Enza Gucciardi

Exploration of the Relationship Between Household Food Insecurity and Diabetes in Canada

OBJECTIVE To determine the household food insecurity (HFI) prevalence in Canadians with diabetes and its relationship with diabetes management, self-care practices, and health status. RESEARCH DESIGN AND METHODS We analyzed data from Canadians with diabetes aged ≥12 years (n = 6,237) from cycle 3.1 of the Canadian Community Health Survey, a population-based cross-sectional survey conducted in 2005. The HFI prevalence in Canadians with diabetes was compared with that in those without diabetes. The relationships between HFI and management services, self-care practices, and health status were examined for Ontarians with diabetes (n = 2,523). RESULTS HFI was more prevalent among individuals with diabetes (9.3% [8.2–10.4]) than among those without diabetes (6.8% [6.5–7.0]) and was not associated with diabetes management services but was associated with physical inactivity (odds ratio 1.54 [95% CI 1.10–2.17]), lower fruit and vegetable consumption (0.52 [0.33–0.81]), current smoking (1.71 [1.09–2.69]), unmet health care needs (2.71 [1.74–4.23]), having been an overnight patient (2.08 [1.43–3.04]), having a mood disorder (2.18 [1.54–3.08]), having effects from a stroke (2.39 [1.32–4.32]), lower satisfaction with life (0.28 [0.18–0.43]), self-rated general (0.37 [0.21–0.66]) and mental (0.17 [0.10–0.29]) health, and higher self-perceived stress (2.04 [1.30–3.20]). The odds of HFI were higher for an individual in whom diabetes was diagnosed at age <40 years (3.08 [1.96–4.84]). CONCLUSIONS HFI prevalence is higher among Canadians with diabetes and is associated with an increased likelihood of unhealthy behaviors, psychological distress, and poorer physical health.

Self-management experiences among men and women with type 2 diabetes mellitus: a qualitative analysis

BackgroundThe purpose of this study is to better understand differences in diabetes self-management, specifically needs, barriers and challenges among men and women living with type 2 diabetes mellitus (T2DM).Methods35 participants were recruited from a diabetes education center (DEC) in Toronto, Canada. Five focus groups and nine individual interviews were conducted to explore men and womens diabetes self-management experiences.ResultsThe average age of participants was 57 years and just over half (51.4%) were female. Analyses revealed five themes: disclosure and identity as a person living with diabetes; self-monitoring of blood glucose (SMBG); diet struggles across varying contexts; utilization of diabetes resources; and social support. Women disclosed their diabetes more readily and integrated management into their daily lives, whereas men were more reluctant to tell friends and family about their diabetes and were less observant of self-management practices in social settings. Men focused on practical aspects of SMBG and experimented with various aspects of management to reduce reliance on medications whereas women focused on affective components of SMBG. Women restricted foods from their diets perceived as prohibited whereas many men moderated their intake of perceived unhealthy foods, except in social situations. Women used socially interactive resources, like education classes and support groups whereas men relied more on self-directed learning but also described wanting more guidance to help navigate the healthcare system. Finally, men and women reported wanting physician support for both affective and practical aspects of self-management.ConclusionsOur findings highlight the differences in needs and challenges of diabetes self-management among men and women, which may inform gender-sensitive diabetes, care, counseling and support.

Assessment of two culturally competent Diabetes education methods: Individual versus Individual plus Group education in Canadian Portuguese adults with Type 2 Diabetes

Objective. To examine the impact of two culturally competent diabetes education methods, individual counselling and individual counselling in conjunction with group education, on nutrition adherence and glycemic control in Portuguese Canadian adults with type 2 diabetes over a three-month period. Design. The Diabetes Education Centre is located in the urban multicultural city of Toronto, Ontario, Canada. We used a three-month randomized controlled trial design. Eligible Portuguese-speaking adults with type 2 diabetes were randomly assigned to receive either diabetes education counselling only (control group) or counselling in conjunction with group education (intervention group). Of the 61 patients who completed the study, 36 were in the counselling only and 25 in the counselling with group education intervention. We used a per-protocol analysis to examine the efficacy of the two educational approaches on nutrition adherence and glycemic control; paired t-tests to compare results within groups and analysis of covariance (ACOVA) to compare outcomes between groups adjusting for baseline measures. The Theory of Planned Behaviour was used to describe the behavioural mechanisms that influenced nutrition adherence. Results. Attitudes, subjective norms, perceived behaviour control, and intentions towards nutrition adherence, self-reported nutrition adherence and glycemic control significantly improved in both groups, over the three-month study period. Yet, those receiving individual counselling with group education showed greater improvement in all measures with the exception of glycemic control, where no significant difference was found between the two groups at three months. Conclusions. Our study findings provide preliminary evidence that culturally competent group education in conjunction with individual counselling may be more efficacious in shaping eating behaviours than individual counselling alone for Canadian Portuguese adults with type 2 diabetes. However, larger longitudinal studies are needed to determine the most efficacious education method to sustain long-term nutrition adherence and glycemic control.

