Type 2 diabetes (T2D) disparities in Latinos in the United States continue to rise despite ongoing efforts to advance health equity. Major drivers of T2D disparities are shaped by the social determinants of health which create unmet social needs such as unstable housing, unreliable transportation, food insecurity, financial need, and insufficient childcare. Latino communities are disproportionately affected by many social determinants of health and thus report disproportionately greater social needs than their Non-Hispanic White counterparts. As T2D prevalence, incidence, and associated complications in Latinos outpace those of Non-Latino Whites, an understanding of the potential influence of social needs on T2D prevention and management in this population is warranted. This integrative review describes the role of social needs in T2D prevention and management among Latinos. This review informs how certain social needs are associated with increased risk for T2D, prediabetes, and poor T2D self-management. Specific social needs interventions had mixed results in affecting T2D outcomes and social needs. There is a lack of research evaluating interventions with comprehensive social needs screen and referral for Latinos with or at risk for T2D across the lifespan.

The study aimed to identify active intervention components to improve glucose sensor time in range (TIR; 70-180 mg/dL [3.9-10.0 mmol/L]) by ≥5 % among adolescents and young adults (13 to 20 yrs) with type 1 diabetes and above recommended glycated haemoglobin (HbA1c ≥ 7.5 % [≥ 58 mmol/mol]), regardless of current insulin therapy.

The 6-week optimisation trial used a 24 factorial experiment to estimate the main effects and interactions of the following candidate intervention components on TIR: real-time continuous glucose monitoring (CGM) technology, sleep extension, healthier snacking support, and values-guided self-management. Twenty-one participants, mean (SD) age 16.1 (2.4) years, were randomised to one of 16 experimental conditions.

The main effects, as measured by the mean difference (95 % CI) in TIR from baseline to 4 weeks, were: CGM, 3.3 (-8.8, 15.4) percentage points; sleep extension, -7.2 (-19.0, 4.6) percentage points; snacking support, 0.9 (-11.8, 13.5) percentage points; values-guided self-management, 6.1 (-7.5, 19.7) percentage points.

The values-guided self-management was the only 'active' component. Conclusions about the less impactful intervention components are limited due to disruptions in research activities from the COVID-19 pandemic. Future work will address other candidate intervention components.

Tele-nursing, which utilizes digital health tools, has the potential to enhance the management of Type 2 Diabetes (T2DM). However, patients' awareness, needs, and barriers to using these services are not well understood. This study employed qualitative interviews to explore the perceptions of patients with T2DM towards tele-nursing and to identify factors influencing their adoption, with the aim of providing tailored strategies for effective service implementation.

A descriptive qualitative research design was used. From June to August 2023, a purposive sampling method was used to select 20 T2DM patients from a hospital, following the principle of maximum variation. Semi-structured interviews were conducted, and the data were analyzed using thematic analysis.

Four main themes were identified: insufficient awareness and willingness to use tele-nursing, the need for tele-nursing services, facilitators of tele-nursing, and barriers to tele-nursing.

The awareness of tele-nursing among T2DM patients needs significant improvement. Patients expressed clear demands for tele-nursing services, including health education, dietary guidance, blood sugar monitoring, and medication reminders. However, the adoption of tele-nursing is influenced by factors such as service accessibility, scope, technological challenges, and associated costs. Tele-nursing should address the specialized nursing needs of T2DM patients by leveraging remote technology to provide personalized and flexible care options that align with their evolving requirements.

The development of mobile health (mHealth) in China has tremendous potential, especially for diabetes, which is one of the major chronic diseases affecting hundreds of millions of people. However, research on the current use of mHealth by patients with diabetes and the factors influencing their decision-making is insufficient. Most existing studies have approached the subject from a technological perspective and often overlooked the identity of patients as users of mHealth services. Based on the Andersen behavioural model, this study aimed to investigate the factors affecting patients' adoption of mHealth, with a special emphasis on individual patient characteristics, and provided recommendations for the promotion of mHealth and the management of diabetes.

This was a cross-sectional study. A convenience sample survey was conducted in one tertiary hospital and two community health service centres, and an anonymous self-administered questionnaire survey was conducted among patients with diabetes. Based on Andersen's behavioural model, the questionnaire divided the influencing factors into predisposing factors, enabling factors and need factors. Multivariate logistic regression analysis was used to explore the factors influencing the utilisation of mHealth.

A total of 533 questionnaires were valid. In this study, 36.8% of patients with diabetes used mHealth services. Among the predisposing factors, having better education and mHealth knowledge were found to be facilitators of mHealth utilisation, and employment status was a factor associated with mHealth utilisation. Among the enabling factors, patients with internet access and living in urban areas were more likely to have access to mHealth, and higher health literacy positively influenced mHealth utilisation. Among the need factors, self-assessed health status was linked to mHealth utilisation, and diabetes duration had a negative impact on mobile health utilisation.

The rate of mobile health utilisation remained low. In the future, improvements can be made in multiple aspects, such as policy, promotion, infrastructure and health education, to advance the development of mobile health and the management and control of diabetes.

PurposeThe purpose of the study was to examine the level of diabetes knowledge among Chinese Americans with type 2 diabetes (T2DM) and the influence of acculturation levels on diabetes knowledge. T2DM is a significant health issue for Chinese Americans because of the unique challenges they face that reflect a complex interplay of culture, language, insufficient numbers of culturally congruent health care providers, and socioeconomic factors. Diabetes knowledge is an essential foundation for effective diabetes self-management behaviors. However, few studies have assessed Chinese Americans' level of diabetes knowledge and its relationship to acculturation.MethodsA secondary analysis of cross-sectional survey data from 110 Chinese Americans with T2DM was conducted. Descriptive analyses summarized specific knowledge deficits, and a hierarchical regression model was used to test the contribution of acculturation to the level of knowledge after controlling for demographics, diabetes duration, treatment, number of comorbidities, and diabetes numeracy.ResultThe average percentage of correct responses on the Diabetes Knowledge Questionnaire-Revised was approximately 77%. Items that were answered incorrectly the most frequently pertained to low or high blood glucose symptoms, desired A1C level, and glucose levels' relation to emotions. Diabetes numeracy and acculturation significantly predicted diabetes knowledge after controlling for demographic and health indicators.ConclusionChinese American patients may have significant gaps in knowledge regarding diabetes and its management that correspond to lower numeracy and acculturation levels. Health care providers should reinforce diabetes education for Chinese American patients who have lower acculturation levels.

