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Erbakan AN, Arslan Bahadır M, Kaya FN, Güleç B, Vural Keskinler M, Aktemur Çelik Ü, Faydalıel Ö, Mesçi B, Oğuz A. Association of the glycemic background patterns and the diabetes management efficacy in poorly controlled type 2 diabetes. World J Diabetes 2025; 16:98322. [PMID: 39817217 PMCID: PMC11718454 DOI: 10.4239/wjd.v16.i1.98322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/26/2024] [Accepted: 10/30/2024] [Indexed: 11/29/2024] Open
Abstract
BACKGROUND Inadequate glycemic control in patients with type 2 diabetes (T2DM) is a major public health problem and a significant risk factor for the progression of diabetic complications. AIM To evaluate the effects of intensive and supportive glycemic management strategies over a 12-month period in individuals with T2DM with glycated hemoglobin (HbA1c) ≥ 10% and varying backgrounds of glycemic control. METHODS This prospective observational study investigated glycemic control in patients with poorly controlled T2DM over 12 months. Participants were categorized into four groups based on prior glycemic history: Newly diagnosed, previously well controlled with recent worsening, previously off-target but now worsening, and HbA1c consistently above 10%. HbA1c levels were monitored quarterly, and patients received medical, educational, and dietary support as needed. The analysis focused on the success rates of good glycemic control and the associated factors within each group. RESULTS The study showed significant improvements in HbA1c levels in all participants. The most significant improvement was observed in individuals newly diagnosed with diabetes: 65% achieved an HbA1c target of ≤ 7%. The results varied between participants with different glycemic control histories, followed by decreasing success rates: 39% in participants with previously good glycemic control, 21% in participants whose glycemic control had deteriorated compared to before, and only 10% in participants with persistently poor control, with mean HbA1c levels of 6.3%, 7.7%, 8.2%, and 9.7%, respectively. After one year, 65.2% of the "newly diagnosed patients", 39.3% in the "previously controlled group", 21.9% in the "previously off-target but now worsened'" group and 10% in the "poorly controlled from the start" group had achieved HbA1c levels of 7 and below. CONCLUSION In poorly controlled diabetes, the rate at which treatment goals are achieved is associated with the glycemic background characteristics, emphasizing the need for tailored strategies. Therefore, different and comprehensive treatment approaches are needed for patients with persistent uncontrolled diabetes.
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Affiliation(s)
- Ayşe N Erbakan
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul 34722, Türkiye
| | - Müzeyyen Arslan Bahadır
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul 34722, Türkiye
| | - Fatoş N Kaya
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul 34722, Türkiye
| | - Büşra Güleç
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul 34722, Türkiye
| | - Miraç Vural Keskinler
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul 34722, Türkiye
| | | | - Özge Faydalıel
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul 34722, Türkiye
| | - Banu Mesçi
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul 34722, Türkiye
| | - Aytekin Oğuz
- Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul 34722, Türkiye
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Venkatesh S, Leal DO, Valdez A, Butler PI, Keenan OE, Montemayor-Gonzalez E. Cooking Well with Diabetes: A Healthy Cooking School for Diabetes Prevention and Management. Nutrients 2024; 16:2543. [PMID: 39125422 PMCID: PMC11313969 DOI: 10.3390/nu16152543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
One in ten Americans suffers from type 2 diabetes, which, if not managed well, can result in severe complications, disability, and premature death. Diabetes education classes can play a pivotal role in providing practical education on diabetes and self-care behaviors, with a particular emphasis on dietary management, which is often regarded as the most demanding diabetes self-care behavior. The Texas A&M AgriLife Extension Service developed Cooking Well with Diabetes (CWWD), a four-week interactive diabetes education series, with each week consisting of a lecture on healthy eating coupled with cooking lessons featuring diabetes-friendly recipes. The current study aimed to examine the effectiveness of CWWD in improving the frequency of healthy food preparation and consumption of program participants. Secondary data from 2017 to 2023 was analyzed involving 1574 adults from 59 predominantly rural Texas counties. Data from self-reported pre and post evaluations showed improvements in healthy food preparation and consumption behaviors. The curriculum enabled Extension Educators to introduce healthful dietary behaviors to a diverse group of clients. The curriculum can be adapted by Extension Educators in other states reaching a broader audience. The findings will inform future research aimed at planning and implementing successful diabetes education programs.
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Affiliation(s)
- Sumathi Venkatesh
- Department of Nutrition, Texas A&M AgriLife Extension Service, College Station, TX 77840, USA
| | - David O. Leal
- Healthy South Texas, Texas A&M AgriLife Extension Service, College Station, TX 77845, USA
| | - Amy Valdez
- Healthy South Texas, Texas A&M AgriLife Extension Service, College Station, TX 77845, USA
| | - Paula I. Butler
- Family and Community Health, Texas A&M AgriLife Extension Service, Dallas, TX 75252, USA
| | - Odessa E. Keenan
- Department of Nutrition, Texas A&M AgriLife Extension Service, College Station, TX 77840, USA
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McGuire MF, Chen PM, Smith-Morris C, Albin J, Siler MD, Lopez MA, Pruitt SL, Merrill VC, Bowen ME. Redesigning Recruitment and Engagement Strategies for Virtual Culinary Medicine and Medical Nutrition Interventions in a Randomized Trial of Patients with Uncontrolled Type 2 Diabetes. Nutrients 2023; 15:4124. [PMID: 37836408 PMCID: PMC10574259 DOI: 10.3390/nu15194124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
In-person culinary medicine (CM) can improve health behaviors, but its translation to virtual platforms and impact on diabetes outcomes are not well described. We designed a pragmatic trial comparing the effectiveness of virtual CM (eCM) to Medical Nutrition Therapy on diabetes outcomes among patients with uncontrolled diabetes within a safety-net healthcare system. All participants were provided cooking equipment and food from a food pantry. Due to low initial eCM participation, recruitment was paused, and eight semi-structured interviews were conducted to solicit feedback on study appeal, operations, and barriers to participation. Rapid thematic analysis was used to modify study operations. We found that participants were interested in the study and motivated by health concerns. While they valued food distribution and cooking equipment, they highlighted transportation barriers and conflicts with the pick-up time/location. Some eCM participants expressed discomfort with the virtual platform or preferred to observe rather than cook along. Study operations were modified by (1) moving supply pick-up to a familiar community clinic and diversifying food pick-up locations; (2) offering an in-person orientation to the program to increase comfort with the virtual platform; (3) emphasizing the credibility and relatability of the eCM instructor and encouraging participation of family members. This redesign led to the recruitment of 79 participants, of whom 75% attended at least one class. In conclusion, participant feedback informed pragmatic changes in study operations that increased engagement in this ongoing trial and may inform future eCM program design.
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Affiliation(s)
- Molly F. McGuire
- University of Texas Southwestern Medical Center, Division of General Internal Medicine, Dallas, TX 75390, USA (M.E.B.)
| | - Patricia M. Chen
- Peter O’Donnell Jr. School of Public Health, Dallas, TX 75390, USA
| | | | - Jaclyn Albin
- University of Texas Southwestern Medical Center, Division of Combined Internal Medicine and Pediatrics, Dallas, TX 75390, USA
| | - Milette D. Siler
- University of Texas Southwestern Medical Center, Division of General Internal Medicine, Dallas, TX 75390, USA (M.E.B.)
