6/10/2016. Hui-Chun Hsu

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1 Hui-Chun Hsu PhD, RN, CDE Chief, Department of Diabetes Management Lee s Endocrinology Clinic Pingtung, Taiwan Disclosure to Participants Conflict of Interest (COI) and Financial Relationship Disclosures: Presenter: Hui-Chun Hsu, PhD, RD, CDE No COI/Financial Relationship to disclose Development of A Simplified Self- Reported Diabetic-Behavior Scoreboard as a Promising Assessment Tool to Key Diabetic Behavior Hsu H-C 1, An L-W 2, Lee Y-J, Wang R-H 3 1 Department of Internal Medicine, Lee s Endocrinology Clinic, Pingtung, Taiwan 2 Department of Medical Education, Beijing Ruijing Diabetes Hospital, Beijing , China 3 Department of Nursing, School of Nursing, Kaohsiung Medical University, Kaohsiung, 80317, Taiwan Diabetes Self- Management Education & Support, (DSME/S ) DSME/S is a complex and ongoing process Provide patients the knowledge and skill training Identifying the barriers Facilitate the problem-solving and coping skills It is effective at enhancing self-care behaviors and improving glycemic control. 2016/6/10 6 1

2 Assessment of DSME/S related behavior & risk factors The initial step for education, training & support. Provide subjective evidence to identify the problem/diagnosis and key etiology that could be modified by intervention procedure. Diabetic Behavior Hypoglycemia awareness & management skill Healthy eating Taking medication Being active Self -monitoring of blood glucose (SMBG) Psychological stress problem Quality of life Aim-(I) Diabetes Information & Management System 1. To construct a self-reported diabetes-related behavior dashboard for daily clinical practice Diabetes Self-Management Behavior Assessment Hypoglycemia Assessment Client History Medication History Physical & Laboratory Exam. Behavior Evaluation Risk Factor & Complication Assessment 2

3 Assessment of Diabetes Self Management Behavior 1st priority- Hypoglycemia awareness and skill of management Simple, accurate, quantifiable scale with reasonable reproducibility and precision Hypoglycemia Assessment Hyperglycemia Assessment Sick day management Skill Health Eating Being Active PAID-Chinese SF Taking Medicine SMBG Scoring Hsu HC, et al. J Nurs Res Sep;21(3): Scoring 3

4 Hsu HC, et al. J Nurs Res Sep;21(3): Hsu HC, et al. J Nurs Res Sep;21(3): WHO 5 well-being index-chinese Scoring WHO 5 well-being index Chinese WHO 5 well-being index Chinese PSQI 4

5 PSQI Risk Factor & Complication Assessment Assessment Hypoglycemia Assessment Diagnosis/Problem Intervention Re-Evaluation Behavior Evaluation Risk Factor & Complication Assessment Diabetes Self-Management Behavior Assessment Dashboard Validity test: Two professors of nursing, four endocrinologists, four certified diabetic educators, three Nutritionists and two diabetic patients were invited to assess the content validity. Results: Content validity index (CVI) :0.866~1.0 The process of inter-rater reliability assessment to : The test-retest reliability of intra-class correlation coefficient :

6 Operating Time 80% (n=8) of CDEs agreed Diabetic- Behavior Scoreboard is easy to assess diabetes behaviors. The mean of operating time was12.8 ±6.9 minutes per patients with type 2 diabetes Aim- (II) Clinical Application Patients: From August 2012 to August 2013 at, a total of 3,404 patients with type 2 diabetes mellitus were enrolled into in a specialized diabetic polyclinic. Subjects The exclusive criteria were age of 18 years or >80 years, being pregnant, having cognitive disabilities (dementia, mental retardation), or having a history of cerebrovascular disease. Patients were followed-up in the program for at least for 2 years were included in this clinical observational study. Subjects a comprehensive diabetic care program under the ADA diabetic practice guidelines covered by the National Health Insurance system In this comprehensive diabetic care program, patients were requested to return to the clinic every 3 months. Table 1. Clinical and biochemical characteristics and diabetes behavior scores of participants Variable Difference between Baseline (N=3,404) 12-Month follow-up (N=3,404) baseline and follow-up Range Mean (SD) Range Mean (SD) t Waist (cm) (10.4) (10.3) 2.7 (p=0.006) Waist-to-hip ratio (0.1) (0.1) 2.3 (p=0.023) Body mass index (kg/m 2 ) (4.3) (4.3) -4.2 (p<.0001) SBP (mmhg) (18) (19) -2.8 (p=0.005) DBP (mmhg) (13) (12.3) -4.7 (p<.0001) Fasting sugar (mg/dl) (51.7) (47.8) -0.0 (p=0.994) HBA1C (%) (1.4) (1.4) -5.0 (p<.0001) T-cholesterol (mg/dl) (34.7) (33.1) (p<.0001) Triglyceride (mg/dl) (117.2) (113.4) -0.2 (p=0.850) HDL-cholesterol (mg/dl) (14.4) (15.0) 0.5 (p=0.607) LDL-cholesterol (mg/dl) (27.8) (25.7) (p<.0001) Creatinine (mg/dl) (0.5) (0.6) 7.4 (p<.0001) egfr (23.6) (24.5) -5.1 (p<.0001) Table 1. Clinical and biochemical characteristics and diabetes behavior scores of participants Variable DBS per dimension Baseline 12-Month follow-up Difference between baseline and followup Range Mean (SD) Range Mean (SD) t Diet (2.3) (2.0) 7.2 (p<.0001) Exercise (2.8) (2.7) 3.7 (p=0.0002) Medication (1.5) (1.6) 0.1 (p=0.927) Monitoring (3.2) (3.2) -2.9 (p=0.004) PAID (6.0) (4.9) -11 (p<.0001) WHO 5 well-being index (3.8) (3.5) 2.0 (p=0.047) Total behavior score (5.9) (5.7) 2.7 (p=0.007) 6