Technologies such as mobile apps, continuous glucose monitors (CGMs), and activity trackers are available to support adults with diabetes, but it is not clear how they are used together for diabetes self-management.

This study aims to understand how adults with diabetes with differing clinical profiles and digital health literacy levels integrate data from multiple behavior tracking technologies for diabetes self-management.

Adults with type 1 or 2 diabetes who used ≥1 diabetes medications responded to a web-based survey about health app and activity tracker use in 6 categories: blood glucose level, diet, exercise and activity, weight, sleep, and stress. Digital health literacy was assessed using the Digital Health Care Literacy Scale, and general health literacy was assessed using the Brief Health Literacy Screen. We analyzed descriptive statistics among respondents and compared health technology use using independent 2-tailed t tests for continuous variables, chi-square for categorical variables, and Fisher exact tests for digital health literacy levels. Semistructured interviews examined how these technologies were and could be used to support daily diabetes self-management. We summarized interview themes using content analysis.

Of the 61 survey respondents, 21 (34%) were Black, 23 (38%) were female, and 29 (48%) were aged ≥45 years; moreover, 44 (72%) had type 2 diabetes, 36 (59%) used insulin, and 34 (56%) currently or previously used a CGM. Respondents had high levels of digital and general health literacy: 87% (46/53) used at least 1 health app, 59% (36/61) had used an activity tracker, and 62% (33/53) used apps to track ≥1 health behaviors. CGM users and nonusers used non-CGM health apps at similar rates (16/28, 57% vs 12/20, 60%; P=.84). Activity tracker use was also similar between CGM users and nonusers (20/33, 61% vs 14/22, 64%; P=.82). Respondents reported sharing self-monitor data with health care providers at similar rates across age groups (17/32, 53% for those aged 18-44 y vs 16/29, 55% for those aged 45-70 y; P=.87). Combined activity tracker and health app use was higher among those with higher Digital Health Care Literacy Scale scores, but this difference was not statistically significant (P=.09). Interviewees (18/61, 30%) described using blood glucose level tracking apps to personalize dietary choices but less frequently used data from apps or activity trackers to meet other self-management goals. Interviewees desired data that were passively collected, easily integrated across data sources, visually presented, and tailorable to self-management priorities.

Adults with diabetes commonly used apps and activity trackers, often alongside CGMs, to track multiple behaviors that impact diabetes self-management but found it challenging to link tracked behaviors to glycemic and diabetes self-management goals. The findings indicate that there are untapped opportunities to integrate data from apps and activity trackers to support patient-centered diabetes self-management.

Diabetic retinopathy (DR) is becoming a more widespread public concern worldwide, leading to visual impairments. It has become the leading cause of blindness among working-age adults globally, despite established treatments that can reduce the risk by 60%.

This study aimed to determine the incidence of diabetic retinopathy and its predictors among adult patients with diabetes in public hospitals in Central and Southern Ethiopia.

A hospital-based follow-up study was conducted in selected public hospitals in Central and Southern Ethiopia. A total of 376 participants of newly diagnosed adult diabetes were enrolled from 2015-2023 and the follow-up the date was from date of enrolment to the development of events. The data were collected by reviewing their records and entered in Epi-data version 4.6.0.2 and exported to STATA version 14 for analysis. Descriptive statistics of the variables were obtained. The Weibull model with gamma frailty distribution was fitted. Bivariable and multivariable analyses were done, and variables with a p-value less than 0.05 and a corresponding 95% confidence interval in the final model were used. The model of adequacy was checked.

376 adult diabetic patient records were reviewed with the mean baseline age (± standard deviation) of 34.8±10 years. The univariate frailty was statistically significant (Theta=0.236 (0.131, 0.496)). A total of 376 adult patients with diabetes were followed for 682.894 person-years. Overall, an incidence rate of 14.06/100 person-years. Proteinuria (AHR = 2.21: 95% CI: 1.45, 3.57), cardiovascular disease (AHR = 2.23: 95% CI: 1.34, 4.03), and type II DM (AHR = 2.87: 95% CI: 1.30, 6.13) were identified as significant predictors of diabetic retinopathy.

Overall incidence rate of diabetic retinopathy was high. The most effective way to protect our vision from diabetic retinopathy is to manage diabetes effectively and offer support to high-risk individuals with diabetes. Therefore, healthcare professionals and relevant health authorities should target on addressing these factors in their initiatives to prevent diabetic retinopathy in diabetic patients.

Current diabetes care and education programs and expert clinical diabetes management guidelines focus on diabetes self-care behaviors and have yet to incorporate complementary therapies. Complementary therapies, such as music therapy, yoga, mindfulness, and art therapy, have been used globally for centuries and have positive metabolic and glycemic outcomes. In this mini-review, we describe complementary therapies successfully used in diabetes, identify current evidence-based practice gaps, and provide recommendations for incorporating complementary therapies into diabetes care.

We thoroughly searched relevant PubMed and Google Scholar studies from 2004 to 2024. Our inclusion criteria were clinical trial studies using the search terms "diabetes self-management" OR "metabolic outcomes" OR "diabetes" OR "type of complementary therapy (music therapy, mindfulness, yoga or art therapy) OR population (type 1 diabetes, type 2 diabetes, prediabetes, diabetes)."

