Purpose The incidence of diabetes mellitus (DM) rises significantly in the post-middle-age population, and stress along with depressive symptoms hinders effective DM management. This study examined the mediating effect of social capital (trust in the physical environment, reciprocity, social participation, and social networks) on the relationship between perceived stress and depression among middle-aged adults with DM in Korea. It also aimed to provide data for developing targeted interventions to enhance blood glucose management in this population.
Methods A descriptive correlational study using data from the 2019 Community Health Survey by the Korea Disease Control and Prevention Agency (KDCA) was conducted. Complex sample regression analysis and the Sobel test were employed for mediation analysis. The study included 9,394 middle-aged adults (aged 45-64 years) diagnosed with DM. The analysis assessed the effects of perceived stress on social capital and depression, as well as the mediating role of social capital.
Results Perceived stress negatively impacted social capital (β=-0.16, p<.001) and positively influenced depression (β=0.37, p<.001). Both perceived stress and social capital significantly affected depression (F=998.83, p<.001), with social capital showing a partial mediating effect (z=2.65, p<.001).
Conclusion Social capital partially mediated the relationship between stress and depression, suggesting its potential as a strategy for reducing stress and lowering depression among middle-aged adults with DM. These findings lay the groundwork for targeted interventions to improve blood glucose management in this population. Future research should explore the relationships among specific components of social capital, stress, and depression.
Purpose Continuous Glucose Monitoring (CGM) plays a crucial role in helping patients with diabetes manage their blood sugar levels. This review aimed to understand the context and scope of CGM-related studies in Korea and identified areas for future research, particularly in nursing science. Methods The search strategy involved examining eight electronic databases for published studies on CGM, with the search period ending in March 2022.
Four independent reviewers conducted screening, selection, and narrative review of the studies. Results Descriptive and substantive analyses were performed for 68 studies on CGM, which covered diverse areas, including: (1) evaluating the CGM performance through comparisons with self-monitoring of blood glucose and correlations with existing indices; (2) validating the efficacy of CGM in improving patient outcomes and assessing various interventions; and (3) expanding the use of CGM, such as clinical guidelines and reviews, developing predictive models, and other clinical studies. Conclusion Research on CGM has expanded to include early performance evaluation, efficacy verification, and utilization in various clinical settings. However, there is a lack of nursing-focused studies of CGM. It is recommended to incorporate CGM in nursing research aimed at enhancing self-management for patients with diabetes. Future projects should focus on developing and applying patient-customized CGM user manuals, comparing the effectiveness of CGM among patients with different types of diabetes, exploring qualitative experiences of CGM use, and addressing related issues.
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Purpose This study aimed to translate and adapt the Type 1 Diabetes Stigma Assessment Scale (DSAS-1) into Korean and investigate its validity and reliability for Korean patients with type 1 diabetes mellitus (T1DM).
Methods Following a forward-backward translation process, six experts evaluated the content validity of the translated DSAS-1. The DSAS-1 scale (19 items) was administered to 106 T1DM patients, and the data were analyzed. Construct validity, convergent validity, discriminant validity, and scale reliability were examined using confirmatory factor analyses and Cronbach’s α coefficient. Data were analyzed using SPSS 28.0 and AMOS 26.0.
Results The item “Some people expect less of me because I have Type 1 diabetes” had a factor loading of .41 in confirmatory factor analyses. When the item was removed, the average variance extracted increased from .47 to .53. The results of the confirmatory factor analysis showed adequate model fit indices (χ2/df=1.60, p<.001, GFI=.82, RMSEA=.075, CFI=.92, TLI=.90). The DSAS-1-K (18 items) exhibited moderate convergent and discriminant validity. Cronbach’s α for the overall scale (18 items) was .90, and the three-factor scale ranged from .84 to .89.
Conclusion Our results indicate that 18 DSAS-1 items are recommended in Korea. However, the original scale’s copyright issue prevented any modifications. When using 19 items, the convergent validity was partially unsatisfactory; the model fit index was somewhat low but within the acceptable range. Therefore, we suggest that researchers using the DSAS-1-K (19 items) should consider the results of our study.
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Purpose This study aimed to identify the prevalence of chronic diabetic complications in patients with type 2 diabetes mellitus.
Methods Data for adults aged over 30 years, who were diagnosed with type 2 diabetes mellitus and who had at least one claim for the prescription of antidiabetic medication were extracted from the National Health Insurance Service-National Health Screening Cohort in Korea from 2002 to 2015. Statistical analyses were performed using R version 3.5.1.
