Type 2 diabetes (T2DM) is a health epidemic that continues to worsen. A major concern is that treatment adherence rates hover around 50%, despite the introduction of new medications, treatments, and technology. Lack of adherence by patients can lead to complications like blindness, kidney disease, and amputations. While there have been many studies conducted to evaluate patient factors related to adherence, fewer studies have been conducted to evaluate the role of the physician-patient relationship. The purpose of this study was to examine the correlation between the physician-patient relationship and patient treatment adherence, and examine the moderators of age, education, ethnicity, and income. Gender was included as a moderator in a secondary analysis. Two theories formed the theoretical framework of this study: biopsychosocial model and self-efficacy theory. This quantitative nonexperimental study was completed with survey data collected from 92 participants in the United States ages 18 or older who were under treatment for T2DM for at least a year, and who had seen their physician at least once in the previous year. Correlational and regression analyses were conducted using data from the modified Clinician and Group Survey and the Diabetes Management Self-Questionnaire. The physician-patient relationship predicted treatment adherence, and gender moderated the relationship. These findings suggest the importance of the physician-patient relationship as a factor in patient treatment adherence. This has important implications for social change because an understanding of which physician factors lead to treatment adherence may help improve patient outcomes, reduce T2DM complications, improve patient quality of life, and reduce healthcare costs.

The goal of diabetes education programs (DEPs) is to improve patients' pattern-management habits for those with type 2 diabetes (T2D), though participation in DEPs is lower than expected due to low physician referral rates. This retrospective study examined secondary data of 162 T2D patients who had been referred to a DEP in a community center in RI to determine whether the source of referral affected patient attendance, participation persistence, and outcomes. Self-referred (n = 62) and physician-referred (n = 100) groups were analyzed for possible associations among the aforementioned variables. Chi-square (p = .04) and logistic regression (p = .04) indicated that the referral source for a DEP does have an effect on participation rates, while logistic regression showed that odds for self-referred patients to participate were 1.97 times higher. Multiple linear regression found no difference between the referral source and the number of sessions patients completed, though covariate analysis showed that age (p = .02) contributes to the model. Multiple linear regression showed no difference between the number of sessions attended and changes in hemoglobin A1c (HbA1c) levels. It is important to note that those who completed the program and reported pre- and post-program HbA1c levels (n = 7) all reported improved outcomes. This highlights the limitation of the small sample size (n = 7), which increased the possibility of a Type II error. This community center DEP model can serve as a blueprint, highlighting the importance of diabetes education and leading to positive social change by improving referral and participation rates and resulting in fewer complications, a decreased disease burden, and an improved quality of life.

People with diabetes are at double the risk of developing depression. Depression is associated with increased morbidity and mortality in people with diabetes. Levels of A1c have been linked to microvascular complications (e.g., retinopathy, nephropathy, and neuropathy) as well as depression. The interrelationship between A1c, microvascular complications, and depression has not previously been investigated in a comprehensive model, and a better understanding of the nature of these associations is needed. Preliminary analyses test the assumption that A1c mediates the relationship between group assignment in the Diabetes Control and Complications Trial (DCCT) and microvascular complications. The primary purpose of the study is to examine multiple mediation models, which hypothesize that the severity of microvascular complications mediates the relationship between A1c and depressive symptomatology levels. Participants were people with type 1 diabetes (N = 1441) enrolled in the DCCT, a longitudinal randomized controlled trial investigating intensive insulin treatment and diabetes complications, and divided into primary (e.g., no retinopathy) and secondary (e.g., mild retinopathy) cohorts. Biological markers were used to measure A1c and microvascular complications. Depressive symptomatology was measured by the depression subscale of the Symptom Checklist-90-Revised. Simple and multiple mediation analyses were used to test proposed models. A1c mediates the relationship between DCCT group assignment and microvascular complications. Microvascular complications partially mediate the relationship between A1c and depression for the full sample and secondary cohort. Results support the hypothesis that the severity of microvascular complications, in part, accounts for the association between A1c and depressive symptomatology in people with type 1 diabetes.