We synthesized the evidence to determine complementary therapies (music therapy, mindfulness, yoga, or art therapy) that benefit individuals with diabetes. Findings showed that complementary therapies support diabetes-related psychological and cardiometabolic outcomes and enhance the Association of Diabetes Care and Education Specialists 7 Self-Care Behaviors for diabetes self-management, specifically healthy coping, monitoring, reducing risks, and problem-solving. Critical gaps included the lack of large-scale randomized controlled trials in North American diabetes self-management education programs.

Complementary therapies have positive psychological and physiological health benefits for people living with diabetes, yet more randomized controlled trials are needed to assess their effectiveness on a large scale. In the interim, complementary therapies can be integrated into diabetes education, specifically as adjunctive hands-on therapies to enhance self-management behaviors and meet self-management goals.

The objective of this review will be to synthesize the effectiveness of school-based programs for type 2 diabetes mellitus (T2DM) prevention for school children and adolescents.

Schools function as a fundamental platform for communicating health-related knowledge, such as information on preventing chronic diseases such as diabetes. However, the effectiveness of school-based programs for preventing T2DM in children and adolescents remains unclear.

This review will consider both experimental and quasi-experimental study designs, including randomized controlled trials, cluster randomized controlled trials, non-randomized controlled trials, before and after studies, and interrupted time-series studies. School children and adolescents aged 6 to 18 years (in Grades 1 to 12) of any ethnicity will be considered. This review will consider studies on T2DM prevention and education programs in school settings. Comparators will include no treatment, standard care, or waitlist controls, with outcomes covering diabetes risk factors, knowledge, health literacy, insulin sensitivity, fasting blood glucose, and glycated hemoglobin. These parameters will be assessed using validated instruments.

This review will follow the JBI methodology for systematic reviews of effectiveness. The databases to be searched will include MEDLINE, CINAHL, Embase, PsycINFO, and Scopus. Two independent reviewers will select studies, critically appraise them using the standard JBI critical appraisal instruments, and extract data. Studies will be pooled in a meta-analysis or presented narratively. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach will be used to grade the certainty of the evidence.

PROSPERO CRD42024499998.

Diabetes self-management education (DSME) is endorsed by the American Diabetes Association (ADA) as an essential component of diabetes management. However, the utilization of DSME remains limited in the USA. This study aimed to investigate current DSME participation among the older population and to identify comprehensive factors of DSME engagement through employing various machine learning (ML) models based on a US nationally representative survey linked to claims data.

Data from the Medicare Current Beneficiary Survey were employed, and this study included data on US Medicare beneficiaries with diabetes from 2017 to 2019. Comprehensive variables following the National Institute on Aging Health Disparities Research Framework were employed to ensure a comprehensive evaluation of factors associated with DSME using five common ML approaches.

In our study, 37.94% of participants received DSME after the application of inclusion and exclusion criteria. A total of 95 variables were used and all ML models achieved accuracy scores exceeding 70%. Random forest had better predictive performance, with an accuracy of 85%. Seventy-four of 95 variables were identified as key variables. Racial/ethnic disparities in predictors for DSME were identified in this study.

This study identified comprehensive and critical factors associated with DSME engagement from biological, behavioral, sociocultural, and environmental domains using different ML models, as well as related racial/ethnic disparities. Aligning these findings with the DSME National Standards from the ADA would enhance the guidelines' effectiveness, promoting tailored and equal diabetes management approaches that cater to diverse races/ethnicities.

Individuals with type 2 diabetes and eating disorders must change their eating behaviors, which are often influenced by psychological factors like depression and anxiety. To efficiently assess daily psychological status, the present study aimed to develop computerized adaptive tests (CAT) based on item response theory (IRT).

Individuals with depression, anxiety disorders, eating disorders, type 2 diabetes, and healthy persons participated in the study. Participants completed six questionnaires, including momentary and most recent one-week depression, anxiety, and positive affect. We selected items meeting the IRT assumptions, applied a graded response model, and conducted CAT simulations.

Across all six questionnaires, the CAT simulations used a smaller number of items and exhibited substantial Pearson's correlation coefficients exceeding 0.95 between simulated and full item-set mood status estimates. These estimated mood scores demonstrated satisfactory concurrent validity with the Hospital Anxiety and Depression Scale and sufficient discriminant validity between the clinical group and healthy controls.

These findings suggest that these scales offer efficient measurement of the mood status of individuals with an eating disorder or type 2 diabetes.

The role of antithrombotic therapy in prognosticating patients with coronary heart disease (CHD) is crucial. This study evaluated the Knowledge, Attitude, and Practice (KAP) of CHD patients regarding antithrombotic therapy.

This cross-sectional study distributed questionnaires to collect data. Participants' demographic information was recorded, and their KAP scores were assessed. The Self-Efficacy for Appropriate Medication Use Scale (SEAMS) measured self-efficacy.

The study comprised 639 individuals. The median scores were as follows: knowledge score 8 (IQR 6-10), attitude score 25 (IQR 23-27), and practice score 22 (IQR 20-24). Notably, up to 70% of patients incorrectly responded to questions about dosage and administration of antithrombotic agents, and approximately 40% lacked awareness of the treatment's importance and side effects. Low practice scores were independently linked to rural residence, low attitude scores, and poor self-efficacy. Furthermore, Predictive factors for low self-efficacy included being underweight, having a high family income, a short medical history, and low attitude scores.

The surveyed patients with CHD exhibited good attitudes, practices, and self-efficacy but demonstrated only median knowledge levels toward antithrombotic therapy, especially about the importance and precautions associated with antithrombotic treatment. Therefore, initiatives aimed at improving adherence to antithrombotic therapy among CHD patients should focus on the knowledge gaps, especially for patients in rural areas. Improving the patient KAP could help improve the physician-patient interaction.

