healthy lifestyle challenges.CONCLUSION This present review provides a deep and broad understanding of the experiences in the self-management of diabetes and can be valuable to nursing practice and provide recommendations for future research.

Predictors of diabetes self-management among type 2 diabetics in Indonesia:Application theory of the health promotion model

Objective:This study aimed to identify factors predicting diabetes self-management among adults with type 2 diabetes mellitus in Malang City,East Java,Indonesia.Methods:A cross-sectional design was used in this study.Participants were selected from five primary health centers in Malang City,East Java,Indonesia using the multistage sampling method.A total of 127 adults with type 2 diabetes mellitus were recruited.Data were collected by questionnaires which were the general diabetes knowledge,the Beliefs of Treatment Effectiveness,the Diabetes Distress Scale,the Self-efficacy for Diabetes Scale,the brief Chronic Illness Resources Survey,the Situational Questionnaire and the Summary of Diabetes Self-care Activities.A self-administered questionnaire was used to collect the data.Multiple linear regression with stepwise method was used toanalyze the data.Results:The scores of seven questionnaires(i.e,diabetes knowledge,perceived benefit of diabetes self-management,diabetes distress,perceived self-efficacy,social support,situational influence,and diabetes self-management)were 13.75±3.59,34.9±4.89,3.03±0.86,3.60±0.53,27.79±5.56,3.27±0.58,3.81±1.08,respectively.The significant predictors of diabetes self-management were treatment,perceived self-efficacy,and situational influences.These variables explained 20.8%(adjusted R^(2)=0.208)of the variance in diabetes self-management among adults with type 2 diabetes mellitus in Malang City.Conclusion:Diabetes self-management among adults with type 2 diabetes mellitus could be improved by enhancing their perceived self-efficacy to achieve their self-management behavior,such as having a healthy diet,exercising regularly,actively monitoring blood glucose level,taking medication and foot care,and providing support to promote good situational influence.

Diabetes self-management (DSM) in Omani with type-2 diabetes

Objective:The aim of this study was to assess the status of diabetes self-management(DSM)among Omanis with type-2 diabetes and its relationship with glycemic control and demographic variables.Methods:A correlational descriptive design using questionnaire was conducted with a convenience sample of 266 Omani patients with type-2 diabetes to collect the data.Results:The findings indicated that DSM among the study subject is sub-optimal.Only 1%of them were regular on SMBG;9.5%of them exercise regularly;and 18%of them maintain healthy diet practices.No significant relationship between DSM and glycemic control(p>0.05)was found.DSM was found to be associated with age,gender,level of education,and duration of diabetes.Examining the differences between two regions in Oman(Muscat&Aldhakiliyah)indicated that participants from Muscat differ only in practicing SMBG.Conclusion:Results indicated that many Omani patients with type-2 diabetes do not perform DSM consistently.Practice implications:The findings of this study set the stage to develop teaching strategies that will improve DSM and subsequently improve diabetes management in patient with type-2 diabetes in Oman.

Patient attitudes about financial incentives for diabetes self-management:A survey

AIM:To study the acceptability of incentives for behavior changes in individuals with diabetes,comparing financial incentives to self-rewards and non-financial incentives.METHODS:A national online survey of United States adults with diabetes was conducted in March 2013(n = 153).This survey was designed for this study,with iterative testing and modifications in a pilot population.We measured the demographics of individuals,their interest in incentives,as well as the perceived challenge of diabetes self-management tasks,and expectations of incentives to improve diabetes self-management(financial,non-financial and self-rewards).Using an ordered logistic regression model,we assessed the association between a 32-point score of the perceived challenge of the self-management tasks and the three types of rewards.RESULTS:Ninety-six percent of individuals were interested in financial incentives,60% in non-financial incentives and 72% in self-rewards.Patients were less likely to use financial incentives when they perceived the behavior to be more challenging(odds ratio of using financial incentives of 0.82(95%CI:0.72-0.93) for each point of the behavior score).While the effectiveness of incentives may vary according to the perceived level of challenge of each behavior,participants did not expect to need large amounts to motivate them to modify their behavior.The expected average amounts needed to motivate a 5 lb weight loss in our population and to maintain this weight change for a year was $258(interquartile range of $10-100) and $713(interquartile range of $25-250) for a 15 lb weight loss.The difference in mean amount estimates for 5 lb and 15 lb weight loss was significant(P < 0.001).CONCLUSION:Individuals with diabetes are willing to consider financial incentives to improve diabetes selfmanagement.Future studies are needed to explore incentive programs and their effectiveness for diabetes.

