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Aim: To examine (1) the mediating role of self‐efficacy between resilience and self‐management behaviours and (2) the moderating role of diabetes distress on the relationship between self‐efficacy and self‐management behaviours in patients newly diagnosed with type 2 diabetes. Design: Cross‐sectional design. Methods: Totally, 195 patients newly diagnosed with type 2 diabetes for more than 5 months but less than 18 months were recruited from three endocrine clinics in Taiwan through convenience sampling. Self‐reported questionnaires including demographic and disease characteristics, resilience, self‐efficacy and self‐management behaviours were used to collect data from October 2020 to May 2021. Moderated mediation analysis was performed by Hayes's PROCESS macro. Result: According to bootstrapping results, the indirect effect of resilience on self‐management was significant, although the direct effect of resilience on self‐management was not. Participants were categorized into with and without diabetes distress groups. The results of moderated mediation analysis indicated self‐efficacy significantly correlated with self‐management behaviours in participants without diabetes distress, although self‐efficacy did not significantly correlate with self‐management in participants with diabetes distress. Conclusion: The association of resilience with self‐management behaviours was fully mediated through self‐efficacy with diabetes distress moderating the relationship between self‐efficacy and self‐management behaviours in patients newly diagnosed with type 2 diabetes. Impact Improving resilience could enhance self‐efficacy leading to possible improvement in self‐management behaviour, although improving self‐efficacy might not benefit self‐management behaviours for those with high levels of diabetes distress. Healthcare providers need to first assess and address the diabetes distress before intervening to improve self‐efficacy to enhance self‐management behaviours in patients newly diagnosed with type 2 diabetes. Patient or Public Contribution: When designing this study, two patients newly diagnosed with diabetes were consulted about the importance of self‐management behaviours for them personally. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To construct a path model addressing influences of diabetes distress, self‐efficacy of injecting insulin, resilience and decisional balance of injecting insulin to quality of life (QoL) in insulin‐treated patients with type 2 diabetes (T2DM). Background: Insulin regimens more negatively impact QoL than oral medication treatments in patients with T2DM. Understanding the factors and influencing pathways associated with subsequent QoL will help nurses design timely interventions to improve QoL of insulin‐treated T2DM patients. Design: A 9‐month prospective design was employed in this study. Methods: Self‐reported questionnaires were used to collect data from 185 insulin‐treated T2DM patients. At baseline, diabetes distress and self‐efficacy of injecting insulin were collected, while QoL, resilience and decisional balance of injecting insulin were collected 9 months later. Data were collected from February 2017 to February 2018. Structural equation modelling was used for analysis. This study was conducted based on the STROBE. Results: Low baseline diabetes distress and high 9‐month decisional balance of injecting insulin directly associated with high 9‐month QoL. High baseline self‐efficacy of injecting insulin and high 9‐month resilience directly associated with high 9‐month decisional balance of insulin injection and indirectly associated with high 9‐month QoL. High baseline diabetes distress directly and indirectly associated with poor 9‐month QoL. Conclusions: Diabetes distress, self‐efficacy of injecting insulin, resilience and decisional balance of injecting insulin play different roles in associating with QoL in insulin‐treated T2DM patients. Relevance to clinical practice: Nurses could provide educational programs focusing on enhancing decisional balance of injecting insulin to improve QoL in insulin‐treated patients. Improving self‐efficacy of injecting insulin and resilience could be promising strategies to improve the decisional balance of injecting insulin. More timely assessment of diabetes distress and intervention might be powerful strategies to improve subsequent QoL in these patients. [ABSTRACT FROM AUTHOR]

The purpose of this cross-sectional study was to explore the determinants of hemoglobin A1c (HbA1c) levels in insulin-treated patients with Type 2 diabetes mellitus (T2DM) based on demographic and disease characteristics, self-reported regimen adherence factors (adherence in insulin regimen and self-monitoring of blood glucose), and psychosocial factors (decisional balance for insulin injection, health literacy, self-efficacy for insulin injection, diabetes distress, and empowerment perceptions). Via convenience sampling, 255 insulin-treated patients with T2DM were recruited from two endocrinology clinics in Taiwan. A self-report questionnaire was used to collect demographic and disease characteristics, regimen adherence factors, and psychosocial factors. The first HbA1c level measured after completion of the questionnaire was the dependent variable. The last HbA1c level measured before patients started insulin therapy as well as body mass index (BMI) was collected from medical records. Results indicated that adherence in insulin regimen was relatively good. Regimen adherence factors did not significantly correlate with HbA1c levels, but empowerment perception, decisional balance for insulin injection, health literacy, and diabetes distress did. The hierarchical multiple regression models indicated that BMI, the last HbA1c levels before starting insulin therapy, empowerment perception, and diabetes distress were important determinants of HbA1c levels. Nurses could periodically assess the diabetes distress of insulin-treated patients with T2DM and refer to mental health professionals when needed. Furthermore, applying empowerment approaches such as enhancing self-awareness of improved glycemic control and sharing more decision-making power with insulin-treated patients with T2DM might have benefits for their glycemic control. [ABSTRACT FROM AUTHOR]

