Self-managing type 2 diabetes is a unique challenge for older patients. A systematic review and thematic synthesis of barriers and facilitators

Autori/Curatori: Julia Menichetti, Pietro Cipresso, Elena Vegni, Guendalina Graffigna
Anno di pubblicazione: 2017 Fascicolo: 2 Lingua: Italiano
Numero pagine: 24 P. 97-120 Dimensione file: 467 KB
DOI: 10.3280/PDS2017-002005
Il DOI è il codice a barre della proprietà intellettuale: per saperne di più clicca qui

Qui sotto puoi vedere in anteprima la prima pagina di questo articolo.

Se questo articolo ti interessa, lo puoi acquistare (e scaricare in formato pdf) seguendo le facili indicazioni per acquistare il download credit.
Acquista Download Credits per scaricare questo Articolo in formato PDF

anteprima articolo

FrancoAngeli è membro della Publishers International Linking Association, Inc (PILA)associazione indipendente e non profit per facilitare (attraverso i servizi tecnologici implementati da l’accesso degli studiosi ai contenuti digitali nelle pubblicazioni professionali e scientifiche

Purpose: To systematize evidences related to self-management practices of older patients with type 2 diabetes, with particular reference to barriers and facilitators. Methods: Electronic databases were searched without year or language restrictions and independently screened and analyzed by two researchers following the SIGN evaluation checklist. Barriers and facilitators to self-care were thematically synthetized. Results: 17 articles were included. Five overarching themes for barriers and facilitators to self-care were identified: disease-related aspects, socio-demographic aspects, psychological aspects, doctor-patient aspects and social community aspects. In particular, diabetes symptoms, comorbidities and chronicity of treatment appeared to hamper self-care practices. On the contrary, working on personal resources and engaging peers and family has been re-ported to strengthen self-care behaviors. Finally, communication with the doctor was reported as the primary source of information and education to sustain self-care behaviors. Conclusions: Since engaging older type 2 diabetes patients in their care management is a multifaceted challenge that encompasses different potentially modifiable levels of action (e.g., individual, relational, social), solutions considering these levels should be considered. The need for a targeted intervention that would consider both ageing and diabetes-related difficulties is highlighted.

