Three articles investigate strategies to support the self-management of diabetes
Diabetes self-management (DSM) is a key component in reducing complications and healthcare needs in people with diabetes. These three articles investigate various strategies to support DSM in varied populations
- People with severe mental illness need tailored interventions to manage the challenges of living with diabetes
- Research is recommended on interventions targeting sedentary behaviour, and reducing obesity in those with a learning disability
- Inclusion in planning and addressing barriers to attendance is needed with self-management programmes
Barriers and enablers of type 2 diabetes self-management in people with severe mental illness
People with severe mental illness (SMI) (including schizophrenia, bipolar disorder or personality disorder) are twice as likely to develop diabetes as the general population. This study aimed to identify the challenges facing this group in diabetes self-management.
Fourteen participants (64% male) with SMI and type 2 diabetes, from an inner London community mental health team, undertook qualitative, semi-structured interviews.
Belief statements across 14 themes were mapped under the Theoretical Domains Framework.
The study found that people with type 2 diabetes and SMI considered diabetes self-management important, but often struggled to do so effectively. The authors recommend tailored interventions to help people with SMI manage the additional challenges of living with type 2 diabetes. Mental health professionals have an important role to play in supporting diabetes self-management in their patients.
Mulligan K, McBain H, Lamontagne-Godwin F et al (2017) Health Expectations. 1020-1030. doi: 10.1111/hex.12543
Randomized controlled feasibility trial of supported self-management in adults with Type 2 diabetes mellitus and an intellectual disability: OK Diabetes
People with intellectual disabilities (ID) have higher rates of diabetes than the general population and are less likely to access traditional diabetes self-management education (DSME). A supported self-management programme was developed, aimed at people with ID and their carers. Recruitment and retention, adherence, and effectiveness of data-collection before full-scale testing were assessed in this study.
The authors recruited 82 adults with mild to moderate ID and type 2 diabetes mellitus, with elevated HbA1c, raised body mass index (BMI), or low physical activity at three sites in Yorkshire, England. Participants received either usual care or usual care plus up to four face-to-face individually tailored DSME sessions.
The Patient Health Questionnaire depression screening tool was difficult for 50% of participants to answer, but the health-related quality of life instrument (EQ5D-3L) was completed for 93%. Changes in BMI and HbA1c were similar between both groups. Limitations included: exclusion of individuals with more complicated diabetes (on insulin); obtaining ongoing participation of identified supporters; variation in ‘usual care’; and the length of DSME intervention being less than optimal for people with ID. However, the four sessions involved more contact than standard DSME interventions.
The authors recommended a full clinical trial on the diabetes self-management education intervention should be undertaken with 392 participants to ensure valid results if HbA1c was a measurable outcome. They suggest focusing future research on the effectiveness of interventions targeting sedentary behaviour and reducing obesity.
House A, Bryant L, Russell A et al (2018) Diabetic Medicine. 35, 776-88. doi: 10.1111/dme.13626
Peer support to improve diabetes care: an implementation evaluation of the Australasian Peers for Progress Diabetes Program
Recent research demonstrates the benefits of peer support in diabetes self-management, but little is known about effective implementation of programmes. This study aimed to evaluate implementation of a group-based, peer support programme (PSP) to improve diabetes self-management in adults with type 2 diabetes in Victoria, Australia, with participants receiving usual care or monthly group meetings with a trained peer leader for 12 months.
The PSP addressed daily management, social and emotional support, access to clinical care, and ongoing diabetes self-management support. Data was collected on participation and the intervention’s effectiveness, and participants’ perceived support and satisfaction.
Of the 82% of PSP participants who completed the 12-month programme, 65% of intervention participants had a five-year cardiovascular disease risk score reduction compared to 45% in the control group, and 94% of PSP participants stated it helped them with day-to-day diabetes self-management. Attending monthly group meetings provided ‘a lot of support’ to 57% and ‘moderate’ support to 34%. Average attendance was 59% for those groups which recorded it, while 44% reported issues affecting attendance (health, work commitments, session timings and location).
The authors recommend future programmes focus on including participants in planning and communication, and addressing barriers to attendance, including reaching disadvantaged groups. Further research is needed on structured, effective peer support programmes for diabetes self-management.
Aziz Z, Riddell M, Absetz P et al (2018) BMC Public Health. 18, 262 https://doi.org/10.1186/s12889-018-5148-8
Kat Millward is a lecturer in practice education at the School of Health Sciences at City, University of London