- Moncrief Cancer Institute, Fort Worth, TX 76104, USA
| | | | - Sandi L. Pruitt
- Peter O’Donnell Jr. School of Public Health, Dallas, TX 75390, USA
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Vincent C. Merrill
- University of Texas Southwestern Medical Center, Division of General Internal Medicine, Dallas, TX 75390, USA (M.E.B.)
| | - Michael E. Bowen
- University of Texas Southwestern Medical Center, Division of General Internal Medicine, Dallas, TX 75390, USA (M.E.B.)
- Peter O’Donnell Jr. School of Public Health, Dallas, TX 75390, USA
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Boehme HM, Kaminski RJ, Mulrooney T, Brown RA, Malhotra R. Violence Within Food Deserts: A Block-Group Examination of Food Access, Racial Composition, and Violent Crime. VIOLENCE AND VICTIMS 2023; 38:435-456. [PMID: 37348956 DOI: 10.1891/vv-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
While there is substantial public health literature that documents the negative impacts of living in "food deserts" (e.g., obesity and diabetes), little is known regarding whether living in a food desert is associated with increased criminal victimization. With the block group as the unit of analysis, the present study examines whether there is a relationship between food deserts and elevated crime counts, and whether this relationship varies by racial composition. Results from multiple count models suggest that living in a food desert is not associated with higher levels of violent or property crime. But multiplicative models interacting percent Black with food deserts revealed statistically significant associations with violent crime but not property crime. Alternatively, multiplicative models interacting percent White with food deserts revealed statistically significant associational reductions in violent crimes. Several policy and research implications are discussed.
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Affiliation(s)
- Hunter M Boehme
- Department of Criminology and Criminal Justice, University of South Carolina, Columbia, SC, USA
| | - Robert J Kaminski
- Department of Criminology and Criminal Justice, University of South Carolina, Columbia, SC, USA
| | - Timothy Mulrooney
- Department of Environmental, Earth and Geospatial Sciences, North Carolina Central University, Durham, NC, USA
| | - Robert A Brown
- Department of Criminal Justice, University of Maryland Eastern Shore, Princess Anne, MD, USA
| | - Rakesh Malhotra
- Department of Environmental, Earth and Geospatial Sciences, North Carolina Central University, Durham, NC, USA
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Yoon S, Kwan YH, Phang JK, Tan WB, Low LL. Personal Goals, Barriers to Self-Management and Desired mHealth Application Features to Improve Self-Care in Multi-Ethnic Asian Patients with Type 2 Diabetes: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15415. [PMID: 36430134 PMCID: PMC9692780 DOI: 10.3390/ijerph192215415] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/02/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
(1) Introduction: The ubiquity of mobile phones suggests the potential of mobile health applications to reach patients with type 2 diabetes and engage them to improve self-care. This study aimed to explore personal goals, barriers to self-management and desired mobile health application features to improve self-care among multi-ethnic Asian patients with type 2 diabetes. (2) Methods: We conducted semi-structured interviews with patients with type 2 diabetes (n = 29). Patients were recruited from a multi-disciplinary center for diabetes and metabolism in Singapore, using a purposive sampling strategy. Various visual materials, collated from existing mobile health application features, were used to facilitate the discussion. Interviews were transcribed verbatim and thematically analyzed. (3) Results: A total of 29 patients participated in 11 focus group discussions or one-on-one interviews. Personal goals for self-management were centered around short-term outcome expectancy, such as better glucose control and a reduced number of medications. Self-management was hampered by competing priorities and limited healthy food options when at work, while a lack of tailored advice from healthcare providers further diminished competence. The desired mobile health app features to improve self-care behaviors included quantifiable goal-setting, personalized nudges based on tracked data, built-in resources from credible sources, in-app social support through virtual interaction with peers and healthcare providers, technology-driven novel data logging and user-defined nudges. (4) Conclusions: We identified a set of app features that may foster motivation to engage in lifestyle modification for patients with T2DM. The findings serve to inform the design of artificial intelligence-enabled mobile health application intervention aimed at improving diabetes self-care.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore 828815, Singapore
| | - Yu Heng Kwan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Pharmacy, National University of Singapore, Singapore 119077, Singapore
- Department of Internal Medicine, Singapore Health Services, Singapore 168753, Singapore
| | - Jie Kie Phang
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore 828815, Singapore
| | - Wee Boon Tan
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore 828815, Singapore
- Population Health & Integrated Care Office (PHICO), Singapore General Hospital, Singapore 168753, Singapore
| | - Lian Leng Low
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore 828815, Singapore
- Population Health & Integrated Care Office (PHICO), Singapore General Hospital, Singapore 168753, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore 169856, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore 168582, Singapore
- Family Medicine Academic Clinical Program, SingHealth Duke-NUS, Singapore 168753, Singapore
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Zavala GA, Ainscough TS, Jimenez‐Moreno AC. Barriers to a healthy diet and physical activity in Mexican adults: results from the Mexican Health and Nutrition Survey. NUTR BULL 2022; 47:298-306. [DOI: 10.1111/nbu.12568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
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Bross R, Genter P, Lu Y, Serpas L, Campa D, Ipp E. Barriers to Healthy Eating and Diabetes Diet Education: Divergent Perspectives of Patients and Their Providers. HEALTH EDUCATION & BEHAVIOR 2021; 49:658-666. [PMID: 34713743 DOI: 10.1177/10901981211052241] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients report that adhering to diet is the most challenging aspect of diabetes management. Provision of diet education is often delegated to health care providers, despite a lack of nutrition education and training and limited awareness of environmental and cultural challenges faced by patients. Aim. We examined perceived barriers to diet self-management among low-income minority patients with type 2 diabetes and their health care providers within a single ecosystem, to test whether providers understood patient barriers. Method. We surveyed 149 members of a safety-net clinic (99 patients, 50 providers), using barriers derived from the literature. Binomial logistic regression was applied to investigate relationships between barriers and patients' sociodemographic variables and Pearson's χ2 was used to compare differences in perceived barriers between patients and providers. Results. Providers expressed divergent perceptions of patients' barriers to healthy eating, including more total barriers and little agreement with patients on their relative importance. Largest differences in providers' perceptions of patient barriers included poor motivation, high use of fast food, inadequate family support, and lack of cooking skills-all suggesting patient inadequacy. In contrast, patients showed evidence of high motivation-in rate of blood glucose measurement and desire for diet education. Patients identified primary care providers as a main source of nutrition education, yet providers indicated lack of time for diet discussion and preferred other staff do the teaching. Conclusion. The findings from this study strongly suggest that health systems need to consider patient, provider, and system barriers when implementing nutrition education and management programs.