A Systematic Review of Attrition from Diabetes Education Services: Strategies to Improve Attrition and Retention Research

ABSTRACT Attrition from diabetes education programs has received little attention in the empirical literature, even though rates tend to be high across programs. Given the time and money invested in the structuring of these interventions and their acknowledged benefits for diabetes self-care behaviours and overall health outcomes, it is imperative that we understand why people choose to disengage from these initiatives. A systematic literature review was conducted to examine studies that investigated factors associated with attrition in existing diabetes education services. Results showed varied proportions of individuals with diabetes dropping out, from 4 to 57% across Britain, the United States, Ireland, Canada and Japan. Most studies did not find an association between sex, age, body mass index or years since diagnosis of diabetes, and attrition or missed appointments; however, 2 studies found an association between working status and attrition. Inconsistent results were found for primary language spoken, smoking status, symptomatology, type of diabetes management, glycosylated hemoglobin, blood pressure, comorbidities and distance travelled to the clinic. Sparse literature and diverse research methods across studies make it difficult to conclusively outline factors that influence attrition from diabetes education programs. The use of more rigorous research methods and standardized measurement would assist in the assessment of attrition from diabetes education programs worldwide. Recommendations on how to improve future research in this area also are discussed.

Gender and nutrition management in type 2 diabetes.

PURPOSE The literature suggests that adherence to dietary recommendations may differ between women and men with type 2 diabetes due to family obligations and spousal support. METHODS To assess division of household labour between spouses, retrospective chart review of 561 individuals who attended the Diabetes Education Centre at the Toronto Western Hospital was performed. Qualitative interviews were also performed with 12 married clients (six female and six male) and seven spouses of clients (three female, four male) to understand how the sharing of household labour influences adherence to nutrition guidelines in type 2 diabetes. RESULTS Results indicate a significant gender difference in responsibility for meal preparation (chi2(3)=140.64, p<.001) and grocery shopping (chi2(3)=88.24, p<0.001), with women more often engaging in these household activities than men. Male clients are more likely to be actively supported by their wives in the form of meal preparation and verbal encouragement, while female clients are only passively supported by their husbands. CONCLUSIONS The results suggest that diabetes educators should recognize gender differences in household labour and support when counselling their clients to ensure that both men and women have the help they need to successfully manage their diabetes.

The Intersection between Food Insecurity and Diabetes: A Review

Access to sufficient, safe, and nutritious food not only affects the health of people who experience food insecurity, but also their ability to manage health conditions, such as diabetes. When people find it difficult to access sufficient food, tailoring their food selection to a diabetes regimen is even more difficult. Food insecurity in North America is consistently more prevalent among households with a person living with diabetes, and similarly, diabetes is also more prevalent in food-insecure households. Diabetes management can be stressful due to the many required responsibilities; when compounded with food insecurity, it becomes an even greater challenge. As a result, many food-insecure diabetics find themselves caught between competing priorities such as procuring food, prescribed medications and supplies for diabetes, and managing other living expenses, potentially worsening their condition and overall health. Healthcare providers should be aware and informed about the significant role that food security can play in the prevention and management of diabetes.

A systematic literature review of diabetes self-management education features to improve diabetes education in women of Black African/Caribbean and Hispanic/Latin American ethnicity.

