Personal understandings of illness among people with type 2 diabetes

BACKGROUND: Professionals and patients understand the experience of illness from different worlds. Professionals' explanatory models focus on aetiology, diagnosis, pathophysiology and treatment, while patients' explanatory models are more focused on consequences and influences on daily life. The differences between patients and professionals in their understanding often result in conflicting expectations about treatment, priorities and outcomes of care. AIM: The aim of this study was to describe personal understandings of illness among people with type 2 diabetes in Sweden. METHOD: A sample of 44 patients, 47-80 years, diagnosed with type 2 diabetes within the last 2 years, was recruited from four health care centres. Narrative thematic interviews were used covering the areas of developing, coping with and living with diabetes. Qualitative content analysis was performed. FINDINGS: The findings were formulated into six categories: image of the disease, meaning of the diagnosis, integration of the illness, space for the illness, responsibility for care and future prospects. CONCLUSIONS: The findings demonstrate that patients' personal understanding of illness is an important complement to the traditional professional view of diabetes. They could serve as a foundation for development of health history interviewing, as well as development of systems of documentation. Patients' personal understandings of diabetes in their daily lives are considered to be an important shared source of information for planning meaningful care.     

2型糖尿病病人疾病感知、用药信念与血糖控制的相关性研究

[目的]了解2型糖尿病病人疾病感知、用药信念及血糖控制情况,探讨疾病感知、用药信念与血糖控制的关系。[方法]2016年10月-2018年10月通过方便抽样选取254例住院的2型糖尿病病人,采用一般资料调查表、改良版疾病感知问卷和用药信念量表调查2型糖尿病病人的一般资料、疾病感知及用药信念情况。[结果]2型糖尿病病人糖化血红蛋白水平为(8.72±2.44)%,病人对疾病病情的看法均分为2.29~3.68分,用药信念的均分为2.67~3.80分。相关分析显示,疾病感知的病程、治疗控制以及疾病周期性维度,用药信念的药物过度使用维度与2型糖尿病病人血糖控制水平具有显著相关性。[结论]2型糖尿病病人的血糖控制水平欠佳,疾病感知、用药信念可直接影响病人的血糖控制水平。     

Gestational diabetes: prospective interview‐study of the developing beliefs about health,illness and health care in migrant women

Aims and objectives. To explore the development over time of beliefs about health, illness and health care in migrant women with gestational diabetes mellitus born in the Middle East and living in Sweden and to study the influence on self‐care and care seeking. Background. With today’s extensive global migration, contact with the new society/health care confronts the migrant’s culture of origin with the culture of the host country. The question is whether immigrants’ patterns of beliefs about health, illness and health‐related behaviour change over time, as no previous studies have been found on this topic. Design. A qualitative prospective exploratory study. Methods. Semi‐structured interviews, with 14 women (28–44 years), on three occasions: during pregnancy in gestational weeks 34–38 and three and 14 months after delivery. Results. There was a U‐shaped development of beliefs, from focusing on worries about the baby’s health during pregnancy and trying to comply with advice from health professionals, particularly a healthy diet, through regression to dietary habits (more sugar, less fibre) and lifestyle held before being diagnosed with gestational diabetes mellitus three months after delivery, back to a healthy diet/lifestyle and worries 14 months after delivery but then focusing on their own risk, as mothers, of developing type 2 diabetes and being unable to care for the child. Over time, the number of persons perceiving gestational diabetes mellitus as a transient condition decreased. Respondents lacked information about gestational diabetes mellitus, diet and follow‐ups. Conclusion. Beliefs changed over time and influenced health‐related behaviour. Beliefs about the seriousness of gestational diabetes mellitus among healthcare staff/care organisation influence the development of patients’ beliefs and need to be considered in planning care. Relevance to clinical practice. Pregnancy should be used as an opportunity to provide complete information about gestational diabetes mellitus and future health risks. This should continue after delivery and wishes for regular follow‐ups should be met.     

