Problem Solving in Diabetes Self-management and Control

Abstract

Problem solving is a multidimensional construct encompassing verbal reasoning/rational problem solving, quantitative problem solving, and coping. Aspects of problem solving can be assessed using newly developed diabetes-specific problem-solving measures for children/adolescents and adults. Cross-sectional studies in adults, but not children/adolescents, provide consistent evidence of associations between problem solving and A1C level. Only 25% of problem-solving intervention studies with children/adolescents and 50% of interventions with adults reported improvement in A1C. Most intervention studies reported an improvement in behaviors, most commonly global adherence in children/adolescents and dietary behavior in adults. Methodological limitations (noninclusion of problem-solving measures, inadequate descriptions of problem-solving interventions, homogenous samples) need to be addressed in future research to clarify the effect of problem solving on diabetes outcomes, identify characteristics of effective interventions, and determine the utility across age and racial/ethnic groups.

Effect of Problem-Solving-Based Diabetes Self-Management Training on Diabetes Control in a Low Income Patient Sample

“…The condensed format can be considered a "best practices" version of the current, brief approaches to problem-solving training within diabetes patient education, which tend to be less structured and less comprehensive in use of the formal PST approach. 9,11 One of the strengths of our study was the high trial completion rate, resulting in few missing data. In such a case, some may consider using the "complete case" analysis, wherein only the outcome differences between baseline and follow-up among patients who completed the trial are used for the analysis.…”

“…8 As a core self-management behavior in the American Association of Diabetes Educators' AADE 7 framework, problem solving is conceptualized as intervening on barriers to self-care and enabling patients to carry out all other behaviors. 9,10 Problem-Solving Training The D'Zurilla and Nezu problemsolving therapy (PST) 11 was the model for the training. The Project DECIDE training is a diabetes-adapted version of this standard PST, 12 developed in a traditional format (eight sessions of health problem-solving training) and a condensed format (one session of health problem-solving training).…”

A Continuous Glucose Monitoring and Problem-Solving Intervention to Change Physical Activity Behavior in Women with Type 2 Diabetes: A Pilot Study

“…These findings are similar to those of other studies in which problem-solving is related to changes in PA behavior, dietary behavior, and weight loss. [39][40][41] To our knowledge, this is the first study to use both CGM counseling and problem-solving in a behavioral intervention addressing PA in women with T2D.…”

Adesão ao tratamento do diabetes mellitus e variáveis sociodemográficas, clinicas e de controle metabólico

“…(2) Non-adherence to the treatment of diabetes mellitus is a problem whose dimensions are renowned in the international and Brazilian contexts, contributes to the low efficiency level of the treatment with complications in the medium and long-term and, consequently, increases the demand for high-complexity health services. (2)(3)(4)(5) The prevalence of non-adherence shows great variation depending on the study design, research population and measuring method. In the literature, the rates vary between 17% and 86% for medication treatment, 62% to 71% for the diet and 47% to 80% for physical exercise.…”