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Affiliation(s)
- Rachelle Bross
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA USA
| | - Pauline Genter
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA USA
| | - Yang Lu
- California State University Long Beach, Long Beach, CA, USA
| | - Lilian Serpas
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA USA
| | - David Campa
- Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Eli Ipp
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA USA
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Associated Factors with Dietary Adherence among People with Cardiovascular Metabolic Risk Factors based on PRECEDE Framework: a Mixed-Method Study. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2021. [DOI: 10.52547/jech.8.2.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sharp LK, Biggers A, Perez R, Henkins J, Tilton J, Gerber BS. A Pharmacist and Health Coach-Delivered Mobile Health Intervention for Type 2 Diabetes: Protocol for a Randomized Controlled Crossover Study. JMIR Res Protoc 2021; 10:e17170. [PMID: 33688847 PMCID: PMC7991981 DOI: 10.2196/17170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 07/17/2020] [Accepted: 01/21/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Aggressive management of blood glucose, blood pressure, and cholesterol through medication and lifestyle adherence is necessary to minimize the adverse health outcomes of type 2 diabetes. However, numerous psychosocial and environmental barriers to adherence prevent low-income, urban, and ethnic minority populations from achieving their management goals, resulting in diabetes complications. Health coaches working with clinical pharmacists represent a promising strategy for addressing common diabetes management barriers. Mobile health (mHealth) tools may further enhance their ability to support vulnerable minority populations in diabetes management. OBJECTIVE The aim of this study is to evaluate the impact of an mHealth clinical pharmacist and health coach-delivered intervention on hemoglobin A1c (HbA1c, primary outcome), blood pressure, and low-density lipoprotein (secondary outcomes) in African-Americans and Latinos with poorly controlled type 2 diabetes. METHODS A 2-year, randomized controlled crossover study will evaluate the effectiveness of an mHealth diabetes intervention delivered by a health coach and clinical pharmacist team compared with usual care. All patients will receive 1 year of team intervention, including lifestyle and medication support delivered in the home with videoconferencing and text messages. All patients will also receive 1 year of usual care without team intervention and no home visits. The order of the conditions received will be randomized. Our recruitment goal is 220 urban African-American or Latino adults with uncontrolled type 2 diabetes (HbA1c ≥8%) receiving care from a largely minority-serving, urban academic medical center. The intervention includes the following: health coaches supporting patients through home visits, phone calls, and text messaging and clinical pharmacists supporting patients through videoconferences facilitated by health coaches. Data collection includes physiologic (HbA1c, blood pressure, weight, and lipid profile) and survey measures (medication adherence, diabetes-related behaviors, and quality of life). Data collection during the second year of study will determine the maintenance of any physiological improvement among participants receiving the intervention during the first year. RESULTS Participant enrollment began in March 2017. We have recruited 221 patients. Intervention delivery and data collection will continue until November 2021. The results are expected to be published by May 2022. CONCLUSIONS This is among the first trials to incorporate health coaches, clinical pharmacists, and mHealth technologies to increase access to diabetes support among urban African-Americans and Latinos to achieve therapeutic goals. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17170.
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Affiliation(s)
- Lisa Kay Sharp
- Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Alana Biggers
- Department of Medicine, Section of Academic Internal Medicine & Geriatrics, University of Illinois at Chicago, Chicago, IL, United States
| | - Rosanne Perez
- Department of Medicine, Section of Academic Internal Medicine & Geriatrics, University of Illinois at Chicago, Chicago, IL, United States
| | - Julia Henkins
- Department of Medicine, Section of Academic Internal Medicine & Geriatrics, University of Illinois at Chicago, Chicago, IL, United States
| | - Jessica Tilton
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Ben S Gerber
- Department of Medicine, Section of Academic Internal Medicine & Geriatrics, University of Illinois at Chicago, Chicago, IL, United States
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Yang L, Li K, Liang Y, Zhao Q, Cui D, Zhu X. Mediating role diet self-efficacy plays in the relationship between social support and diet self-management for patients with type 2 diabetes. ACTA ACUST UNITED AC 2021; 79:14. [PMID: 33517902 PMCID: PMC7849071 DOI: 10.1186/s13690-021-00533-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/19/2021] [Indexed: 01/02/2023]
Abstract
Background It has previously been established that patients who have strong barriers to their diet self-management are more likely to have weak social support; however, the key mechanisms underlying the association between these two variables have not yet been established. This study aims to examine the potential role that diet self-efficacy plays in the relationship between social support and diet behavior in patients with type 2 diabetes mellitus (T2DM). Methods It was a cross-sectional survey. Three hundred-eighty patients diagnosed with T2DM were recruited for this study from five community health centers in China. The Chronic Disease Resource Scale (CIRS), Cardiac Diet Self-efficacy Scale (CDSE), and Food Control Behavior Scale (FCBS) were used to estimate participants’ utilization of social resources, diet self-efficacy, and diet self-management, respectively. The data were analyzed utilizing structural equation modelling. Results The results suggest that both higher levels of social support and diet self-efficacy are related to higher levels of diet self-management. The mediating effect that diet self-efficacy has on the relationship between social support and diet self-management was significant (β = .30, p < .05), explaining 55.68% of the total effect of social support on diet self-management. Conclusions Diet self-efficacy plays a mediating role in the association between social support and diet behavior in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Li Yang
- School of Nursing, Qingdao University, 15 Ningde Road, Qingdao, Shandong, 266071, People's Republic of China.
| | - Kun Li
- Department of Statistics, The 2nd Affiliated Hospital of Harbin Medical University, 246 XueFu Road, Harbin, 150086, Heilongjiang Province, China.
| | - Yan Liang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China
| | - Qiuli Zhao
- School of Nursing, Harbin Medical University, Harbin, 150086, Heilongjiang Province, China
| | - Dan Cui
- Department of Nursing, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang Province, China
| | - Xuemei Zhu
- School of Nursing, Harbin Medical University, Harbin, 150086, Heilongjiang Province, China
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Cradock KA, Quinlan LR, Finucane FM, Gainforth HL, Martin Ginis KA, de Barros AC, Sanders EBN, ÓLaighin G. Identifying Barriers and Facilitators to Diet and Physical Activity Behaviour Change in Type 2 Diabetes Using a Design Probe Methodology. J Pers Med 2021; 11:jpm11020072. [PMID: 33530618 PMCID: PMC7911111 DOI: 10.3390/jpm11020072] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/11/2021] [Accepted: 01/21/2021] [Indexed: 12/19/2022] Open
Abstract
Treatment of Type 2 Diabetes (T2D) typically involves pharmacological methods and adjunct behavioural modifications, focused on changing diet and physical activity (PA) behaviours. Changing diet and physical activity behaviours is complex and any behavioural intervention in T2D, to be successful, must use an appropriate suite of behaviour change techniques (BCTs). In this study, we sought to understand the perceived barriers and facilitators to diet and PA behaviour change in persons with T2D, with a view to creating artefacts to facilitate the required behaviour changes. The Design Probe was chosen as the most appropriate design research instrument to capture the required data, as it enabled participants to reflect and self-document, over an extended period of time, on their daily lived experiences and, following this reflection, to identify their barriers and facilitators to diet and PA behaviour change. Design Probes were sent to 21 participants and 13 were fully completed. A reflective thematic analysis was carried out on the data, which identified themes of food environment, mental health, work schedule, planning, social support, cravings, economic circumstances and energy associated with diet behaviour. Similar themes were identified for PA as well as themes of physical health, weather, motivation and the physical environment.
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Affiliation(s)
- Kevin A. Cradock
- Physiology Department, School of Medicine, National University of Ireland Galway, Galway, Ireland;
- Electrical & Electronic Engineering, School of Engineering, National University of Ireland Galway, Galway, Ireland;
| | - Leo R. Quinlan
- Physiology Department, School of Medicine, National University of Ireland Galway, Galway, Ireland;
- Centre for Research in Medical Devices (CÚRAM), Science Foundation of Ireland, Galway, Ireland
- Correspondence: ; Tel.: +353-91-524411 (ext. 3710)
| | - Francis M. Finucane
- Bariatric Medicine Service, Galway Diabetes Research Centre, Health Research Board Clinical Research Facility, Galway, Ireland;
| | - Heather L. Gainforth
- School of Health and Exercise Sciences, Faculty of Health and Social Development, The University of British Columbia, Kelowna, BC V1V 1V7, Canada; (H.L.G.); (K.A.M.G.)
| | - Kathleen A. Martin Ginis
- School of Health and Exercise Sciences, Faculty of Health and Social Development, The University of British Columbia, Kelowna, BC V1V 1V7, Canada; (H.L.G.); (K.A.M.G.)
