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A Tailored Cognitive-Behavioural Intervention Produces Comparable Reductions in Regimen-Related Distress in Adults With Type 2 Diabetes Regardless of Insulin Use: 12-Month Outcomes From the COMRADE Trial.
Lutes, LD, Cummings, DM, Littlewood, K, Le, MT, Kirian, K, Patil, S, Solar, C, Carraway, M, Hambidge, B
Canadian journal of diabetes. 2020;(6):530-536
Abstract
OBJECTIVES Our aim in this study was to determine whether a cognitive-behavioural therapy plus small changes lifestyle intervention can produce comparable improvements in insulin users vs patients not using insulin with uncontrolled type 2 diabetes (T2D) and comorbid depressive or regimen-related distress (RRD) symptoms. METHODS This study is a secondary analysis of Collaborative Care Management for Distress and Depression in Rural Diabetes Study, a randomized, controlled trial of a 16-session, severity-tailored cognitive-behavioural therapy plus small changes lifestyle intervention compared with usual care. Outcomes included glycated hemoglobin (A1C), regimen-related distress, depression, medication adherence and diabetes self-care. Our investigation provides 2 sets of contrasts: 1) insulin users in the intervention group compared with insulin users in the usual-care group and 2) insulin users compared with noninsulin users in the intervention group only. RESULTS Of the 139 participants, 72 (52%) were using insulin at baseline and had significantly higher levels of A1C (10.2±2.1% vs 8.9±1.6%) and RRD (3.3±1.4 vs 2.8±1.1), and significantly poorer medication adherence (5.2±2.1 days/wk vs 5.5±1.7 days/wk). Intervention patients using insulin exhibited significantly greater reductions in RRD and marginally significant improvements in medication adherence and A1C compared with insulin users in usual care. Within the intervention group, changes in RRD, medication adherence and A1C did not differ significantly by insulin use. CONCLUSIONS Tailored cognitive-behavioural therapy with a small-changes lifestyle intervention improved elevated RRD and A1C outcomes at least as effectively in insulin users as non‒insulin users. Future powered studies need to address the role of insulin use in uptake and treatment outcomes.
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Dietary Self-Monitoring Through Calorie Tracking but Not Through a Digital Photography App Is Associated with Significant Weight Loss: The 2SMART Pilot Study-A 6-Month Randomized Trial.
Dunn, CG, Turner-McGrievy, GM, Wilcox, S, Hutto, B
Journal of the Academy of Nutrition and Dietetics. 2019;(9):1525-1532
Abstract
BACKGROUND Dietary self-monitoring (DSM) of foods and beverages is associated with weight loss in behavioral interventions; however, DSM may be burdensome, and adherence may decrease over time. Novel methods of DSM, including apps that track food using photographs, may decrease burden, increase DSM adherence, and improve weight loss. OBJECTIVE The objective was to test a mobile photo DSM app compared to a calorie-tracking DSM app on tracking frequency and weight loss in a remotely delivered behavioral weight-loss intervention. DESIGN This was a 6-month (October 2016 to April 2017) randomized trial. PARTICIPANTS/SETTING Participants were adults (n=41) classified as overweight or obese (body mass index 25 to 49.9) from South Carolina. INTERVENTION Participants received remotely delivered twice-weekly behavioral weight-loss podcasts and tracked diet using a calorie-tracking DSM app (Calorie Group) or a photo DSM app (Photo Group). MAIN OUTCOME MEASURES Main outcomes were the number of days diet was tracked, podcasts downloaded, and weight change at 6 weeks and 6 months. STATISTICAL ANALYSES Researchers used nonparametric Wilcoxon rank sum tests and χ2 analysis to test for differences between groups at baseline; repeated-measures models to estimate weight change and Spearman correlations to determine relationships between DSM frequency, podcasts downloaded, and weight change at 6 months. RESULTS There were no differences between groups for the number of days that diet was recorded (P=0.18), which was low overall (<30% of days) but was statistically significantly and strongly correlated with weight change for all participants pooled (r=0.63; P<0.001) and for the calorie tracking group (r=0.70; P=0.004), but not the photo tracking group (r=0.51; P=0.06). Participants in both groups had significant weight loss at 6 months (Photo Group, -2.5±0.9 kg; P=0.008; Calorie Group -2.4±0.9 kg; P=0.007), with no differences between groups at either 6 weeks (P=0.66) or at 6 months (P=0.74). CONCLUSIONS As part of a remotely delivered weight loss intervention, frequency of DSM was significantly associated with overall weight loss for participants using a calorie DSM app but not a photo DSM app. DSM was low regardless of group and weight loss was significant, although minimal. Increasing user engagement with any DSM may be important to increase self-monitoring and improve weight loss.
