Effective Strategies For Improving Outcomes In Adult Patients With Type II Diabetes Essay.

Overview of Diabetes

More than 34 million people in the United States are diagnosed with diabetes (CDC, 2021). The common types of diabetes include Type 1 and Type 2, with other varieties including prediabetes and gestational diabetes (Forouhi & Wareham, 2019). Type II diabetes is more common in adults and accounts for about 90% of all cases involving diabetes. Diabetes is an impairment in how the body regulates and uses sugar. Various risk factors contribute to the cause of type II diabetes. These risk factors include weight, fat distribution, family history, race and ethnicity, blood lipid levels, and pregnancy-related risks. In addition, diabetes is associated with heart and blood vessel diseases, damaging the nerve, kidney disease, and hearing impairment. The integrative review aimed to look for successful strategies to improve outcomes in adult patients with Type II diabetes.

In the case of adults with type II diabetes, Guidelines 5 of the American Diabetes Association Standards of Medical care in Diabetes 2021 state that behavior change and well-being can be used to improve health outcomes. In this integrative review, a clinical question is formulated by following PICOT format where P stands for patient/problem, intervention is denoted as I, C stands for comparison, O illustrate about outcome and T stands for time period for the intervention. By following this framework, the clinical question would be: " What is the effectiveness of Guideline 5 of the ADA Standards of Medical Care in Diabetes 2021, Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care, compared to current practice, for adults with Type II diabetes, to control the fasting blood glucose levels within 8–10 weeks?"

Globally, diabetes has become a common cause of death among various nations. The global death due to diabetes has increased significantly from 0.61 million recorded in 1990 to 1.37 million in 2017 (Lin et al., 2020). Complications and comorbidities of Type II diabetes include heart and blood vessel diseases, nerve damage in the limbs, diseases related to the kidney, impairment of the eye, skin conditions, and hearing impairments (Parsa, Agahamohammadi & Abazari, 2019). Type 2 Diabetes refers to an impairment in how the body uses sugar as a fuel and regulates them. Insulin causes the breakdown of glucose and makes it available to the cells so that the glucose level in the blood can be reduced; however, in the case of Type II DM, enough insulin is not produced, resulting in high blood glucose levels (American Diabetes Association, 2021). There is no cure for Type II DM other than managing weight, eating well, and performing exercises that help in controlling sugar level. Subsequently, the chronic health condition symptoms include blurred visons, slow healing of wounds, numbness, increased thirst, weight loss, fatigue, etc. (Peek, Vela & Chin, 2020).) The complications include increased risk of stroke, hypertension, nerve damage, kidney disease, eye damage, dementia, hearing impairment, skin conditions, etc. Societal impactors also create a pivotal impact on the management of diabetes. Healthcare professionals and other caregivers are responsible for addressing diabetes to reduce the high costs associated with managing the disease (Yang et al., 2017). The prevalence of diabetes increases as most Americans live longer, and obesity continues to grow. As a result, the vast treatments and different costs used to provide care for diabetes increase, and the burden of diabetes will increase. The cost involved in the treatment of diabetes has increased from $174 billion in 2007 to $245 billion in 2012, representing an increase of 41% in just five years (Grace et al., 2017).

Risk Factors for Type II Diabetes

The theory used is the Translational Science Model. Translational science involves the application of research findings in a practice setting. The Knowledge to Action (KTA) Framework is a model that describes the mechanism through which individuals, small groups, and organizations diffuse, adapt, and uptake new knowledge and innovation. The model has two components involving Knowledge Creation and an Action cycle. Each of the two components has multiple phases (Graham, et al., 2018). The KTA Framework applies to the intervention to improve awareness of self-management for diabetes patients. The model emphasizes using research-based evidence to facilitate the adoption of interventions that encourage enhanced patient care. The primary premises of the Action Cycle include identifying the problem and relevant research, adapting research to the local context, assessing barriers to using the knowledge, selecting, tailoring, and implementing interventions, monitoring knowledge use, evaluating outcomes, and sustaining knowledge use (Graham, et al., 2006). Type II diabetes (T2D) is a preventable disease and accounts for almost 90% of the cases in the world. A sizeable number of risk factors linked to T2D can be modified. The treatment of the disorder can be done using self-management behavior such as adherence to a healthy lifestyle such as diet, physical activity, and having an ideal body weight (Van Ommen et al., 2018). However, the lack of adequate scientific literature about the assessment of self-management in T2D has affected the step in mitigating the lapse that can be observed in day-to-day clinical practice. Therefore, the research effort within self-care behavior can be directed solely to the niche area in the qualitative exploration of the research problem. A grounded theory approach can be employed in the qualitative inquiry to allow for theory building with relevant mediators of self-management practices that directly impact the internal psychological aspects of T2D patients. This theory systematically collects and interprets qualitative data on a procedural front, similar to inferential study design. The new concept is included in the behavioral model that helps explain participants' experiences from scientific exploration.