| | - Ana Correia de Barros
- Fraunhofer Portugal AICOS (Fraunhofer Center for Assistive Information and Communication Solutions), Rua Alfredo Allen, 455/461, 4200-135 Porto, Portugal;
| | - Elizabeth B. N. Sanders
- Department of Design, The Ohio State University, 100 Hayes Hall, 108 North Oval Mall, Columbus, OH 43210, USA;
| | - Gearóid ÓLaighin
- Electrical & Electronic Engineering, School of Engineering, National University of Ireland Galway, Galway, Ireland;
- Centre for Research in Medical Devices (CÚRAM), Science Foundation of Ireland, Galway, Ireland
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Bukhsh A, Goh BH, Zimbudzi E, Lo C, Zoungas S, Chan KG, Khan TM. Type 2 Diabetes Patients' Perspectives, Experiences, and Barriers Toward Diabetes-Related Self-Care: A Qualitative Study From Pakistan. Front Endocrinol (Lausanne) 2020; 11:534873. [PMID: 33329377 PMCID: PMC7729167 DOI: 10.3389/fendo.2020.534873] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/25/2020] [Indexed: 01/03/2023] Open
Abstract
Objective: This study aimed to qualitatively explore perspectives, practices, and barriers to self-care practices (eating habits, physical activity, self-monitoring of blood glucose, and medicine intake behavior) in urban Pakistani adults with type 2 diabetes mellitus (T2DM). Methods: Pakistani adults with T2DM were recruited from the outpatient departments of two hospitals in Lahore. Semistructured interviews were conducted and audiorecorded until thematic saturation was reached. Two researchers thematically analyzed the data independently using NVivo® software with differences resolved by a third researcher. Results: Thirty-two Pakistani adults (aged 35-75 years, 62% female) participated in the study. Six themes were identified from qualitative analysis: role of family and friends, role of doctors and healthcare, patients' understanding about diabetes, complication of diabetes and other comorbidities, burden of self care, and life circumstances. A variable experience was observed with education and healthcare. Counseling by healthcare providers, family support, and fear of diabetes-associated complications are the key enablers that encourage study participants to adhere to diabetes-related self-care practices. Major barriers to self care are financial constraints, physical limitations, extreme weather conditions, social gatherings, loving food, forgetfulness, needle phobia, and a hectic job. Conclusion: Respondents identified many barriers to diabetes self care, particularly related to life situations and diabetes knowledge. Family support and education by healthcare providers were key influencers to self-care practices among Pakistani people with diabetes.
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Affiliation(s)
- Allah Bukhsh
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Bey-Hing Goh
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- Malaysia School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Edward Zimbudzi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Nephrology, Monash Health, Melbourne, VIC, Australia
| | - Clement Lo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Monash Diabetes, Monash Health, Melbourne, VIC, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kok-Gan Chan
- Division of Genetics and Molecular Biology, Faculty of Science, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Guangdong Provincial Key Laboratory of Marine Biology, Institute of Marine Sciences, Shantou University, Shantou, China
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
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A Resilience Intervention for Adults with Type 2 Diabetes: Proof-of-Concept in Community Health Centers. Int J Behav Med 2020; 27:565-575. [DOI: 10.1007/s12529-020-09894-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Struik NA, Brinkworth GD, Thompson CH, Buckley JD, Wittert G, Luscombe-Marsh ND. Very Low and Higher Carbohydrate Diets Promote Differential Appetite Responses in Adults with Type 2 Diabetes: A Randomized Trial. J Nutr 2020; 150:800-805. [PMID: 31953540 DOI: 10.1093/jn/nxz344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/03/2019] [Accepted: 12/31/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Effects of very low carbohydrate (VLC) diets on appetite response in individuals with type 2 diabetes remain unclear. OBJECTIVE A secondary analysis was conducted to determine appetite responses to an energy-restricted [30% of energy (%E) deficit] very low carbohydrate (VLC) diet compared with a higher carbohydrate (HC) diet in adults who were overweight or obese with type 2 diabetes. METHODS Forty-four men and 40 women (mean ± SD, age: 58.7 ± 6.6 y; weight: 100.4 ± 15.5 kg; BMI: 34.5 ± 4.1 kg/m2; glycated hemoglobin: 7.3 ± 1.0%; duration of diabetes: 6.7 ± 5.6 y) were randomly assigned to diets categorized as VLC [14%E carbohydrate (<50 g/d), 28%E protein, 58%E fat (<10%E saturated fat)], or energy-matched HC [53%E carbohydrate, 17%E protein, 30%E fat (<10%E saturated fat)] combined with progressive multicomponent exercise (60 min; 3 d/wk). Body weight, average weekly "daily fasting" and "daily overall" appetite perceptions (hunger, fullness, prospective consumption, and desire to eat-visual analog scales) were assessed at baseline and after 4 and 16 wk. Changes between diets over time were assessed using repeated measures ANOVA. RESULTS Significant decreases in body weight did not differ between groups (VLC: -11.0 ± 5.4 kg/16 wk compared with HC: -10.1 ± 4.3 kg/16 wk, P = 0.40). Compared with HC, VLC had greater decreases in "daily overall" ratings of fullness (P time × diet < 0.01), such that scores were higher in HC at Week 4 (VLC:48 ± 3 vs HC:56 ± 3 mm, P = 0.001) and 16 (VLC:51 ± 2 vs HC:57 ± 3 mm, P = 0.019). Compared with HC, VLC had greater increases in prospective consumption ratings (P time × diet = 0.03), such that scores were lower in HC at Week 4 (VLC:33 ± 2 vs HC:28 ± 2 mm, P = 0.008), but not at Week 16 (VLC:33 ± 2 vs HC 31 ± 2 mm, P = 0.289). CONCLUSIONS In the context of energy restriction, both HC and VLC energy-matched diets promoted comparable effects on fasting perceptions of appetite, but the HC diet resulted in greater "daily overall" fullness and reduced prospective consumption. Further research is required to evaluate the effects of ad libitum diets differing in amounts of carbohydrate on appetite response in populations with type 2 diabetes. This trial was registered at www.anzctr.org.au as ACTRN12612000369820.
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Affiliation(s)
- Noor A Struik
- Commonwealth Scientific and Industrial Research Organisation - Health and Biosecurity, North Ryde, Australia.,Division of Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands
| | - Grant D Brinkworth
- Commonwealth Scientific and Industrial Research Organisation - Health and Biosecurity, North Ryde, Australia
| | | | - Jonathan D Buckley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Gary Wittert
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Natalie D Luscombe-Marsh
- Commonwealth Scientific and Industrial Research Organisation - Health and Biosecurity, Adelaide, Australia
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Wetherill MS, Williams MB, White KC, Seligman HK. Characteristics of Households of People With Diabetes Accessing US Food Pantries: Implications for Diabetes Self-Management Education and Support. DIABETES EDUCATOR 2019; 45:397-407. [PMID: 31204590 DOI: 10.1177/0145721719857547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study is to explore the associations between food insecurity (FI) and coping strategies of relevance to diabetes self-management among households of people with diabetes (HHDM) who access US food pantry programs. METHODS The authors conducted a secondary data analysis of HHDM accessing US food pantry programs from the Hunger in America 2014 study (n = 16 826). Weighted analyses included descriptive statistics for household sociodemographics, food pantry service utilization, FI, and coping behaviors. The authors used chi-square and logistic regression to estimate the relationship between FI and coping behaviors. RESULTS Nearly one-half of HHDM reported visiting food pantries at least 6 times in the past year. Most HHDM were FI, with the majority experiencing the most severe form of FI. Over one-fifth of households reported lacking health insurance. The majority of HHDM reported purchasing inexpensive unhealthy foods to ensure household food adequacy, and many reported watering down food and beverages. The odds of reporting these behaviors significantly increased as FI worsened. CONCLUSION Food pantries represent an opportunity for the delivery of community-based diabetes self-management education and support programs. These programs should be adapted to address population barriers to self-management and to support access to healthful foods and medical care.
