Background: There is considerable interest in advocating empowerment in diabetes care. Health professionals, however, often fail to realize empowerment in clinical practice, especially in patients with poorly controlled type 2 diabetes. Objectives: To evaluate the effectiveness of an empowerment-based intervention on empowerment level, psychological distress, and quality of life among patients with poorly controlled type 2 diabetes. Design: An analysis of secondary outcomes of a prospective multi-center, randomized, parallel, investigator-blinded controlled trial. Methods: A total of 242 adult patients with poorly controlled type 2 diabetes [Hemoglobin A1c (HbA1c)>= 58 mmol/mol in the recent six months] were randomly allocated to either intervention (n = 121) or attentional control (n = 121) groups. The design of the intervention was based on the Empowerment Process Model. The intervention group received a 6-week empowerment-based transitional care program, with significant emphasis on establishing personally meaningful goals, facilitating collaborative partnership and shared decision-making, resolving life-disease conflicts via situational reflection. Participants in the attentional control group received two general health education classes and post-discharge social calls on top of routine care. Outcomes of interest include empowerment level, diabetes distress, and quality of life. Participants were invited to complete a set of questionnaires before randomization, one-week, and three-month post-intervention. Statistical analyses were performed using the generalized estimating equations based on the intention-to-treat principle. Results: Comparing with the attention control group, participants in the intervention group showed significant improvements on empowerment level [(beta = 0.163; 95% confidence interval (CI): 0.011 to 0.316, p = 0.036) at one-week post-intervention and (beta = 0.176; 95% CI: 0.020 to 0.331, p = 0.027) at three-month post-intervention, respectively]. This group of patients also displayed significant reduction in terms of emotional-distress (beta= -0.424, 95% CI: -0.798 to -0.049, p = 0.027) and regimen-distress (beta= -0.397, 95% CI: -0.702 to -0.091, p = 0.011) at three-month post-intervention and physician-related distress (beta= -0.236, 95% CI: -0.466 to -0.006, p = 0.044) at one-week post-intervention. Significant improvement in quality of life (beta= 4.151, 95% CI: 1.291, 7.012, p = 0.004) at three-month post-intervention was also observed in the intervention group. Conclusions: Findings provide empirical evidence for the values of an empowerment-based intervention program for patients with poorly controlled type 2 diabetes in increasing the empowerment level and perceived quality of life and reducing diabetes distress. Long-term effects of the intervention and its underlying mechanisms need further investigation. (C) 2019 Elsevier Ltd. All rights reserved.

Background: Despite extensive efforts and advances in evidence-based diabetes management, poor glycaemic control still remains a challenge in many countries. There is a paucity of research addressing the needs of patients with poorly controlled type 2 diabetes, or exploring the effectiveness of empowerment-based interventions in this vulnerable population. Objectives: To evaluate the effectiveness of a patient-centred, empowerment-based programme on glycaemic control and self-management behaviours among patients with poorly controlled type 2 diabetes. Design: A prospective multi-centre, single-blind, randomised controlled trial. Settings and participants: Adult patients with poorly controlled type 2 diabetes [Haemoglobin A1c (HbA1c) >= 7.5% in the recent six months] were recruited from two tertiary hospitals in Xi'an city, China. Methods: A total of 242 eligible patients were recruited and randomly assigned to the intervention or attentional control groups after baseline measurement. Participants in the intervention group received a 6-week patient centred, empowerment-based self-management programme, which is theoretically grounded on the principles of the Empowerment Process Model-setting personally meaningful goals, taking action towards goals and reflecting on the impact of action plans. Those in the attentional control group received health education classes and post discharge follow-up. Outcome measures included glycaemic control (measured by HbA1c) and self-management behaviours. Data were collected at baseline, and at 8th and 20th week after enrolment. Intervention effect were analysed using the generalised estimating equation model on the basis of the intention-to-treat principle. Results: Compared with the attention control group, the intervention group showed a non-significant HbA1c reduction of 0.476% (Cohen's d effect size = 0.31, p = 0.162). The intervention group exhibited significant improvements in general diet management at the 8th-week (beta = 0.740; p = 0.013), specific diet management at 8th-week (beta = 0.646; p = 0.022) and 20th-week (beta = 0.517; p = 0.043), and blood glucose self-monitoring at both the 8th- (beta = 0.793; p = 0.009) and 20th-week (beta = 0.739; p = 0.017) follow-ups. No intervention-related adverse events were observed. Conclusions: Findings indicate that the patient-centred, empowerment-based self-management intervention program did not induce a significant HbA1c reduction. Whereas this intervention yields improvements in diet management and blood glucose self-monitoring among patients with poorly controlled type 2 diabetes.