In this study, the papers which were selected were found from the databases like PubMed, MEDLINE, EMBASE, Cochrane Database, and other libraries based on the clinical question formulated above as well as following a specific search criterion. The article selection was filtered according to the inclusion and exclusion criteria provided by the PubMed filters: systematic review article types from years ranging from 2017 to 2021 were selected. More than 400 results were found according to which articles were selected, considering keywords such as ‘diabetes’, ‘prevention’, ‘guidelines’, ‘improvement’, ‘medical care’, ‘fasting blood glucose’, and so on (Eriksen & Frandsen, 2018). The exclusion criteria were that secondary and summary-based articles were excluded because the study only focused on literature-based. Also, articles published before 2017 were not considered. According to the mentioned criteria, filtering the articles made the research more precise and narrower.

Planning for the search strategy helps determine the databases to search, point out the main elements of the PICOT question, and translate the natural language terms to medical subject headings, subject descriptors, or synonyms. The search strategy involved listing the PICOT elements, the keywords, search items, and search strategies from the clinical question.

Effective Strategies for Improving Outcomes in Adult Patients with Type II Diabetes

The integrative review was based on specific criteria selected based on the understanding of the research and its aim. Ali and Usman (2018) opined that inclusion criteria are those factors based on which the study sample are included, and exclusion criteria are those factors based on which the samples are excluded. Since this is an integrative review; thus, the relevance of inclusion and exclusion criteria cannot be denied. From the understanding, the inclusion criteria include articles with primary and secondary research on T2D patients aged above 18 years and older. In addition, self-management strategies or interventions, behavioral change, papers published only after 2017, papers are written in English, full-text pdf articles were only included, and informed consent of authors was obtained. Conversely, the exclusion criteria include articles that did not focus on type II diabetes, patients below 18 years. Therefore, treatment includes alternatives other than self-management, papers published before or in 2017, papers available in a language other than English, abstract only pdf, and consent from authors were not taken. 

The data analysis is a process used by researchers to reduce data to a story and interpret it to derive insights. The data analysis process helps reduce a large chunk of data into smaller fragments, which makes sense. Three essential things occur during the data analysis process — the first is data organization. Summarization and categorization contribute to becoming the second known method used for data reduction. It helps find patterns and themes in the data for easy identification and linking. The third and last way is data analysis, which involves a top-down and bottom-up fashion.

On the other hand, describing data analysis is messy, ambiguous, time-consuming, creative, and fascinating. A mass of collected data is brought to order, structure and meaning. The data analysis and interpretation process represent deductive and inductive logic in the research and data analysis. The data analysis of the integrative review involved gathering data from various databases and screening them to obtain the desired number. The data was organized based on the PICOT question; thus, the extracted data was selected and thematically segregated. The integrative review results were thoroughly investigated and understood, and information from each paper was included in the review. The quality of the articles was assessed using the Joanna Briggs Institute checklist or JBI checklist for quality appraisal purposes, which helped maintain the study's reliability and validity. The integrative study involves a review of various articles based on the research problem to address the issue and evaluate three interventions that can help manage T2D. Further, the analysis provides a literature synthesis table that focuses on the aim, findings, study design, level of evidence, etc.

In this integrated review, the articles were retrieved from the databases mentioned earlier PubMed, MEDLINE, EMBASE, Cochrane Database, and other free libraries. For simplifying the search Google scholar was used at last of the search which might help to review the retrieved article quickly and efficiently. A total of 400 articles were initially found from the databases mentioned above after putting the search words into the search box. After putting the filters that means the inclusion criteria the suitable articles reduced and a total of 40 articles were found suitable and 360 articles were excluded.