Black adults disproportionately experience poor glycemic control and medication nonadherence, yet few diabetes self-management programs address their unique health beliefs, provider mistrust and sociocultural barriers to taking diabetes medications. This 6-month pilot randomized feasibility trial compared a culturally tailored diabetes self-management program, incorporating beliefs about diabetes, mistrust, and race-congruent peer support to a standard diabetes program.

An embedded mixed methods design examined the feasibility of the pilot trial, including recruitment, retention, intervention adherence and participant acceptability. Data were collected through participant self-reported questionnaires, field notes, semi-structured interviews, and focus groups. Qualitative content analysis inductively explored participants' feedback on the program, participation barriers and potential strategies to overcome the challenges. Mixed methods integration was implemented using a side-by-side joint display to compare, synthesize and interconnect the quantitative and qualitative results across all feasibility domains.

Thirteen participants (93%) completed the trial, demonstrating high adherence and retention. Community outreach and a prerequisite orientation using motivational interviewing were feasible and appropriate to recruit potential participants. Participants expressed high satisfaction and acceptability, highlighting the importance of peer support, cultural relevant content and a safe space for sharing experiences. Barriers to participation were identified including schedule conflicts and difficulties in engagement.

Future large-scale effectiveness trials should consider combining multimedia into recruitment methods, tailoring the program to address medication-taking goals, and addressing social and environmental barriers to support sustained lifestyle changes.

The purpose of the study was to examine the extent to which adults with diabetes engage in self-management practices to lower their blood glucose levels and determine factors associated with these engagements.

The study analyzed data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). The sample included 1171 adults ages 20 and older with a laboratory A1C level of 6.5% or greater. The statistical analyses used included descriptive, chi-square, and logistic regression.

The study revealed that 36% of participants used insulin, and 28% visited a diabetes specialist yearly. Additionally, 68% took medication to lower blood glucose, and 65% monitored their blood glucose daily. Although 86% checked their A1C level annually, only 14% adhered to a diabetes diet plan. A small percentage of respondents (11%) reported engaging in recreational activities at least 5 days a week. The engagement of American adults with diabetes in self-management practices is associated, to varying extents, with the type of diabetes diagnosis, diabetes status, and social determinants of health in adults with diabetes.

The recommended self-management practices among adults with diabetes in the United States are not fully embraced and are associated with several factors. Study findings also indicated that the numbers of undiagnosed and dated-diagnosed diabetes as prediabetes continue to be a problem.

Evidence over the past few decades have proven the benefits and cost savings of diabetes self-management education and support (DSMES) and medical nutrition therapy (MNT). Yet, the benefits continue to be underutilized. Little evidence is available to definitively assess insurance coverage for both services. Strategies are presented to more efficiently assess coverage as well as Identify methods to increase referrals and more effectively bill for both services.

Estimated statistics for both type 1 and type 2 diabetes reveal increases globally, especially in those under 20 and over 65. Individuals meeting the current A1C guidelines are still well below current recommendations. The economic costs of diabetes continue to rise. Both DSMES and MNT are effective, cost-saving methods that are critical components to the ongoing care of people with diabetes. While insurance coverage does vary based on each specific type, billing correctly and following the requirements for NSDSMES are essential to receive appropriate reimbursement for services.

This study aimed to determine the incidence of diabetic retinopathy (DR) and predictors among adult patients with diabetes in central and southern Ethiopia.

A hospital-based retrospective cohort study was conducted.

The study was conducted in selected public hospitals in central and southern Ethiopia.

A total of 376 adult participants newly diagnosed with diabetes were enrolled from 2015 to 2023, and the follow-up date was from the date of enrolment to the development of events.

The data were collected by reviewing their records and entered in EpiData V.4.6.0.2 and exported to STATA V.14 for analysis. Descriptive statistics of the variables were obtained. The Cox proportional hazards assumption was checked. The Cox regression model was used to determine the median time to develop DR and identify predictors of DR. Bivariable and multivariable analyses were done; variables with a value of p<0.05 and a corresponding 95% CI in the final model were used. The model of adequacy was checked.

Records of a total of 376 adult patients with diabetes were reviewed with a mean baseline age (±SD) of 34.8±10 years. Of the total study participants, half (189, 50.3%) were female. A total of 376 adult patients with diabetes were followed for 45 752 person-months (PMs). Overall, the incidence rate was 11.7 per 1000 PMs of observation. Positive proteinuria (adjusted HR (AHR)=2.19; 95% CI 1.18 to 4.08), hypertension (HTN) (AHR=2.23; 95% CI 1.39 to 3.55) and type 2 diabetes mellitus (AHR=2.89; 95% CI 1.19 to 7.05) were independently significant predictors of DR.

The overall incidence rate of DR (type 1 and type 2) was high. Adult patients with diabetes with HTN, proteinuria and type of diabetes were independent predictors of DR. The best strategy to protect our eyesight from DR is to control high glucose level and giving due attention to high-risk individuals with diabetes. Thus, health professionals and concerned health authorities should target these factors in their efforts to prevent DR among diabetics.

By 2045, the global population of people with diabetes (PWD) is projected to reach 783 million. Health education tools are needed to enhance glycemic management among PWD.

This study evaluated the effects of a diabetes conversation map (CM) intervention on glycated hemoglobin (HbA1c) and examined the mediating roles of health behavior improvements among PWD in Taiwan.

A large randomized controlled trial (N = 602) investigated: (1) whether an additional 1-hour, theory-driven CM intervention (N = 300), compared with usual shared-care service only (N = 302), could significantly better improve PWD's HbA1c at 3-month posttest, and (2) whether the CM intervention's effects on HbA1c reduction were mediated through desired changes in diet and exercise health behaviors between pretest and 3-month posttest.

