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Redefining diabetes and the concept of self-management from a patient's perspective: implications for disease risk factor management.

ABSTRACT: The colliding epidemics of non-communicable diseases including diabetes with chronic infectious diseases in Sub-Saharan Africa requires contextualized innovative disease management strategies. This qualitative study conducted in a peri-urban township near Cape Town, South Africa aimed to identify and gain in-depth understanding of contextual and environmental issues pertinent to the patient that could influence Type 2-diabetes mellitus (T2DM) care and self-management. Participants included purposively sampled diabetics or pre-diabetics from the community, PURE study database, facility health club and health care providers. Data collection employed in-depth interviews, focus group discussions (FGDs) using structured interviews and FGD topic guides. Thematic data analysis was done to identify recurrent themes. Themes identified: knowledge and awareness about T2DM; health-seeking behaviour; weight perceptions; healthy lifestyles; self-management; health education needs and health care provider experiences. Patients defined T2DM as a physically and emotionally dangerous disease caused by socio-cultural factors, influenced by the sufferers' food and socio-cultural environment with significance placed on physical, social and emotional effects of T2DM diagnosis. Patient-centred definition of T2DM is key to enhancing T2DM self-management. Patients suggested that personally rewarding benefits of physical activity and healthy diet such as anti-ageing, brain boosting, energy boosting which are commonly harnessed by food, tobacco and beauty industry should be considered in T2DM self-management strategies.

SUBMITTER: Masupe TK

PROVIDER: S-EPMC6018984 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Patients' perspective on self-management: type 2 diabetes in daily life.

Project description:BackgroundThe number of type 2 diabetes mellitus (T2DM) patients and related treatment costs are rapidly increasing. Consequentially, more cost-effective and efficient strategies for the treatment of T2DM are needed. One such strategy is improving patients' self-management. As patients are more and more expected to self-manage their disease, it is important to provide them with suitable self-management support. This way, success of self-management will increase and complications and related costs of T2DM can be reduced. Currently, self-management support is developed mainly from the perspective of health professionals and caregivers, rather than patients. This research focused on gaining a better understanding of patients' perspectives on self-management and support.MethodsSemi-structured interviews, preceded by preparatory assignments, were conducted with ten patients with T2DM treated in Dutch primary care.ResultsWe found that patients experience 'active' self-management when recently diagnosed. As time progresses and no problems occur, patients do not experience their disease-related behaviour as self-management. Diabetes has 'just' become part of their daily life, now including new routines taking diabetes into account.ConclusionsWith this knowledge, support solutions can be designed and implemented that better fit the needs, preferences and abilities of patients with T2DM.

| S-EPMC6714441 | biostudies-literature

Outcomes from a multiple risk factor diabetes self-management trial for Latinas: ¡Viva Bien!

Project description:BackgroundCulturally appropriate interventions are needed to assist Latinas in making multiple healthful lifestyle changes.PurposeThe purpose of this study was to test a cultural adaptation of a successful multiple health behavior change program, ¡Viva Bien!MethodsRandom assignment of 280 Latinas with type 2 diabetes to usual care only or to usual care + ¡Viva Bien!, which included group meetings for building skills to promote the Mediterranean diet, physical activity, stress management, supportive resources, and smoking cessation.Results¡Viva Bien! participants compared to usual care significantly improved psychosocial and behavioral outcomes (fat intake, stress management practice, physical activity, and social-environmental support) at 6 months, and some improvements were maintained at 12 months. Biological improvements included hemoglobin A1c and heart disease risk factors.ConclusionsThe ¡Viva Bien! multiple lifestyle behavior program was effective in improving psychosocial, behavioral, and biological/quality of life outcomes related to heart health for Latinas with type 2 diabetes.

| S-EPMC3108326 | biostudies-literature

Links between osteoarthritis and diabetes: implications for management from a physical activity perspective.

Project description:Osteoarthritis (OA) and type 2 diabetes mellitus (T2DM) often coexist in older adults. Those with T2DM are more susceptible to developing arthritis, which has been traditionally attributed to common risk factors, namely, age and obesity. Alterations in lipid metabolism and hyperglycemia might directly impact cartilage health and subchondral bone, contributing to the development/progression of OA. Adequate management of older persons with both conditions benefits from a comprehensive understanding of the associated risk factors. We discuss common risk factors and emerging links between OA and T2DM, emphasizing the importance of physical activity and the implications of safe and effective physical activity.

| S-EPMC4254543 | biostudies-other

An update review of intradialytic hypotension: concept, risk factors, clinical implications and management.

