- Current Status of Self-management and Barriers in Elderly Diabetic Patient.
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Gyong Ae Choi, Soo Mi Jang, Hong Woo Nam
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Korean Diabetes J. 2008;32(3):280-289. Published online June 1, 2008
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DOI: https://doi.org/10.4093/kdj.2008.32.3.280
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- BACKGROUND
Diabetes has a critical effect on elderly diabetic patients' quality of life. Elderly diabetic patients have many difficulties in diabetes self-management because their physical, psychological and social functions are decreased as a result of the aging process. Therefore, we evaluated the current status of self-management and barriers in elderly diabetic patients METHODS: The sample was 124 elderly diabetic patients (over 61 years) who visited a hospital and two senior welfare centers in Seoul from July to August 2006. The results of the study were analyzed by descriptive statistics, ANOVA, T-test, and hierarchical regression. RESULTS: 1) Diabetes self-management was composed of insulin injection, diet, exercise, foot management, smoking and drinking alcohol. An average score of self-management in the elderly diabetic patients was 4.5784. In demographic variables, only job status showed a significant effect on self-management. 2) Barriers such as 'forgetting taking diet and medication', 'being interrupted by others', and 'lack of family and social support' were significant factors in diabetes self-management. 3) These barriers for diabetes self-management were still significant in the case of controlling demographic and clinical variables. CONCLUSION: Diabetic educator should identify the significant factors that affect patient's self-management such as whether they have a full-time job, or the type of their job. In addition, diabetes education should focus on assertiveness training to deal with various interpersonal barriers and empowerment for enhancing patient's self-efficacy. These approaches would benefit patients who experience barriers of diabetes self-management
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Citations
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- Effect of Glucose Concentrations on the Cell Proliferation and Expression of L-type Calcium Channel mRNA in Cultured Rat Aortic Vascular Smooth Muscle Cells.
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Young Jung Cho, Hyung Joon Yoo, Hong Woo Nam, Ji Young Suh, In Kyung Jeong, Sung Hee Ihm, Hyeon Kyu Kim, Cheol Young Park, Jae Myung Yoo, Doo Man Kim, Moon Gi Choi, Sung Woo Park
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Korean Diabetes J. 2003;27(3):253-259. Published online June 1, 2003
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Abstract
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- BACKGROUND
Vascular smooth muscle cell (VSMC) proliferation is one of the major pathogenic mechanisms for atherosclerosis. It is known that L-type calcium channels play a role in VSMC proliferation in diabetic rats. However, there have been no studies that show an association between the L-type calcium channels and the VSMC proliferation due to various glucose concentrations in the culture media. Therefore, the association between the voltage-dependent L-type calcium channels of the VSMCs, and the growth of vascular smooth muscle cells, was examined. METHODS: Rat aortic VSMCs were isolated from the aorta of Sprague-Dawley and OLETF rats, using an enzymic method. The VSMCs were cultured in various concentrations of glucose (5.5, 11.0, 16.6, 25, 30 and 40 mM). The VSMCs (1x10(4) cells in 24-well plates) were incubated in the presence of Bay K 8644 (10(-6)M), both with and without verapamil (10(-6)M), for 48 hours. The proliferation was then assessed by the MTT (methylthiazole tetrazolium) assay, and the expression of L-type calcium channel mRNA by RT-PCR. RESULTS: The vascular smooth muscle cell proliferation was significantly increased, in a dose-dependent manner, with glucose concentrations below 25 mM in both in a dose-dependent manner, with glucose concentrations below 25 mM in both kinds of rat. However, the increase in the VSMC proliferation of the OLETF rat was significantly higher than in the Sprague-Dawley rat. After the Bay K 8644 treatment, with the same glucose concentration, the VSMC proliferation and the expression of L-type calcium channel mRNA were significantly increased in both kinds of rat. After treatment with verapamil, the increased VSMC proliferation and expression of L-type calcium channel mRNA, due to the Bay K 8644, were suppressed to control levels in both kinds of rat. CONCLUSION: The results suggest that below certain concentrations of glucose, 25 mM, the L-type calcium channels may play a role in the VSMC proliferation of OLETF and Sprague-Dawley rats. The growth of the VSMCs in OLETF rats, due to various glucose concentrations (< 25 mM), was significantly higher than in the Sprague-Dawley rats.
- The Effects of Teaching Methods on the Dietary Compliance and Hemoglobin A1c Level in Patients with Diabetes Mellitus.