Complications and Comorbidities of Type II Diabetes

After finding 40 suitable articles, JBI checklist was utilized for selecting the most suitable articles. By following JBI checklist the article number reduced to 15. The strengths as well as weaknesses of the research articles was reviewed by using the Critical Appraisal Skills Programme tool or CASP tool (Brice, 2022). The CASP Tool helped to analyze the validity as well as reliability of the research. It can be seen that most of the studies were of high quality from the appraisal. Therefore, the overall score of the review was high in terms of quality.

From analyzing the research articles that were selected in this integrative review, 5 major themes have been identified which were: use of mobile applications, self-management education, behavioral management, lifestyle interventions, and screening for depression.  The themes are described below in detail:

The authors Jeffrey et al. (2019) led a qualitative study to assess the intervention of the le applications in managing type 2 diabetes. The authors stated that mobile applications had shown incredible outcomes in managing Type II diabetes mellitus among patients suffering from these issues. For the review, the members above or equivalent to the age scope of 18 years were thought. The researchers utilized semi-structured cell phone interviews with 16 cell phone users and 14 members who are non-cell phone clients. The authors examined the information using deductive content analysis. It was viewed that the vast majority of the members showed further improved outcomes concerning the management of type 2 diabetes mellitus. The applications help to make positive communications among medical services experts and patients. The non-cell phone client has confronted a vast boundary concerning utilizing the application and following their well-being. The authors deduced in their review that consolidation of client highlights and applications would make the board of type II diabetes mellitus simple driven

The authors Alkawaldeh et al., (2020) directed a qualitative study with old individuals to manage diabetes. Electronic self-management approaches can help older adults to screen their condition, remain active, and maintain their mobility. The authors led the review was to examine adults with type 2 diabetes mellitus and points of view about utilizing tablet-based applications and tablet-based applications time diabetic self-management treatment throughout everyday living. Semi-structured interviews were used in the exploration approach. The authors found that the tablet-based applications were a valuable and significant part of the clients' regular self-management efforts. Five attributes emerged from the discussions: confidence, getting, positive affect mindset and conduct, support, and balance. Individual meetings uncovered those cutting-edge innovations should support the underpinnings for behaviour and mental changes toward self-management standards of conduct, bringing about superior clinical outcomes.

The authors' Gal et al. (2020) led a review to comprehend the intercession of persistent glucose observing review to comprehend if such is viable in self-management of type 2 diabetes. The authors isolated the member given to type 1 and type 2 diabetes. The reaction was accumulated from 27 members with type 1 diabetes and seven members with type 2 diabetes. Every one of the members was utilizing a continuous glucose-checking instrument for quite a long time. The authors say that the mean HbA1c level diminished to 1.6. The authors noticed it brought down diabetes inconvenience, higher happiness with diabetes control, and fewer design obstacles to treatment with constant glucose observation. In their review following 12 weeks, the authors deduced that remote CGM start was good in laying out delayed use, improved glycemic control, and worked on personal satisfaction markers. The authors inferred that if broadly upheld, the telehealth method might be fundamentally valuable in enhancing CGM utilization and upgrading glucose control for people with diabetes who use insulin.

Societal Impact of Diabetes

The author Chester et al. (2018) led a review regarding the diabetes self-management education (DSME). The authors clarified that T2D is a persistent issue, and self-management is fundamental. The authors examined reactions with surveys from 332 patients with type two diabetes. In the response, the patients referenced the specialists generally prescribe them to talk with dietitians; in any case, it is seen that just 38% of the members spoke with the dietitians. The specialist stresses the meaning of food and movement and a proposal to a dietician for specific consideration; if one is available, clients can start to make the right strides.

The authors McCarthy and Gray (2018) led a cross-sectional review to get examples of self-management of diabetes. The authors figured out that arising adults utilize fewer insulin siphons and are vulnerable to missing a portion. In the review, it was observed that two variables are most fundamental in every one of the gatherings: the recurrence of the blood glucose checks and the missing insulin dosages.

The authors Mirzaei et al., (2022) conducted a psychometric study to understand the intervention of social cognitive factors related to self-management of type II diabetes. The authors claimed that self-care behaviors are significantly reducing the blood sugar level. In addition, the authors highlighted negative correlations between the DSMQ-SCT and HbA1c. The authors concluded that the DSMQ-SCT is a viable and effective tool for assessing social cognitive aspects linked to self-management practices in Type 2 diabetic patients. As a result, this equipment can be employed in academic and therapeutic treatment.