Multivariate linear autoregression analysis demonstrated that controlling for baseline levels, the CM group exhibited significantly lower HbA1c (β = -0.101) at 3-month posttest than the control group. In addition, the CM group showed significantly greater improvements in both diet (β = 0.261) and exercise (β = 0.239) health behaviors between the pretest and 3-month posttest, compared with the control group. Further mediation analysis revealed that the CM intervention's effects on HbA1c reduction were primarily mediated through improvements in diet (β = -0.126, P < .001), rather than improvements in exercise (β = -0.023, P = .465).

Integrating brief, single-session CM interventions, as described in this study, into existing diabetes shared-care frameworks may effectively enhance diet and exercise health behaviors and thereby improve HbA1c management among PWD.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Background/Objectives: This study aimed to adapt evidence-based diabetes self-management education and support (DSMES) into a faith-based (FB) context for Hispanic communities and compare its effectiveness to a faith-placed (FP) approach using the church as a venue for DSMES delivery. Methods: A cluster-randomized trial was conducted among adults with type 2 diabetes from predominantly Hispanic churches. The churches were assigned to either the FB Group (nine churches, n = 146) or the FP Group (seven churches, n = 125). The FB Group, led by trained lay health leaders, received a health sermon, a six-session DSMES program, and a seven-session Healthy Bible Study. The FP Group, led by outside health professionals, received the same six-session DSMES and a seven-session partial attention control curriculum. Key outcomes, including hemoglobin A1c (HbA1c), waist circumference (WC), diabetes distress, self-care activities, and self-efficacy, were assessed at baseline, 6, 9, and 12 months. Results: The FB Group had lower HbA1c levels than the FP Group at 6 months (-0.3%, p < 0.01), with no within-group differences post-intervention. No significant between-group differences were found for other outcomes. Within-group comparisons from baseline showed that both groups reduced WC at 9 and 12 months. Both groups showed reductions in diabetes distress and increased self-efficacy at all time points post-intervention (p < 0.05). The FB Group increased self-care scores at all time points post-intervention, while the FP Group increased at 9 and 12 months. Conclusions: DSMES can be effectively delivered in church settings by trained lay leaders or health professionals in Hispanic communities. Adding a spiritual dimension to DSMES may enhance outcomes.

The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This guideline serves as an update to the 2022 ISPAD consensus guideline on staging for type 1 diabetes (T1D). Key additions include an evidence-based summary of recommendations for screening for risk of T1D and monitoring those with early-stage T1D. In addition, a review of clinical trials designed to delay progression to Stage 3 T1D and efforts seeking to preserve beta-cell function in those with Stage 3 T1D are included. Lastly, opportunities and challenges associated with the recent US Food and Drug Administration (FDA) approval of teplizumab as an immunotherapy to delay progression are discussed. The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This guideline serves as an update to the 2022 ISPAD consensus guideline on staging for type 1 diabetes (T1D). Key additions include an evidence-based summary of recommendations for screening for risk of T1D and monitoring those with early-stage T1D. In addition, a review of clinical trials designed to delay progression to Stage 3 T1D and efforts seeking to preserve beta-cell function in those with Stage 3 T1D are included. Lastly, opportunities and challenges associated with the recent US Food and Drug Administration (FDA) approval of teplizumab as an immunotherapy to delay progression are discussed.

This study aimed to assess the perceptions towards chronic disease self-management and its program among patients with chronic diseases.

A cross-sectional study using pre-validated questionnaire was conducted among patients with chronic diseases at outpatient pharmacy in a hospital in Penang, Malaysia from April to June 2021.

Of 270 patients participated in this study, 87.8% were interested in chronic disease self-management. Nonetheless, they faced common barriers including time constraint (71.1%), no health monitoring devices (44.1%) and poor health knowledge (43.0%). More than half of the patients expressed that having a better knowledge of the disease and its treatment (64.1%), getting supportive guidance from healthcare providers (59.6%) and having monitoring devices (58.1%) were the top three facilitators to self-management. The patients preferred chronic disease self-management programs that (a) discuss the topic of motivation (b) are available both as mobile applications and hands-on training, (c) individual session, (d) range between 1 and 5 sessions with a duration of 1 to 2 h/session, (e) occurring on monthly basis, (f) conducted by doctor or healthcare professionals and (g) fully sponsored by government or at affordable fee.

The findings serve as pre-requisite step in future design and development of chronic disease self-management program, targeting the patients' needs and preferences.

Online Diabetes Self-Management Education and Support (DSMES) offers people with type 2 diabetes mellitus (T2DM) accessible and tailored education, utilising innovative and interactive tools such as social media to enhance engagement and outcomes. Despite the demonstrated effectiveness of social media-based DSMES in improving health outcomes, there remains a significant gap in qualitative insights regarding participants' experiences.

This study aims to explore the experiences of people with T2DM who are using a newly developed WhatsApp-based DSMES.

A qualitative descriptive approach was adopted. Data consisted of 23 semi-structured phone interviews with people with T2DM who had received the WhatsApp-based DSMES. Interviews were analysed using qualitative content analysis. The present study adheres to the COREQ guidelines.

Four themes emerged from the data: (1) acceptability of the programme, (2) flexible accessibility of the programme, (3) promoting healthy lifestyle and (4) future preferences for the programme use.

This study explored the experiences of people with T2DM participating in a 6-week WhatsApp-based DSMES. The findings indicated that the programme was acceptable, accessible, effectively revealing necessary self-management knowledge and skills, and provided essential support from professional and peer. The study also indicated that WhatsApp-based programmes could be feasibly implemented in various populations, healthcare settings and communities to support people with T2DM globally.

Diabetes structured education programs have been demonstrated to effectively improve glycemic control and self-management behaviors. However, evidence on the health economic evaluation of these programs is limited.