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Sung Oh Chung, O Keum Song, Jae Min Ko, Jun Hwan Wi, Tae Hoon Lee, Ju Hyup Yum, Dae Kyoung Cho, Jin Hee Son, Hong Woo Nam, Hyung Joon Yoo, Young Nam Lee, Sung Gon Kim, Hyun Kyung Moon, Eul Sang Kim
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Korean Diabetes J. 2000;24(5):560-573. Published online January 1, 2001
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Abstract
- BACKGROUND
Diet control plays an important role in diabetic management, but it is often hard for diabetic patients to follow the dietary control program. Poor dietary compliance leads to metabolic derangements in patients with diabetes and it may derive mainly from defects in dietary education program rather than from patients themselves. Therefore, we performed a randomized prospective study to compare the effects of three different teaching methods for diet control. METHODS: Forty eight diabetic patients with poor glycemic control (mean HbA1c 11.4+/-1.5%) were enrolled during hospitalization and allocated at random to three different teaching methods i.e. Conventional diet sheet instruction (Group 1), Food recording on every meal (Group 2), and Meal time demonstration (Group 3). For evaluation, knowledge about DM diet and barriers to diet control were assessed by a questionnaire. Consistency in carbohydrate intake (Coefficient of variation) and serial HbA1C measurements were used for the estimation of dietary compliance and glycemic control respectively. RESULTS: During five months' follow-up period, there was no remarkable improvement in knowledge about diabetic diet control, dietary compliance and glycemic control in Group 1 patients. But both dietary compliance and glycemic control improved in Group 2 and 3 patients during follow-up period. In Group 2 CV (Coefficient of Variation ) fell from 36.4+/-15.2% to 27.7+/-17.3% and in Group 3 from 32.1+/-9.6% to 23.2+/-10.5% (p<0.05). In Group 2 HbA1c fell from 12+/-2.2% to 8.3 +/-2.0% and in Group 3 from 11.5+/-2.0% to 7.5+/-1.9% (p<0.01). The change of HbA1c level showed an appreciable correlation with dietary compliance (r= 0.75). Among the perceived barriers to dietary practice in patients of Group 2 and Group 3, extrinsic factors related to knowledge lowered during the intervention (p<0.05). Even though Group 3 patients had good dietary compliance, they still felt that intrinsic factors related to motive and attitude were the major barriers at the end of the study (p<0.05). CONCLUSION: We found that meal time demonstration teaching method may improve dietary compliance and glycemic control compared with the conven tional diet sheet instruction method.
- Perceived barriers to Dietary Practice Adherence Among Persons with Diabetes.
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O Keum Song, Hong Woo Nam, Do Ho Moon, Kyung Ho Lim, Hyun Kyung Moon, Eul Sang Kim
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Korean Diabetes J. 1998;22(3):381-391. Published online January 1, 2001
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Abstract
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- BACKGROUND
Diet therapy is viewed as a cornerstone of diabetes care and emphasized to all the type of diabetes. The diet has been identified by many patients as one of the most difficult part of managing their diabetes. They may have several factors to influence adherence to a dict. The purpose of this study was to identify dietary practice adherence and perceived barriers(intrinsic and extrinsic factors) among the persons with diabetes at Diabetes Clinic in Nationwide.. METHODS: The survey questionnaire was mailed to 852 persons with diabetes member via diabetes educators of 156 hospitals, clinics and 24 health centers. Questionnaire divided into 3 part;(1)background information (2)meal regularity and food intake as a dietary practice adherence (3)40 items with motive/ attitude as a intrinsic factor and knowledge, resources/authority as a extrinsic factor was rated by the thoughts and feelings associated with barriers to dietary practice adherence. 432 questionnaires were returned. The response rate was 51%. RESULTS: Meal regularty was more satisfactory than food intake. Deficit of meal regularity was reasonable spacing between meal and snack' due to "grazing", "weak will", "hunger feeling". Deficit of food Intake was protein food in 3 meal a day' 43% less recommendation due to I wouldnt disturb anyone so I used to eat something available", fear of hyperglycemia, bother to prepare food. Conclusions: The respondents to this questionnaire were members of Diabetes Clinics. They perceived that motive/attitude(intrinsic factors) was as the major barriers while authority/resources(extrinsic factors) was as a minor barriers to the dietary practice adherence. Tliese results suggest that dietary strategies may need to be developed cognitive-behavioral aspect and problem-solving skills for alteration in 'Real-life' diabetic situation to dietary practice adherence.
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