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Affiliation(s)
- Marianna S Wetherill
- Department of Health Promotion Sciences, Hudson College of Public Health and Department of Family and Community Medicine, OU-TU School of Community Medicine, University of Oklahoma-Tulsa Schusterman Center, Tulsa, Oklahoma
| | - Mary B Williams
- Department of Biostatistics and Epidemiology, Hudson College of Public Health and Department of Family and Community Medicine, OU-TU School of Community Medicine, University of Oklahoma-Tulsa Schusterman Center, Tulsa, Oklahoma
| | - Kayla C White
- Hudson College of Public Health, University of Oklahoma-Tulsa Schusterman Center, Tulsa, Oklahoma
| | - Hilary K Seligman
- Department of Medicine, University of California San Francisco, San Francisco, California and Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California
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16
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Deng F, Chan CB. Defining modifiable barriers to uptake of dietary recommendations in Chinese immigrants with type 2 diabetes: a qualitative study. Facets (Ott) 2019. [DOI: 10.1139/facets-2019-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objective is to support development of a nutritional intervention for Chinese immigrants with diabetes by defining current deficiencies and identifying modifiable factors and mechanisms of change. Semi-structured interviews conducted with 13 ethnic Chinese with type 2 diabetes identified modifiable problems related to culturally relevant diabetes resources and low cultural acceptability of recommended diets. These factors could be addressed through creation of resources developed in partnership with Chinese-speaking health care professionals and persons with diabetes.
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Affiliation(s)
- Feiyue Deng
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Catherine B. Chan
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Department of Physiology, University of Alberta, Edmonton, AB T6G 2H7, Canada
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Caperon L, Arjyal A, K. C. P, Kuikel J, Newell J, Peters R, Prestwich A, King R. Developing a socio-ecological model of dietary behaviour for people living with diabetes or high blood glucose levels in urban Nepal: A qualitative investigation. PLoS One 2019; 14:e0214142. [PMID: 30908526 PMCID: PMC6433239 DOI: 10.1371/journal.pone.0214142] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/07/2019] [Indexed: 11/18/2022] Open
Abstract
Instances of non-communicable diseases such as diabetes are on the rise globally leading to greater morbidity and mortality, with the greatest burden in low and middle income countries [LMIC]. A major contributing factor to diabetes is unhealthy dietary behaviour. We conducted 38 semi structured interviews with patients, health professionals, policy-makers and researchers in Kathmandu, Nepal, to better understand the determinants of dietary behaviour amongst patients with diabetes and high blood glucose levels. We created a social ecological model which is specific to socio-cultural context with our findings with the aim of informing culturally appropriate dietary behaviour interventions for improving dietary behaviour. Our findings show that the most influential determinants of dietary behaviour include cultural practices (gender roles relating to cooking), social support (from family and friends), the political and physical environment (political will, healthy food availability) and individuals' motivations and capabilities. Using these most influential determinants, we suggest potentially effective dietary interventions that could be implemented by policy makers. Our findings emphasise the importance of considering socio-cultural context in developing interventions and challenges one-size-fits-all approaches which are often encouraged by global guidelines. We demonstrate how multifaceted and multi layered models of behavioural influence can be used to develop policy and practice with the aim of reducing mortality and morbidity from diabetes.
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Affiliation(s)
- Lizzie Caperon
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Abriti Arjyal
- HERD International, Prasuti Griha Marg, Kathmandu, Nepal
| | - Puja K. C.
- HERD International, Prasuti Griha Marg, Kathmandu, Nepal
| | - Jyoti Kuikel
- HERD International, Prasuti Griha Marg, Kathmandu, Nepal
| | - James Newell
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Remco Peters
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Andrew Prestwich
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Rebecca King
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
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Cheng LJ, Wang W, Lim ST, Wu VX. Factors associated with glycaemic control in patients with diabetes mellitus: A systematic literature review. J Clin Nurs 2019; 28:1433-1450. [PMID: 30667583 DOI: 10.1111/jocn.14795] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 11/19/2018] [Accepted: 01/14/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To perform a systematic review search and critically review the empirical evidence concerning the factors affecting glycaemic control in patients with type 1 or 2 diabetes mellitus. BACKGROUND Previous primary studies have investigated the factors associated with glycaemic control among patients with type 1 or 2 diabetes, but attempts to amalgamate these evidences have been methodologically limited. Hence, a robust review of the evidence is essential to explore factors that can be addressed to promote good glycaemic control in patients with diabetes. DESIGN Mixed-method systematic review using the Preferred Reporting Items for Systematic review and Meta-Analysis 2009 flow diagram, integrating evidence from qualitative and quantitative studies (see Supporting Information File S1). METHODS A systematic review of the literature published between 2006-2017 was conducted in seven electronic databases (CINAHL, MEDLINE, Scopus, EMBASE, PsycINFO, PubMed and ScienceDirect) using the search terms "diabetes mellitus," "glycemic control," "self-concept," "knowledge," "self-efficacy," "empowerment," "race," "ethnicity," "duration," "medication," "obesity" and "comorbidity." RESULTS A total of 1,582 articles were initially retrieved, and 24 of these articles were included in this systematic literature review. The overall empirical evidence suggested that higher socio-economic status, greater dietary knowledge, and higher self-efficacy and empowerment improve glycaemic control among patients with diabetes mellitus. CONCLUSIONS This review presented the factors associated with glycaemic control that may pose significant socio-economic problems to most nations worldwide and impede development nationally, regionally and even globally. Greater emphasis needs to be placed on implementing lifestyle changes on a societal level to stem the tide of the epidemic. RELEVANCE TO CLINICAL PRACTICE There is a need to implement self-management initiatives, that incorporate dietary knowledge, to empower patients with diabetes in their own care. Future public health policy must be geared towards increasing the capability of dealing with the rising incidence of diabetes and implementing primary prevention.
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Affiliation(s)
- Ling Jie Cheng
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, Singapore City, Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Suan Tee Lim
- National University Hospital, National University Health System, Singapore City, Singapore
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
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Cheng LJ, Wu VX, Dawkes S, Lim ST, Wang W. Factors influencing diet barriers among outpatients with poorly-controlled type 2 diabetes: A descriptive correlational study. Nurs Health Sci 2018; 21:102-111. [PMID: 30264523 DOI: 10.1111/nhs.12569] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 07/06/2018] [Accepted: 07/27/2018] [Indexed: 01/06/2023]
Abstract
The aim of the present descriptive correlational study was to investigate diet barriers and their influencing factors among outpatients with poorly-controlled type 2 diabetes in Singapore. One hundred and ten patients with poorly-controlled type 2 diabetes were recruited from a tertiary hospital in Singapore. The Personal Diabetes Questionnaire and Appraisal of Diabetes Scale were used to measure the study variables. Our participants reported that the most common diet barriers were eating out, followed by food cravings. Eating problems and negative diabetes appraisal were identified as significant predictors of diet barriers. The findings laid the groundwork with preliminary findings for the development of culturally-tailored and patient-centered education programs to enhance eating behaviors and promote positive appraisal.