Structured primary care for type 2 diabetes has positive effects on clinical outcomes

Background Patients with type 2 diabetes have an increased risk of developing microvascular and macrovascular complications. In routine diabetes care an adequate reduction of risk factors for these complications is often not achieved. Objective The aim of the study was to evaluate the effects of structured diabetes care on clinical outcomes of patients with type 2 diabetes in primary care. Methods We performed a quasi‐experimental study on the effects of structured care consisting of organizational and educational components (n = 581) compared with care‐as‐usual (n = 152). We assessed clinical outcomes of HbA1c, blood pressure, cholesterol, creatinine and body mass index, at baseline and after 1 year. The long‐term effects in the structured care group were determined after another 2 years. Results Structured care led to improvement in HbA1c and long‐term improvements in blood pressure and cholesterol compared with care‐as‐usual. After 1 year, the percentage of patients who did not deteriorate was higher in the structured care group, again for HbA1c, diastolic blood pressure, low‐density lipoprotein cholesterol and body mass index. Conclusions Structured diabetes care consisting of multiple components has a positive effect on clinical outcomes compared with care‐as‐usual. Our findings support its further implementation in order to reduce complications in type 2 diabetes patients.     

The role of social support in the self-management of diabetes mellitus among a Hispanic population

The rising incidence of diabetes mellitus continues to be a major health concern among Hispanic Americans. Social support has been found to be a relevant factor in diabetes self-management, however, it has not been explored within a Hispanic community. This cross-sectional study was therefore conducted with 95 insulin-requiring Hispanic adults to explore the composition of the support network, the type of assistance needed, the degree of satisfaction with support received, and the relationship between social support and diabetes self-management. Overall, the participants had fairly large networks, composed primarily of family members. The greatest need for assistance was associated with transportation or interactions that involved speaking English, and the assistance offered in these areas was viewed as highly satisfactory. Participants were least satisfied with the help they received for diabetes-related self-care, personal care, and financial assistance. Social support was not strongly related to diabetes self-management. Community health nurses must be aware that this population may have needs that are unsatisfactorily met. They should provide education and resources for support persons and carefully evaluate the support network, not only for availability, but also for satisfaction. Effort should also be directed toward developing alternative support for those without available family.     

临床护理路径在提高2型糖尿病病人自我管理能力中的应用

[目的]探讨临床护理路径在提高2型糖尿病病人自我管理能力中的应用。[方法]将100例2型糖尿病病人随机分为观察组和对照组,每组50例,对照组采用传统护理方式,观察组根据临床护理路径对病人实施护理。比较两组病人相关知识的掌握情况以及出院后血糖、血脂、血压的控制程度,以评价病人的自我管理能力。[结果]观察组病人对糖尿病相关知识的掌握情况、出院后6个月血糖、血脂、血压的控制水平均优于对照组。[结论]临床护理路径可提高2型糖尿病病人自我管理能力,提高治疗及护理效果。     

临床护理路径在提高2型糖尿病病人自我管理能力中的应用

[目的]探讨临床护理路径在提高2型糖尿病病人自我管理能力中的应用。[方法]将100例2型糖尿病病人随机分为观察组和对照组,每组50例,对照组采用传统护理方式,观察组根据临床护理路径对病人实施护理。比较两组病人相关知识的掌握情况以及出院后血糖、血脂、血压的控制程度,以评价病人的自我管理能力。[结果]观察组病人对糖尿病相关知识的掌握情况、出院后6个月血糖、血脂、血压的控制水平均优于对照组。[结论]临床护理路径可提高2型糖尿病病人自我管理能力,提高治疗及护理效果。     

The role of exercise in the African-American woman with type 2 diabetes mellitus: application of the health belief model

PURPOSE: To determine whether aging African-American women with a diagnosis of type 2 diabetes mellitus who maintain a regular exercise regimen possess different health beliefs and benefit from greater glycemic control than those who do not exercise regularly. DATA SOURCES: A 32-item health belief model diabetes scale was administered to a convenience sample of 31 African-American women with type 2 diabetes. CONCLUSIONS: A group t-test identified statistically significant differences between "exercisers" and "non-exercisers" in perceived benefits and barriers to exercise and glycemic control. IMPLICATIONS FOR PRACTICE: Findings may be utilized in the development of diabetic educational programs and compliance-enhancing treatment interventions that focus on the barriers and benefits of diabetes self-management.     