Diabetes is associated with increased psychological distress which, in turn, is associated with poorer diabetes outcomes. This study examined the impact of a nine-week Internet based cognitive-behavioral therapy intervention that targeted stress and mood in people with diabetes. It was hypothesized that the intervention would decrease psychological distress and improve diabetes outcomes and adherence to diabetes treatment regimens. Participants with type 1 and type 2 diabetes were randomly assigned to the intervention (n = 103) or a waiting-list control group (n = 74). ANCOVAs demonstrated significant group effects for the reduction of perceived generalized stress (F (1, 105) = 7.06, p = .01; d = .84), diabetes-related distress (F (1, 105) = 13.45, p < .01; d = .54), depression (F (1, 90) = 7.06, p < .01; d = .40), anxiety (F (1, 89) = 6.78, p = .01; d = .41), and negative affect (F (1, 103) = 13.02, p < .01; d = .56). There were also significant group effects for the reduction of psychological fatigue (F (1, 98) = 7.34, p = .01; d = .40), cognitive symptoms (F (1,95) = 6.40, p = .01; d = .48), hyperglycemic symptoms (F(1, 95) = 11.16, p <.01; d = .41) and hypoglycemic symptom (F(1, 98) = 6.16, p= .02; d= .53). Further, there were significant indirect effects of the intervention on the above diabetes symptoms, through psychological distress. There was no effect of the intervention on hemoglobin A1c (F(1.43) = 0.28, p= .60), though this analysis was underpowered. The intervention also had no effect on adherence to diabetes treatment regimen. This study provides evidence of a convenient and effective way to reduce psychological distress and improve symptoms in those with diabetes. It also provides evidence of reduced psychological distress as a mechanism for improving diabetes outcomes.

Evidence is limited regarding whether periodontal treatment improves hemoglobin A1c (HbA1c) among people with prediabetes and periodontal disease, and it is unknown whether improvement of metabolic status persists >3 mo. In an exploratory post hoc analysis of the multicenter randomized controlled trial “Antibiotika und Parodontitis” (Antibiotics and Periodontitis)—a prospective, stratified, double-blind study—we assessed whether nonsurgical periodontal treatment with or without an adjunctive systemic antibiotic treatment affects HbA1c and high-sensitivity C-reactive protein (hsCRP) levels among periodontitis patients with normal HbA1c (≤5.7%, n = 218), prediabetes (5.7% < HbA1c < 6.5%, n = 101), or unknown diabetes (HbA1c ≥ 6.5%, n = 8) over a period of 27.5 mo. Nonsurgical periodontal treatment reduced mean pocket probing depth by >1 mm in both groups. In the normal HbA1c group, HbA1c values remained unchanged at 5.0% (95% CI, 4.9% to 6.1%) during the observation period. Among periodontitis patients with prediabetes, HbA1c decreased from 5.9% (95% CI, 5.9% to 6.0%) to 5.4% (95% CI, 5.3% to 5.5%) at 15.5 mo and increased to 5.6% (95% CI, 5.4% to 5.7%) after 27.5 mo. At 27.5 mo, 46% of periodontitis patients with prediabetes had normal HbA1c levels, whereas 47.9% remained unchanged and 6.3% progressed to diabetes. Median hsCRP values were reduced in the normal HbA1c and prediabetes groups from 1.2 and 1.4 mg/L to 0.7 and 0.7 mg/L, respectively. Nonsurgical periodontal treatment may improve blood glucose values among periodontitis patients with prediabetes (ClinicalTrials.gov NCT00707369).

Background: The One Drop vertical bar Mobile app supports manual and passive (via HealthKit and One Drop's glucose meter) tracking of self-care and glycated hemoglobin A(1c) (HbA(1c)). Objective: We assessed the HbA(1c) change of a sample of people with type 1 diabetes (T1D) or type 2 diabetes (T2D) using the One Drop vertical bar Mobile app on iPhone and Apple Watch, and tested relationships between self-care tracking with the app and HbA(1c) change. Methods: In June 2017, we identified people with diabetes using the One Drop vertical bar Mobile app on iPhone and Apple Watch who entered two HbA(1c) measurements in the app 60 to 365 days apart. We assessed the relationship between using the app and HbA(1c) change. Results: Users had T1D (n=65) or T2D (n=191), were 22.7% (58/219) female, with diabetes for a mean 8.34 (SD 8.79) years, and tracked a mean 2176.35 (SD 3430.23) self-care activities between HbA(1c) entries. There was a significant 1.36% or 14.9 mmol/mol HbA(1c) reduction (F=62.60, P<.001) from the first (8.72%, 71.8 mmol/mol) to second HbA(1c) (7.36%, 56.9 mmol/mol) measurement. Tracking carbohydrates was independently associated with greater HbA(1c) improvement (all P<.01). Conclusions: Using One Drop vertical bar Mobile on iPhone and Apple Watch may favorably impact glycemic control.