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Does the mode of delivery in routine cardiac rehabilitation have an association with cardiovascular risk factor outcomes?
Harrison, AS, Doherty, P
European journal of preventive cardiology. 2018;(18):1925-1933
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Abstract
AIMS: Cardiac rehabilitation is one of the most cost-effective interventions for patients with cardiovascular disease. Worldwide supervised group-based cardiac rehabilitation is the dominant mode of delivery followed by facilitated self-managed (FSM), which is emerging as part of a cardiac rehabilitation menu. Modern research evidence, using trials and well-resourced interventions, suggests FSM is comparable to supervised rehabilitation in its outcomes for patients; however, this is yet to be established using routine clinical practice data. METHODS Including 81,626 patients from routine clinical data in the National Audit of Cardiac Rehabilitation, this observational study investigated whether mode of delivery, supervised or FSM, was associated with similar cardiac rehabilitation outcomes. Hierarchical regression models included patient and service covariates such as age, gender, cardiac rehabilitation duration and programme staff type. RESULTS The results showed 85% of the population received supervised cardiac rehabilitation. The FSM group were significantly older, female and predominantly in lower socioeconomic groups. The results showed that all patients on average benefit from cardiac rehabilitation, independently of mode of delivery, across all risk factors. Additional benefit of 13% and 11.4% increased likelihood of achieving the target state for physical activity and body mass index respectively when using FSM approaches. CONCLUSION This is the first study to investigate traditional cardiovascular risk factors with cardiac rehabilitation mode of delivery using routine clinical data. Both modes of delivery were associated with comparable statistically significant positive outcomes. Despite having equivalent outcomes, FSM cardiac rehabilitation continues to be underutilised, with less than 20% of patients receiving this mode of delivery in the UK.
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A Multiple Behavior Self-Monitoring Intervention for African- American Veterans with Type 2 Diabetes: A Feasibility Implementation Study.
Mbue, ND, Wang, J, Cron, SG, Anderson, JA
Journal of National Black Nurses' Association : JNBNA. 2017;(1):1-8
Abstract
The purpose of this study was to determine the feasibility of implementing a multiple-behavior self-monitoring intervention within a diabetes education program. This study was a 3-month pre- post-design, conducted with African-Americans (N = 20), who attended diabetes education classes at a large Veteran's Affairs (VA) hospital in Southwest Texas. Participants selfmonitored their blood glucose, diet, exercise, and weight on either a smart phone application or paper diaries. Paired t tests showed strong evidence that patient self-monitoring of healthy lifestyle behaviors improved blood glucose (t = -3.858, p = .001) and HbAlc (t = -4.428, p <.001), respectively. Moreover Spearman's correlation coefficient showed significant correlations between blood glucose and exercise (rs = -.68, p = .008) and HbAlc and exercise (rs = -.56, p = .036). This feasibility study showed that multiple-behavior self-monitoring was effective in lowering blood glucose and HbA1c levels among African-American Veterans; however, a randomized controlled trial with a larger sample is needed to validate these preliminary findings.
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The complex interplay between clinical and person-centered diabetes outcomes in the two genders.
Rossi, MC, Lucisano, G, Pintaudi, B, Bulotta, A, Gentile, S, Scardapane, M, Skovlund, SE, Vespasiani, G, Nicolucci, A, ,
Health and quality of life outcomes. 2017;(1):41
Abstract
BACKGROUND New approaches to cope with clinical and psychosocial aspects of type 2 diabetes (T2DM) are needed; gender influences the complex interplay between clinical and non-clinical factors. We used data from the BENCH-D study to assess gender-differences in terms of clinical and person-centered measures in T2DM. METHODS Clinical quality of care indicators relative to control of HbA1c, lipid profile, blood pressure, and BMI were derived from electronic medical records. Ten self-administered validated questionnaires (SF-12 Health Survey; WHO-5 well-being index; Problem Areas in Diabetes (PAID) 5, Health Care Climate Questionnaire, Patients Assessment of Chronic Illness Care, Diabetes Empowerment Scale, Diabetes Self-care Activities, Global Satisfaction for Diabetes Treatment, Barriers to Taking Medications, Perceived Social Support) were adopted as person-centered outcomes indicators. RESULTS Overall, 26 diabetes clinics enrolled 2,335 people (men: 59.7%; women: 40.3%). Lower percentages of women reached HbA1c levels < =7.0% (23.2% vs. 27.8%; p = 0.03), LDL-cholesterol < 100 mg/dl (48.3 vs. 57.8%; p = 0.0005), and BMI <27 Kg/m2 (27.2 vs. 31.6%; p = 0.04) than men. Women had statistically significant poorer scores for physical functioning, psychological well-being, self-care activities dedicated to physical activities, empowerment, diabetes-related distress, satisfaction with treatment, barriers to medication taking, satisfaction with access to chronic care and healthcare communication, and perceived social support than men; 24.8% of women and 8.8% of men had WHO-5 < =28 (likely depression) (p < 0.0001); 67.7% of women and 55.1% of men had PAID-5 > 40 (high levels of diabetes-related distress) (p < 0.0001). At multivariate analysis, factors associated with an increased likelihood of having elevated HbA1c levels (≥8.0%) were different in men and women, e.g. having PAID-5 levels >40 was associated with a higher likelihood of HbA1c ≥8.0% in women (OR = 1.15; 95%CI 1.05-1.25) but not in men (OR = 1.00; 95%CI 0.93-1.08). CONCLUSIONS In T2DM, women show poorer clinical and person-centered outcomes indicators than men. Diabetes-related distress plays a role as a correlate of metabolic control in women but not in men. The study provides new information about the interplay between clinical and person-centered indicators in men and women which may guide further improvements in diabetes education and support programs.
