PURPOSE:The purpose of this study was to examine diabetes self-management education and support (DSMES) utilization in the Medicaid population with diabetes to obtain actionable information to encourage uptake. METHODS:This pooled cross-sectional study analyzed Transformed Medicaid Statistical Information System Analytic Files from 2016 to 2023 for adults ages 19 to 64 years with diabetes (N = 3 735 182). Descriptive and bivariate analyses were used to examine the sociodemographic characteristics (eg, sex, race/ethnicity) and geographic patterns (eg, rural/urban status) of ever-utilization of DSMES. RESULTS:Overall, 5.6% (n = 210 078) of study beneficiaries with diabetes received ≥1 DSMES encounter. Utilization was higher among females (6.2%) and younger adults ages 19 to 34 years (7.5%). DSMES was received by 8.9% of non-Hispanic (NH) multiracial beneficiaries, 7.5% of Hawaiians/Pacific Islanders, 7.4% of NH Asians, 6.7% of NH Whites, 5.6% of NH Blacks, 4.6% of NH American Indians/Alaska Natives, and 4.4% of Hispanics. Utilization was higher in counties with a lower Social Vulnerability Index (8.7% in the lowest quartile) and slightly higher for those living in rural areas (6.2%) than those in urban areas (5.8%). State-level variation was substantial (0.1%-32.0%), although some differences likely reflect variation in data completeness, coding practices, and encounter reporting across state Medicaid programs. By state, there was substantial variation in DSMES utilization across counties (eg, in West Virginia, utilization rates ranged from 1.5% to 18.2%). Many DSMES suppliers were concentrated in counties associated with big cities, and many counties still lacked a DSMES supplier. CONCLUSIONS:DSMES utilization among Medicaid beneficiaries was low and highly uneven across demographic groups and geographic locations. These findings offer insights that can inform strategies and policies aimed at promoting equitable access and uptake.
PURPOSE:The purpose of this study was to develop and validate a theoretically informed instrument to measure diabetes-related resilience. METHODS:Experts in diabetes self-management and resilience provided feedback on 55 candidate items. Factor structure and validity were examined using a sample of 255 adults with type 2 diabetes. RESULTS:Expert feedback and exploratory factor analysis yielded a final scale of 15 items comprised of two factors: adaptability (α = .92) and determination (α = .87). Both subscales demonstrated good convergent validity with trait resilience (r = .39 and r = .42). Both subscales showed emergent evidence of discriminant validity with measures of impression management (r = .13, P = .061; r = .13, P = .047) but not of self-deceptive enhancement (rs = .34 and .38, P < .001). Subscales demonstrated small to moderate correlations with diabetes self-management behaviors (rs = .22-.40). Diabetes self-efficacy was positively correlated with adaptability (r = .45, P < .001) and determination (r = .56, P < .001) subscales. CONCLUSION:The factor structure is consistent with conceptualizations of resilience that emphasize active resistance and plasticity to stressors. The Resilience Among Adults With Diabetes Scale demonstrated good reliability and validity and may help identify patients who may benefit from tailored interventions.
PURPOSE:The purpose of the study was to explore the self-management experiences of low-income patients with diabetes. METHODS:This qualitative study employed thematic analysis to derive inductive themes from in-depth interviews with 25 low-income patients with diabetes in Korea. Data were collected through face-to-face interviews between February and August 2022, transcribed verbatim, and analyzed using Braun and Clarke's 6-phase framework. RESULTS:The results revealed that participants developed diabetes due to factors including busy and stressful lifestyles, alcohol dependence, and treatments for other illnesses. Unemployment, smoking and drinking, and financial difficulties hindered self-management, resulting in the participants losing motivation. Financial instability made diabetes management more difficult. Their medical and living expenses were covered by government support, which led them to prioritize maintaining their eligibility for this assistance over having a job and income. However, this ultimately had a devastating effect on the management of their disease. CONCLUSIONS:The hardships of life, financial burden of diabetes self-management, and lack of motivation and education on diabetes self-management hinder effective self-management. It is recommended that a program be developed that can help low-income patients with diabetes cope with the disease, provide continuous motivation, and increase their self-efficacy. Educational programs on diabetes management following diagnosis are essential to support long-term self-management and reduce health inequalities in the country.