To systematically review the health economic evaluation of structured education programs for patients with type 1 and type 2 diabetes mellitus.

The English databases PUBMED, WEB OF SCIENCE, OVID, COCHRANE LIBRARY, EMBASE, and EBSCO, along with the Chinese databases CNKI, WANFANG, VIP, and SINOMED, were searched from their inception to September 2024. The quality of the literature was assessed using the CHEERS 2022 checklist. A descriptive analysis was performed on the studies included in the review, with all currencies converted to international dollars. An incremental cost-effectiveness ratio of less than one times the per capita GDP was considered highly cost-effective, while a ratio between one and three times the per capita GDP was considered cost-effective.

A total of 28 studies from upper-middle-income and high-income countries were included. The average quality score of the included studies was 18.6, indicating a moderate level of reporting quality. Among these, eleven studies demonstrated that diabetes structured education programs were highly cost-effective and twelve were found to be cost-effective. In contrast, three studies were deemed not cost-effective, and two studies provided uncertain results. The ranges of the incremental cost-effectiveness ratios for short-term, medium-term, and long-term studies were - 520.60 to 65,167.00 dollars, -24,952.22 to 14,465.00 dollars, and -874.00 to 236,991.67 dollars, respectively.

This study confirms the cost-effectiveness of structured education programs for diabetes and highlights their importance for patients with type 2 diabetes who have HbA1c levels exceeding 7% and are receiving non-insulin therapy. Additionally, the potential advantages of incorporating telecommunication technologies into structured diabetes education were emphasized. These findings offer valuable insights and guidance for decision-making in diabetes management and clinical practice, contributing to the optimization of medical resource allocation and the improvement of health status and quality of life for patients.

Living with type 1 diabetes requires burdensome and complex daily diabetes self-management behaviors. This study aimed to determine the association between integrated behavior performance and HbA1c, while identifying the behavior with the most significant impact on HbA1c.

A simple and feasible questionnaire was used to collect diabetes self-management behavior in patients with type 1 diabetes (n = 904). We assessed six dimensions of behavior performance: continuous glucose monitor (CGM) usage, frequent glucose testing, insulin pump usage, carbohydrate counting application, adjustment of insulin doses, and usage of apps for diabetes management. We evaluated the association between these behaviors and HbA1c.

In total, 21.3% of patients performed none of the allotted behavior, while 28.5% of patients had a total behavior score of 3 or more. 63.6% of patients with a behavior score ≥ 3 achieved HbA1c goal, contrasting with only 30.4% of patients with a behavior score of 0-1. There was a mean 0.54% ± 0.05% decrease in HbA1c for each 1-unit increase in total behavior score after adjustment for age, family education and diabetes duration. Each behavior was independently correlated with a lower HbA1c level, with CGM having the most significant effect on HbA1c levels.

Six optimal self-management behaviors, especially CGM usage, were associated with improved glycemic control, emphasizing the feasibility of implementing a simplified version of DSMES in the routine clinical care.

ClinicalTrials.gov Identifier: NCT03610984.

Approximately 10-15 % of individuals with type 2 diabetes have persistently poorly-controlled diabetes mellitus (PPDM) despite receiving available care, and frequently have comorbid hypertension. Mobile monitoring-enabled telehealth has the potential to improve outcomes in treatment-resistant chronic disease by supporting self-management and facilitating patient-clinician contact but must be designed in a manner amenable to real-world use.

Expanding Technology-Enabled, Nurse-Delivered Chronic Disease Care (EXTEND) is an ongoing randomized trial comparing two 12-month interventions for comorbid PPDM and hypertension: 1) EXTEND, a mobile monitoring-enabled self-management intervention; and 2) EXTEND Plus, a comprehensive, nurse-delivered telehealth program incorporating mobile monitoring, self-management support, and pharmacist-supported medication management. Both arms leverage a novel platform that uses existing technological infrastructure to enable transmission of patient-generated health data into the electronic health record. The primary study outcome is difference in HbA1c change from baseline to 12 months. Secondary outcomes include blood pressure, weight, implementation barriers/facilitators, and costs.

Enrollment concluded in June 2023 following randomization of 220 patients. Baseline characteristics are similar between arms; mean age is 54.5 years, and the cohort is predominantly female (63.6 %) and Black (68.2 %), with a baseline HbA1c of 9.81 %.

The EXTEND trial is evaluating two mobile monitoring-enabled telehealth approaches that seek to improve outcomes for patients with PPDM and hypertension. Critically, these approaches are designed around existing infrastructure, so may be amenable to implementation and scaling. This study will promote real-world use of telehealth to maximize benefits for those with high-risk chronic disease.

Diabetes self-management education and support can be effectively and efficiently delivered in primary care in the form of shared medical appointments (SMAs). Comparative effectiveness of SMA delivery features such as topic choice, multi-disciplinary care teams, and peer mentor involvement is not known.

To compare effects of standardized and patient-driven models of diabetes SMAs on patient-level diabetes outcomes.

Pragmatic cluster randomized trial.

A total of 1060 adults with type 2 diabetes in 22 primary care practices.

Practice personnel delivered the 6-session Targeted Training in Illness Management (TTIM) curriculum using either standardized (set content delivered by a health educator) or patient-driven SMAs (patient-selected topic order delivered by health educators, behavioral health providers [BHPs], and peer mentors).

Outcomes included self-reported diabetes distress and diabetes self-care behaviors from baseline and follow-up surveys (assessed at 1st and final SMA session), and HbA1c, BMI, and blood pressure from electronic health records. Analyses used descriptive statistics, linear regression, and linear mixed models.