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Evaluation of the efficacy of a short-course, personalized self-management and intensive spa therapy intervention as active prevention of musculoskeletal disorders of the upper extremities (Muska): a research protocol for a randomized controlled trial.
Lanhers, C, Pereira, B, Gay, C, Hérisson, C, Levyckyj, C, Dupeyron, A, Coudeyre, E
BMC musculoskeletal disorders. 2016;(1):497
Abstract
BACKGROUND Musculoskeletal disorders (MSDs) constitute a major occupational health problem in the working population, substantially impacting the quality of life of employees. They also cause considerable economic cost to the healthcare system, with, notably, the reimbursement of treatments and compensation for lost income. MSDs manifest as localized pain or functional difficulty in one or more anatomical areas, such as the cervical spine, shoulder, elbow, hand, and wrist. Although prevalence varies depending on the region considered and the method of assessment, a prevalence of 30% is found in different epidemiological studies. The disease needs to be prevented, not only for medical and economic reasons, but also for legal reasons, owing to the requirement of assessing occupational risks. The strategy envisaged may thus revolve around active, multimodal prevention that has employees fully involved at the heart of their care. Although physical exercise is widely recommended, few studies with a good level of evidence have enabled us to base a complete, well-constructed intervention on exercise that can be offered as secondary prevention in these disorders. METHODS A prospective, multicenter, comparative (intervention arm vs. control arm), randomized (immediate vs. later treatment) study using Zelen's design. This study falls under active prevention of MSDs of the upper extremities (UE-MSDs). Participants are workers aged between 18 and 65 years with latent or symptomatic MSDS, with any type of job or workstation, with or without an history of sick leave. The primary aim is to show the superiority at 3 months of a combination of spa therapy, exercise, and self-management workshops for 6 days over usual care in the management of MSDs in terms of employee functional capacity in personal and professional daily life. Secondary aims are to assess the benefit of the intervention in terms of pain, quality of life, and accumulated duration of sick leave. DISCUSSION This randomized controlled trial is the first that will aim to evaluate multidisciplinary management of UE-MSDs using nonpharmacological treatment combining exercise, self-management, and spa therapy. The originality of this intervention lies, in its short, intensive format, which is compatible with remaining in work; and in its multidisciplinary approach. This trial has the potential to demonstrate, with a good level of evidence, the benefits of a short course of spa therapy combined with a personalized self-management program on the functional capacity, pain, and quality of life of employees in their daily life. TRIAL REGISTRATION Clinical trial.gov NCT02702466 retrospectively registered. PROTOCOL Version 4 of 9/10/2015.
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[Support of diabetes dietary management and self-management using mobile applications].
Szálka, B, Kósa, I, Vassányi, I, Mák, E
Orvosi hetilap. 2016;(29):1147-53
Abstract
The key components of successful diabetes therapy are pharmacotherapy, hospital care and lifestyle education. Lifestyle education, self-management, and composing the right diet can be effectively supported with mobile applications. In this paper Hungarian mobile applications are reviewed and compared to some international competitors. Besides plenty of useful functions some deficiencies are identified, based on dietary recommendations. The related improvements together with clinical trials validating effectiveness and reliability can strengthen medical evidence as well as the penetration of such mobile applications. Orv. Hetil., 2016, 157(29), 1147-1153.
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Diabetes self-management education improves medication utilization and retinopathy screening in the elderly.