According to Perrin et al. (2017), in type II diabetic adults, successful conduct control and psychosocial prosperity are basic measures for accomplishing restorative targets. Diabetes self-management instruction and backing (DSMES), withdrawal of smoking guidance, ordinary activity, psychosocial treatment, and dietary help treatment are fundamental in accomplishing these objectives. DSMES efforts work with the judgment, data, and ability building vital for ideal diabetic taking care of oneself, taking care of procedures, and consolidating the affected patient's considerations, sentiments, yearnings, and necessities.

Diagnosis is made every year or after accomplishing drug targets, whenever testing components happen, yet four essential phases of diabetes taking care of oneself management are featured (Powers et al., 2021). DSMES enjoys different benefits, including mental, clinical, and conduct impacts. Raised haemoglobin (A1C) with combined prescription and social treatment diminishes are valuable fundamental benefits. For instance, a 0.57 percent drop in A1C in type 2 diabetes contrasts with standard therapy. DSMES additionally upgrades expectations for everyday comforts and encourages a positive way of life practices like successive standard action and food planning.

On focusing on the challenges of self-management education it can be found that the authors Whittemore et al. (2019) led a subjective elucidating study to comprehend and assess the difficulties looked by people during the self-management of diabetes. The authors clarified that diabetes is one of Mexico's main elements of mortality and that self-management is incredibly fundamental. The authors accumulated reactions from 20 adults determined to have type II diabetes. With the assistance of their review, the authors featured that the vast majority of the members face individual difficulties in managing diabetes caused by the absence of means in conjunction with issues with the way of life, lack of help from the family, and emotional well-being concern social convictions.

The Translational Science Model

Howland and Wakefield (2021) led an integrative examination to determine the significance of conducting self-management among adults with type II diabetes. The authors featured that type II diabetes is a constant medical problem all over the planet, and the usual way of life changes to control and moderate the issue. The authors featured that telephone-based medicines and cell phones brought about impressive expansions in everyday workout and inactivity. Hyperglycaemia was seen to have improved somewhat. The usage and consolidation of hypothetical structures were confined throughout the review, and the span and follow-up of intercessions went considerably across the exploration inspected. Self-report and estimations made had been utilized to evaluate results; nonetheless, objective appraisals were used less generally. The writing upholds web and cell phone medical services treatments to improve ordinary activity, lessen undesirable practices, and upgrade diabetes the board. The authors featured that it is vital to research the impacts of intercessions on distant networks.

The authors Sayeed et al. (2020) led an observational review to comprehend the effect of diabetes-related self-management in type II diabetes mellitus. The authors clarified in their assessment that taking care of oneself exercises are fundamental practices that an individual should take on to work on their well-being. The examples in the review were the patients with type II diabetes above or equivalent to the age scope of 45 years of age. Reaction from the example was gathered with the assistance of the Diabetes Self-Management Questionnaire (DSMQ), and it was examined with the aid of the SPSS instrument. The authors tracked down that type of diabetes, for the most part, influences men as 172 members were male and 152 members were female. Excellent outcomes were seen from the patients with great glycaemic control. The authors deduced in their review that taking care of oneself exercises impact glycaemic management among patients with diabetes.

Social and financial attributes, schooling, body weight, and glucose levels were accumulated for a clinical appraisal from an experimental mediation investigation of around fifty individuals (Mohamed, 2017). The examination showed a quantitatively significant improvement in the patient's ability and mental prosperity propensities, a substantial weight reduction, and reduction in glucose levels. Therefore, medical services schooling projects can assist you with further developing your medical services scores, glucose levels, weight reduction, and well-being-related practices. Individuals with type 2 diabetes require routine activity, autonomously or in blend with the oral diabetic drugs, insulin organization, or sustenance.

As per Nery et al. (2017), type 2 diabetes has been displayed to have metabolic results moderated by standard movement. Opposition preparing seemed, by all accounts, to be more fruitful in further developing the most remarkable oxygen admission in twelve-week conventions, without any distinctions in diabetes and lipid board between the two types of preparing. There is no undeniable proof proposing that food or normal activity freely, instead of standard treatment, diminishes the rate of Type 2 diabetes mellitus and its ramifications in individuals at risk for gaining Type 2 diabetes. In those with IGT, however, a blend of diet and day-to-day active work eases back the movement of Type 2 diabetes. For those with moderate hyperglycaemia, as depicted by other glycaemic pointers, information on the effect of sustenance joined with active work is insufficient. Most of the methodical surveys did not take a gander at well-being results (Hemmingsen et al., 2017). As indicated by da Rocha et al. (2020), the populace's obligation to powerful self-strategies is low, as seen by the ascent in type II diabetes comorbidities.