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Affiliation(s)
- Ling Jie Cheng
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, Singapore
| | - Vivien Xi Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Susan Dawkes
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | - Suan Tee Lim
- National University Hospital, National University Health System, Singapore
| | - Wenru Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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20
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Sievenpiper JL, Chan CB, Dworatzek PD, Freeze C, Williams SL. Nutrition Therapy. Can J Diabetes 2018; 42 Suppl 1:S64-S79. [DOI: 10.1016/j.jcjd.2017.10.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 02/07/2023]
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Agee MD, Gates Z, Irwin PM. Effect of Medical Nutrition Therapy for Patients With Type 2 Diabetes in a Low-/No-Cost Clinic: A Propensity Score-Matched Cohort Study. Diabetes Spectr 2018; 31:83-89. [PMID: 29456430 PMCID: PMC5813315 DOI: 10.2337/ds16-0077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although many studies have been conducted regarding the effectiveness of medical nutrition therapy (MNT) for type 2 diabetes management, less is known about the effectiveness of MNT for low-income adults. This study evaluated the contribution of MNT in improving A1C and blood pressure in a population of low-income adults with type 2 diabetes. METHODS This was a population-based, propensity score-matched cohort study using provincial health data from Altoona, Blair County, Pa. Patients who had been diagnosed with type 2 diabetes for at least 6 months before March 2014 were selected from two separate clinics that serve low-income populations. Patients who received MNT (n = 81) from a registered dietitian were compared to a matched group of patients who received primary care alone (n = 143). Outcome measures were A1C and systolic and diastolic blood pressure. The follow-up period was 1 year. RESULTS Improvements in A1C and systolic and diastolic blood pressure were statistically significant for patients who received MNT at uniform 3-month intervals through 1 year. At the 1-year follow-up, A1C reduction was -0.8% (P <0.01), systolic blood pressure reduction was -8.2 mmHg (P <0.01), and diastolic blood pressure reduction was -4.3 mmHg (P <0.05). CONCLUSION Although low-income individuals encounter a variety of barriers that reduce their capacity for success with and adherence to MNT, provision of nutrition therapy services by a registered dietitian experienced in addressing these barriers can be an effective addition to the existing medical components of type 2 diabetes care.
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Affiliation(s)
- Mark D. Agee
- Department of Economics, Pennsylvania State University, Altoona, PA
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Beverly EA, Ritholz MD, Wray LA, Chiu CJ, Suhl E. Understanding the Meaning of Food in People With Type 2 Diabetes Living in Northern Appalachia. Diabetes Spectr 2018; 31:14-24. [PMID: 29456422 PMCID: PMC5813303 DOI: 10.2337/ds16-0059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Food and eating convey memories and feelings and serve important functions in creating and maintaining relationships. Given the increasing rate of diabetes in the United States, research understanding the meaning of food may shed light on how patients negotiate everyday food choices while managing type 2 diabetes. The purpose of this qualitative study was to explore the meaning of food among adults with type 2 diabetes living in Northern Appalachia. METHODS In-depth, face-to-face interviews were conducted with type 2 diabetes patients. Interviews were coded and analyzed via thematic analysis. RESULTS Nineteen adults with type 2 diabetes (mean age 68.7 ± 10.6 years, mean A1C 7.4 ± 1.4%, mean diabetes duration 10.9 ± 11.9 years, 52.6% female, 100% white) participated in the study. Qualitative analysis revealed three themes: 1) "Sustaining Life:" Food and the Demands of Diabetes Management, in which participants described the role of food as operational and said that eating was dictated by time rather than hunger or pleasure; 2) "Diabetes Feels Like a Yield Sign:" Diabetes Changes Perceptions of Food, Enjoyment, and Social Relationships, in which most participants described a negative or ambivalent relationship with food after their diabetes diagnosis; and 3) "Food is Everywhere; It's Seducing:" Struggling With Diabetes Management in a Fast-Food Culture, in which participants discussed how the American fast-food culture was in direct conflict with the demands of diabetes and described how they struggled to follow a healthful diet in a culture that advertised the opposite in many venues. CONCLUSION Adults with diabetes may benefit from education that addresses both the personal and sociocultural factors that guide food choices.
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Affiliation(s)
| | | | | | - Ching-Ju Chiu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Swoboda CM, Miller CK, Wills CE. Frequency of Diet and Physical Activity Goal Attainment and Barriers Encountered Among Adults With Type 2 Diabetes During a Telephone Coaching Intervention. Clin Diabetes 2017; 35:286-293. [PMID: 29263571 PMCID: PMC5734174 DOI: 10.2337/cd17-0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
IN BRIEF Participants with type 2 diabetes established personalized dietary and physical activity goals as behavioral strategies to reduce cardiovascular risk during a 16-week telephone coaching intervention. People were most likely to attain dietary goals that involved altering the intake of specific foods rather than certain nutrients and were more successful at physical activity goals to increase activity levels rather than to add new types of activity. Barriers to goal success included time management, physical limitations/illness, and social/cultural activities.
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Kamran A, Sharifirad G, Heydari H, Sharifian E. The Effect of Theory Based Nutritional Education on Fat Intake, Weight and Blood Lipids. Electron Physician 2016; 8:3333-3342. [PMID: 28163845 PMCID: PMC5279963 DOI: 10.19082/3333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 11/10/2016] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Though Nutrition plays a key role in the control of hypertension, it is often forgotten in Iranian patients' diet. In fact, dietary behavior can be regarded as unsatisfactory among Iranian patients. This study was aimed to assess the effectiveness of theory based educational intervention on fat intake, weight, and blood lipids among rural hypertensive patients. METHODS This quasi experimental study was conducted on 138 hypertensive patients who had referred to Ardabil rural health centers during 2014. The nutritional education based on DASH and Health Promotion Model (HPM) was treated for six sessions. The pre-test and post-test had intervals of two and six months. Data were analyzed using SPSS-18 and Chi-square, independent-samples t-test, paired-samples t-test and repeated measure ANOVA. RESULTS After treating intervention, weight, dietary fat, LDL_C and Total cholesterol, systolic and diastolic blood pressures decreased significantly in the intervention group compared with the control group (p < 0.001). In contrast, HDL_C increased significantly in the intervention group. CONCLUSION Educational intervention, provided based on Pender's health promotion model, affecting fat intake, blood lipids, and blood pressure, led to their decrease.
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Affiliation(s)
- Aziz Kamran
- Ph.D. of Health Education and Promotion, Assistant Professor, Public Health Department, Khalkhal Faculty of Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Gholamreza Sharifirad
- Ph.D. of Health Education and Promotion, Professor, Islamic Azad University, Qom Branch, Qom, Iran
| | - Heshmatolah Heydari
- Ph.D. of Community Health Nursing, Assistant Professor, Department of Community Health Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran; Ph.D. of Community Health Nursing, Assistant Professor, Department of Community Health Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Sharifian
- M.Sc., Nursing Department, Nursing School, Khalkhal Faculty of Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran
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Cheng L, Sit JW, Leung DY, Li X. The Association Between Self-Management Barriers and Self-Efficacy in Chinese Patients with Type 2 Diabetes: The Mediating Role of Appraisal. Worldviews Evid Based Nurs 2016; 13:356-362. [DOI: 10.1111/wvn.12159] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2015] [Indexed: 01/15/2023]
Affiliation(s)
- Li Cheng
- Doctoral Student, The Nethersole School of Nursing, Faculty of Medicine; The Chinese University of Hong Kong; Shatin Hong Kong
| | - Janet W.H. Sit
- Associate Professor, The Nethersole School of Nursing, Faculty of Medicine; The Chinese University of Hong Kong; Shatin Hong Kong
| | - Doris Y.P. Leung
- Assistant Professor, The Nethersole School of Nursing, Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong
| | - Xiaomei Li
- Professor, The School of Nursing, Faculty of Medicine; The Xi'an Jiaotong University; Xi'an China
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Perceived barriers to recommended dietary adherence in patients with type 2 diabetes in Iran. Eat Behav 2016; 21:205-10. [PMID: 26994360 DOI: 10.1016/j.eatbeh.2016.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 01/27/2016] [Accepted: 03/01/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify barriers to recommended dietary adherence in patients with type 2 diabetes. DESIGN Observational cross-sectional study. SAMPLE One hundred-forty six overweight/obese volunteers with type 2 diabetes, who had previously received dietary advice for at least one year, were recruited from two diabetes clinics in Tabriz, north-west of Iran. MEASUREMENTS A 24-item questionnaire was designed to assess dietary barriers. The validity and reliability of the questionnaire were assessed by Content Validity Index, Content Validity Ratio and Cronbach's alpha, respectively. An exploratory factor analysis with principal component analysis extraction and varimax rotation was utilized in order to extract the underlying factors of dietary nonadherence. RESULTS Factor analysis yielded seven barrier factors including: situational barriers/difficulty resisting temptation [percent variance=11.64%], stress-related eating disorder/cost [percent variance=9.11%], difficulty with meal and snack plans [percent variance=8.76%], confusion [percent variance=8.45%], work-related issues [percent variance=7.72%], small portion size [percent variance=6.87%] and lack of palatability/family support [percent variance=6.78%]. These factors explained about 59.4% of the total variance. CONCLUSIONS Overall, patients with type 2 diabetes perceived some barriers to recommended dietary adherence. In dietary counseling, considering and addressing these barriers will likely be effective in increasing the dietary adherence for patients with type 2 diabetes in Iran.