Background: Women with diabetes face a significantly elevated risk of developing depression. Clarifying the factors associated with depression is critical to designing more timely interventions for this vulnerable population. Purpose: This study was developed to examine the impact of Type D personality, diabetes-care-related role strain, and diabetes-related distress on depression in women with Type 2 diabetes. Methods: A cross-sectional design was used. Convenience sampling was used to recruit 298 women aged 20–64 years who had been diagnosed with Type 2 diabetes for over 6 months from three outpatient endocrine clinics in Taiwan. Demographic and disease characteristics and Type D personality (negative affectivity and social inhibition), diabetes-care-related role strain, and diabetes-related distress and depression status information were collected using self-reported questionnaires and medical records. The important factors of influence on depression were examined using hierarchical multiple regression. Results: On the basis of the results of the hierarchical multiple regression analysis, age, negative affectivity, diabetes-care-related role strain, and diabetes-related distress were identified as significantly associated with depression, with negative affectivity explaining most (43.4%) of the variance in depression, followed by diabetes-care-related role strain and diabetes-related distress, which respectively explained 3% and 2.5% of the variance. Conclusions/Implications for Practice: The negative affectivity associated with the Type D personality was shown to be more significantly associated with depression than diabetes-related psychosocial factors such as diabetes-related distress and diabetes-care-related role strain. Timely assessment of negative affectivity and the provision of brief mindfulness intervention to reduce negative affectivity may be useful in preventing depression in women with Type 2 diabetes, whereas addressing diabetes-related distress and diabetes-care-related role strain should not be neglected when providing comprehensive depression-preventing interventions to young women with diabetes. [ABSTRACT FROM AUTHOR]

Purposes: Women with diabetes (WD) are more severely impacted by the consequence of suboptimal diabetes control. This study aims to examine the impact of demographic and disease characteristics, baseline self-stigma, role strain, diabetes distress on Hemoglobin A1C (A1C) levels, quality of life (D-QoL) and 6-month A1C levels in younger WD. Methods: This study was a 6-month prospective study. In total, 193 WD aged 20–64 years were selected by convenience sampling from three outpatient clinics in Taiwan. Demographic and disease characteristics, self-stigma, role strain, diabetes distress, A1C levels, and D-QoL were collected at baseline. A1C levels were further collected 6 months later. Structural equation modeling was conducted to test the hypothesized model. Results: The final model supported that higher baseline D-QoL directly associated with lower concurrent A1C levels and indirectly associated with lower 6-month A1C levels through baseline A1C levels. Higher baseline self-stigma, role strain, and diabetes distress directly associated with lower baseline D-QoL, and indirectly associated with higher 6-month A1C levels through D-QoL. Conclusion: Improving self-stigma, role strain, and diabetes distress should be considered as promising strategies to improve D-QoL in young WD. D-QoL plays a mediation role between baseline self-stigma, role strain, diabetes distress and subsequent glycemic control in younger WD. Enhancing baseline D-QoL is fundamental to improve subsequent glycemic control. [ABSTRACT FROM AUTHOR]

Aims: To explore the risk factors of falls and the gender differences based on demographic and disease characteristics, physical capability, and fear of falling in older adults with diabetes visiting outpatient clinics in Taiwan. Design: Cross‐sectional design. Methods: A total of 485 patients with type 2 diabetes aged between 65 and 80 years were recruited from three endocrine outpatient clinics in Taiwan. Demographic and disease characteristics, fall history in the previous one year and fear of falling were collected by a self‐reported questionnaire. Calf circumference, handgrip strength, one‐leg standing and time up‐and‐go tests were all performed to assess the physical capability of participants. Data were collected from May 2019 to May 2020. Results: Female gender (OR = 1.75), handgrip strength (OR = 2.43) and fear of falling (OR = 3.38) were important risk factors of falls overall, although fear of falling (OR = 4.69) was the only important risk factor of falls in males, while handgrip strength (OR = 3.48) and fear of falling (OR = 2.86) were important risk factors of falls in females. The sensitivity of simultaneous screening handgrip strength and fear of falling were 85.7, 86.4 and 86.2 in males, females and older adults overall with diabetes, respectively. Conclusion: Fear of falling was an important risk factor of falls in both genders, especially in males. Handgrip strength was an important risk factor of falls specifically for females. By simultaneously screening fear of falling and handgrip strength, risk of falls in older adults with diabetes at outpatient clinics could be identified in a more timely manner. Impact Nurses could periodically and simultaneously assess fear of falling and handgrip strength of older adults with diabetes at outpatient clinics. For those are identified at risk of falls on either fear of falling or handgrip strength, nurses could provide corresponding interventions to reduce the fear of falling or improve muscle strength to prevent such falls. [ABSTRACT FROM AUTHOR]