Murray, CM, Shah, BR
Primary care diabetes. 2016;(3):179-85
Abstract
AIMS: To evaluate the effect of diabetes education program attendance, which provides patients with diabetes self-management education, on prescriptions for cardiovascular risk reduction, prescriptions for diabetes treatments, and visits for retinopathy screening. METHODS A population based cohort study of residents of Ontario, Canada with diagnosed diabetes aged ≥65 years was performed using administrative databases. Diabetes education program attendance was identified using a registry of visits to all diabetes education programs in the province in 2006. Using propensity score methods, 22,606 diabetes education program attendees were matched to an equal number of non-attendees. The proportions of patients with prescriptions filled and with ophthalmology/optometry visits were compared. RESULTS Patients attending diabetes education programs had greater utilization of statins (70.6%) than non-attendees (69.4%, p<0.0001). Diabetes education program attendance was also associated with greater utilization of glucose lowering medications (83.7% vs. 82.0%, p<0.0001), antihypertensive medications (90.2% vs. 89.7%, p<0.0001), angiotensin converting enzyme inhibitors/angiotensin receptor blockers (79.8% vs. 78.9% p<0.0001), and glucose monitoring strips (82.2% vs. 65.6%, p<0.0001); and visits to ophthalmology/optometry (78.7% vs. 72.7%, p<0.0001). CONCLUSIONS Diabetes self-management education at diabetes education programs is associated with better quality of care in the elderly in Ontario.
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Effectiveness of a Stroke Risk Self-Management Intervention for Adults with Prehypertension.
Song, HY, Nam, KA
Asian nursing research. 2015;(4):328-35
Abstract
PURPOSE The aim of this study was to evaluate the effectiveness of a community-based intervention for prehypertensive adults, to enhance stroke risk awareness and to adopt a preventive lifestyle for primary stroke prevention. METHODS This was a single-blinded, repeated measures quasi-experimental study with 47 participants (23 in the experimental group and 24 in the control group) recruited through convenience sampling from two urban areas. The stroke risk self-management intervention consisted of three weekly, 2-hour, face-to-face sessions and two booster telephone sessions, utilizing strategies to enhance motivation for behavioral changes based on the Self-Determination Theory. All participants completed a pretest, a 1-month and a 3-month post test of stroke risk awareness and preventive lifestyle including blood pressure self-monitoring, healthy diet, and regular physical activity. Data were analyzed using descriptive statistics, chi-square test, two sample t test, repeated measures analysis of variance, and Friedman test with PASW Statistics 18.0. RESULTS After the intervention, significant improvements were found in the experimental group for stroke risk awareness, blood pressure self-monitoring and regular physical activity, and were sustained over time. CONCLUSIONS Our preliminary results indicate that the stroke risk self-management intervention is feasible and associated with improvement in self-management of stroke risk factors for primary stroke prevention among a prehypertensive population.
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Mobile phone intervention for increasing adherence to treatment for type 2 diabetes in an urban area of Bangladesh: protocol for a randomized controlled trial.
Islam, SM, Lechner, A, Ferrari, U, Froeschl, G, Alam, DS, Holle, R, Seissler, J, Niessen, LW
BMC health services research. 2014;:586
Abstract
BACKGROUND Mobile phone technologies including SMS (short message service) have been used to improve the delivery of health services in many countries. However, data on the effects of mobile health technology on patient outcomes in resource-limited settings are limited. The aim of this study therefore is to measure the impact of a mobile phone SMS service on treatment success of newly diagnosed type 2 diabetes in an urban area of Bangladesh. METHODS/DESIGN This is a single-centred randomized controlled intervention trial (prospective) comparing standard-of-care with standard-of-care plus a mobile phone-based SMS intervention for 6 months. A total of 216 participants with newly diagnosed type 2 diabetes will be recruited. Data will be collected at the outpatient department of Bangladesh Institute of Health Science (BIHS) hospital at baseline and after 6 months. The primary outcome measure will be change in HbA1c between baseline and 6 months. The secondary outcome measures are self-reported medication adherence, clinic attendance, self-reported adoption of healthy behaviours, diabetes knowledge, quality of life and cost effectiveness of the SMS intervention. The inclusion criteria will be as follows: diagnosed as patients with type 2 diabetes by the BIHS physician, using oral medication therapy, living in Dhaka city, registered with the BIHS hospital, using a mobile phone, willing to return for follow up after 6 months and providing written informed consent. Participants will be allocated to control and intervention arms after recruitment using a randomization software. Data will be collected on socio-demographic and economic information, mobile phone use and habits, knowledge of prevention, management and complications of diabetes, self-perceived quality of life assessment, self-reported diseases, medical history, family history of diseases, medication history, medication adherence, health seeking behaviour, tobacco use, physical activity, diet, mental health status, life events and disability, anthropometric measurements of weight, height, blood pressure and blood tests for HbA1c. DISCUSSION Mobile phone SMS services have the potential to communicate with diabetes patients and to build awareness about the disease, improve self-management and avoid complications also in resource-limited setting. If this intervention proves to be efficient and cost-effective in the current trial, large-scale implementation could be undertaken. TRIAL REGISTRATION DRKS00005188 .