Dataset Information

Veterans' Interpretation of Diabetes Distress in Diabetes Self-Management: Findings From Cognitive Interviews.

ABSTRACT:

Purpose

The purpose of this project was to identify additional facets of diabetes distress (DD) in veterans that may be present due to the veteran's military-related experience.

Methods

The study team completed cognitive interviews with veterans with type 2 diabetes mellitus (T2DM) to examine how they answered the Diabetes Distress Scale (DD Scale), a tool that assesses DD. The DD Scale was used because of its strong associations with self-management challenges, physician-related distress, and clinical outcomes.

Results

The veterans sample (n= 15) was 73% male, mean age of 61 (SD = 8.6), 53% Black, 53% with glycosylated hemoglobin level <9%, and 67% with prescribed insulin. The DD Scale is readily understood by veterans and interpreted. Thematic analysis indicated additional domains affecting DD and T2DM self-management, including access to care, comorbidities, disruptions in routine, fluctuations in emotions and behaviors, interactions with providers, lifelong nature of diabetes, mental health concerns, military as culture, personal characteristics, physical limitations, physical pain, sources of information and support, spirituality, and stigma.

Conclusions

This study describes how a veteran's military experience may contribute to DD in the context of T2DM self-management. Findings indicate clinicians and researchers should account for additional domains when developing self-management interventions and discussing self-management behaviors with individuals with T2DM.

SUBMITTER: Lewinski AA

PROVIDER: S-EPMC9494356 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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Publications

Veterans' Interpretation of Diabetes Distress in Diabetes Self-Management: Findings From Cognitive Interviews.

Lewinski Allison A AA Shapiro Abigail A Bosworth Hayden B HB Crowley Matthew J MJ McCant Felicia F Howard Teresa T Jeffreys Amy S AS McConnell Eleanor E Tanabe Paula P Barcinas Susan S Coffman Cynthia J CJ King Heather A HA

The science of diabetes self-management and care 20210924 5

<h4>Purpose</h4>The purpose of this project was to identify additional facets of diabetes distress (DD) in veterans that may be present due to the veteran's military-related experience.<h4>Methods</h4>The study team completed cognitive interviews with veterans with type 2 diabetes mellitus (T2DM) to examine how they answered the Diabetes Distress Scale (DD Scale), a tool that assesses DD. The DD Scale was used because of its strong associations with self-management challenges, physician-related ...[more]

PMID: 34559032

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Project description:PurposeDiabetes 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.MethodsUsing 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.ResultsCompared 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.ConclusionDSME/S programs have the potential to improve psychological health among African Americans and Hispanics/Latinos, which can lead to better diabetes outcomes.

Project description:ImportanceDiabetes is a substantial public health issue. Peer mentoring is a low-cost intervention for improving glycemic control in patients with diabetes. However, long-term effects of peer mentoring and creation of sustainable models are not well studied.ObjectiveAssess the effects of a peer support intervention for improving glycemic control in patients with diabetes and evaluate a model in which former mentees serve as mentors.Design, setting, and participantsA randomized clinical trial was conducted from September 27, 2012, to March 21, 2018, at the Corporal Michael J. Crescenz Medical Center. US veterans with type 2 diabetes aged 30 to 75 years with hemoglobin A1C (HbA1c) greater than 8% received support over 6 months from peers with prior poor glycemic control but who had achieved HbA1c less than or equal to 7.5% (phase 1). Phase 1 mentees were then randomized to become a mentor or not to new randomly assigned participants in phase 2. Outcomes were assessed at 6 and 12 months. Data were analyzed from October 5, 2016, to September 4, 2018.InterventionsMentors who received an initial training session and monthly reinforcement training were assigned 1 mentee and given $20 for each month they contacted their mentee at least weekly.Main outcomes and measuresPrimary outcome was HbA1c change at 6 months. Secondary outcomes included HbA1c change at 12 months and change in low-density lipoprotein, blood pressure, diabetes quality of life, and depression symptoms at 6 and 12 months.ResultsThe study enrolled 365 participants into phase 1 and 122 participants into phase 2. Most participants were Black (341 [66%]) and male (454 [96%]), with a mean (SD) age of 60 (7.5) years. Mean phase 1 HbA1c change at 6 months for usual care was -0.20% (95% CI, -0.46% to 0.06%) vs -0.52% (95% CI, -0.76% to -0.29%) for mentees (P = .06). Mean phase 2 HbA1c change at 6 months for usual care was -0.46% (95% CI, -1.02% to 0.10%) vs 0.08% (95% CI, -0.42% to 0.57%) for mentees (P = .16). There were no differences in secondary outcomes or HbA1c levels at 12 months. There was no benefit to past mentees who became mentors.Conclusions and relevanceIn this randomized clinical trial, a peer mentor intervention did not improve 6-month HbA1c levels and did not have sustained benefits.Trial registrationClinicalTrials.gov Identifier: NCT01651117.

Dataset Information

Veterans' Interpretation of Diabetes Distress in Diabetes Self-Management: Findings From Cognitive Interviews.

Purpose

Methods

Results

Conclusions

Publications

Veterans' Interpretation of Diabetes Distress in Diabetes Self-Management: Findings From Cognitive Interviews.

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