Gaps in the Public's Knowledge About Chronic Pain: Representative Sample of Hispanic Residents From 5 States

Educating the general public about chronic pain and its care is a national health priority. We evaluated knowledge, attitudes, and beliefs (KAB) of a 5-state, population-based sample of Hispanic individuals aged 35 to 75 years without chronic pain, representing more than 8.8 million persons. A Web-based survey assessed KAB using an adapted version of the Survey of Pain Attitudes-Brief and self-reported knowledge about chronic pain (nothing, a little, a lot). In unweighted analyses of participants (N = 349), the mean age was 52.0 (±10.6) years, 54% were women, 53% preferred Spanish, and 39% did not graduate from high school. More participants reported knowing nothing about chronic pain (24%) than a lot (12%). In weighted logistic models with knowing nothing as the reference, knowing a lot was associated with greater KAB for chronic pain-related emotions, functioning, and cure (all P < .01) but poorer KAB about pain medications (P < .001). Associations were similar for those knowing a little. Men and women preferring Spanish had poorer KAB about pain medications than men preferring English (both P < .001). In view of Hispanic individuals’ disparities in chronic pain care, these data underscore the need for effective public educational campaigns about chronic pain.

2型糖尿病合并肺癌的临床特点分析

目的 分析2型糖尿病患者合并肺癌的临床特点。方法 对1998—2003年住院的58例2型糖尿病合并肺癌患者的临床资料进行回顾性分析。结果 2型糖尿病合并肺癌患者占同期2型糖尿病住院患者的5．31％;糖尿病确诊在肺癌之前、同时及之后的发生率分别为84．5％、12,1％、3．4％;合并肺癌的病理类型以腺癌多见,占51．7％;鳞癌次之,占36．2％。结论 2型糖尿病患者合并肺癌的发生率较高,应高度重视;良好的血糖控制及早期、规律的抗肿瘤治疗,是取得良好预后的关键。     

社区2型糖尿病病人足部护理的研究进展

从2型糖尿病足部发病的相关因素、社区护理措施以及应用早期护理干预和筛查预防糖尿病足的发生等方面综述社区2型糖尿病病人足部护理的研究进展,指出我国社区护理的体制和设施还不够完善,引进和开发早期筛查技术至关重要。     

Primary care physician beliefs about insulin initiation in patients with type 2 diabetes

Background: Insulin is the most effective drug available to achieve glycaemic goals in patients with type 2 diabetes. Yet, there is reluctance among physicians, specifically primary care physicians (PCPs) in the USA, to initiate insulin therapy in these patients. Aims: To describe PCPs’ attitudes about the initiation of insulin in patients with type 2 diabetes and identify areas in which there is a clear lack of consensus. Methods: Primary care physicians practicing in the USA, seeing 10 or more patients with type 2 diabetes per week, and having > 3 years of clinical practice were surveyed via an internet site. The survey was developed through literature review, qualitative study and expert panel. Results: Primary care physicians (n = 505, mean age = 46 years, 81% male, 62% with > 10 years practice; 52% internal medicine) showed greatest consensus on attitudes regarding risk/benefits of insulin therapy, positive experiences of patients on insulin and patient fears or concerns about initiating insulin. Clear lack of consensus was seen in attitudes about the metabolic effects of insulin, need for insulin therapy, adequacy of self‐monitoring blood glucose, time needed for training and potential for hypoglycaemia in elderly patients. Conclusions: The beliefs of some PCPs are inconsistent with their diabetes treatment goals (HbA1c ≤ 7%). Continuing medical education programmes that focus on increasing primary care physician knowledge about the progression of diabetes, the physiological effects of insulin, and tools for successfully initiating insulin in patients with type 2 diabetes are needed.     

Patients' beliefs about medicines in a primary care setting in Germany

Objectives The aim of this study was to explore patients' beliefs about medicines by administering the German version of the Beliefs about Medicines Questionnaire (BMQ) in a primary care setting among chronically ill patients and to examine its psychometric properties. The BMQ assesses patients' beliefs about their individual prescribed medication as well as their beliefs about medicines in general. Methods A cross‐sectional survey of 485 chronically ill patients was performed. The German version of the BMQ was evaluated in terms of internal consistency, validity and scale structure. To assess validity the Medication Adherence Report Scale (MARS‐D) and the Satisfaction with Information about Medicines Scale (SIMS‐D) were applied. Results The BMQ showed good internal consistency (Cronbach's α 0.79–0.83). Patients' belief about the specific necessity of their medicines correlated positively with the MARS‐D (ρ = 0.202; P < 0.01). There were significant correlations in the predicted direction between the MARS‐D and all the BMQ subscales with the exception of the General‐Overuse subscale (ρ = ?0.06; P = 0.30). Relationship to the SIMS‐D was comparable to the original study. Factor analysis corroborated the scale structure. Conclusions The BMQ is a suitable instrument to measure patients' beliefs in medicines in German primary care settings. Most patients in our sample had positive beliefs concerning the necessity of their medication. Their levels of concern were associated with higher non‐adherence.