This study examined the psychometric properties of the Chinese version of the Personal Diabetes Questionnaire (C-PDQ). The PDQ was translated into Chinese using a forward and backward translation approach. After being reviewed by an expert panel, the C-PDQ was administered to a convenience sample of 346 adults with Type 2 diabetes. The Chinese version of the Summary of Diabetes Self-Care Activities (C-SDSCA) was also administered. The results of the exploratory factor analysis revealed a one-factor structure for the Diet Knowledge, Decision-Making, and Eating Problems subscales and a two-factor structure for the barriers-related subscales. The criterion and convergent validity were supported by significant correlations of the subscales of the C-PDQ with the glycated hemoglobin values and the parallel subscales in the C-SDSCA, respectively. The C-PDQ subscales also showed acceptable internal consistency (α = .61-.89) and excellent test-retest reliability (intraclass correlation coefficients: .73-.96). The results provide preliminary support for the reliability and validity of the C-PDQ. This comprehensive, patient-centered instrument could be useful to identify the needs, concerns, and priorities of Chinese patients with type 2 diabetes.

BackgroundPsychological distress remains a significant challenge for patients with poorly controlled type 2 diabetes. This study aimed to evaluate if an empowerment-based self-management programme would optimise psychological wellbeing in this vulnerable population of patients with diabetes.MethodsAdult patients with poorly controlled type 2 diabetes from two tertiary hospitals in Xi'an city, China, were randomly allocated to intervention or control groups using a computer-generated randomisation list with a block size of four. Participants in the intervention group received the DESIRE programme, which is a patient-centred consultation programme to empower and engage patients in self-management and active coping. The trial's primary outcome was effect on HbA1c. In this secondary analysis, we report findings for diabetes distress measured by the Diabetes Distress Scale [DDS]; patients with a mean score of three or higher were deemed to be those with diabetes distress worthy of clinical attention. Analysis was with a generalised estimating equation model according to the intention-to-treat method. Data were collected at baseline and at 8 and 20 weeks after randomisation by trained nurses who were masked to group assignment. Written consent was obtained from participants before study commencement. This trial is registered with the Chinese Clinical Trial Register, number ChiCTR-IPR-14005492.FindingsBetween April, 2014, and October, 2015, 242 patients were enrolled and randomised to control (n=121) or intervention (n=121) groups. Participants had similar social, demographic, and disease characteristics at baseline (mean diabetes duration 8·0 years [SD 6·0]; mean HbA1c 10·0% [SD 1·8]). Compared with participants in the control group, those in the intervention group had a significantly greater reduction in emotional-related distress (from mean score 3·24 [SD 1·19] to 2·54 [1·05] in the intervention group vs 3·45 [1·21] to 3·21 [1·23] in the control group; effect size 0·59, 95% CI 0·45–0·73, p=0·027) and regimen-related distress (from 3·45 [1·28] to 2·97 [0·96] vs 3·68 [1·14] to 3·55 [1·13]; effect size 0·56, 95% CI 0·42–0·69, p=0·011) after 20 weeks of follow-up. These reductions were clinically significant.InterpretationThe empowerment-based, patient-centred DESIRE programme could significantly reduce diabetes distress in patients with poorly controlled type 2 diabetes. Our findings provide a basis for integrating the DESIRE programme into routine care.FundingNo funding.