PURPOSE:The purpose of this study was to examine facilitators, preferences, and goals influencing exercise self-management among Australian females with type 2 diabetes (T2D) to inform more person-centered exercise counselling and support. METHODS:This was a mixed-methods analysis of females with self-reported T2D (≥18 years) who completed an anonymous online survey regarding exercise self-management. The survey included quantitative items assessing demographics, physical activity levels, exercise facilitators, and exercise preferences and free-text responses that were thematically analyzed to explore exercise goals. Responses were also compared by age group (younger: 18-54 years; older: ≥55 years) to explore potential differences across adulthood. RESULTS:Participants (n = 119) were aged 22 to 87 years (mean: 59.5 ± 13.3 years), with a median T2D duration of 4.1 years. Most (57%) reported being physically active ≥150 min/wk. Participants were primarily motivated by the perceived health benefits of exercise, particularly weight and glycemic management; however, qualitative insights revealed that these were often framed as strategies to reduce the need for medication. Exercise facilitators, preferences, and goals were largely consistent across age groups. CONCLUSION:These findings highlight opportunities to better align exercise counselling and support with the priorities of females with T2D. Educating females about the broader benefits of exercise beyond weight and glycemia and framing it as a strategy to reduce medication burden may enhance its perceived relevance and uptake. The consistency of findings across age groups suggests that strategies to support exercise self-management may be broadly applicable across adulthood.
PURPOSE:The purpose of this study was to systematically review the literature to examine the efficacy of family-dyad-focused intervention for people WITH Type 2 diabetes. METHODS:The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guided the study. Four databases were searched (ie, PubMed, Embase, CINAHL, and Scopus) for articles from January 1, 2019 to December 18, 2025. Controlled vocabulary and key terms in the search included "diabetes, mellitus, type 2"; "type 2 diabetes"; "self-management"; "self-care"; "spouses"; "dyad"; "caregiver"; and "partner support," among others. Additional studies were identified through review of reference lists of relevant articles. Studies focusing on peer-support dyads were excluded. RESULTS:A total of 1816 records were identified; 886 were duplicates. Among the remaining 930 articles that were screened, 882 were not relevant, 48 were sought for full-text retrieval, together with another 4 identified from other resources such as reference lists. Nine failed full-text retrieval because of being conference abstracts, and a total of 43 full-texts were examined for eligibility. After excluding 20 that were not eligible, 23 studies were included in the final review. About half of the included studies were pilot studies, mainly to test the feasibility and acceptability of an intervention. Among the rest of the randomized controlled trials that involved family dyad as a part of the intervention, mixed results were reported in diabetes control outcomes measured with A1C, and short-term efficacy was reported in behavioral and psychosocial measurements (self-efficacy, diabetes self-management). CONCLUSIONS:Future studies are warranted to generate stronger evidence for dyad-focused interventions among people with diabetes.
PURPOSE:The purpose of the study was to translate, culturally adapt, and validate the Diabetes Distress Scale (DDS) in Spain. METHODS:A cross-sectional validation study was conducted among adults with diabetes attending public health centers in Spain. Participants completed the Spanish DDS and Problem Areas in Diabetes (PAID) questionnaire. Exploratory and confirmatory factor analyses used polychoric correlations and diagonally weighted least squares estimation. Reliability was examined with Cronbach's α and McDonald's ω. Concurrent, convergent, discriminant, and incremental validity were tested through correlation and regression analyses. Gender invariance was assessed using multigroup confirmatory factor analysis. RESULTS:The 4-factor model was supported. Internal consistency was excellent. DDS total scores strongly correlated with PAID scores, explaining 84.5% of variance (R2 = 0.845). Original DDS cutoffs (<2.0, 2.0-2.9, ≥3.0) were confirmed, showing PAID differences. Gender invariance was achieved. CONCLUSIONS:The Spanish DDS showed strong psychometric properties, replicating the original 4-factor structure with high reliability and validity, offering a culturally appropriate tool for diabetes-related distress in Spain.