  1. American Diabetes Association (2003). Standard of medical care for patients with diabetes mellitus. Diabetes Care, 26: 33-50.
  2. Bai Y.L., Chiou C.P. and Chang Y.Y. (2009). Self‐care behaviour and related factors in older people with Type 2 diabetes. Journal Clin Nurs, 18 (23): 3308-3315.
  3. Beverly E.A., Wray L.A., Chiu C.J. and Weinger K. (2001). Perceived challenges and priorities in co‐morbidity management of older patients with Type 2 diabetes. Diabetic Med, 28: 781-784.
  4. Bos-Touwen I., Schuurmans M., Monninkhof E.M. et al. (2015). Patient and disease characteristics associated with activation for self-management in patients with diabetes, chronic obstructive pulmonary disease, chronic heart failure and chronic renal disease: a cross-sectional survey study. PloS one, 10: e0126400.
  5. Braun A.K., Kubiak T., Kuntsche J., Meier-Höfig M., Müller U.A., Feucht I. and Zeyfang A. (2009). SGS: a structured treatment and teaching programme for older patients with diabetes mellitus ‒ a prospective randomised controlled multi-centre trial. Age Ageing, 45: afp056.
  6. Choi S., Song M., Chang S.J. and Kim S.A. (2014). Strategies for enhancing information, motivation, and skills for self-management behavior changes: a qualitative study of diabetes care for older adults in Korea. Patient Prefer Adherence, 8: 219. DOI: 10.2147/PPA.S5863
  7. Ciechanowski P.S., Katon W.J. and Russo J.E. (2000). Depression and diabetes: impact of depressive symptoms on adherence, function and costs. Arch Intern Med, 160: 3278-3285.
  8. Clark N.M., Becker M.H., Janz N.K., Lorig K., Rakowski W. and Anderson L. (1991). Self-management of chronic disease by older adults. J Aging Health, 3: 3-27. DOI: 10.1177/08982643910030010
  9. Currie M., Philip L.J. and Roberts A. (2015). Attitudes towards the use and acceptance of eHealth technologies: a case study of older adults living with chronic pain and implications for rural healthcare. BMC Health Serv Res, 15: 1.
  10. Duckworth W., Abraira C., Moritz T. et al. (2009). Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med, 360: 129-139.
  11. Eakin E.G., Bull S.S., Glasgow R.E. and Mason M. (2002). Reaching those most in need: a review of diabetes self‐management interventions in disadvantaged populations. Diabetes Metab Res Rev, 18: 26-35.
  12. European Commission. Life online. Digital agenda scoreboard. 2012. -- Published 2012. Accessed February 10, 2016.
  13. Feil D.G., Zhu C.W. and Sultzer D.L. (2012). The relationship between cognitive impairment and diabetes self-management in a population-based community sample of older adults with Type 2 diabetes. J Behav Med, 35: 190-199.
  14. Gallant M. (2003). The Influence of Social Support on Chronic Illness Self-Management: A Review and Directions for Research. Health Educ Behav, 30: 170-195. DOI: 10.1177/109019810225103
  15. Gonzalez J.S., Safren S.A., Cagliero E. et al. (2007). Depression, self-care and medication adherence in type 2 diabetes: relationships across the full range of symptom severity. Diabetes Care, 30: 2222-2227.
  16. Graffigna G., Barello S., Bonanomi A. and Menichetti J. (2016). The Motivating Function of Healthcare Professional in eHealth and mHealth Interventions for Type 2 Diabetes Patients and the Mediating Role of Patient Engagement. J Diabetes Res, 501: 2974521. DOI: 10.1155/2016/297452
  17. Graffigna G., Barello S., Libreri C. and Bosio C.A. (2014). How to engage type-2 diabetic patients in their own health management: implications for clinical practice. BMC Public Health, 14: 1. DOI: 10.1186/1471-2458-14-64
  18. Graffigna G., Barello S. and Riva G. (2013). How to make health information technology effective: the challenge of patient engagement. Arch Phys Med Rehabil, 94(10): 2034-2035.
  19. Guariguata L., Whiting D.R., Hambleton I., Beagley J., Linnenkamp U. and Shaw J.E. (2014). Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes research and clinical practice, 103: 137-149.
  20. Haas L., Maryniuk M., Beck J. et al. (2012). Standards Revision Task Force. National Standards for diabetes self-management education and support. Diabetes Care, 35: 2393-2401.
  21. Haltiwanger E.P. and Galindo D. (2013). Reduction of Depressive Symptoms in an Elderly Mexican‐American Female with Type 2 Diabetes Mellitus: A Single‐Subject Study. Occup Ther Int, 20: 35-44.
  22. Haltiwanger E.P. (2012). Effect of a group adherence intervention for Mexican-American older adults with type 2 diabetes. Am J Occup Ther, 66 (2012): 447-454.
  23. Harbour R. and Miller J. (2001). A new system for grading recommendations in evidence based guidelines. BMJ, 323: 334.
  24. Harris P., Mann L., Philips P., Bolger-Harris H. and Webster C. (2011). Diabetes Management in General Practice: Guidelines for Type 2 Diabetes: Diabetes Australia and Royal Australian College of General Practitioners; 2011 [cited 2011 Aug 20].
  25. Hewitt J., Smeeth L., Chaturvedi N., Bulpitt C.J. and Fletcher A.E. (2011). Self management and patient understanding of diabetes in the older person. Diabetic Med, 28: 117-122.
  26. Huang E.S., Gorawara‐Bhat R. and Chin M.H. (2005). Self‐Reported Goals of Older Patients with Type 2 Diabetes Mellitus. J Am Geriatr Soc. 53: 306-311.
  27. Imam K. (2013). Management and treatment of diabetes mellitus. In: Shamim I. Ahmad, eds. Diabetes. An Old Disease, a New Insight. New York, NY: Springer, pp. 356-380.