Project description:Intradialytic hypotension (IDH) is a frequent and serious complication of chronic haemodialysis, linked to adverse long-term outcomes including increased cardiovascular and all-cause mortality. IDH is the end result of the interaction between ultrafiltration rate (UFR), cardiac output and arteriolar tone. Thus excessive ultrafiltration may decrease the cardiac output, especially when compensatory mechanisms (heart rate, myocardial contractility, vascular tone and splanchnic flow shifts) fail to be optimally recruited. The repeated disruption of end-organ perfusion in IDH may lead to various adverse clinical outcomes affecting the heart, central nervous system, kidney and gastrointestinal system. Potential interventions to decrease the incidence or severity of IDH include optimization of the dialysis prescription (cool dialysate, UFR, sodium profiling and high-flux haemofiltration), interventions during the dialysis session (midodrine, mannitol, food intake, intradialytic exercise and intermittent pneumatic compression of the lower limbs) and interventions in the interdialysis period (lower interdialytic weight gain and blood pressure-lowering drugs). However, the evidence base for many of these interventions is thin and optimal prevention and management of IDH awaits further clinical investigation. Developing a consensus definition of IDH will facilitate clinical research. We review the most recent findings on risk factors, pathophysiology and management of IDH and, based on this, we call for a new consensus definition of IDH based on clinical outcomes and define a roadmap for IDH research.

| S-EPMC7769545 | biostudies-literature

Patient perspective on barriers in type 2 diabetes self-management: A qualitative study.

Project description:AimTo explore the perceived barriers in Type 2 Diabetes care among patients with diabetes. Design The study adopted a qualitative exploratory-descriptive design.MethodsA semi-structured interview guide was used to collect data from fifteen (15) purposively sampled patients with Type 2 Diabetes at a primary level health facility in the Bono East region. Participants' ages ranged between 42-72 years. The interviews were audio-recorded, transcribed verbatim and analysed using thematic content analysis.ResultsPatients with Type 2 Diabetes encountered a range of barriers in diabetes care. These barriers included lack of knowledge of diabetes dietary management strategies, financial constraints, non-compliance to treatment, lack of glucometers, lack of social support, and increased waiting time at health care facilities. The findings indicate that more education on diabetes and dietary management is required as well as social support from peers, family, and non-governmental organizations.Patient or public contributionDiabetes self-management barriers as revealed by the patients who were participants of this study requires nurses and midwives to ensure that self-management education is well understood by patients and their relatives. This would empower the patients and bring clarity to their confusion about self-care practices.

| S-EPMC10495717 | biostudies-literature

Cross-sectional study about the use of telemedicine for type 2 diabetes mellitus management in Spain: patient's perspective. The EnREDa2 Study.

Project description:ObjectivesThe usefulness of telemedicine (TM) in type 2 diabetes mellitus (T2DM) has been discussed in recent years. The aim of this study is to describe patients' perceptions about TM and to identify preferences on TM resources, in Spain.DesignAn observational, cross-sectional study was conducted using a structured questionnaire.Participants1036 patients with T2DM accepted to participate in the study (response rate: 68%).ResultsBlood glucose values were recorded by 85.9% of the patients while data such as lifestyle habits were only recorded by 14.4% of the patients. Previous experience in TM was reported by 9.8% of the patients, out of which 70.5% were satisfied with its service and 73.5% considered that the use of TM had optimised their T2DM management. However, most of these patients noted aspects to be improved such as user-friendliness (81.4%), interaction with the medical team (78.4%) and time required for recording/transferring data (78.4%). Experienced patients had better perception about TM usefulness than naïve patients for all listed aspects (p<0.05). Among naïve patients, 38.2% expressed their willingness to participate in TM programmes, but only 4.7% were invited to do so. Patients considered that physicians' (77.5%) and pharmacists' (75.5%) encouragement can boost the use of TM.ConclusionsIn Spain, nearly 10% of patients with T2DM have experience with TM and it is well accepted, especially one based on glucometers. Nevertheless, in order to promote TM use, easier and time-saving programmes for patient-physician interaction should be optimised.

| S-EPMC6596977 | biostudies-literature

Delineating the concept of self-management in chronic conditions: a concept analysis.