Abstract Background Interventions that specifically target patients with poorly controlled type 2 diabetes have not received much attention, despite the numerous interventional studies in patients with diabetes. This study evaluated the effectiveness of a culturally tailored, empowerment-based self-management intervention programme in Chinese patients with poorly controlled type-2 diabetes. Methods This randomised, controlled trial was conducted at two hospitals in Xiu0027an, China. 242 adult patients with poorly controlled type 2 diabetes (glycated haemoglobin [HbA1c] u003e7·5%) were randomly allocated (1:1) to receive a Diabetes Empowerment Self-management Interactive Research (DESIRE) programme or attentional control condition, by computer-generated randomisation with a block size of four. DESIRE was a nurse-led, patient-centred, empowerment-based programme consisting of six sessions on setting personally meaningful goals, making self-management action plans, and reflecting on the effect of self-management practices. HbA1c measurements, as primary outcome, were compared between the intervention and control groups at baseline and 3 months post-intervention. Data analysis adhered to intention-to-treat principles. Ethics approval was obtained from the Joint Chinese University of Hong Kong–New Territories East Clinical Research Ethics Committee. Written consent form were obtained from participants. The trial is registered at http://www.chictr.org.cn (ChiCTR-IPR-14005492). Findings The intervention (n=121) and control (n=121) participants were similar at baseline. Participants in the intervention group had significant changes in HbA1c concentration (from mean 9·94% [SD 1·81] to 9·10% [2·03] in intervention group vs 10·15% [1·81] to 9·76% [2·20] in control group; effect size 0·31, 95% CI 0·05–0·58; p=0·030). Compared with participants in the control group, more participants in the intervention group achieved HbA1c targets of less than 7% (n=27 [22·3%] vs n=15 [12·4%]; relative risk 1·80, 95% CI 1·01–3·21; p=0·042). Sensitivity analysis showed consistent results for significant changes in HbA1c in the intervention group. No adverse events were observed. Interpretation The DESIRE programme targeting patients with poorly controlled type 2 diabetes resulted in clinically significant improvement in glycaemic control. Future studies with a larger scale and longer duration are warranted to confirm the beneficial effects of such self-management programmes in this patient group. Funding None.

Background: The study was conducted to investigate the diet barriers perceived by patients with poorly controlled type 2 diabetes and examine the associations between diet barriers and sociodemographic characteristics, medical condition, and patient-centered variables.Methods: Secondary subgroup analyses were conducted based on the responses of 246 adults with poorly controlled type 2 diabetes from a multicenter, cross-sectional study. Diet barriers were captured by the Diet Barriers subscale of the Personal Diabetes Questionnaire. Participants also completed validated measures of diet knowledge, empowerment level, and appraisal of diabetes. Multiple regression techniques were used for model building, with a hierarchical block design to determine the separate contribution of sociodemographic characteristics, medical condition, and patient-centered variables to diet barriers.Results: Diet barriers were moderately evident (2.23 +/- 0.86) among Chinese patients with poorly controlled type 2 diabetes. The feeling of deprivation as a result of complying with a diet was the most recognized diet barrier (3.24 +/- 1.98), followed by "eating away from home" (2.79 +/- 1.82). Significantly higher levels of diet barriers were observed among those with lower levels of diet knowledge (beta=-0.282, P < 0.001) and empowerment (beta=-0.190, P=0.015), and more negative appraisal (beta=0.225, P=0.003).Conclusion: Culturally tailored, patient-centered intervention programs that acknowledge individuals' preferences and allow for flexibility in diet management should be launched. Interventions programs that could enhance diet knowledge, promote positive appraisal, and improve empowerment level might effectively address diet barriers perceived by patients with poorly controlled type 2 diabetes.

Objective To translate the Appraisal of Diabetes Scale(ADS) into Chinese and establish its psychometric properties among patients with type 2 diabetes mellitus. Methods The content validity of the translated ADS were evaluated by 10 experts. The psychometric properties of Chinese version of ADS were tested in 243 type 2 diabetes patients. Results Psychometric analysis supported the reliability and validity of the C-ADS and three subscales:sense of self-control,psychological impact of diabetes,belief and attitude toward personal effort. These three factors explained 76.44% of the variance. The findings also demonstrated a high factor loading indicating good construct validity of the ADS. The criterion validity was acceptable. The Cronbach's α coefficient was 0.731 and the test-retest reliability was 0.926. Conclusion The CADS is a reliable and valid measure for patients' stress and psychosocial burden among Chinese people with type 2 diabetes.

Objective To investigate the current status of the appraisal of diabetes-related stress in diabetic patients,and to analyze its influential factors.Methods A total of 243 diabetic patients were investigated with the Chinese version of the Appraisal of Diabetes Scale(ADS).Results The score of ADS was 19.19±6.23.Multiple linear regression analysis indicated that age,occupa-tion,HbA1c,duration of diabetes,having or not received the diabetes related education,diet control,medication use,blood glucose monitoring and exercise were the influential factors of the appraisal of diabetes.Conclusion The patients' appraisal of diabetes-related stress is positive.Nurses should take these influential factors into consideration to enhance diabetes patients' self-management education and stress management training.