  28. Jackson C.L., Bolen S., Brancati F.L., Batts-Turner M.L. and Gary T.L. (2006). A systematic review of interactive computer-assisted technology in diabetes care. J Gen Intern Med, 21: 105-110.
  29. James J. (2013). Health Policy Brief: Patient Engagement. Health Affairs, 32 (2013): 1-6.
  30. Karter A.J., Ferrara A., Darbinian J.A., Ackerson L.M. and Selby J.V. (2000). Self-monitoring of blood glucose: language and financial barriers in a managed care population with diabetes. Diabetes Care, 23: 477-483.
  31. Kim K.S., Kim S.K., Sung K.M., Cho Y.W. and Park S.W. (2012). Management of type 2 diabetes mellitus in older adults. Diabetes Metab J. 36: 336-344.
  32. Khalil H., Tan L. and George J. (2012). Diabetes management in Australian rural aged care facilities: A cross-sectional audit. Australasian Med J. 5: 575-580. DOI: 10.4066/AMJ.2012.141
  33. Krishna S. and Boren S.A. (2008). Diabetes self-management care via cell phone: a systematic review. J Diabetes Sci Technol. 2: 509-517. DOI: 10.1177/19322968080020032
  34. Lee P.G., McEwen L.N., Waitzfelder B., Subramanian U., Karter A.J., Mangione C.M. and Herman W.H. (2012). Is the physical functioning of older adults with diabetes associated with the processes and outcomes of care? Evidence from Translating Research Into Action for Diabetes (TRIAD). Diabetic Med. 29: e321-e325.
  35. Lin E.H., Katon W., Von Korff M. et al. (2004). Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care. 27: 2154-2160.
  36. Moghissi E. (2013). Management of type 2 diabetes mellitus in older patients: current and emerging treatment options. Diabetes Therapy, 4: 239-256.
  37. Moser A., van der Bruggen H., Widdershoven G., Spreeuwenberg C. (2008). Self-management of type 2 diabetes mellitus: a qualitative investigation from the perspective of participants in a nurse-led, shared-care programme in the Netherlands. BMC Public Health 8 (2008): 91. DOI: 10.1186/1471-2458-8-9
  38. Network, Scottish Intercollegiate Guideline (2001). SIGN 50: A guideline developers’ handbook. SIGN publication 50.
  39. Powers M.A., Bardsley J., Cypress M. et al. (2015). Diabetes Self-management Education and Support in Type 2 Diabetes A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Educ. 41(4): 417-430.
  40. Pratley R.E. and Heller S.R. (2014). Treatment of Type 2 Diabetes Mellitus in the Older Adult: A Review. Endocrine Practice, 20: 722. DOI: 10.4158/EP13192.R
  41. Quandt S.A., Bell R.A., Snively B.M. et al. (2005). Ethnic disparities in glycemic control among rural older adults with type 2 diabetes. Ethnicity Disease, 15 (4): 656.
  42. Sazlina S.G., Mastura I., Cheong A.T. et al. (2015). Predictors of poor glycaemic control in older patients with type 2 diabetes mellitus. SMJ, 56: 284.
  43. Sharifirad G., Najimi A., Hassanzadeh A. and Azadbakht L. (2011). Application of BASNEF educational model for nutritional education among elderly patients with type 2 diabetes: improving the glycemic control. JRMS, 16: 1149-58.
  44. Shen H., Edwards H., Courtney M., McDowell J. and Wei J. (2013). Barriers and facilitators to diabetes self‐management: Perspectives of older community dwellers and health professionals in China. Int J Nurs Pract, 19: 627-635.
  45. Shrestha A.D., Kosalram K. and Gopichandran V. (2013). Gender difference in care of type 2 diabetes. JNMA. 52: 245-250.
  46. Sinclair A.J., Girling A.J. and Bayer A.J. (2000). Cognitive dysfunction in older subjects with diabetes mellitus: impact on diabetes self-management and use of care services. Diabetes Res Clin Pract. 50: 203-212. DOI: 10.1016/S0168-8227(00)00195-
  47. Shaw J.E., Sicree R.A. and Zimmet P.Z. (2010). Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract, 87: 4-14.
  48. Skelly A.H., Arcury T.A., Snively B.M. et al. (2005). Self-monitoring of blood glucose in a multiethnic population of rural older adults with diabetes. Diabetes Educ. 31: 84-90.
  49. Song M, Lee M. and Shim B. (2010). Barriers to and facilitators of self‐management adherence in Korean older adults with type 2 diabetes. Int J Older People Nurs. 5: 211-218.
  50. Tan E., Polello J., Woodard and L.J. (2014). An Evaluation of the Current Type 2 Diabetes Guidelines: Where They Converge and Diverge. Clinical Diabetes, 32: 133-139.
  51. Thomas J., Harden A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol, 8: 45. DOI: 10.1186/1471-2288-8-4
  52. Toljamo M., Hentinen M. (2001). Adherence to self-care and glycaemic control among people with insulin-dependent diabetes mellitus. J Adv Nurs. 34: 780-786.
  53. van Dam H.A., Van der Horst F., Van den Borne B., Ryckman R., Crebolder H. (2003). Provider-patient interaction in diabetes care: effects on patient self-care and outcomes: a systematic review. PEC, 51: 17-28.
  54. Wild S., Roglic G., Green A., Sicree R., King H. (2004). Global prevalence of diabetes estimates for the year 2000 and projections for 2030. Diabetes Care, 27: 1047-1053.
  55. Williams J.W., Katon W., Lin E.H. et al. (2004). The effectiveness of depression care management on diabetes-related outcomes in older patients. Annals Int Med, 140, 12: 1015-1024.
  56. World Health Organization. Health and ageing: A discussion paper (2011). U.S. Department of Health and Human Services. -- Published 2011. Accessed February 10, 2016.

Julia Menichetti, Pietro Cipresso, Elena Vegni, Guendalina Graffigna, Self-managing type 2 diabetes is a unique challenge for older patients. A systematic review and thematic synthesis of barriers and facilitators in "PSICOLOGIA DELLA SALUTE" 2/2017, pp 97-120, DOI: 10.3280/PDS2017-002005