Results In total, 1,407 patients with type 2 diabetes mellitus without complications were extracted from the database. Patients were observed for an average of 10.43 years. The prevalence of chronic diabetic complications was 84.7% and was significantly higher for patients who were older women, who lived in the capital, and had diabetes mellitus for a longer time. The prevalence of eye disease was the highest at 42.4%, and cerebrovascular disease was the lowest at 15.1%. Cardiovascular disease, peripheral vascular disease, neuropathy, and foot ulcers often occurred between two and four years, and eye disease and nephropathy often occurred over eight years after the diagnosis of diabetes. Prior to the occurrence of nephropathy, microvascular complications such as neuropathy, peripheral vascular disease, and eye disease occurred.
Conclusion These findings provide compelling evidence of the prevalence of chronic diabetic complications based on a national database. Since a high incidence of diabetic complications occurs within a short period of time after the diagnosis of diabetes, aggressive interventions are required to prevent diabetic complications in the early stages after diagnosis.
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PURPOSE The purpose of this study was to investigate the health literacy and self-care activities of elderly diabetes patients and identify the effects of mediation of resilience in the relationship between them. METHODS A structured self-report questionnaire measuring health literacy, resilience and self-care activities was completed by 145 elderly people aged 65 years or older, who were diagnosed with type 2 diabetes mellitus at the Pusan National University hospital in Busan city, and who visited the outpatient clinic for endocrinology. Data collection was conducted from February 10, 2017 to March 31, 2017, and the collected data were analyzed using SPSS/WIN 23.0 program. RESULTS The subjects' health literacy and resilience (r=.19, p=.023), health literacy and self-care activities (r=.26, p=.001), resilience and self-care activities (r=.39, p < .001) were significantly correlated. Resilience completely mediated in the relationship between health literacy and self-care activities (z=2.37, p=.017). CONCLUSION Resilience plays a mediating role in the association among health literacy and self-care activities. It is necessary to develop a variety of intervention programs that can improve resilience in increasing self-care activities.
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PURPOSE The purpose of this study was to identify the factors contributing to diabetic foot ulcers (DFU) among patients with type 2 diabetes mellitus (DM). METHODS Data were collected from 131 patients who had been diagnosed with DM for more than six months. Patients recruited from three hospitals in Gwangju city were given both a foot examination to confirm the presence of a foot ulcer and an individual time of survey using questionnaires about foot care knowledge and self management behavior. RESULTS Factors contributing to DFU were male (adjusted odds ratio [aOR]=4.86, 95% confidence interval [CI]=1.16~20.44), history of DM-related hospitalization (aOR=4.56, 95% CI=1.17~17.84), duration of DM (aOR=13.75, 95% CI=2.31~82.66 for those with time since diagnosis of 11~15 years; aOR=6.37, 95% CI=1.09~37.36 for those with time since diagnosis of 16–20 years; aOR=12.97, 95% CI=2.26~74.32 for those with time since diagnosis of over 21 years), DM diet (aOR=0.13, 95% CI=0.03–0.64 for those who did not practice dietary control), and exercise (aOR=15.59, 95% CI=3.49~69.64 for those who did not engage in regular exercise). CONCLUSION The factors identified in this study provided strategic information for developing educational program targeting patients with DM to prevent DFC.
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PURPOSE The purpose of this study was to identify the factors and the relative risk associated with admission of patients with diabetes mellitus (DM). METHODS The sample included one hundred twenty-eight patients with type II DM. Seventy-seven patients who were admitted within six months of a hospitalization to one hospital from the first of February to the 31st of August 2014, were compared with fifty-one patients who regularly attended an outpatient clinic and had no hospitalizations. RESULTS Hospitalization probabilities among patients who had only diet and exercise or took oral diabetic medication were 0.03 (p=.004) and 0.21 (p=.007) times independently lower than the ones with insulin injection. The risks for hospitalization increases 6.33 times if there is absence of a spouse (p=.027) whereas the presence of a spouse seems to make hospitalization less likely. The risk among the ones having diabetic complications was 5.15 times higher than ones having no recognition of the complications (p=.040). For every one point increase in self-efficacy and every 1 mg/dL increase in high density lipoprotein (HDL) cholesterol, there was a 0.84 (p=.005) and a 0.96 (p=.036) decrease in hospitalization risk, respectively. CONCLUSION Nurses should be sensitive to the risk groups of hospital admission among patients with DM including no spouse, insulin injection, diabetic complications, low self-efficacy, and low HDL cholesterol.