7 Table 2. Correlations between baseline diabetes behavior scoreboard dimensions and health indicators A. Correlations between baseline diabetes behavior scoreboard dimensions and health indicators Variable HbA1c BMI Waist LDL-C Triglycerides MBP egfr Age Sex DM duration Education level Diet-b Exercise-b Medication-b Monitoring-b Total score of PAID-b Total score of WHO well-being index-b Total diabetic behavior score-b Table 2. Correlations between 12-month follow-up of diabetes behavior scoreboard dimensions and health indicators B. Correlations between 12-month follow-up of diabetes behavior scoreboard dimensions and health indicators Variable HbA1c BMI Waist LDL-C Triglycerides MBP egfr Age Sex DM duration Education level Diet-a Exercise-a Medication-a Monitoring-a Total score of PAID-a Total score of WHO well-being index-a Total diabetic behavior score-a Table 3. Linear regression analysis of variables associated with baseline HbA1c levels in subjects studied Baseline HbA1c levels Simple Multiple Variable β coefficient p value β coefficient p value Age < Sex Diabetes duration < <.0001 Education level BMI-b < Mean BP-b < Triglyceride-b < <.0001 LDL-cholesterol-b < <.0001 egfr-b Diet-b < <.0001 Exercise-b < Medication-b < Monitoring-b Total score of PAID-b < <.0001 Total score of WHO 5 wellbeing < index-b Total behavior score-b < Baseline Table 3. Linear regression analysis of variables associated with 12-month follow-up HbA1c levels in subjects studied 12-month follow-up HbA1c levels Simple Multiple Variable β coefficient p value β coefficient p value Age < Sex Diabetes duration < <.0001 Education level BMI-a < Mean BP-a < Triglyceride-a < <.0001 LDL-cholesterol-a < <.0001 egfr-a Diet-a < <.0001 Exercise-a < Medication-a < Monitoring-a < Total score of PAID-a < <.0001 Total score of WHO 5 wellbeing < index-a Total behavior score-a < < month follow up 7

8 Demographic character Age, Sex, Diabetic duration, Education level H 1 H 2 Diabetic-Behavior health eating, taking medication, exercise, blood glucose self-monitoring, psychologic behavior H3 H 4 Age Sex Education Duration (Diabetes) Demographic character *** 0.46*** Diabetic Behavior DM control HbA1c BMI MBP TG LDL Diabetes mellitus control BMI, B;ood pressure, HaA1C, LDL-Cholesterol, egfr WHO PAID Monitoring Medication Exercise Diet Figure 1. Theoretical model of diabetic behavior and diabetes mellitus control. Figure 2. Final model of diabetic behavior and diabetes mellitus control (baseline report). ***p < Table 4. Linear regression analysis of 12-month diabetes behavior scoreboard associated with difference in baseline and 12-month HbA1C levels in subjects studied Age 0.90 HbA1c 0.59 Sex Demographic BMI 0.09* DM control 0.46 character 0.18 Education MBP *** Duration 0.41*** 0.16 TG (Diabetes) LDL Diabetic Behavior WHO PAID Monitoring Medication Exercise Diet Figure 3. Final model of diabetic behavior and diabetes mellitus control (12-month follow-up report). *p<0.05, ***p < Simple Multiple Variable β coefficient p value β coefficient p value Age Sex Diabetes duration <.0001 Education level Baseline HbA1c < <.0001 Diet-d < Exercise-d Medication-d < Monitoring-d < Total score of PAID-d < Total score of WHO 5 well-being index-d < Total behavior score-d < <.0001 Summary 1. High Validity with 0.866~ Convenient, easy performed, time saving. 3. Self reported diabetes related behavior correlated with glycemic control status. Conclusion Diabetes Behavior Scoreboard a precise, convenient computer-based system to evaluate and follow the changes of diabetes related behavior in patients with T2DM 8

9 Diabetes life, Health life, Joyous life, Living more amazing Thank you 9