Both standardized and patient-driven SMAs effectively improved diabetes distress, self-care behaviors, BMI (- 0.29 on average), and HbA1c (- 0.45% (mmol/mol) on average, 8.3 to 7.8%). Controlling for covariates, there was a small, significant effect of condition on overall diabetes distress in favor of standardized SMAs (F(1,841) = 4.3, p = .04), attributable to significant effects of condition on emotion and regimen distress subscales. There was a small, significant effect of condition on diastolic blood pressure in favor of standardized SMAs (F(1,5199) = 4.50, p = .03). There were no other differences between conditions.

Both SMA models using the TTIM curriculum yielded significant improvement in diabetes distress, self-care, and HbA1c. Patient-driven diabetes SMAs involving BHPs and peer mentors and topic selection did not lead to better clinical or patient-reported outcomes than standardized diabetes SMAs facilitated by a health educator following a set topic order.

NCT03590041.

The global rise in diabetes prevalence poses a significant challenge to healthcare providers, stimulating interest in digital interventions such as educational games. However, the impact and availability of research-developed diabetes games remain uncertain. This scoping review aimed to provide a comprehensive overview of serious games for diabetes, encompassing their availability, characteristics and health effects. Through an electronic search in multiple databases, a total of 21 articles addressing 23 games were included in the literature review. The majority of these games were inaccessible outside of research settings, despite demonstrating positive effects on various aspects of diabetes management, including knowledge, physical activity, self-management, mental well-being, and HbA1c levels. Most games were designed for mobile phones, targeting both children and adults. A subsequent app store search revealed 13 additional diabetes games, however nearly none (7.7%) of these underwent research scrutiny, leaving their expected effects uncertain. The disparity between evidence-based games and those available in app stores underscores the need for bridging this gap to ensure the availability of effective digital games for diabetes management worldwide.

The purpose of this study was to examine the relationships between symptom burden and sleep problems and the role of depressive symptoms on these relationships in middle-aged and older adults with type 2 diabetes.

The study employed a cross-sectional, correlational design with secondary analysis. De-identified data sets from three original studies were combined. A total of 189 men and women with type 2 diabetes were recruited using convenience sampling in midwestern United States. Symptom burden, sleep impairment and sleep disturbance, depressive symptoms, demographics, and diabetes-related variables were assessed. The participants were grouped into glucose-controlled and -uncontrolled groups to examine a multigroup effect. Multigroup path analyses were conducted.

The results indicated that symptom burden had direct and indirect effects through depressive symptoms on sleep disturbance in the controlled group, whereas only a direct effect was found in the uncontrolled group. For sleep-related impairment, significant direct and indirect effects of symptom burden were found via depressive symptoms in both groups, and the strength of the effects on each path differed between the groups.

Diabetes symptom burden was associated with sleep disturbance and sleep-related impairment in middle-aged and older adults with diabetes. A different approach should be considered for sleep management according to their A1C levels, and depressive symptoms can be a therapeutic target to treat sleep problems in the population.

The aim of this study is to prospectively evaluate whether individual and group Therapeutic Patient Education (TPE) can reduce the need to intensify treatment of diabetes and hypertension in newly diagnosed type 2 diabetic patients.

A total of 937 patients were recruited and followed-up for 42.7 ± 21.5 months. TPE was a structured comprehensive education delivered by trained nurses: 322 patients received individual TPE (ITPE), 291 underwent group TPE (GTPE), and 324 were in Usual Care (UC). The primary endpoints were intensification of diabetes treatment and intensification of hypertension treatment.

The rate of diabetes treatment intensification was 40.1% in patients receiving ITPE, 47.8% in patients undergoing GTPE, and 64.2% in patients in UC (p < 0.001). The rate of hypertension treatment intensification was 24.2% in patients following ITPE, 31.3% in patients receiving GTPE, and 41.0% in patients in UC (p < 0.001). Multivariate analysis showed that both ITPE and GTPE were associated with reduced intensification of diabetes (ITPE: HR:0.51; 95% IC:0.40-0.64; p < 0.001 - GTPE: HR:0.46; 95% IC:0.44-0.70; p < 0.001) and hypertension medication (ITPE: HR:0.45; 95% IC:0.34-0.61; p < 0.001 - GTPE: HR:0.49; 95% IC:0.38-0.65; p < 0.001). The association was independent of age, sex, BMI, HbA1c, and presence of hypertension at baseline.

TPE, delivered as both individual and group sessions, represents an effective tool to reduce the need to intensify treatment of both diabetes and hypertension. Therefore, it can ensure better control of diabetes and hypertension with fewer medications. This could reduce adverse effects and costs and improve quality of life and medication taking in patients with type 2 diabetes.

Uncontrolled blood glucose may lead to serious complications in patients with type two diabetes mellitus (T2DM). Patients may not have the support, motivation, or encouragement to adhere to the lifestyle changes necessary to control their T2DM.

More than 75% of the primary care clinic's patients are diagnosed with T2DM, with most patients at the practice site having an average hemoglobin A1c (HbA1c) level of 8.5%. The primary care clinic did not use text messaging to disseminate diabetes self-management education and support (DSMES) as outlined in Standard 4 of the American Diabetic Association's (ADA) clinical practice guideline.

This evidence-based quality improvement project was conducted in a rural outpatient primary care clinic to determine whether implementing the ADA's 2022 National Standards for DSMES using text messaging would affect HbA1C levels among adult patients with T2DM.

Patients were sent weekly text messages over a 12-week period. Text messages contained information promoting self-care, tips about healthy diet, exercise reminders, instructions about proper blood glucose monitoring, and reminders about medication adherence.

A total of 160 patients were included. A paired-sample t -test showed a reduction in HbA1c levels after the intervention from baseline (M = 7.53, SD = 1.72) to postimplementation (M = 6.91, SD = 0.89), t (159) = 11.88, p = .001.

Based on the results, implementing the ADA's National Standards for DSMES Standard 4 may affect HbA1c levels in this population.