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PURPOSE The aim of this study was to identify the effect of dextrose intravenous fluid (IVF) on the blood glucose levels taken from both fingertips of patients with diabetes mellitus (DM) and those without DM. METHODS From October 2012 to February 2013, 21 DM and 25 non-DM patients were recruited. Blood glucose levels taken from the both fingertips of patients at 7AM while IVF was not infusing and at 11AM, 5PM, and 9PM while IVF was infusing. RESULTS The differences between the mean values of blood glucose from the fingertips at four different times was not statistically significant in DM patients as well as non-DM patients. Also intra-class correlation for blood glucose levels from the fingertips with and without IVF infusion in both groups was shown over about 0.95 at each time (p<.001). CONCLUSION Blood glucose levels measured in the same fingertips of both arms were the same regardless of dextrose IVF infusion. The results indicated that IVF with dextrose may not have any significant effect on the fingertip results of blood glucose level. This study may suggest that patients' both arms and any fingertips can be used for blood glucose monitoring even when the patients are on dextrose IVF infusion.
PURPOSE The purpose of the study was to understand what are the experiences and management of type 2 diabetes in everyday lives among Korean people. METHODS A grounded theory method was utilized to explore how people with type 2 diabetes to experience and manage their disease under the Korean socio-cultural context. The data were collected via narrative in-depth interviews with 21 people with type 2 diabetes during 2010-2011 and all interviews were transcribed for verbatim analysis. RESULTS The core category was 'Rearranging everyday lives by accepting diabetes as lifelong annoying companion.' Four stages were identified: ignoring; struggling compromising and conciliating. Each stage illustrates major problems and/or strategies that the participants face in dealing with diabetes. The process illustrates the transference from their ordinary life, in which diabetes or health was ignored, to the health-oriented life, within which diabetes is integrated into their lives. The most difficult barriers they faced in everyday lives include social stigma of diabetes and collectivistic culture in Korea. Within the culture, the group goals are concerned over individual ones, making it harder for the participants to take care of their own health. CONCLUSION The findings of the study imply that health care professionals may consider the influence of social stigma in caring diabetic patients. Also, the intervention study is warranted to educate Korean people with diabetes to get aware of the sociocultural context and stigma as well as personal difficulties in self-caring diabetes.
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PURPOSE The purpose of this study was to examine relationships among blood glucose, HbA1c, and self management comparing these with general and illness characteristics of subjects with Type II Diabetes living in the community. METHODS Using a comprehensive survey developed for the study, data were collected from 82 type II diabetes patients who were registered at five community health departments. The variables of self management, blood glucose and HbA1c were assessed by nurses. Data were analyzed with descriptive statistics including t-test, ANOVA and Pearson's correlation coefficient to compare self management and level of HbA1c by subject's general and illness characteristics and to examine the relationships among variables. RESULTS About 73.2% of the subjects' HbA1c were 7.0% or higher and 54.9% of subjects' blood glucose were 200 mg/dL or higher. The level of self management was moderate. Most frequently perceived reasons for failure of blood glucose control were dietary failure (32.9%). There was significant relationship between self management and HbA1c(r=-.223, p=.040). The mean score of self management were higher among female (t=-2.37, p=.021), who are not on diabetes medication (t=6.70, p=.011). CONCLUSION Comprehensive intervention is needed to improve dietary self management, especially for male and those who is on diabetes medication.
PURPOSE This study was to identify the mental health and self-care activities according to perceived stress level in type 2 diabetic patients with metabolic syndrome. METHODS The descriptive survey design was conducted using a convenient sample. One hundred and fifty-two diabetic participants with metabolic syndrome were recruited in a university hospital. The data were analyzed using descriptive statistics, Students' t-test, and ANOVA with SPSS/WIN 12.0. RESULTS The high, moderate, and low stress groups according to perceived stress score consisted of 30.9%, 38.2%, and 30.9%, respectively. Differences of mental health and total self-care activities among the three groups were statistically significant. Depression (F=46.73, p<.001), trait anger (F=5.75, p<.01), and anger expression-in (F=4.60, p<.01) of participants in the high stress group were higher than other groups, whereas the total of self-care activities (F=2.85, p<.05) and exercise (F=3.49, p<.05) were lower than other groups. CONCLUSION This study concluded that type 2 diabetic patients with metabolic syndrome with a high stress level were low in self-care activities along with elevated depression and anger.