Bakgrund: Hemoblobin-A1c är ett mått på blodsockrets medelvärde efter mellan 60-90 dagar och är en grundläggande indikator på blodsockerkontrollen hos patienter med typ 2-diabetes. Kondition- och styrketräning har visat sig kunna påverka hemoglobin-A1c och används därför som en av flera behandlingsformer hos patienter med typ-2 diabetes. Emellertid verkar det finnas en bristande enighet vad gäller den effektiva dosen av fysisk träning och den mest effektiva kombinationen av styrka gentemot konditionsträning. Syfte: Syftet med denna studie var att systematiskt granska och sammanställa den senaste forskningen vad gäller effekten av fysisk träning vid typ 2-diabetes. Metod: Studien genomfördes som en systematisk litteraturstudie med meta-analys i enlighet med PRISMA riktlinjer. Databaserna som användes i artikelsökningarna var PubMed, Web of Science, Sport Discus, Cinahl och Medline. Studiens inklusionskriterier var studier på engelska, studier som undersöker både män-och eller kvinnor i olika åldersgrupper, studier som undersöker effekten av fysisk träning på hemoglobin-A1c samt randomiserade kontrollerade studier. Resultat: Effekten av fysisk träning visade en signifikant skillnad på hemoglobin-A1c hos patienter med typ 2-diabetes. Effektstorleken på hemoglobin-A1c mellan grupperna var -0.434 efter interventionerna p &lt;0.001. Av samtliga studier var det 11 av 22 som åstadkom ett värde av hemoglobin-A1c som visar &lt;7%. Sekundära resultatet av fysisk träning på typ 2-diabetes påvisades vara en signifikant minskning i den totala kroppsvikten i sex av samtliga inkluderade studier. Slutsats: Fysisk träning verkar vara en viktig komponent för att minska hemoglobin-A1c hos patienter med typ 2-diabetes. / Background: Hemoglobin-A1c is a measure of long‐term glycemiais after between 60-90 days and is a good indicator of glucose control in patients with type-2 diabetes. Both strenght and aerobic exercise seem to have benefical effects on Hemoglobin-A1c and, thus, the management of type 2 diabetes. However, the consensus on the effective dose of exercise and the most effective combination of strength versus aerobic have been inconsistent. Purpose: The purpose of this study was to systematically review and compile the latest research regarding the effect of physical exercise in type 2 diabetes. Method: The study was conduced as a systematic review with meta-analysis according to PRISMA guidelines. The study was conducted as a systematic review with meta-analysis. The databases used in this study, were PubMed, Web of Science, Sport Discus, Cinahl and Medline. The study’s inclusion criteria were studies in english, studies including both men and-or women in different ages, studies examining the effect of physical exercise on hemoglobin-A1c, and studies of a randomized controlled design. Results: The effect of physical training showed a significant difference between groups. The effect size on hemoglobin-A1c between groups was -0.434 after the interventions p &lt;0.001. In this study, it was 11 of 22 studies that achieved a value of hemoglobin-A1c showing &lt;7%. Secondary results of physical training on type-2 diabetes were found to be a significant decrease in total body weight in six of all included studies. Conclusion: Physical training seems to be an important component of reducing hemoglobinA1c in patients with type 2-diabetes. / <p>Presentationen ägde rum hemifrån var och för sig via Zoom på grund av smittrisken för coronavirus. </p>

Adolescents with Type I and Type II diabetes need to monitor blood glucose and food intake, administer insulin, and participate in activities including physical education during school hours to maintain glycemic control. Glycemic management programs (GMPs) exist for the improvement of diabetes management during school hours. The purpose of this project was to evaluate a GMP in a school system in a rural area in the Southeastern United States. The goal was to determine if the existing GMP met objectives and to make recommendations for continuation, revision, or discontinuation of the GMP. The logic model provided the basic framework for the evaluation of the GMP by using a graphic flowchart depicting health outcomes prior to and after the implementation of the program. The review consisted of approximately 2,100 students from 9th to 12th grade, and out of those students there were 77 participants from 2010 and 89 participants from 2015 with diagnosis of diabetes. A t-test outcome evaluation found the updated GMP was associated with the lowering of hemoglobin A1c readings. Mean A1c in 2009 was 8.6% (180 - 190 mg/dl), with the mean decreasing to 7.2% (150 mg/d) in 2015. Changes in the program led to 1-to-1 care management based on children's individual needs and parental involvement. Findings show that the GMP improved glycemic management by empowering and individualizing care. This project contributes to positive social change by contributing to data from the Diabetes Prevention Program Research Group study showing that prevention of onset of Type II diabetes mellitus in adults and adolescents is successful through early detection of prediabetes in childhood.

