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Seiglie J, Tobolsky S, Crespo Trevino R, Cordova L, Cromer S, Caballero AE, Alegria M, Miranda JJ, Wexler D, Mayberry L. Adapting a Text Messaging Intervention to Improve Diabetes Medication Adherence in a Spanish-Speaking Population: Qualitative Study. JMIR Hum Factors 2025; 12:e66668. [PMID: 40311126 PMCID: PMC12061353 DOI: 10.2196/66668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 03/06/2025] [Accepted: 03/12/2025] [Indexed: 05/03/2025] Open
Abstract
Background Latino adults with type 2 diabetes (T2D) have higher rates of diabetes medication nonadherence than non-Hispanic White adults. REACH (Rapid Encouragement/Education And Communications for Health) is a text message platform based on the information-motivation-behavioral skills model that addresses barriers to adherence and was shown to improve adherence and glycated hemoglobin (HbA1c) levels, but it is only available in English. Objective This study aimed to report the multiphase, stakeholder-driven adaptation of the REACH barriers to diabetes medication adherence content to a Latino population (REACH-Español). Methods This was a qualitative study using focus groups. We identified potentially eligible patients (≥18 y old, Latino ethnicity, Spanish-language preference, and T2D diagnosis) using a Mass General Brigham Hospital query. Eligible patients were invited to participate in a focus group conducted in Spanish between April 13 and November 9, 2023. A total of 5 focus groups were conducted. Focus groups 1-3 centered on ranking 40 barriers to diabetes medication adherence (derived from REACH and the extant literature), whereas focus groups 4-5 centered on translation and cultural modifications of the original SMS text message content associated with each of the REACH barriers. Barriers were mapped onto information-motivation-behavioral constructs. We used descriptive statistics to summarize participant characteristics. Focus groups were audio-recorded, professionally transcribed, and analyzed with thematic content analysis using NVivo (Lumivero). Results In total, 22 participants attended the focus groups. The mean (SD) age was 63.2 (11) years, 55% (n=10/22) were female, and the mean HbA1c level was 8.5%. All participants were born in Latin America or the Caribbean and spoke Spanish as their preferred language, and 54.5% (12/22) had completed middle-school education or less. Among the top 10 ranked barriers, 50% (n=5) corresponded to information, 20% (n=2) to social motivation, 20% (n=2) to behavioral skills, and 10% (n=1) to personal motivation. Personal motivation barriers (medication burden and fear of side effects) and behavioral skills (forgetting to take medication) emerged as important themes in the focus groups. Conclusions A stakeholder-driven approach to intervention adaptation identified and prioritized relevant barriers to diabetes medication adherence among Latino adults with T2D and facilitated the adaptation of the REACH platform to a Spanish-speaking population.
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Affiliation(s)
- Jacqueline Seiglie
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Diabetes Unit, Massachusetts General Hospital, 50 Staniford St, Suite 340, Boston, MA, 02114, United States, 1 6177268722, 1 6177248534
| | - Seth Tobolsky
- Diabetes Unit, Massachusetts General Hospital, 50 Staniford St, Suite 340, Boston, MA, 02114, United States, 1 6177268722, 1 6177248534
| | | | - Lluvia Cordova
- Diabetes Unit, Massachusetts General Hospital, 50 Staniford St, Suite 340, Boston, MA, 02114, United States, 1 6177268722, 1 6177248534
| | - Sara Cromer
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Diabetes Unit, Massachusetts General Hospital, 50 Staniford St, Suite 340, Boston, MA, 02114, United States, 1 6177268722, 1 6177248534
| | - A Enrique Caballero
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA, United States
| | - Margarita Alegria
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Departments of Medicine & Psychiatry, Harvard Medical School, Boston, MA, United States
| | - J Jaime Miranda
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Camperdown, Australia
| | - Deborah Wexler
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Diabetes Unit, Massachusetts General Hospital, 50 Staniford St, Suite 340, Boston, MA, 02114, United States, 1 6177268722, 1 6177248534
| | - Lindsay Mayberry
- Vanderbilt University Medical Center, Nashville, TN, United States
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Müller N, Lehmann T, Müller UA, Kloos C. Is there an HbA1c Threshold for Symptoms of Chronic Hyperglycemia? Exp Clin Endocrinol Diabetes 2021; 130:386-392. [PMID: 34100271 DOI: 10.1055/a-1493-0683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS OF THE STUDY The minimum therapeutic goal regarding metabolic control for people with diabetes mellitus is the "absence of symptoms of hyperglycemia." However, it is uncertain whether a level of HbA1c can be defined that guarantees the absence of these symptoms. The aim was to define an HbA1c threshold above which most patients show hyperglycemic symptoms. METHODS In a multicenter cross-sectional study, 137 patients with type 1 and 285 with type 2 diabetes were asked about their symptoms during periods of hyperglycemia with a standardized questionnaire. Seventeen symptoms of hyperglycemia were summarized to the total hyperglycemia symptom score (THSS; min. 0; max. 68). The answers could be given according to the frequency and intensity in the last 4 - 6 weeks. RESULTS The HbA1c threshold above which most patients showed hyperglycemic symptoms was 10.05% for patients with diabetes type 1 and 8.9%. for patients with type 2. Most confidence was reached on the symptoms of frequent urination" and "tiredness." The mean THSS was 19.4 (±9.0) and showed a positive correlation with age (r=0.167; p<0.001) and HbA1c (r=0.254; p<0.001). CONCLUSIONS We identified an HbA1c threshold above which most patients show symptoms of hyperglycemia. In the treatment of people with diabetes mellitus, a safety margin to this threshold should be maintained to preserve well-being and avoid distress. However, since hyperglycemia symptoms are subject to many influencing factors, an adjustment of the therapy-both intensification and de-intensification-should always be carried out in combination with the requested hyperglycemia symptoms and HbA1c value.