PURPOSE The purpose of this study was to investigate the level of self management of patients with poorly controlled type 2 diabetes, and to investigate the factors influencing self management. METHODS The subjects consisted of 117 diabetes patients who visited the outpatient department of a university hospital from March to August 2008. Data were collected by asking the subjects to answer a 54-item questionnaire and were analyzed using the SPSS/WIN 14.0 program. RESULTS The total mean score of the patients in self -management was 4.38 out of 7. Medication adherence obtained the highest score under self-management, and the self-monitoring of blood glucose obtained the lowest score. Family support, self-efficacy, severity, and depression were found to be significantly correlated with self-management. In stepwise multiple regression analysis a total of 44.5% of the variance in self management was accounted for by family support, self-efficacy, severity, and depression. CONCLUSION Therefore, a diabetic intervention program should be designed and provided for increasing family support, self efficacy, and severity and for reducing depression of patients with poorly controlled type 2 diabetes.
PURPOSE This study was to identify the relationship between knowledge, self efficacy, and self care behavior regarding foot care among elderly diabetes mellitus (DM) patients. METHODS The subjects consisted of 146 elderly with DM. The data collected from February to October 2008 were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, and stepwise multiple regression. RESULTS The mean scores of knowledge (13.21 +/- 1.99), self efficacy (2.23 +/- 0.54), and self care behavior (2.29 +/- 0.51) regarding foot care were moderate. The level of knowledge was significantly different according to education about DM (p = .012) and drinking (p = .007). Self efficacy was significantly different according to gender (p = .019), educational level (p = .014), spouse (p = .048), disease period (p = .000), admission of DM (p = .000), complication of DM (p = .001), education of DM (p = .023). Self care behavior was significantly different according to educational state (p = .003), disease period (p = .039), and other disease (p = .000). Significant correlations were found between knowledge and self care behavior (p = .001), self efficacy and self care behavior (p = .000), knowledge and self efficacy(p = .012). Knowledge and self efficacy were a predictor of self care behavior (18.2%). CONCLUSION These findings indicate that perceived knowledge and self efficacy may be necessities to improve self care behavior regarding foot care among elderly DM patients. The above mentioned results will be reflected in developing patient educational programs.
PURPOSE This research was carried out to evaluate the validity and reliability of the Korean version of the Summary of Diabetes Self-Care Activities Questionnaire (SDSCA) for Korean older adults with type 2 diabetes. METHODS Translation and back-translation were performed to develop the Korean version of the SDSCA. Then the Korean version SDSCA was applied to a sample of 112 older adults who had participated in diabetes self management education in Seoul. The internal consistency and the test-retest reliability were examined to test the reliability. Factor analysis was used to examine the construct validity. RESULTS The internal consistency measured with Cronbach's alpha was .77 and the total test-retest reliability was .68 with items ranging from .21 to 1.00. As the result of the factor analysis, six factors -foot care, diet, exercise, blood sugar test, medication, and smoking- were revealed as the original instrument subcategories. These six factors explained 81.17% of total variance. CONCLUSION The reliability and validity of the Korean version SDSCA Questionnaire was supported for use in older patients with type 2 diabetes in Korea.
PURPOSE This study was conducted to identify the effects of diabetes education and telephone counseling on depression in diabetic patients. METHODS: 49 diabetic patients(24 in the control group and 25 in the experimental group) completed diabetes education and telephone counseling. Data were analyzed using chi-square test, paired t-test and unpaired t-tests. RESULTS: There were no significant differences in depression between the experimental and control groups. But, Depression scores were much decreased in the experimental group. CONCLUSION: Depression decreased following the diabetes education and telephone counseling. These findings indicate that diabetes education and telephone counseling could be one of the way to decrease depression.
PURPOSE This study was to investigate the sex differences in risk of cardiovascular disease(CVD), depression and self-care activities in type 2 diabetes with metabolic syndrome. METHODS The descriptive correlational design was conducted using a convenient sample. One hundred and twenty-nine diabetic patients with metabolic syndrome were recruited in a university hospital. The data were analyzed using descriptive statistics, the Pearson correlation coefficient, Students' t-test, one way ANOVA, and stepwise multiple regression with SPSS/WIN 12.0. RESULTS The risk of CVD in diabetic patients with metabolic syndrome indicated a significantly negative correlation to self-care activities and age, and positive correlation to waist_C, SBP, DBP and TG. The metabolic syndrome is associated with an approximate 1.7-fold increase in the relative risk in CVD in diabetic women. The main significant predictors influencing CVD risk of diabetes with metabolic syndrome were age, waist_C, SBP and TG, which explained about 29.7%. CONCLUSION These results indicate that patients with diabetes with metabolic syndrome with a high degree of waist_C, SBP and TG are likely to be high in risk of CVD.
