An Issue of Diabetes and Self-Efficacy

Abstract

While self-efficacy is a proven clinical predictor of metabolic and glycemic control among people with poorly controlled Type 1 and Type 2 diabetes (Abubakari et al., 2015), few health care systems integrate effective biochemical individual strategies for disease management.  Customized clinical meal plans, personalized education, high intensity interval training (HIIT) and targeted health coaching have demonstrated significant improvement in clinical biomarkers associated with Type 2 diabetes and metabolic syndrome (MetS) including HOMA-IR, triglyceride/HDL ratio, HgA1c, fasting insulin, fasting glucose, fasting triglycerides, LDL, VLDL, HDL, total cholesterol and C-reactive protein (Brown & Gibas, 2018; Dahlgren & Gibas, 2018; Gibas & Gibas, 2017; Hallberg et al., 2018; Lennarz et al., 2018; McKenzie et al., 2017).  In this case study, a 65 year old woman who has had Type 2 diabetes and comorbid clinical depression for the past 23 years was placed on a ketogenic diet combined with high intensity interval training, personalized education and weekly health coaching for 10 weeks.  Intervention goals included reduced insulin defect and impaired peripheral insulin signaling as measured by the HOMA-IR, sustained glycemic control as measured via HgA1c, reduced visceral fat pattern storage as measured through the triglyceride/HDL ratio, improved depressive symptoms as measured by the PHQ-9 and improved self efficacy as measured by the General Self Efficacy Questionnaire (GSE) and Adherence Questionnaire.  The results of the 10-week intervention were statistically significant.

Introduction

Diabetes is an epidemic in the United States.  According to the Centers for Disease Control and Prevention, from 1980 through 2014, the number of Americans with diagnosed diabetes has increased fourfold (from 5.5 million to 22.0 million)(Centers for Disease Control and Prevention, 2014, p. 3).  The tragedy is that type II diabetes is largely preventable through lifestyle changes.  Stuart Weinerman, from the division of endocrinology at North Shore University Hospital/Long Island Jewish Medical Center in New Hyde Park, N.Y., states that diabetes is being considered the major health burden of our day (Paoli et al., 2015).  The diabetes epidemic is unnecessary and due to obesity.  A worsening epidemic of diabetes and its precursor, metabolic syndrome (MetS) is engulfing America. Medical doctors have the basic knowledge and know what works but have failed to apply it effectively (Paoli et al., 2015).  In addition, adherence with medical regimen is essential to disease management and reversal, but research shows that few patients are adherent with physician-recommended pharmacological guidelines and lifestyle modifications (Fisher et al., 2010; Osterberg & Blaschke, 2005; Pan et al., 2008). Poor self-efficacy around disease management is associated with non-adherence.  This case study was purposed at exploring the quantifiable impact of metabolic syndrome-specific psychoeducation, clinical meal plans and high intensity interval training on self-efficacy, adherence, weight and triglyceride levels for a patient with type 2 diabetes in an integrated care setting.  The results of the 10-week intervention were statistically significant.  Self-efficacy improved by 65% and adherence by 70%, in addition to a reduction in triglyceride levels by 54% and individual average weight loss of 26 pounds.  The clinical relevance and implications of the results are supported in the research.  Metabolic syndrome-specific interventions yielding outcomes consistent with those in this study demonstrate a promising trend for medical interventions in settings other than primary care.

A 26% increase in costs of diabetes between 2012 to 2017 (American Diabetes Association, 2018) has staggering implications for the exponential rise in associated disease risk including cardiovascular disease, stroke, Alzheimer’s disease and cancer.  Increased cost per person is exemplified among the population of 65 years and older.  The remarkably high rates of mortality and morbidity are primarily due to poor metabolic control, specifically poor glycemic control (Polonsky & Henry, 2016).  Inadequate glycemic control is also associated with key non-patient factors, including lack of integrated care in the majority of health care systems and sluggish clinical inertia among health care providers (Polonsky & Henry, 2016).  Adherence with medical regimen is essential to disease management and reversal; however, research demonstrates that few patients are adherent with physician-recommended pharmacological guidelines and lifestyle modifications (Awodele & Osuolale, 2015; Fisher et al., 2010; Osterberg & Blaschke, 2005; Pan et al., 2008; Polonsky & Henry, 2016 ).  Diabetes distress, a known affective disorder, comprises a complexity of factors that contribute to poor adherence (Devarajooh & Chinna, 2017).  Worry, frustration, conflict and discouragement encompass the overall lifetime disease experience of many diabetic patients and is closely linked to depression.  Diabetes distress negatively impacts individual problem solving skills required for adequate self-care, which may ultimately result in substandard glycemic control.  Self-efficacy, a personal belief in one’s innate ability to effectively deal with prospective situations, is commonly influenced by diabetes and diabetes distress.  Recent research demonstrates that higher levels of self-efficacy are associated with better diabetes self-care practices and glycemic control (Devarajooh & Chinna, 2017).

Diabetes is an epidemic in the United States.  According to the Centers for Disease Control and Prevention, from 1980 through 2014, the number of Americans with diagnosed diabetes has increased fourfold (from 5.5 million to 22.0 million)(Centers for Disease Control and Prevention, 2014, p. 3).  The tragedy is that type II diabetes is largely preventable through lifestyle changes.  Stuart Weinerman, from the division of endocrinology at North Shore University Hospital/Long Island Jewish Medical Center in New Hyde Park, N.Y., states that diabetes is being considered the major health burden of our day (Paoli et al., 2015).  The diabetes epidemic is unnecessary and due to obesity.  A worsening epidemic of diabetes and its precursor, metabolic syndrome (MetS) is engulfing America. Medical doctors have the basic knowledge and know what works but have failed to apply it effectively (Paoli et al., 2015).  In addition, adherence with medical regimen is essential to disease management and reversal, but research shows that few patients are adherent with physician-recommended pharmacological guidelines and lifestyle modifications (Fisher et al., 2010; Osterberg & Blaschke, 2005; Pan et al., 2008). Poor self-efficacy around disease management is associated with non-adherence.  This study was purposed at exploring the quantifiable impact of metabolic syndrome-specific psychoeducation and clinical meal plans on self-efficacy, adherence, weight and triglyceride levels for MetS patients in an optometry setting.  The results of the eight-week intervention were statistically significant.  Self-efficacy improved by 65% and adherence by 70%, in addition to a reduction in triglyceride levels by 54% and individual average weight loss of 26 pounds.  The clinical relevance and implications of the results are supported in the research.  Metabolic syndrome-specific interventions yielding outcomes consistent with those in this study demonstrate a promising trend for medical interventions in settings other than primary care.

 

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