The moderating effect of social cognitive factors on self-management activities and HbA1c in Thai adults with type-2 diabetes

Background: Diabetes mellitus (DM) has become a serious chronic disease.Self-management strategies help persons with DM make choices which will develop skills needed to reach their goal of blood glucose control and allow them to be successful in reaching goals.Objective: To examine the impact of self-management activities on HbA1c for persons with DM and to examine the impact of social support,self-efficacy and Buddhist values as moderators on the relationship between the self-management activities and HbA1c.Method: This study is a cross-sectional design.The sample included 401 Thai adults diagnosed with type 2 diabetes,aged 20-65 years old who had at least one HbA1c test in the last three months were recruited.Participants completed four questionnaires to measure self-management activities,as well as self-efficacy,Buddhist values and social support as moderating factors on self-management activities and HbA1 c,Results: The self-management activities were negatively associated (β =-2.05,p ≤ 0.001) with HbA1c.The Social support,self-efficacy and Buddhist values had a significant interaction effect between selfmanagement activities and HbA1c (β =-0.97,p ≤ 0.05,β =-0.18,p ≤ 0.05 and β =-2.76,p ≤ 0.001).Conclusion: The diabetes self-management activities were more strongly associated with HbA1c under conditions of high social support,self-efficacy and health beliefs with Buddhist values.Future interventions for T2DM self-management programs should incorporate mechanisms to measure and support these factors.

Psychometric evaluation of the Thai translation of the Diabetes Self-management Questionnaire in type 2 diabetes

Objectives:To explore the content validity and the internal consistency of the diabetes Self-management Questionnaire(DSMQ)for persons with T2DM in Thailand.Methods:Diabetes Self-management Questionnaire(DSMQ)was developed in English.The translation of DSMQ into Thai language was performed by native Thai translators.A panel of five experts in Thailand evaluated the translation.Content validity was quantified by the content validity index(CVI).A crosssectional design was used to test internal consistency by calculating Cronbach's alpha.Results:The DSMQ contains 16 items.There are eleven items(69%)which showed excellent CVI;two items(12.5%)showed good CVI and three items showed acceptable CVI.The average scale of CVI was 0.90.The internal consistency of the DSMQ was 0.73.Conclusion:The Thai version of DSMQ showed excellent content validity;good internal consistency.The instruments can be used among Thai adults with DM in future research studies.

Family functioning integrated with diabetes self-management： a concept analysis

Although the concept of family functioning has gained recent popularity, the terms ＂family functioning＂ and ＂family resilience＂ are sometimes confused and used interchangeably. The aim of this concept analysis was to clarify what is meant by family functioning in the context of diabetes self-management by assessing specific attributes, antecedents, and consequences. A concept analysis model by Walker and Avant was applied. The identified attributes of family functioning in a diabetes self-management context included problem-solving, communication, roles, affective responsiveness, affective involvement, and behavioral control. Antecedents included family structure, socioeconomic status, family functioning relationships, family stage, and life events. Consequences included family satisfaction, family cohesion, and family relationships. This analysis provided a deeper understanding of a family functioning concept within a diabetes self-management context. It is recommended that health care providers should be aware of antecedent factors that could inhibit outcome improvement. Further research is needed to explain family functioning attributes in relation to antecedents and potential consequences.

Preferences of Persons with Type 2 Diabetes for Diabetes Self-Management Education Interventions: An Exploration

Objectives: Treatment preferences affect treatment engagement, adherence and outcomes. There is limited knowledge of patients’ preferences for Diabetes Self-Management Education (DSME). This study explored the preferences of Canadians with diabetes for components, mode and dose for implementing DSME interventions. Methods: A cross-sectional design was used. Adults with diabetes completed a questionnaire to assess participants’ preferences for components (i.e. content), mode (i.e. teaching strategies, delivering formats) and dose (i.e. number and length of sessions) of DSME. Descriptive statistics were used to analyze the data. Results: Participants (n = 100) were middle-aged men and women, who had diabetes for 6.1 years and previously received (95.0%) DSME. They indicated preference for DSME to include a combination of educational, behavioral and psychological components;to be delivered in individual, face-to-face sessions (4 sessions, 60 minutes each, given monthly) that allowed discussion with one diabetes educator to develop and carry out a care plan. Conclusions: Diabetes educators may consider eliciting patient’s preferences and tailoring DSME to fit patients’ preferences. Delivering interventions that are consistent with patients’ preferences increases their motivation to engage in intervention, satisfaction and adherence to treatment and achievement of desired outcomes.

Systematic Review of Diabetes Self-Management: Focusing on the Middle-Aged Population of Pakistan and Saudi Arabia

The aim is to synthesize the most contemporary qualitative research on the self-management of type 2 diabetes with specific interest in the population of Pakistan and Saudi Arabia. The electronic databases searched include the Cochrane library, MEDLINE, PubMed, EMBASE and PsycINFO, between the year 1993 and 2013. The inclusion criteria was the middle-aged population aged 40 - 60 years. Studies must report qualitative research on diabetes self-management, diabetic complications, quality of life, and patient-doctor relationship or interaction. Out of the 36 identified studies, 30 studies from the literature search representing self-management in context suggest that the multiple contextual factors identified are the fertile ground for further research, and the context which is useful for health care professionals suggests that coping with diagnosis and living with diabetes are affected by a complex constellation of factors, including life circumstances, social support, gender roles and economy. Three conceptual themes were identified from the analysis. The review has revealed that there is a lack of studies in literature on self-management of type 2 diabetes in both the countries.