The Knowledge to Action (KTA) Framework

Perrin et al. (2017), diabetic nervousness is typical among patients with type II diabetes-related well-mannered orientation and temperament issues. The connection between diabetic tension and weakness and the broad crossover between the two sicknesses should be considered. The paper and its discoveries likewise back up ideas to consume more soy items to keep away from the event and rise of type 2 diabetes. Tang et al. (2020) calls for more high information connections from randomized associate investigations.

The authors Shuhaida et al. (2019) directed a cross-sectional review to comprehend and distinguish the dangers like pressure, the socio-segment, and gloom related to type II diabetes. The authors involved a self-managed survey for the assortment of information. Information was gathered from 338 patients with diabetes mellitus. The authors say that the number of patients related to poor glycaemic control was high, at 76%.

From the thematic analysis it can be seen that application of mobile phones enables the T2D patients to stay in touch with the clinicians and help them to monitor their BGL level that improve the condition by reducing BGL. The second and most important factor that help the T2D patients is self-management education as without self-management controlling the BGL level is not possible. On other hand, behavioural management as well as lifestyle interventions such as exercise have been associated with reducing BGL largely and enhancing insulin function that would help to T2D patients largely.

In conclusion, the integrative review has answered the question posed question where the project determined that behavioral change, compared to current practice, improves blood glucose levels in adults with type II diabetes. The integrative review has significant implications for nursing leaders as it demonstrates the positive impact of educational interventions in promoting healthy behavior. The main strength is determining the effect of educational intervention in improving the levels of education and awareness and improving the FBG levels. In addition, the integrative review supports findings by Giguère et al. (2020), which demonstrate the impact of educational interventions in improving healthcare outcomes. Type 2 diabetes is a perplexing condition that requires the patient's continuous self-choices. The collection of academic, clinical, social, and mental advising standards expected for routine self-management are caught by diabetic self-management education and support (DSMES). It involves helping all individuals with diabetes complete their day-to-day mindfulness schedules with certainty and better outcomes. DSMES was made to give individuals with diabetes information, abilities, and confidence to control and roll out fundamental improvements.

Hyperglycaemia in adults is a far and wide ailment that is viewed as a genuine danger to individual well-being. Thus, diabetes treatment requires a considerable change in one's life. Therefore, the impact of course of life medicines on glucose levels, medical services propensities, and stoutness among individuals with diabetes should be assessed. Furthermore, the provisions of the self-management activities give rise to favorable health outcomes in such patients that reflect the primary aspects of better glycemic stability. However, it needs to be noted that self-management behavior requires changes based on changing the lifelong habit of an individual.

Conclusions and Contributions to the Professions of Nursing

The review provided patients with information on managing blood glucose levels within the skillset and knowledge. According to Clarke et al. (2019), examples of cultural issues that may affect the success of healthcare interventions include lack of trust in medical professionals and outsiders and social beliefs about healthcare behaviors. In addition, it has demonstrated that diabetes patients can also implement interventions to manage blood glucose levels. The nursing professionals need to understand various social, cultural, and financial aspects; as a result, the self-management intervention needs to be self-tailored for each patient. Improved self-management comprehension, self-announced weight, diminished A1C, bringing down all-cause endurance rates, higher fulfilment of living, and lower clinical costs is connected to DSMES. Nourishment has a suitable influence in treating type 2 diabetes. People's wholesome requirements are tended to because of local and individual inclinations, medical care information, availability of nutritious food varieties, limit and inspiration to change, and likely obstacles to adjust. Practice and legitimate weight control have worked on diabetic patients' health. The integrative review is necessary for nursing because it would help reduce the complications nurses face due to the non-management of diabetes among older people. The nursing staff needs to be aware that the basics related to self-management of diabetes can be instilled in people, which require time; thus, it is their duty to try and instill the habits more effectively.

Self-management program with broad training needs would assist with giving to patients with diabetes. Such likewise need to consider the social determinants of well-being for the management of diabetes. Social perspectives, poise, and lacking medical services information impact diabetes self-management in people with T2D with asset limitations. T2D will require exhaustive group-based treatment to address their mental prosperity and financial worries.