OBJECTIVE This systematic literature review aims to identify diabetes self-management education (DSME) features to improve diabetes education for Black African/Caribbean and Hispanic/Latin American women with Type 2 diabetes mellitus. METHODS We conducted a literature search in six health databases for randomized controlled trials and comparative studies. Success rates of intervention features were calculated based on effectiveness in improving glycosolated hemoglobin (HbA1c), anthropometrics, physical activity, or diet outcomes. Calculations of rate differences assessed whether an intervention feature positively or negatively affected an outcome. RESULTS From 13 studies included in our analysis, we identified 38 intervention features in relation to their success with an outcome. Five intervention features had positive rate differences across at least three outcomes: hospital-based interventions, group interventions, the use of situational problem-solving, frequent sessions, and incorporating dietitians as interventionists. Six intervention features had high positive rate differences (i.e. ≥50%) on specific outcomes. CONCLUSION Different DSME intervention features may influence broad and specific self-management outcomes for women of African/Caribbean and Hispanic/Latin ethnicity. PRACTICAL IMPLICATIONS With the emphasis on patient-centered care, patients and care providers can consider options based on DSME intervention features for its broad and specific impact on outcomes to potentially make programming more effective.

Gender, ethnocultural, and psychosocial barriers to diabetes self-management in Italian women and men with type 2 diabetes.

Although several ethnic groups experience a greater burden of diabetes, this has not been examined in first-generation Italians, who compose one of the largest ethnocultural groups in Canada. In this cross-sectional study, the authors examined the relationship among gender and ethnocultural factors, family support, depressive symptomatology, and illness perceptions on diabetes self-management (DSM) in 50 Italian women and men with type 2 diabetes. The authors first conducted a focus group to explore cultural barriers. They then assessed gender, ethnocultural, and psychosocial barriers quantitatively by an interviewer-administered questionnaire, Compared with Italian men, Italian women reported significantly greater depressive symptomatology and perceived disease seriousness. Greater depressive symptomatology was significantly associated with perceived family sabotage and DSM barriers. In univariate analyses, shorter duration of diabetes and greater perceived treatment effectiveness significantly predicted better DSM. In conclusion, certain illness perceptions and culturally relevant gender-specific barriers should be addressed by health care providers to maximize DSM in this population.

Importance of Reaction Kinetics and Oxygen Crossover in aprotic Li-O2 Batteries Based on a Dimethyl Sulfoxide Electrolyte.

Although still in their embryonic state, aprotic rechargeable Li-O2 batteries have, theoretically, the capabilities of reaching higher specific energy densities than Li-ion batteries. There are, however, significant drawbacks that must be addressed to allow stable electrochemical performance; these will ultimately be solved by a deeper understanding of the chemical and electrochemical processes occurring during battery operations. We report a study on the electrochemical and chemical stability of Li-O2 batteries comprising Au-coated carbon cathodes, a dimethyl sulfoxide (DMSO)-based electrolyte and Li metal negative electrodes. The use of the aforementioned Au-coated cathodes in combination with a 1 M lithium bis(trifluoromethane)sulfonimide (LiTFSI)-DMSO electrolyte guarantees very good cycling stability (>300 cycles) by minimizing eventual side reactions. The main drawbacks arise from the high reactivity of the Li metal electrode when in contact with the O2 -saturated DMSO-based electrolyte.

Exploring interprofessional collaboration during the integration of diabetes teams into primary care

BackgroundSpecialised diabetes teams, specifically certified nurse and dietitian diabetes educator teams, are being integrated part-time into primary care to provide better care and support for Canadians living with diabetes.This practice model is being implemented throughout Canada in an effort to increase patient access to diabetes education, self-management training, and support. Interprofessional collaboration can have positive effects on both health processes and patient health outcomes, but few studies have explored how health professionals are introduced to and transition into this kind of interprofessional work.MethodData from 18 interviews with diabetes educators, 16 primary care physicians, 23 educators’ reflective journals, and 10 quarterly debriefing sessions were coded and analysed using a directed content analysis approach, facilitated by NVIVO software.ResultsFour major themes emerged related to challenges faced, strategies adopted, and benefits observed during this transition into interprofessional collaboration between diabetes educators and primary care physicians: (a) negotiating space, place, and role; (b) fostering working relationships; (c) performing collectively; and (d) enhancing knowledge exchange.ConclusionsOur findings provide insight into how healthcare professionals who have not traditionally worked together in primary care are collaborating to integrate health services essential for diabetes management. Based on the experiences and personal reflections of participants, establishing new ways of working requires negotiating space and place to practice, role clarification, and frequent and effective modes of formal and informal communication to nurture the development of trust and mutual respect, which are vital to success.