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Cheng L, Leung DYP, Sit JWH, Li XM, Wu YN, Yang MY, Gao CX, Hui R. Factors associated with diet barriers in patients with poorly controlled type 2 diabetes. Patient Prefer Adherence 2016; 10:37-44. [PMID: 26834464 PMCID: PMC4716765 DOI: 10.2147/ppa.s94275] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The study was conducted to investigate the diet barriers perceived by patients with poorly controlled type 2 diabetes and examine the associations between diet barriers and sociodemographic characteristics, medical condition, and patient-centered variables. METHODS Secondary subgroup analyses were conducted based on the responses of 246 adults with poorly controlled type 2 diabetes from a multicenter, cross-sectional study. Diet barriers were captured by the Diet Barriers subscale of the Personal Diabetes Questionnaire. Participants also completed validated measures of diet knowledge, empowerment level, and appraisal of diabetes. Multiple regression techniques were used for model building, with a hierarchical block design to determine the separate contribution of sociodemographic characteristics, medical condition, and patient-centered variables to diet barriers. RESULTS Diet barriers were moderately evident (2.23±0.86) among Chinese patients with poorly controlled type 2 diabetes. The feeling of deprivation as a result of complying with a diet was the most recognized diet barrier (3.24±1.98), followed by "eating away from home" (2.79±1.82). Significantly higher levels of diet barriers were observed among those with lower levels of diet knowledge (β=-0.282, P<0.001) and empowerment (β=-0.190, P=0.015), and more negative appraisal (β=0.225, P=0.003). CONCLUSION Culturally tailored, patient-centered intervention programs that acknowledge individuals' preferences and allow for flexibility in diet management should be launched. Interventions programs that could enhance diet knowledge, promote positive appraisal, and improve empowerment level might effectively address diet barriers perceived by patients with poorly controlled type 2 diabetes.
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Affiliation(s)
- Li Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Shatin, New Territories, Hong Kong
- Correspondence: Li Cheng, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Shatin, New Territories, 999077, Hong Kong, Tel +852 3943 9908, Fax +852 26035935, Email
| | - Doris Yin-ping Leung
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Shatin, New Territories, Hong Kong
| | - Janet Wing-hung Sit
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Shatin, New Territories, Hong Kong
| | - Xiao-mei Li
- The Department of Nursing, Faculty of Medicine, The Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yu-ning Wu
- The Department of Endocrinology, The Ninth Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Miao-yan Yang
- The Department of Endocrinology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Cui-xia Gao
- The Department of Endocrinology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Rong Hui
- The Department of Endocrinology, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China
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Vandenplas Y, De Ronne N, Van De Sompel A, Huysentruyt K, Robert M, Rigo J, Scheers I, Brasseur D, Goyens P. A Belgian consensus-statement on growing-up milks for children 12-36 months old. Eur J Pediatr 2014; 173:1365-71. [PMID: 24764116 DOI: 10.1007/s00431-014-2321-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/10/2014] [Accepted: 04/10/2014] [Indexed: 11/28/2022]
Abstract
UNLABELLED Growing-up milks (GUM) are milk-based drinks with low protein and added minerals and vitamins intended for children 12-36 months. Since the advantages of GUM are heavily debated, we reviewed the literature. A literature search was done using the classic databases (Pubmed, Embase, Cochrane) on the use of GUM in 12- to 36-month-old young children. Only limited data are available. GUM have a highly variable composition as their marketing is not regulated. Nevertheless, all papers conclude that GUM help to cover nutritional requirements of 12- to 36-month-old infants. CONCLUSION Appropriate intakes of macro- and micronutrients in 1- to 3-year-old children have long-term health benefits. Present diets offered to toddlers do in general not meet the requirements. Supplemented foods are therefore helpful, of which GUM is a possibility.
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Affiliation(s)
- Yvan Vandenplas
- Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium,
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Soria-Contreras DC, Bell RC, McCargar LJ, Chan CB. Feasibility and efficacy of menu planning combined with individual counselling to improve health outcomes and dietary adherence in people with type 2 diabetes: a pilot study. Can J Diabetes 2014; 38:320-5. [PMID: 25175312 DOI: 10.1016/j.jcjd.2014.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 01/21/2014] [Accepted: 03/26/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The purpose of this study was to test the feasibility and efficacy of implementing a 4-week menu plan combined with individual counselling among people with type 2 diabetes. METHODS A 12-week pilot study with a pretest and post-test design was conducted among 15 participants with type 2 diabetes. The menu plan incorporated the overall recommendations of the Canadian Diabetes Association nutrition therapy guidelines and considered factors such as the accessibility, availability and acceptability of foods. Change in glycated hemoglobin (A1C) was the primary outcome, and secondary outcomes were changes in serum lipid, anthropometric and dietary measures. RESULTS Mean (±SD) age of the participants was 59.3±9.9 years, and duration of diabetes was 8.1±8.3 years. After the program, A1C decreased by 1.0%±0.86% (p<0.05). There were significant reductions (p<0.05) in weight, body mass index, waist circumference and fat mass and increased high-density lipoprotein cholesterol. No significant changes were observed in dietary measures except for perceived dietary adherence score, which increased significantly (p<0.05). Participants reported using the menu plan an average of 5.0±1.9 days a week and attended, on average, 4 of 6 counselling sessions. CONCLUSIONS Menu planning and individual counselling were demonstrated to be feasible and effective for diabetes management, and they represent a simple and practical approach to implement the nutritional recommendations for diabetes in Canada.
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Affiliation(s)
- Diana C Soria-Contreras
- Department of Agricultural, Food and Nutritional Science, Alberta Diabetes Institute, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Science, Alberta Diabetes Institute, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Linda J McCargar
- Department of Agricultural, Food and Nutritional Science, Alberta Diabetes Institute, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine B Chan
- Department of Agricultural, Food and Nutritional Science, Alberta Diabetes Institute, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada; Department of Physiology, Medical Sciences Building, University of Alberta, Edmonton, Alberta, Canada.