From the project, it can be known that there is a positive relationship between an increase in knowledge through educational intervention and awareness of diabetes, thus, improving BGL levels. There is a requirement of replicating the review in a more culturally appropriate fashion in the future. Although, as found in many studies, a more culturally friendly educational intervention needs to be developed to help the patients maintain their blood glucose levels to an optimal level. One of the studies highlighted that even though young adults can be more flexible in changing habits to accommodate self-management strategies, it is challenging for older adults. Thus, the recommendation involves formulating interventions that would be more appropriate for older adults with the alignment of nursing professionals who can help address the issue more effectively. Self-management program with broad training needs would assist with giving to patients with diabetes. Such likewise need to consider the social determinants of well-being for the management of diabetes. Social perspectives, poise, and lacking medical services information impact diabetes self-management in people with T2D with asset limitations. T2D will require exhaustive group-based treatment to address their mental prosperity and financial worries. In Mexico and all over the planet, further examination on quality principles for executing and increasing proof-based patient-focused T2D preventive and DSME intercessions for the devastated and desperate individuals are required. Thus, the fulfillment of such strategies is hindered in most people with T2D as maintenance of behavioral changes concerning the intervention needs a life-long commitment to the self-management practice.

References

Ali, N. B., & Usman, M. (2018). Reliability of search in systematic reviews: Towards a quality assessment framework for the automated-search strategy. Information and Software Technology, 99, 133-147.

Alkawaldeh, M. Y., Jacelon, C. S., & Choi, J. (2020). Older adults' experiences with a tablet-based self-management intervention for diabetes mellitus type II: A qualitative study. Geriatric Nursing, 41(3), 305-312. https://doi.org/10.1016/j.gerinurse.2019.11.010

American Diabetes Association. (2021). 5. Facilitating behavior change and well-being to improve health outcomes: Standards of Medical Care in Diabetes—2020. Diabetes Care, 43(Supplement 1), S48-S65. https://doi.org/10.2337/dc20-S005

Brice, R. (2022). Home - CASP - Critical Appraisal Skills Programme. CASP - Critical Appraisal Skills Programme. Retrieved 7 April 2022, from https://casp-uk.net/.

(2021). National Diabetes Statistics Report 2020: Estimates of diabetes and its burden in the United States. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

Chester, B., Stanely, W. G., & Geetha, T. (2018). Quick guide to type 2 diabetes self-management education: creating an interdisciplinary diabetes management team. Diabetes, Metabolic Syndrome, and Obesity: Targets and Therapy, 11, 641–645. https://doi.org/10.2147/DMSO.S178556

Eriksen, M. B., & Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: A systematic review. Journal of the Medical Library Association: JMLA, 106(4), 420.

Forouhi, N. G., & Wareham, N. J. (2019). Epidemiology of diabetes. Medicine, 47(1), 22-27. https://doi.org/10.1016/j.mpmed.2014.09.007

Gal, R. L., Cohen, N. J., Kruger, D., Beck, R. W., Bergenstal, R. M., Calhoun, P., ... & Aleppo, G. (2020). Diabetes telehealth solutions: improving self-management through remote initiation of continuous glucose monitoring. Journal of the Endocrine Society, 4(9), bvaa076. https://doi.org/10.1210/jendso/bvaa076

Grace, A., Chan, E., Giallauria, F., Graham, P. L., & Smart, N. A. (2017). Clinical outcomes and glycemic responses to different aerobic exercise training intensities in type ii diabetes: A systematic review and meta-analysis. Cardiovascular Diabetology, 16(1). https://doi.org/10.1186/s12933-017-0518-6

Hemmingsen, B., Gimenez-Perez, G., Mauricio, D., Roqué I Figuls, M., Metzendorf, M. I., & Richter, B. (2017). Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus. The Cochrane Database of Systematic Reviews, 12(12), CD003054. https://doi.org/10.1002/14651858.CD003054.pub4

Howland, C., & Wakefield, B. (2021). Assessing telehealth interventions for physical activity and sedentary behavior self-management in adults with type 2 diabetes mellitus: An integrative review. Research in Nursing & Health, 44(1), 92–110. https://doi.org/10.1002/nur.22077

Jeffrey, B., Bagala, M., Creighton, A., Leavey, T., Nicholls, S., Wood, C., ... & Pit, S. (2019). Mobile phone applications and their use in the self-management of type 2 diabetes mellitus: a qualitative study among app users and non-app users. Diabetology & Metabolic Syndrome, 11(1), 1-17. https://doi.org/10.1186/s13098-019-0480-4

Lin, X., Xu, Y., Pan, X., Xu, J., Ding, Y., Sun, X., Song, X., Ren, Y., & Shan, P.-F. (2020, September 8). Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Nature News. https://www.nature.com/articles/s41598-020-71908-9.