PURPOSE:The purpose of this study was to examine the associations of demographics, diabetes-related symptoms, and egocentric social networks with loneliness among Black/African American men with type 2 diabetes (T2D). METHODS:As part of a National Institute of Health-funded study, cross-sectional data were collected using an internet-based survey. Eligible respondents (n = 1220) were men who identified as Black/African American and self-reported having T2D. The dependent variable was loneliness, measured with the 3-item UCLA Loneliness Scale (UCLA-3; score ≥6 indicating loneliness). Diabetes symptoms were measured by Diabetes Care Profile items. Egocentric networks were elicited with a multiprompt name generator to derive network size, perceived support, and frequency of diabetes-specific discussions. Poisson egressions were fitted to examine associations of demographics, T2D symptoms, and social-network factors with loneliness. RESULTS:Of the participants, 45.3% reported being lonely. In the Poisson regression, older age (prevalence ratio [PR] 0.99, 95% CI, 0.98-0.99), higher household income (PR 0.93, 95% CI, 0.88-0.98), and rural residence (PR 0.75, 95% CI, 0.59-0.96) were associated with a lower likelihood of loneliness. Greater hypoglycemia symptom burden was associated with a higher likelihood of loneliness (PR 1.24, 95% CI, 1.16-1.33). Higher perceived network support was associated with a lower likelihood of loneliness (PR 0.79, 95% CI, 0.72-0.88), while network size and diabetes-specific discussions with others were not significantly associated with loneliness. CONCLUSIONS:Diabetes care should routinely screen for loneliness, prioritize younger and lower income patients, and actively reduce hypoglycemia. Efforts to strengthen social support should emphasize strategies such as culturally responsive coaching to mobilize existing ties, warm handoffs to peer mentors, and community partnerships.
PURPOSE:The purpose of the study was to adapt and psychometrically evaluate an Indonesian version of the Type 2 Diabetes Stigma Assessment Scale (I-DSAS-2) for Indonesians with type 2 diabetes. METHODS:A cross-sectional psychometric and correlational study was conducted among 190 participants recruited from outpatient clinics. The Type 2 Diabetes Stigma Assessment Scale was translated and culturally adapted following established guidelines. Psychometric evaluation included exploratory factor analysis, internal consistency testing (Cronbach's alpha), and test-retest reliability (intraclass correlation coefficient). Clinical outcomes were assessed using A1C, the Indonesian Multidimensional Fatigue Inventory, and the Beck Depression Inventory-2nd Edition. Associations between stigma and clinical outcomes were analyzed using Pearson correlations and multiple linear regression, adjusting for age, gender, diabetes duration, and comorbidities. RESULTS:The I-DSAS-2 demonstrated excellent psychometric properties, revealing a 3-factor structure (treated differently, blame and judgement, and self-stigma), strong internal consistency, and high test-retest reliability. Higher stigma scores were significantly associated with elevated A1C, greater fatigue, and more severe depressive symptoms. In multivariate models, stigma independently predicted all 3 outcomes, with the strongest association observed for depression. CONCLUSION:The I-DSAS-2 is a valid, reliable, and culturally relevant instrument for assessing diabetes-related stigma in Indonesian populations. It captures the multifaceted nature of stigma and its significant links to critical clinical outcomes.