Effect of Medical Advice for Diet on Diabetes Self-Management and Glycemic Control for Haitian and African Americans with Type 2 Diabetes

Adequate care of type 2 diabetes is reflected by the individual’s adherence to dietary guidance;yet, few patients are engaged in diabetes self-care at the recommended level, regardless of race/ethnicity. Few studies on the effect of dietary medical advice on diabetes self-management (DSM) and glycemic control have been conducted on Haitian and African American adults with type 2 diabetes. These relationships were assessed in total of 254 Blacks with type 2 diabetes (Haitian Americans = 129;African Americans = 125) recruited from Miami-Dade and Broward Counties, Florida by community outreach methods. Although dietary advice received was not significantly different between the two Black ethnicities, given advice “to follow a diet” as a predictor of “using food groups” was significant for Haitian Americans, but not for African Americans. Haitian Americans who were advised to follow a diet were approximately 3 times more likely to sometimes or often use food groups (or exchange lists) in planning meals. Less than optimal glycemic control (A1C > 7.2) was inversely related to DSM for African Americans;but the relationship was not significant for Haitian Americans. A one unit increase in DSM score decreased the odds ratio point estimate of having less than optimal glycemic control (A1C > 7.2%) by a factor of 0.94 in African Americans. These results suggest that medical advice for diet plans may not be communicated effectively for DSM for some races/ethnicities. Research aimed at uncovering the enablers and barriers of diet management specific to Black ethnicities with type 2 diabetes is recommended.

The Process by Which Girls Who Develop Type 1 Diabetes before School Age Acquire Self-Management Skills during Puberty and Adolescence

Our aim was to clarify the process by which girls who develop type 1 diabetes before school age acquire self-management skills during puberty and adolescence. We conducted semi-structured interviews with such women who had reached adolescence, and analyzed the results using the modified grounded theory approach (M-GTA). We found the process to be composed of eight categories: Girls begin to feel they understand their own bodies;Girls give precedence to fun, and forget about their disease;Girls build a foundation for taking control of their physical health;Girls feel “out of sync” with their physical sensations;Girls gain new awareness of their disease due to discrimination and comparing themselves to others;Girls revisit their lifestyle and diabetes care practices, with an eye to their future;Girls employ the wisdom and knowledge they have gained from experience;Girls are frustrated at diabetes’ relent-less presence in their lives. The learning process could be roughly divided into two periods: a period dominated by annoyance, where girls prioritize fun activities and try to forget about their disease, and a period where they leverage their wisdom to revisit their care behaviors and change their lifestyle.

Self-Management of Type 2 Diabetes in Middle-Aged Population of Pakistan and Saudi Arabia

This research protocol design is aimed at exploring the qualitative health research in self-management of Type 2 diabetes and patient’s perceptions and experiences of undertaking physical activity and eating behaviour as part of their diabetes self-management. In addition, the study would analyze how the health issue related to diabetes is viewed and addressed in the community (Pakistan and Saudi Arabia) and would use the concepts of socio-ecological approach to self-management of Type 2 diabetes and explore the factors affecting the self-management practices in these countries. The other objective of this protocol is to examine the role of physical inactivity and obesity in the development of Type 2 diabetes and its self-management in middle-aged population living in rural area of Pakistan and to evaluate a lifestyle intervention (Physical Activity and Diet) in the management of Type 2 diabetes. The brief review conducted in this protocol design will identify the potential areas of health care which need attention including the overall functioning of community healthcare clinics to diabetes care in terms of recognizing the symptoms of diabetes to early detection and diagnosis, easy access to community doctors. This review will impress upon the need to recognize that in developing strategies and interventions to address diabetes, self-care, family support, community education and community ownership are important and it will be demonstrated by the comparison of two culturally diversified populations of Pakistan and Saudi Arabia in relation to the self-management of Type 2 diabetes.

Self-management of cataract extraction among diabetes patients

Background:Diabetes-related cataract extraction is a minor surgery required to regain full vision.One of the recognized factors that can delay or prevent full-vision recovery is poor management,and most of this management is being carried out by patients themselves.Objective:This study aimed to assess the knowledge of diabetes patients on self-management after cataract extraction in two tertiary hospitals in Osun State.Methods:A cross-sectional descriptive design was conducted among 97 diabetes patients who underwent cataract extraction and were attending clinics and follow-up visits in Osun State.A self-structured questionnaire was used for data collection.Results:Moderate knowledge was found among the participants on an appropriate diet(56.7%),prevention of injury risk(57.5%),prevention of infection risk(50.9%),and low knowledge on the technique of administration of eye drop(60.8%)after cataract extraction,whereas 74.7%of the total respondents were knowledgeable on the indication for follow-up visit after cataract extraction,these results were found to be below the expected knowledge level.Conclusion:An intensive and comprehensive educational initiative by nurses should be tailored to meet the specific needs of diabetes patients with cataract surgery.Nurses also need to implement the use of checklist which will enhance learning and improve patient understanding of self-management after cataract extraction.