Given the proven benefits of screening to reduce diabetic ketoacidosis (DKA) likelihood at the time of stage 3 type 1 diabetes diagnosis, and emerging availability of therapy to delay disease progression, type 1 diabetes screening programmes are being increasingly emphasised. Once broadly implemented, screening initiatives will identify significant numbers of islet autoantibody-positive (IAb+) children and adults who are at risk of (confirmed single IAb+) or living with (multiple IAb+) early-stage (stage 1 and stage 2) type 1 diabetes. These individuals will need monitoring for disease progression; much of this care will happen in non-specialised settings. To inform this monitoring, JDRF in conjunction with international experts and societies developed consensus guidance. Broad advice from this guidance includes the following: (1) partnerships should be fostered between endocrinologists and primary-care providers to care for people who are IAb+; (2) when people who are IAb+ are initially identified there is a need for confirmation using a second sample; (3) single IAb+ individuals are at lower risk of progression than multiple IAb+ individuals; (4) individuals with early-stage type 1 diabetes should have periodic medical monitoring, including regular assessments of glucose levels, regular education about symptoms of diabetes and DKA, and psychosocial support; (5) interested people with stage 2 type 1 diabetes should be offered trial participation or approved therapies; and (6) all health professionals involved in monitoring and care of individuals with type 1 diabetes have a responsibility to provide education. The guidance also emphasises significant unmet needs for further research on early-stage type 1 diabetes to increase the rigour of future recommendations and inform clinical care.

People with diabetes receiving inpatient rehabilitation have multiple unique care needs. Although the condition, event, or disability resulting in admission to an inpatient rehabilitation facility (IRF) may not have a causal relationship with chronic conditions such as diabetes, the condition precipitating referral to IRF care may increase a person's risk for worsening cardiometabolic disease. Furthermore, diabetes management in the IRF setting may be complicated by stress hyperglycemia from illness and/or drug-induced hyperglycemia from the use of glucocorticoids or other offending medications. The availability of a multidisciplinary team of clinicians and therapists in the IRF setting holds great opportunity for development of robust diabetes care and education programs to optimize therapy, teach or reinforce diabetes self-management survival skills, and facilitate safe transitions of care to individuals' next setting of care.

Poorly controlled diabetes is a principal cause of end stage renal disease (ESRD), generating an estimated 44% of new cases. Diabetes self-management education and support (DSMES) has been documented to reduce adverse outcomes such as ESRD. Helping patients better manage their condition could ultimately reduce ESRD prevalence.

We compared the county-level availability of DSMES and dialysis as of November 2022 sorted by the estimated prevalence of diabetes among residents aged 18 years or older. The locations of DSMES programs and ESRD dialysis facilities were obtained from 2 professional organizations and the Centers for Medicare & Medicade Services. Estimated diabetes prevalence was obtained from the Centers for Disease Control and Prevention's PLACES data set. Counties were considered to have high diabetes prevalence if they fell into the top quartile for diabetes prevalence in 2019 (≥14.4% of adults). Analyses were conducted in 2023.

DSMES was available in 41.0% of counties but in only 20.7% of counties with high diabetes prevalence versus 47.9% of low prevalence counties. Dialysis facilities were present in 59.2% of all counties, in 52.8% of all high diabetes prevalence counties, and in 61.4% of other counties. DSMES availability was linked to the presence of a hospital in the county, with only 6.3% of counties without a hospital offering the service.

DSMES could play a role in reducing the prevalence of ESRD. Public health professionals need to be aware of the differing levels of local availability of this service and work to develop partnerships to provide DSMES in high-prevalence areas not currently served.

Hispanic adults with type 2 diabetes (T2D) are more likely to develop complications and die from the disease than the US general population. Digital storytelling interventions are narrative-based videos elicited through a community-based participatory research approach to surface the authentic voices of participants overcoming obstacles to health-promoting behaviors that perpetuate health inequities; research on the effect of digital storytelling on T2D outcomes among Hispanic adults is lacking.

To assess the impact of a digital storytelling intervention on glycemic control and its acceptability among Hispanic patients with poorly controlled T2D.

This was a multicenter, randomized clinical trial conducted within 2 primary care networks in Minnesota and Arizona among Hispanic adults with poorly controlled T2D (hemoglobin A1c level ≥8%). Enrollment and follow-up were conducted between February 14, 2019, and November 1, 2023.

The intervention group viewed a 12-minute digital storytelling video. The video included 4 Spanish-language stories that reinforced 4 diabetes self-management behavioral goals (healthful diet for diabetes, physical activity, medication adherence, and glucose self-monitoring). The control group received printed, culturally tailored T2D education materials.

The primary outcome was the mean change from baseline to 3 months for hemoglobin A1c levels, adjusting for baseline hemoglobin A1c, age, gender, education, and income. Acceptability and narrative quality of the intervention were assessed through questionnaires.

There were 451 study participants, with 227 (mean [SD] age, 54.3 [9.3] years; 158 [69.3%] women) randomized to the intervention group and 224 (mean [SD] age, 54.5 [9.1] years; 156 [69.3%] women) to the control group. Of these, 390 completed 3-month follow-up of the primary outcome (86% retention). There was a small improvement in the mean (SD) hemoglobin A1c level in the intervention group compared with the control group in the adjusted model (9.1% [1.7] to 8.4% [1.6] vs 9.4% [1.8] to 8.8% [2.0]; P = .04] but not in the unadjusted model. Acceptability and narrative quality of the intervention were high.

In this randomized clinical trial, a digital storytelling intervention developed with and for Hispanic adults with T2D was highly acceptable and feasibly implemented within primary care settings and resulted in a modest improvement of glycemic control. This was a highly scalable intervention that may be integrated into clinical practice as part of a longitudinal diabetes self-management program for Hispanic adults.

ClinicalTrials.gov Identifier: NCT03766438.