Background: In order to provide good diabetes care it is important for the health care professionals to share patients’ personal understanding of living with diabetes, which differs from a professional understanding of the illness. Patients’ beliefs about health, illness, control and cure are predictive of the outcome of lifestyle changes and pharmacological treatment. Narratives about illness could be used to elucidate what people believe to be central to their experience of an illness and its management. The overall aim of this thesis was to investigate experiences of diabetes and diabetes care among people with type 2 diabetes and district nurses responsible for diabetes care within primary health care. Methods: Forty-four patients diagnosed with diabetes during the previous 2 years were interviewed about their personal understanding of illness and experiences of care. They also participated in an intervention study consisting of group sessions during 9 months. The intervention focused on the patients’ understanding of living with diabetes and was directed at the patients and their nurses (n = 5). The outcome variables haemoglobin A1c (HbA1c), lipids, blood pressure (BP) and body mass index (BMI) as well as well-being, treatment satisfaction and diabetes symptoms of the intervention group were compared with those in a control group (n = 60). Another ten patients were interviewed about their views of their lives. Seventeen nurses in diabetes care were interviewed about their views of their work with patients. The narrative, thematic interviews and focus group interviews were analysed using qualitative content analysis. Findings: Patients’ personal understanding of illness included the categories “image of the disease”; “meaning of the diagnosis”; “integration of the illness”; “space for the illness”; “responsibility for care”; and “future prospects”. Patients’ narratives about their lives included views of knowledge, and capacity, motivation and courage, aspects important for effective self-management. Patients’ views on clinical encounters in diabetes care, interpreted as satisfying or not, included the themes “being in agreement v. in disagreement about the goals”; “being autonomous and equal v. being forced into adaptation and submission”; “feeling worthy as a person v. feeling worthless”; “being attended to and feeling welcome v. being ignored”; and “feeling safe and confident v. feeling unsafe and lacking confidence”. The results of the intervention study with group sessions showed improvements in metabolic balance and treatment satisfaction in the intervention group. At the 1-year follow-up the mean difference between groups in HbA1c was 0.94% (95% confidence interval (CI) 0.58–1.29). Nurses’ views of their work included the themes “Perspectives on illness and caring are not easily integrated into views of disease and its treatment”; “Nurses view their knowledge as more important than the patients’ knowledge”; Nurses’ conscience is challenged by some of their nursing decisions”; “The individuality of each patient is undermined when patients are regarded as a collective group”; and “Nurses are confirmed in their role of nurses by patients who assume a traditional patient role”. Conclusion: These results demonstrate that the understanding of illness and care differs between patients and nurses working in diabetes care; furthermore, that an intervention involving patients and their nurses based on patients’ personal understanding of illness is effective with regard to metabolic control and treatment satisfaction. The cost of the intervention is moderate. Also, we believe that it is possible to clinically implement this intervention within the existing resources for primary health care.

Studies demonstrate localized neuro-retinal dysfunction in patients with diabetes and no visible diabetic retinopathy (DR). Poor glycemic control is a strong risk factor for DR. We hypothesized that poor glycemic control predicts increased areas of localized neuro-retinal dysfunction in patients with diabetes. Forty-eight adolescents with diabetes and 45 controls were tested using the standard (103 hexagons) multifocal electroretinogram (mfERG). Negative binomial regression analysis was conducted with number of abnormal hexagons (delayed responses) as the dependent variable and glycated hemoglobin (HbA1c), disease duration, age and sex as covariates. Results indicate that a one-unit increase in HbA1c predicts an 80% (p = 0.002) increase in the number of abnormal hexagons when controlling for age. Increased areas of neuro-retinal dysfunction are predicted by worsening glycemic control in patients with no visible DR. Standard mfERG may be useful in monitoring patients with diabetes and identifying those who may be at risk of developing DR.