PURPOSE The purpose of this study was to investigate the knowledge and learning needs on coronary artery disease in diabetic patients by glycemic control. METHODS The subjects consisted of 188 patients at the hospital who had diabetes mellitus. Data was obtained using a knowledge and learning needs questionnaire from January to April 2006. RESULTS Treatment method, the levels of fasting blood glucose(FBG), and 2-hour postprandial blood glucose (PP2hr) showed meaningful differences between normo-glycemic group(HbA1c<7%) and hyper-glycemic group (HbA1c> or =7%). The levels of knowledge on coronary artery disease by glycemic control tend to show higher in normo-glycemic group. Etiology and prevention of coronary artery disease were significantly higher in normo- glycemic group than in hyper-glycemic group. The levels of learning needs on coronary artery disease by glycemic control tend to show higher in normo-glycemic group. The learning needs on items of diet control were higher in normo-glycemic group than in hyper-glycemic group. CONCLUSION On the base of these results, we should focus on the coronary artery disease education for hyper-glycemic group. Also individual coronary artery disease educational program should be developed for the patients with different level of knowledge and learning needs.
PURPOSE The purpose of this study was to examine the effects of a cognitive behavioral stress management program on diabetic self-care and glycemic control with type 2 diabetic patients. METHODS Thirty three diabetic patients who were older than 40 were recruited from a public health center and conveniently assigned into both experimental(n=16) and control groups(n=17). Participants in the experimental group had attended the weekly cognitive behavioral program for 8 weeks. Data were collected from June 2005 to August 2006 and analyzed by independent t-test using the SPSS WIN program. RESULTS After an 8 week intervention, participants in the experimental group reported on increasement of diabetic self-care behaviors and an increasement of blood glucose levels, which were significantly different from those in the control group. CONCLUSION On the basis of those findings, we concluded that the cognitive behavioral stress management program has positive effects on diabetic self-care and glycemic control for the patients with DM. Further research is needed to identify the long-term effects of the cognitive behavioral program.
PURPOSE This study was conducted to compare the process of change, decisional balance, and self-efficacy according to the stages of change of exercise on the basis of the Transtheoretical Model in order to investigate factors associated with the change of exercise in adult diabetic patients. METHOD Data were collected from January to April 2005. The subjects were 160 patients in the G university hospital and public health center in J city. RESULTS The entire process of change showed the significant difference depending on the stage of change(F=20.007, p=.000). For each process of change, the Consciousness Raising(F=14.602, p=.000), Dramatic Relief(F=7.751, p=.000), Environmental Re-evaluation(F=11.843, p=.000), Self Re-evaluation(F=16.035, p=.000), Social Liberation(F=10.968, p=.000), Counter-conditioning (F=24.090, p=.000), Helping Relationships(F= 7.625, p=.000), Reinforcement Management(F= 16.693, p=.000), Self Liberation(F=11.990, p= .000) and Stimulus Control(F=4.020, p=.002) demonstrated significant differences depending on the stages of change of exercise. For the decisional balance, the Pros showed the significant difference depending on the stage of change(F=14.121, p=.000). For the self efficacy showed significant difference depending on the stage of change(F=17.137, p=.000). CONCLUSION In order to proceed the stage of change of exercise in patients with Diabetes Mellitus, intensive use of a specific process of change, a stage of change matching is needed.
PURPOSE Thisstudy was performed to identify the process of change, decisional balance and self-efficacy corresponding to the stage of exercise behavior using Transtheoretical Model in patients with type 2 diabetes mellitus. METHOD The study method was a survey in 100 type 2 DM patients at out-patients clinic of Y medical center from March 19, 2000 to October 30, 2000. RESULT The results were as follows:The subjects were divided into five stages of exercise behavior ;15.0% in pre-contemplation stage, 33.0% in contemplation stage, 17.0% in preparation stage, 16.0% in action stage and 19.0% in maintenance stage. The subjects in pre-contemplation stage used all processes of change in the least. "Dramatic relief(DR)", "Environmental reevaluation(ER)" and "Self reevaluation(SR)" were identified as main processes ofchangein contemplation stage. "Consciousness raising(CR)", "DR" were used higher than average in preparation stage. "Helpingrelationships(HR)","CR", "ER", "SR", "Social liberation(SL)", "Counter conditioning (CC)", "Reinforcement management(RM)", "Self liberation(SEL)" and "Stimulus control(SC)" were used higher than average in action stage. The subjects in maintenance stage used all process of change the highest except "DR"and "HR". "Cons" score of decisional balance was the highest in pre-contemplation stage, "Pros" score was the highest in action stage and "Self-efficacy" score was the highest in maintenance stage. CONCLUSION This study can provide the basis of staged matching exercise program using TTM for more effective and useful intervention.
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