Assessment of self-management in patients with diabetes using the novel LMC Skills, Confidence and Preparedness Index (SCPI)

Aronson, Ronnie; Brown, Ruth E.; Jiandani, Dishay; Walker, Ashleigh; Orzech, Naomi; Mbuagbaw, Lawrence

doi:10.1016/j.diabres.2017.10.028

Cited by 10 publications

(19 citation statements)

References 20 publications

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“…Hyperglycemia is a major risk factor for developing both microvascular and macrovascular complications associated with T2D; as such, good glycemic control remains a critical issue. Patients with refractory T2D (RT2D) are those who cannot maintain good glycemic control, with persistent elevations in hemoglobin A1c (HbA1c) ≥8% even with appropriate therapy [7,8]. Only a few studies have described refractory diabetes, and the major causes of refractory diabetes come from the environment of specialist centers, poor healthcare, a lack of adherence to treatment and clinical inertia [7,9,10].…”

Section: Introductionmentioning

confidence: 99%

Akkermansia muciniphila is Negatively Correlated with Hemoglobin A1c in Refractory Diabetes

et al. 2020

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Patients with refractory diabetes are defined as type 2 diabetes (T2D) patients; they cannot achieve optimal glycemic control and exhibit persistent elevations of hemoglobin A1c (HbA1c) ≥8% while on appropriate therapy. Hyperglycemia can lead to severe microvascular/macrovascular complications. However, in contrast to T2D, few studies have focused specifically on the gut microbiota in refractory diabetes. To examine this issue, we recruited 79 subjects with T2D and refractory diabetes (RT2D), and all subjects received standard therapy with Metformin or other hypoglycemic agents with or without insulin for at least one year. The α-diversity displayed no significant difference, whereas the β-diversity showed a marginal significance (p = 0.054) between T2D and RT2D. The evaluation of taxonomic indices revealed reductions in both Akkermansia muciniphila and Fusobacterium and a corresponding enrichment of Bacteroides vulgatus, Veillonella denticariosi among those with RT2D. These microbial markers distinguished RT2D from T2D with an acceptable degree of discrimination (area under the curve (AUC) = 0.719, p < 0.01) and were involved in several glucose-related functional pathways. Furthermore, the relative abundance of Akkermansia muciniphila was negatively correlated with HbA1c. Our combined results reveal unique features of the gut microbiota in RT2D and suggest that the evaluation of the gut microbiota could provide insights into the mechanisms underlying glycemic control and the impact of therapeutic modalities in patients with RT2D.

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Section: Introductionmentioning

confidence: 99%

Akkermansia muciniphila is Negatively Correlated with Hemoglobin A1c in Refractory Diabetes

et al. 2020

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“…The SCPI is a simple tool, based on the AADE7 Self-Care Behaviors, that meets ISOQOL standards for patient-reported outcomes research (23) and is easy for a patient to complete on a tablet (in ;5 min) and with minimal instruction. In large cohorts of individuals living with type 1 and type 2 diabetes, the SCPI showed a high degree of validity (both construct and convergent [26]), internal consistency, and test-retest reliability and with no influence from age, sex, ethnicity, income, or level of education. Questionnaire generalizability across varying levels of individual health literacy is a common concern (19), and SCPI scoring was not related to level of education, income, or ethnicity.…”

Section: Discussionmentioning

confidence: 95%

“…A sequential exploratory mixed-methods design was used to develop the questions, based on the AADE7 Self-Care Behaviors (24) and informed by the Diabetes Canada Clinical Practice Guidelines (27), Social Cognitive Theory (28), and the Transtheoretical Model of Health Behavior Change (29). A prototype of the tool had already shown internal validity, readability at an eighth or ninth grade level (30), convergent validity to existing scales (Diabetes Empowerment Scale [15] and Michigan Knowledge Test [31]), and criterion validity to HbA 1c (25,26). After a series of patient interviews and HCP reviews, several changes were implemented to enhance clarity and ease of use of this final version of the SCPI: 1) the number of questions was reduced from 25 to 23; 2) the 1-10 horizontal visual analog scale was changed to a 7-point Likert scale to reduce clustering of responses; 3) individual questions were organized within their respective subscale; 4) an eighth response option, "already doing," was added to the Preparedness subscale (scored as a 7); and 5) a "not taking diabetes medications and/or insulins" option was added to four applicable questions.…”

Section: Methodsmentioning

confidence: 99%

“…The resulting SCPI was an easy-to-use, web-based, 25-item questionnaire, based on the AADE7 Self-Care Behaviors (24). The SCPI was validated in two cohorts of people with type 1 diabetes and type 2 diabetes who had poorly controlled HbA 1c (25) and in a broader specialist clinic population (26). In both populations, the SCPI showed high internal consistency, reliability, and generalizability, with scoring unaffected by sociodemographic variables, including age, sex, ethnicity, and education level.…”