PURPOSE:The purpose of the study was to assess a culturally tailored, family-focused diabetes self-management education and support intervention with community health worker (CHW) support among Black families with prediabetes and diabetes. METHODS:The study enrolled 70 Black family members and assigned them CHWs for a 20-week diabetes prevention and self-management education and support intervention. Family members and CHWs were interviewed, and thematic analysis identified 4 themes associated with family-CHW dynamics that affected program outcomes: (1) family and CHW communication, (2) health literacy support, (3) technology support, and (4) program adherence support. The communication dynamics were bidirectional, and the health literacy, program adherence, and technology support flowed from CHWs to families. RESULTS:Participants appreciated that their CHWs were empathetic, relatable, adaptable, and good communicators, and both families and CHWs spoke of strong emotional and task-based bonds. CHWs' positive impact on adherence was confirmed. Data on health literacy and technology support activities identify families' additional needs to be successful in these programs. CONCLUSIONS:The study results on family-CHW dynamics add to the literature on family-based diabetes prevention and self-management education and support programs and the limited literature on how participants and CHWs interact, communicate, and share information during lengthy chronic disease programs. Expanding the public health impact of diabetes programs for Black adults may come from innovations in family-based programs supported by positive CHW interactions.
PURPOSE:The purpose of this systematic review and meta-analysis was to evaluate the impact of continuous glucose monitoring (CGM) on glycemic control and quality of life (QoL) among adults with type 2 diabetes (T2DM) managed within primary care settings. METHODS:Following PRISMA 2020 guidelines, 4 databases were comprehensively searched for randomized controlled trials (RCTs) published through July 9, 2025. Eligible trials reported on A1C, QoL, diabetes distress, and device satisfaction. Shorter term (6-8 months) and longer term (12-14 months) A1C outcomes were synthesized using random effects meta-analysis models. RESULTS:Of 739 records, 4 multisite RCTs (6 reports) met inclusion criteria and represent data from 566 adults with T2DM in primary care settings. Two trials utilized real time CGM, while others employed retrospective or intermittently scanned CGM. Participants attended primary care visits during the trial, receiving diabetes management and medication changes as required. The CGM intervention significantly improved glycemic control with pooled A1C reduction of -0.46% at 6 to 8 months and -0.33% at 12 to 14 months and device satisfaction with no differences in QoL. CONCLUSION:These results demonstrate that CGM significantly improves glycemic control with no change in QoL among adults with T2DM in primary care and suggest that CGM utilization within this setting offers distinct advantages in patient engagement and diabetes management, particularly when integrated through a multidisciplinary team approach. Future research should prioritize populations currently ineligible for CGM coverage, such as non-insulin-using patients and underserved groups, while also investigating the impact of updated sensors' accuracy on clinical outcomes.
Purpose: The purpose of this study is to test the feasibility and exploratory within-participant changes associated with implementing a multiple-behavior self-monitoring intervention in a diabetes care and support program. Methods: In this 3-month mixed-method implementation study, 45 adults with type 2 diabetes were planned for enrollment from certified diabetes care and support programs. Participants logged diet, activity, blood glucose, and weight using smartphone apps or paper diaries, based on preference. All received a brief lifestyle intervention adapted from Look AHEAD (Action for Health in Diabetes). Outcomes included weight and A1C at 3 months, and feasibility was assessed through retention and qualitative interviews. Results: Thirty-one participants completed the study. Participants showed modest within-participant weight loss and maintained glycemic control, with A1C remaining stable during the study period. Exploratory descriptive comparisons did not suggest meaningful differences between participants using smartphone versus paper methods. Qualitative interviews supported feasibility, with participants reporting the intervention as both acceptable and useful. Conclusions: Implementing a digital-optimized multiple-behavior self-monitoring intervention is feasible in a diabetes self-monitoring diabetes care and support program. The findings suggest that implementation of the intervention is feasible and acceptable, with observed weight loss and maintenance of glycemic control over 3 months.