Project description:ObjectivesSelf-management is a concept frequently used within healthcare but lacks consensus. It is the aim of this study to clarify the concept.DesignConcept analysis according to Walker and Avant, comprises eight steps: select concept, determine purpose, identify uses, determine defining attributes, identify model case, identify additional cases, identify antecedents and consequences and define empirical referents.Sources usedPubMed, Scopus and Web of Science.ResultsTen attributes delineating the concept have been identified and organised into three groups. Group (a): person-oriented attributes: the person must (1) actively take part in the care process, (2) take responsibility for the care process and (3) have a positive way of coping with adversity. Group (b): person-environment-oriented attributes: (4) the person must be informed about the condition, disease and treatment and self-management, (5) should be individualised, which entails expressing needs, values and priorities, (6) requires openness to ensure a reciprocal partnership with healthcare providers and (7) demands openness to social support. Finally, Group (c): summarising attributes: self-management (8) is a lifetime task, (9) assumes personal skills and (10) encompasses the medical, role and emotional management.ConclusionsThe findings of this study recognise the complexity of the concept, but also show the need for further investigation to make the concept more measurable. Clarity about the concept will enhance understanding and facilitate implementation in self-management programmes for chronic conditions.

| S-EPMC6661649 | biostudies-literature

Barriers to and facilitators of diabetes self-management practices in Rupandehi, Nepal- multiple stakeholders' perspective.

Project description:BackgroundSelf-management of diabetes is associated with glycaemic control and adherence to medication and healthy lifestyle practices. There is lack of information on the barriers to and facilitators of diabetes self-management practices in low income country, Nepal. This study aimed to explore the barriers to and facilitators of Type 2 diabetes self-management practices taking multiple stakeholders' perspectives in Nepal.MethodsFour focus group discussions and 16 semi-structured interviews with people with Type 2 diabetes, caregivers, health care providers and health managers were conducted from April to May 2018 in Rupandehi district of Western Nepal. They were audio-recorded, transcribed, and analysed using a thematic approach.ResultsFive main themes emerged that influenced diabetes self-management practices: individual factors, socio-cultural and economic factors, health system and policy factors, availability and accessibility of resources, and environmental factors. The important barriers were: lack of knowledge about diabetes self-management practices, cultural practices, insufficient counselling, lack of guidelines and protocols for counselling, and financial problems. The major facilitators were: motivation; support from family, peers, and doctors; and availability of resources in the community.ConclusionBased on our findings, a multilevel approach is needed to address these barriers and facilitators. These findings will help guide strategies to develop programs that impart knowledge and skills to improve the diabetes self-management practices of people with Type 2 diabetes.

| S-EPMC8243465 | biostudies-literature

Diabetes: Risk factor and translational therapeutic implications for Alzheimer's disease.

Project description:Type 2 diabetes mellitus (T2DM) and Alzheimer's disease (AD) commonly co-occur. T2DM increases the risk for AD by approximately twofold. Animal models provide one means of interrogating the relationship of T2DM to AD and investigating brain insulin resistance in the pathophysiology of AD. Animal models show that persistent hyperglycaemia results in chronic low-grade inflammation that may contribute to the development of neuroinflammation and accelerate the pathobiology of AD. Epidemiological studies suggest that patients with T2DM who received treatment with specific anti-diabetic agents have a decreased risk for the occurrence of AD and all-cause dementia. Agents such as metformin ameliorate T2DM and may have other important systemic effects that lower the risk of AD. Glucagon-like peptide 1 (GLP-1) agonists have been associated with a decreased risk for AD in patients with T2DM. Both insulin and non-insulin anti-diabetic treatments have been evaluated for the treatment of AD in clinical trials. In most cases, patients included in the trials have clinical features of AD but do not have T2DM. Many of the trials were conducted prior to the use of diagnostic biomarkers for AD. Trials have had a wide range of durations and population sizes. Many of the agents used to treat T2DM do not cross the blood brain barrier, and the effects are posited to occur via lowering of peripheral hyperglycaemia and reduction of peripheral and central inflammation. Clinical trials of anti-diabetic agents to treat AD are ongoing and will provide insight into the therapeutic utility of these agents.

| S-EPMC9393901 | biostudies-literature

Patient's Perspective on Management of Chronic Pain Associated With Frequent Emergency Attendances and Psychiatric Diagnoses.

Project description:This case presents a patient's perspective of clinical care and management of chronic pain with a psychiatric component, the latter of which was not initially apparent to both patient and services. It aims to understand patient's experience of illness (part A), its effects on patient's family (part B), experience of care from liaison psychiatry (part C), service provision for persons with chronic pain and its often-neglected mental health aspect (part D), and patient's hopes for the future (part E). Early involvement of liaison psychiatry may target the interaction between physical and psychological factors and provide appropriate interventions across the health-care system.

| S-EPMC6739679 | biostudies-literature

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