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The role of psychological insulin resistance in diabetes self-care management.

ABSTRACT: Aims:The purpose of this study was to identify the role of psychological insulin resistance in the relationship between diabetes self-efficacy and diabetes self-care management in people with diabetes over 65 years of age. Design:A descriptive, cross-sectional design was used. Methods:Participants included 326 patients with type 2 diabetes who were over 65 years of age. Structural equation modelling was performed to estimate the direct and indirect effects of diabetes self-efficacy on diabetes self-care management when psychological insulin resistance was entered as a mediator. Data were collected from May 2015 to January 2017. Results:Diabetes self-efficacy (r = .53, p < .001) and psychological insulin resistance (r = .33, p < .001) were significantly associated with diabetes self-care management, whereas a negative association was found between diabetes self-efficacy and psychological insulin resistance (r = -.16, p < .001). When psychological insulin resistance was entered as a mediator, the association between diabetes self-efficacy and diabetes self-care management was attenuated. Therefore, psychological insulin resistance served as a mediator of diabetes self-care management.

SUBMITTER: Lim A

PROVIDER: S-EPMC7113521 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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The role of psychological insulin resistance in diabetes self-care management.

Lim Ancho A Song Youngshin Y

Nursing open 20200219 3

<h4>Aims</h4>The purpose of this study was to identify the role of psychological insulin resistance in the relationship between diabetes self-efficacy and diabetes self-care management in people with diabetes over 65 years of age.<h4>Design</h4>A descriptive, cross-sectional design was used.<h4>Methods</h4>Participants included 326 patients with type 2 diabetes who were over 65 years of age. Structural equation modelling was performed to estimate the direct and indirect effects of diabetes self- ...[more]

PMID: 32257276

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Project description:ObjectivesSignificant problems with patients engaging with diabetes self-management education (DSME) exist. The role of healthcare professionals (HCPs) has been highlighted, with a lack of enthusiasm, inadequate information provision and poor promotion of available programmes all cited as affecting patients' decisions to attend. However, little is known about HCPs' views towards DSME. This study investigates the views of HCPs towards self-management generally and self-management in the context of DSME more specifically.DesignA qualitative study using semi-structured interviews to investigate HCPs views of type 2 diabetes self-management and DSME. Data were analysed thematically and emergent themes were mapped on to the constructs of Normalisation Process Theory (NPT).SettingTwo boroughs in London, UK.ParticipantsSampling was purposive to recruit a diverse range of professional roles including GPs, practice nurses, diabetes specialist nurses, healthcare assistants (HCAs), receptionists and commissioners of care.ResultsInterviews were conducted with 22 participants. The NPT analysis demonstrated that while a self-management approach to diabetes care was viewed by HCPs as necessary and, in principle, valuable, the reality is much more complex. HCPs expressed ambivalence about pushing certain patients into self-managing, preferring to retain responsibility. There was a lack of awareness among HCPs about the content of DSME and benefits to patients. Commitment to and engagement with DSME was tempered by concerns about suitability for some patients. There was little evidence of communication between providers of group-based DSME and HCPs or of HCPs engaging in work to follow-up non-attenders.ConclusionsHCPs have concerns about the appropriateness of DSME for all patients and discussed challenges to engaging with and performing the tasks required to embed the approach within practice. DSME, as a means of supporting self-management, was considered important in theory, but there was little evidence of HCPs seeing their role as extending beyond providing referrals.

Project description:Purpose:Diabetes self-management education and support (DSME/S) is an effective strategy to improve health outcomes. However, little is known about the impact of formal DSME/S on psychological distress among minority populations. The study purposes were to 1) explore the impact of a culturally tailored DSME/S intervention on psychological distress and diabetes-related outcomes among African-American and Hispanic/Latino participants and 2) examine differences across groups in self-care, self-efficacy, diabetes knowledge, and psychological distress. Methods:Using a pre- and post-test research design, baseline and post-test assessments were conducted at weeks 1 and 7 of the intervention, respectively. Statistical analyses included descriptive statistics for demographic variables and four outcomes (self-care, self-efficacy, knowledge, and psychological distress score), general linear regression analysis of the post-test outcomes, and the Spearman correlation between psychological distress score and the outcomes. Results:Compared to African-American participants (n = 122), Hispanic/Latino participants (n = 137) were significantly younger and less educated. The two groups were comparable in sex, income, and health status. Significant pre- to post-test improvements were seen in each group for self-care, self-efficacy, and psychological distress. Diabetes knowledge had moderate improvement. Hispanics/Latinos had significantly greater post-test self-efficacy and self-care scores compared to African Americans. For both African-American and Hispanic/Latino participants, lower psychological distress scores were generally associated with greater self-efficacy and self-care. Psychological distress scores were not significantly associated with knowledge in African-Amerian or Hispanic/Latino participants. For African Americans only, better health status was significantly associated with less psychological distress. Conclusion:DSME/S programs have the potential to improve psychological health among African Americans and Hispanics/Latinos, which can lead to better diabetes outcomes.

Project description:BackgroundThe impact of lockdown measures can be widespread, affecting both clinical and psychosocial aspects of health. This study aims to assess changes in health services access, self-care, behavioural, and psychological impact of COVID-19 and partial lockdown amongst diabetes patients in Singapore.MethodsWe conducted a cross-sectional online survey amongst people with diabetes with the Diabetes Health Profile-18 (DHP-18). Hierarchical regression analyses were performed for each DHP-18 subscale (Psychological Distress, Disinhibited Eating and Barriers to Activity) as dependent variables in separate models.ResultsAmong 301 respondents, 45.2% were women, 67.1% of Chinese ethnicity, 24.2% were aged 40 to 49 years, 68.4% have Type 2 diabetes and 42.2% on oral medications alone. During the pandemic and the lockdown, nearly all respondents were able to receive care safely from the clinics they attend (94%) and obtain their medications and diabetes equipment and supplies (97%) when needed. Respondents reported less frequent engagement in physical activity (38%), checking of blood pressure (29%) and blood glucose (22%). Previous diagnosis of mental health conditions (β = 9.33, P = .043), Type 1 diabetes (β = 12.92, P = .023), number of diabetes-related comorbidities (β = 3.16, P = .007) and Indian ethnicity (β = 6.65, P = .034) were associated with higher psychological distress. Comorbidities were associated with higher disinhibited eating (β = 2.49, P = .014) while ability to reach their doctor despite not going to the clinic is negatively associated with psychological distress (β = -9.50 P = .002) and barriers to activity (β = -7.53, P = .007).ConclusionHealth services access were minimally affected, but COVID-19 and lockdown had mixed impacts on self-care and management behaviours. Greater clinical care and attention should be provided to people with diabetes with multiple comorbidities and previous mental health disorders during the pandemic and lockdown.

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The role of psychological insulin resistance in diabetes self-care management.

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The role of psychological insulin resistance in diabetes self-care management.

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