PURPOSE:The purpose of the study was to evaluate the use of telemedicine for diabetes self-management education (DSME) for newly diagnosed youth and adolescents with type 1 diabetes on glycemic outcomes and health care utilization. METHODS:A retrospective study of youth <18 years old receiving new-onset DSME between January 1, 2020, and September 30, 2022, was conducted. New-onset DSME includes teaching survival skills at diagnosis and advanced skills 7 to 10 days later, either in person or via telemedicine. A1C levels, readmission rates, emergency department (ED) visits, diabetes clinic visit attendance, and the probability of utilizing telemedicine for outpatient visits in the first year following diagnosis were compared between the in-person and hybrid groups using generalized linear models, adjusted by distance to the hospital. RESULTS:Groups included 296 in-person and 246 hybrid participants. Baseline mean A1C improved 1-year post-diagnosis from 11.7% ± 2.1% (15.77 ± 3.27 mmol/l) and 11.8% ± 1.8% (15.93 ± 2.8 mmol/l) to 7.8% ± 1.7% (9.71 ± 2.64 mmol/l) and 7.8% ± 1.3% (9.71 ± 2.02 mmol/l) for in-person and hybrid groups, respectively, with no statistical difference after adjusting for baseline A1C and distance to clinic (difference: -0.06; P = .73). Groups did not differ significantly in ED visits (odds ratio [OR] 0.67; P = .33), readmission rates (OR 0.58; P = .35), or clinic visit attendance (incidence rate ratio 0.97; P = .46). After adjusting for distance from the nearest diabetes clinic, the hybrid group had 89% higher odds of completing a visit via telemedicine (P < .001). CONCLUSIONS:New-onset DSME via telemedicine is a reasonable alternative to in-person education. Ongoing engagement with telemedicine suggests this modality may help reduce barriers to care.
Purpose: The purpose of the study was to explore adolescents' experiences of being a sibling of a child with type 1 diabetes (T1D) and how diabetes affects the family. Methods: A descriptive qualitative study was conducted in Norway through individual, semistructured interviews with adolescents (16-20years) who had been siblings of a child with T1D before the age of 18.All interviews were audio recorded and transcribed verbatim. Thematic analysis, as described by Braun and Clarke, was used to analyze the data. Results: Four main themes were identified during the analysis, each comprising related subthemes. The main themes were (1) the start was difficult, but it gradually got better; (2) diabetes affects the atmosphere in the family; (3) a desire to be included; and (4) diabetes affects everyday life to a great extent. Conclusions: The findings of the study confirmed that T1D has a major impact on a family's everyday life, but the siblings experienced that it affected the family dynamics both positively and negatively. Siblings expressed a desire for more information and support from health care professionals and a desire to be included in the diabetes management of their sibling with T1D. The findings highlight the need for health care professionals to include siblings in diabetes education and follow-up.
PURPOSE:The purpose of the study was to examine a hypothetical model of medication-taking behavior in individuals with type 2 diabetes based on the information-motivation-behavioral skills (IMB) model and to investigate pathways depending on the presence of depressive symptoms. METHODS:This study employed a theory-driven, cross-sectional correlational design and used path analysis to examine the hypothesized relationships. Participants comprised 325 adults with type 2 diabetes mellitus who attended a university-affiliated hospital in South Korea. Structured questionnaires were used to measure IMB-model-driven variables: medication knowledge (information), health beliefs about medication (cognitive motivation), depressive symptoms (affective motivation), medication self-efficacy (behavioral skills), and medication-taking behavior (behavioral change). Path analysis was conducted using AMOS 26.0, and multigroup analysis examined structural pathway differences between individuals with and without depressive symptoms. RESULTS:Medication self-efficacy and health beliefs about medication directly influenced medication-taking behavior, and depressive symptoms had an indirect effect through self-efficacy. The path from medication self-efficacy to medication-taking behavior was significantly stronger among individuals with depressive symptoms compared to those without depressive symptoms. CONCLUSIONS:The findings provide empirical support for the model, demonstrating that behavioral skills are a crucial mediator in the relationships between motivation and medication-taking behavior.