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Affiliation(s)
- Nicolle Müller
- Department for Internal Medicine III, Jena University Hospital, Jena, Germany
| | - Thomas Lehmann
- Jena University Hospital, Center for Clinical Studies, Jena, Germany
| | - Ulrich Alfons Müller
- Practice for Endocrinology and Diabetology, Dr. Kielstein Ambulante Medizinische Betreuung GmbH, Jena, Germany
| | - Christof Kloos
- Department for Internal Medicine III, Jena University Hospital, Jena, Germany
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Grisham-Takac C, Lai P, Srinivasa M, Vasquez L, Rascati KL. Correlation of antidepressant target dose optimization and achievement of glycemic control. Ment Health Clin 2019; 9:12-17. [PMID: 30627498 PMCID: PMC6322821 DOI: 10.9740/mhc.2019.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Depression is a recognized cause of disability globally with a propensity to be comorbid in patients with diabetes, leading to poorer health-related outcomes. Although a number of studies have investigated the correlation between improvement in depression and chronic disease, none have reported on achievement of target doses of antidepressant therapies and diabetes control. The objective of this study is to determine the influence of antidepressant dosing optimization on reducing hemoglobin A1c (HbA1c). Methods This was a retrospective cohort study of patients seen at CommUnityCare Health Centers who were initiated on an antidepressant and had uncontrolled diabetes (HbA1c > 7%). Eligible patients were followed for 12 months after initiation and separated into those who achieved target dose and those who did not. Patient health questionnaire scores were collected when available in an attempt to quantify change in depressive symptoms. Results A total of 178 patients met inclusion criteria with 76 achieving an optimal dose (target group) and 102 patients below optimal dose (control group) at the end of the study period. Patients in both groups were similar at baseline with an HbA1c of 9.29% compared to 9.24% in the target and control groups, respectively. At the end of the study period, more patients in the target group achieved an HbA1c < 7% (22.9%, n = 48 vs 4.3%, n = 23, respectively; P < .05). Discussion These results suggest that optimization of antidepressant dosing in patients with diabetes may lead to an increased likelihood of reaching goal HbA1c < 7% although correlation to improvement of depression remains unknown.
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Affiliation(s)
- Catlin Grisham-Takac
- PGY2 Ambulatory Care Resident (at time of study), CommUnityCare Health Centers/University of Texas at Austin College of Pharmacy, Austin, Texas,
| | - Phillip Lai
- Medical Science Liason, Otsuka Pharmaceuticals Development and Commercialization, Austin, Texas
| | - Maaya Srinivasa
- Clinical Pharmacist, CommUnityCare Health Centers/University of Texas at Austin College of Pharmacy, Austin, Texas
| | - Lindsay Vasquez
- Clinical Pharmacist and Associate Residency Program Director, CommUnityCare Health Centers/University of Texas at Austin College of Pharmacy, Austin, Texas
| | - Karen L Rascati
- Professor, University of Texas at Austin College of Pharmacy, Austin, Texas
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Ahola AJ, Forsblom C, Groop PH. Association between depressive symptoms and dietary intake in patients with type 1 diabetes. Diabetes Res Clin Pract 2018; 139:91-99. [PMID: 29475022 DOI: 10.1016/j.diabres.2018.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/25/2018] [Accepted: 02/13/2018] [Indexed: 02/07/2023]
Abstract
AIMS Depressive mood negatively affects self-care practices, and thereby increases the risk of long-term complications. Not much is known about the association between depressive symptoms and dietary intake in patients with type 1 diabetes, a population with high risk of cardiovascular disease. METHODS Subjects (n = 976, 41% men, age 48 ± 14 years) were participants in the Finnish Diabetic Nephropathy Study. Depressive symptomatology was assessed with the Beck Depression Inventory (BDI). Dietary patterns were derived from food frequency questionnaire-entries by exploratory factor analysis. Energy and macronutrient intakes were calculated from food records. In the same record, participants also reported the results of their daily blood glucose monitoring. Associations between BDI score and self-care variables were analysed using generalized linear regression. For macronutrients, a substitution model was applied. RESULTS Two dietary patterns ("Fish and vegetables", and "Traditional") negatively associated with the BDI score. Instead, an increase in the "Sweet" pattern score was positively associated with depressive symptomatology. Of the macronutrients, favouring protein over carbohydrates or fats associated with lower depression scores. Higher blood glucose self-monitoring frequency and higher variability of the measurements were positively associated with the BDI score. However, no association was observed between depressive symptoms and the mean of the blood glucose measurements. CONCLUSIONS Depressive symptoms are reflected in the dietary intake and the self-monitoring of blood glucose, in type 1 diabetes. Whether depression, via compromised self-care practices, negatively affect long-term outcomes in this patient group has to be the subject of future studies.
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Affiliation(s)
- Aila J Ahola
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Finland; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
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