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The role of perceived barriers in explaining socio-economic status differences in adherence to the fruit, vegetable and fish guidelines in older adults: a mediation study. Public Health Nutr 2014; 18:797-808. [PMID: 25089647 DOI: 10.1017/s1368980014001487] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We aimed to identify barriers for meeting the fruit, vegetable and fish guidelines in older Dutch adults and to investigate socio-economic status (SES) differences in these barriers. Furthermore, we examined the mediating role of these barriers in the association between SES and adherence to these guidelines. DESIGN Cross-sectional. SETTING Longitudinal Aging Study Amsterdam (LASA), the Netherlands. SUBJECTS We used data from 1057 community-dwelling adults, aged 55-85 years. SES was measured by level of education and household income. An FFQ was used to assess dietary intake and barriers were measured with a self-reported lifestyle questionnaire. RESULTS Overall, 48.9 % of the respondents perceived a barrier to adhere to the fruit guideline, 40.0 % for the vegetable and 51.1 % for the fish guideline. The most frequently perceived barriers to meet the guidelines were the high price of fruit and fish and a poor appetite for vegetables. Lower-SES groups met the guidelines less often and perceived more barriers. The association between income and adherence to the fruit guideline was mediated by 'perceiving any barrier to meet the fruit guideline' and the barrier 'dislike fruit'. The association between income and adherence to the fish guideline was mediated by 'perceiving any barrier to meet the fish guideline' and the barrier 'fish is expensive'. CONCLUSIONS Perceived barriers for meeting the dietary guidelines are common in older adults, especially in lower-SES groups. These barriers and in particular disliking and cost concerns explained the lower adherence to the guidelines for fruit and fish in lower-income groups in older adults.
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Sabzmakan L, Morowatisharifabad MA, Mohammadi E, Mazloomy-Mahmoodabad SS, Rabiei K, Naseri MH, Shakibazadeh E, Mirzaei M. Behavioral determinants of cardiovascular diseases risk factors: A qualitative directed content analysis. ARYA ATHEROSCLEROSIS 2014; 10:71-81. [PMID: 25161674 PMCID: PMC4144369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 12/29/2013] [Indexed: 12/02/2022]
Abstract
BACKGROUND The PRECEDE model is a useful tool for planers to assess health problems, the behavioral and environmental causes of the problems, and their determinants. This study aims to understand the experiences of patients and health care providers about the behavioral causes of cardiovascular diseases (CVDs) risk factors and their determinants. METHODS This qualitative study utilized content analysis approach based on the PRECEDE model. The study was conducted for over 6 months in 2012 at the diabetes units of health centers associated with Alborz University of Medical Sciences, which is located in Karaj, Iran. Data were collected using individual semi-structured interviews with 50 patients and 12 health care providers. Data analysis was performed simultaneously with data collection using the content analysis directed method. RESULTS Stress, unhealthy eating, and physical inactivity were the behaviors, which predict the risk factors for CVD. Most of the patients considered stress as the most important underlying cause of their illness. In this study, 110 of the primary codes were categorized into seven subcategories, including knowledge, attitude, perceived susceptibility, severity, perceived benefits, barriers, and self-efficacy, which were located in the predisposing category of the PRECEDE model. Among these determinants, perceived barriers and self-efficacy for the mentioned behaviors seemed to be of great importance. CONCLUSION Identifying behavioral determinants will help the planners design future programs and select the most appropriate methods and applications to address these determinants in order to reduce risky behaviors.
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Affiliation(s)
- Leila Sabzmakan
- PhD Candidate, Department of Health Education, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Ali Morowatisharifabad
- Associate Professor,Department of Health Education, Shahid Sadoughi University of Medical Sciences, Yazd, Iran,Correspondence to: Mohammad Ali Morowatisharifabad,
| | - Eesa Mohammadi
- Associate Professor, Department of Nursing, Tarbiat Modares University, Tehran, Iran
| | | | - Katayoun Rabiei
- PhD Candidate, Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hassan Naseri
- Associate Professor, Department of Surgery, Baqiyatallah University of Medical Sciences, Tehran AND Department of Surgery, Alborz University of Medical Sciences, Karaj, Iran
| | - Elham Shakibazadeh
- Assistant Professor, Department of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Masoud Mirzaei
- Assistant Professor, Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Rendle KAS, May SG, Uy V, Tietbohl CK, Mangione CM, Frosch DL. Persistent Barriers and Strategic Practices. DIABETES EDUCATOR 2013; 39:560-7. [DOI: 10.1177/0145721713492218] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this study was to explore the everyday barriers to and practices of low-income patients managing their diabetes. Methods The study team conducted semistructured qualitative interviews with 20 patients with type 2 diabetes who were receiving care at safety-net clinics in Southern California. Transcripts were analyzed using grounded theory to identify emergent themes across participants. Results Participants described managing diabetes with limited financial resources as often a game of balance and negotiation, whereby purchasing healthy foods is abandoned because of a more pressing concern in their life. Although participants described strategic attempts at incorporating healthy dietary practices for diabetes management into their daily decisions, these efforts were significantly impeded by the existence of persistent and seemingly insurmountable barriers. Conclusions Although the challenges that low-income patients face in managing their diabetes may seem insurmountable at times, there are several ways that health care providers can help reduce the burden of these challenges, including tailoring their recommendations to incorporate the everyday socioeconomic environment of patients and engaging in clear, open communication with patients.
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Affiliation(s)
- Katharine A. S. Rendle
- University of Michigan, Ann Arbor, Michigan (Ms Rendle)
- Palo Alto Medical Foundation Research Institute, Palo Alto, California (Ms Rendle, Dr May, Ms Tietbohl, Dr Frosch)
- University of California, Los Angeles, California (Mr Uy, Dr Mangione, Dr Frosch)
| | - Suepattra G. May
- University of Michigan, Ann Arbor, Michigan (Ms Rendle)
- Palo Alto Medical Foundation Research Institute, Palo Alto, California (Ms Rendle, Dr May, Ms Tietbohl, Dr Frosch)
- University of California, Los Angeles, California (Mr Uy, Dr Mangione, Dr Frosch)
| | - Visith Uy
- University of Michigan, Ann Arbor, Michigan (Ms Rendle)
- Palo Alto Medical Foundation Research Institute, Palo Alto, California (Ms Rendle, Dr May, Ms Tietbohl, Dr Frosch)
- University of California, Los Angeles, California (Mr Uy, Dr Mangione, Dr Frosch)
| | - Caroline K. Tietbohl
- University of Michigan, Ann Arbor, Michigan (Ms Rendle)
- Palo Alto Medical Foundation Research Institute, Palo Alto, California (Ms Rendle, Dr May, Ms Tietbohl, Dr Frosch)
- University of California, Los Angeles, California (Mr Uy, Dr Mangione, Dr Frosch)
| | - Carol M. Mangione
- University of Michigan, Ann Arbor, Michigan (Ms Rendle)
- Palo Alto Medical Foundation Research Institute, Palo Alto, California (Ms Rendle, Dr May, Ms Tietbohl, Dr Frosch)
- University of California, Los Angeles, California (Mr Uy, Dr Mangione, Dr Frosch)
| | - Dominick L. Frosch
- University of Michigan, Ann Arbor, Michigan (Ms Rendle)
- Palo Alto Medical Foundation Research Institute, Palo Alto, California (Ms Rendle, Dr May, Ms Tietbohl, Dr Frosch)
- University of California, Los Angeles, California (Mr Uy, Dr Mangione, Dr Frosch)
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Correlation Between Hemoglobin A1C Level and Fasting Blood Glucose Level: a Summary on the Reports in the Setting with High Prevalence of Hemoglobin Disorder. ACTA FACULTATIS MEDICAE NAISSENSIS 2012. [DOI: 10.2478/v10283-012-0012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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