PURPOSE:The purpose of this integrative literature review was to synthesize quantitative and qualitative evidence describing the impact of cultural perceptions on diabetes self-care behaviors among Filipino American adults with type 2 diabetes (T2DM), identifying knowledge gaps and generating practice implications for diabetes care and education specialists. METHODS:Using Whittemore and Knafl's integrative review framework, 4 databases (CINAHL, PubMed, Medline, and ScienceDirect) were searched for English-language studies published from 2000 to 2025. Inclusion criteria included empirical studies examining cultural factors, classified as (1) family-centered values (e.g., bayanihan, pakikisama), (2) traditional food practices, (3) spirituality and fatalism, (4) acculturation and colonial mentality, and (5) community support networks and at least 1 ADCES7 self-care behavior in Filipino American adults with T2DM. Methodological quality was evaluated using the Johns Hopkins evidence-based practice tool. Data were extracted into standardized matrices and analyzed through constant comparative analysis. RESULTS:Nine studies (6 quantitative, 3 qualitative) identified 5 cultural domains that facilitated or hindered ADCES7 behaviors, including healthy eating, medication adherence, and blood glucose monitoring. Evidence strength ranged from Level II to Level III. CONCLUSIONS:Diabetes care and education specialists must assess these 5 cultural domains, incorporating family involvement, culturally appropriate nutrition counseling, spiritual considerations, and community-based support, to enhance ADCES7 self-care behaviors.
Purpose: The purpose of this study was to describe adaptations and participant characteristics and engagement in family-focused diabetes self-management education (DSME) before and during a large-scale disruption in health care access and research participation, which prompted a pivot to virtual DSME.Methods: The study was conducted at a federally qualified health center (FQHC) serving a predominantly low-socioeconomic status Hispanic community. Two hundred twenty-two adults with type 2 diabetes (85% Hispanic) receiving care from the FQHC enrolled with a support person (SP); dyads were randomized to community health worker (CHW)-led dyad-focused Family Support for Diabetes Health Action (FAM-ACT) or patient-focused DSME. Survey, health record, and session data were compared between those enrolled before (n = 77) versus during the disruption (n = 145).Results: In hybrid (virtual+in person) DSME, CHWs prioritized group discussion and shorter sessions emphasizing participants' personal health goals and social-emotional concerns. Enrollment was lower after versus before switching to hybrid (23% vs 30% recruited). Those with less complex diabetes and preferring Spanish enrolled at higher rates during hybrid offerings. Overall, patient DSME attendance slightly decreased during versus before hybrid implementation (mean -0.3 sessions/6) but increased in FAM-ACT patients (mean +0.3 sessions/6) and SPs (mean +0.5 sessions/6). During hybrid programs, patients choosing virtual attendance were more often female, living with children, have food insecurity and difficulty prioritizing diabetes over other demands.Conclusions: Group DSME delivered via hybrid sessions maintained participant engagement during a large-scale disruption in health care access by addressing language, health and social needs, life demands, and technological barriers.Trial registry: The underlying trial was registered with www.clinicaltrials.gov (NCT03812614, 01/18/2019).
PURPOSE:The purpose of this study is to understand the experiences and support needs for oral health self-care among older adults with type 2 diabetes. METHODS:From November 2024 to January 2025, a descriptive qualitative study was conducted in China through individual semistructured interviews. All interviews were audio recorded and transcribed verbatim. Data were analyzed using thematic analysis. RESULTS:A total of 23 participants were recruited. The findings are described in 3 themes and 6 subthemes. The first theme, perception of oral health: dental care is not a top priority in the context of aging, contained two subthemes: oral health illness perception and the role of diabetes and reliance on personal experience with limited knowledge and education. The second theme, oral health self-care: focusing on alleviating symptoms in oral health decisions, contained two subthemes: symptom-driving management and passive coping and adapting to oral changes to minimize the interruptions. The third theme, unmet support needs: multifaceted barriers and expectations in managing oral health, contained two subthemes: barriers to oral health-seeking behaviors and expectations for support from multiple stakeholders. CONCLUSION:The findings highlight the need for tailored oral health self-care education and support. Incorporating effective, culturally appropriate oral care into routine diabetes management is recommended to ensure high-quality care.