McCarthy, M. M., & Grey, M. (2018). Type 1 diabetes self-management from emerging adulthood through older adulthood. Diabetes Care, 41(8), 1608-1614. https://doi.org/10.2337/dc17-2597

Mirzaei, H., Siavash, M., Shahnazi, H., & Eslami, A. A. (2022). Development and evaluation of a new questionnaire to assess social cognitive factors of self-management in patients with type 2 diabetes: a psychometric study. Journal of Diabetes & Metabolic Disorders, 1-10. https://doi.org/10.1007/s40200-022-00999-0

Mohamed, S. A. (2017). Effect of lifestyle intervention on health behaviors, weight and blood glucose level among patients with diabetes mellitus. Journal of Nursing Education and Practice, 4(12), 75. https://dx.doi.org/10.5430/jnep.v4n12p75v

Nery, C., Moraes, S., Novaes, K. A., Bezerra, M. A., Silveira, P., & Lemos, A. (2017). Effectiveness of resistance exercise compared to aerobic exercise without insulin therapy in patients with type 2 diabetes mellitus: a meta-analysis. Brazilian Journal of Physical Therapy, 21(6), 400–415. https://doi.org/10.1016/j.bjpt.2017.06.004

Parsa, S., Aghamohammadi, M., & Abazari, M. (2019). Diabetes distress and its clinical determinants in patients with type II diabetes. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 13(2), 1275-1279. doi: 10.1016/j.dsx.2019.02.007

Peek, M. E., Vela, M. B., & Chin, M. H. (2020). Practical lessons for teaching about race and racism: successfully leading free, frank, and fearless discussions. Academic Medicine, 95(12S), S139-S144.

Perrin, N. E., Davies, M. J., Robertson, N., Snoek, F. J., & Khunti, K. (2017). The prevalence of diabetes-specific emotional distress in people with Type 2 diabetes: A systematic review and meta-analysis. Diabetic medicine: a journal of the British Diabetic Association, 34(11), 1508–1520. https://doi.org/10.1111/dme.13448

Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., ... & Uelmen, S. (2021). Diabetes self-management education and support in adults with type 2 diabetes: a consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. The Science of Diabetes Self-Management and Care, 47(1), 54-73. https://doi.org/10.2337/dci20-0023

Sayeed, K. A., Qayyum, A., Jamshed, F., Gill, U., Usama, S. M., Asghar, K., & Tahir, A. (2020). Impact of diabetes-related self-management on glycemic control in type II diabetes mellitus. Cureus, 12(4). https://doi.org/10.7759/cureus.7845

Shuhaida, M. H. N., Suhaila, M. Y. S., Azidah, K. A., Norhayati, N. M., Nani, D., & Juliawati, M. (2019). Depression, anxiety, stress and socio-demographic factors for poor glycaemic control in patients with type II diabetes. Journal of Taibah University Medical Sciences, 14(3), 268-276. https://doi.org/10.1016/j.jtumed.2019.03.002

Van Ommen, B., Wopereis, S., Van Empelen, P., Van Keulen, H. M., Otten, W., Kasteleyn, M., ... & Pijl, H. (2018). From diabetes care to diabetes cure—The integration of systems biology, eHealth, and behavioral change. Frontiers in Endocrinology, 8, 381.

Whittemore, R., Vilar-Compte, M., De La Cerda, S., Marron, D., Conover, R., Delvy, R., ... & Pérez-Escamilla, R. (2019). Challenges to diabetes self-management for adults with type 2 diabetes in low-resource settings in Mexico City: A qualitative descriptive study. International Journal for Equity in Health, 18(1), 1-10. https://doi.org/10.1186/s12939-019-1035-x

Yang, J. S., Lu, C. C., Kuo, S. C., Hsu, Y. M., Tsai, S. C., Chen, S. Y., ... & Tsai, F. J. (2017). Autophagy and its link to type II diabetes mellitus. Biomedicine, 7(2). https://doi.org/10.1051/bmdcn/2017070201