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confidence: 99%

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Optimizing Diabetes Self-management Using the Novel Skills, Confidence, and Preparedness Index (SCPI)

Aronson

Brown

et al. 2019

Diabetes Care

Self Cite

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The Skills, Confidence, and Preparedness Index (SCPI) is an electronic tool designed to assess three dimensions (knowledge, confidence, and preparedness) in a clinically relevant measure with immediate feedback to guide the individualization of patient education. This study sought to assess the validity and reliability of the final SCPI generation, its relevance to glycemia, and its responsiveness to patient education. RESEARCH DESIGN AND METHODS In Part 1, patients with type 1 and type 2 diabetes were recruited from specialist clinics over a 6-month period and completed the 23-item SCPI using a tablet. In Part 2, participants also underwent a diabetes self-management education (DSME) program. Baseline SCPI score was used to guide the DSME, and SCPI and glycemia were assessed at completion. RESULTS In total, 423 patients met inclusion criteria and 405 had evaluable data. SCPI scores were found to have a high degree of validity, internal consistency, and test-retest reliability, with no floor or ceiling effects. Scoring was negatively correlated with HbA 1c (type 1 diabetes: r = 20.26, P = 0.001; type 2 diabetes: r = 20.20, P = 0.004). In 51 participants who underwent a DSME intervention (6.4 6 0.6 visits over a mean 6 SD 3.4 6 0.8 months), mean HbA 1c improvement was 1.2 6 0.2% (13.1 6 2.2 mmol/mol, P < 0.0001). Total SCPI score and each subscore improved in parallel. CONCLUSIONS The SCPI tool is a quick and easy-to-use measurement of three domains: skills, confidence, and preparedness. The instant scoring and feedback and its relationship to glycemic control should improve the efficiency and quality of individualizing care in the diabetes clinic. The past decade has seen significant growth in the breadth of oral antihyperglycemic agents (AHAs), insulin and other injectable therapies, and new technologies available to people with type 1 and type 2 diabetes. The move toward patientcentered therapy has also led to more robust diabetes self-management education (DSME) programs. Despite these advances, achievement of optimal glycemic control remains low and may have actually deteriorated (1,2). Optimal diabetes care uniquely entails the rate-limiting step of an individual's own ability to provide his/her self-care.

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“…Thus, integration of these factors into interventions could foster patients' engagement with DSM. Adequate self-management skills are provided through knowledge about the disease and understanding of the relationship between various self-management behaviours and resulting health outcomes [22]. Self-efficacy, on the other hand, develops patients' confidence to perform these behaviours and overcome barriers that prevent the achievement of behavioural goals [23].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Acceptability of My Care Hub Mobile App to Support Self-Management in Australians with Type 1 or Type 2 Diabetes

Adu

Malabu

Malau‐Aduli

et al. 2020

IJERPH

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The aim of this study was to evaluate the preliminary efficacy and user acceptance of My Care Hub (MCH) mobile app-developed to provide evidenced-based support and education on diabetes self-management (DSM). Using a mixed-methods design, the efficacy and acceptability of MCH were measured among people with type 1 or type 2 diabetes after three weeks of intervention. The primary outcome measure was level of involvement with DSM, while the mediating factors were skills and self-efficacy for DSM. Telephone interviews were conducted to elucidate information on perceptions of the app's impact on participants' DSM and interest in future use. Statistically significant improvements were observed between pre-and post-intervention measures: DSM activities (4.55 ± 1.14 vs. 5.35 ± 0.84; p = 0.001); skills (7.10 ± 1.99 vs. 7.90 ± 1.67; p = 0.04); and self-efficacy (7.33 ±1.83 vs. 8.07 ± 1.54; p = 0.03). Multivariate analysis showed that self-efficacy had the strongest, though not significant influence on DSM. Interview findings revealed that the app reinforced knowledge and provided motivation to participate in DSM activities. The study suggested a positive impact of MCH on DSM and acceptability by patients. To confirm these promising results, further large scale and long-term studies are required.

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Assessment of self-management in patients with diabetes using the novel LMC Skills, Confidence and Preparedness Index (SCPI)

Abstract: The SCPI tool is a quick (25 items), easy to use measure of three domains - knowledge, confidence and preparedness. The instant scoring and specific feedback, as well as the relationship to glycemic control should provide significant value in the patient assessment in the diabetes clinic.

Cited by 10 publications

References 20 publications

Akkermansia muciniphila is Negatively Correlated with Hemoglobin A1c in Refractory Diabetes

Akkermansia muciniphila is Negatively Correlated with Hemoglobin A1c in Refractory Diabetes

Optimizing Diabetes Self-management Using the Novel Skills, Confidence, and Preparedness Index (SCPI)

Efficacy and Acceptability of My Care Hub Mobile App to Support Self-Management in Australians with Type 1 or Type 2 Diabetes

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