Stability and change. Glycemic control and lifestyle support in type 2 diabetes.
(2021) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2020:- Abstract
- Type 2 diabetes is a serious, lifestyle-related condition characterized by insufficient glycemic control resulting in hyperglycemia. Long-term hyperglycemia is a major risk factor for a range of health complications, and type 2 diabetes complications are among the leading causes of morbidity and mortality worldwide. Of all forms of diabetes, type 2 diabetes constitutes around 90% of cases, indicating its impact on both an individual and a societal level. The management of type 2 diabetes is an everyday task, and the main responsibility for healthy glycemic control lies with the individual. Most individuals with type 2 diabetes, however, do not meet recommended treatment targets, implying a need for a better understanding of factors related... (More)
- Type 2 diabetes is a serious, lifestyle-related condition characterized by insufficient glycemic control resulting in hyperglycemia. Long-term hyperglycemia is a major risk factor for a range of health complications, and type 2 diabetes complications are among the leading causes of morbidity and mortality worldwide. Of all forms of diabetes, type 2 diabetes constitutes around 90% of cases, indicating its impact on both an individual and a societal level. The management of type 2 diabetes is an everyday task, and the main responsibility for healthy glycemic control lies with the individual. Most individuals with type 2 diabetes, however, do not meet recommended treatment targets, implying a need for a better understanding of factors related to glycemic control, as well as for new, cost-effective solutions to support those with the disease. The overall aim of this thesis was to examine patient factors associated with glycemic control, and to develop and evaluate a web-based intervention to support diabetes self-management. Two prospective cohort studies (studies I and II) were conducted to examine the associations between sociodemographic and psychological factors, and glycemic control. A qualitative study utilizing semi-structured interviews (study III) was conducted to explore patients’ needs and expectations regarding support for diabetes self-management, and views on the development of an intervention to support diabetes management. The effect of a new, web-based lifestyle tool for glycemic control in individuals with type 2 diabetes was investigated through a randomized controlled trial (study IV). The effect of the tool was further examined in a subgroup of insulin- resistant and obese individuals, and the cost-effectiveness of the tool was estimated. Results showed that men, individuals with obesity, and participants who reported a more negative appraisal of diabetes, had less stable glycemic control compared to other groups. Patients reported physical and emotional barriers to appropriate diabetes management, as well as a disconnect between their way of life and the lifestyle advice they received from health care professionals, and described a need for accessible and reliable support for diabetes self-management. Based on these results, a web-based lifestyle tool was developed and evaluated. Improved glycemic control was found in participants using the tool, compared to a waitlist control group. The response was further pronounced in a subgroup of insulin-resistant and obese individuals, and the tool was estimated to be cost-effective based on its potential ability to control risk factors for the disease. Men, individuals with obesity, and individuals with a more negative experience of type 2 diabetes may be at greater risk of developing future diabetes complications due to their attenuated glycemic variability. There is a need for personalized and autonomy-supportive interventions that can provide both encouragement and relevant information to the patient group, to support risk factor control. A new, web-based intervention supporting self- reflection and including a personal adaptation of health information can be used to support enhanced glycemic control in individuals with type 2 diabetes, and may be particularly effective in obese and insulin-resistant individuals. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/e08e9499-efe6-4eff-bea1-6d4d8ad18810
- author
- Mellergård, Emelia LU
- supervisor
-
- Frida Eek LU
- Per Johnsson LU
- opponent
-
- Professor Andersson, Gerhard, Department of Behavioral Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Sweden
- organization
- publishing date
- 2021
- type
- Thesis
- publication status
- published
- subject
- keywords
- Type 2 diabetes; Glycemic control; HbA1c; Self-management; Psychological adjustment; Health psychology; Web-based interventions
- in
- Lund University, Faculty of Medicine Doctoral Dissertation Series 2020:
- issue
- 2021:107
- pages
- 90 pages
- publisher
- Lund University, Faculty of Medicine
- defense location
- H01-salen, Health Science Centre, Baravägen 3 i Lund. Join by Zoom: https://lu-se.zoom.us/j/65167277905
- defense date
- 2021-10-28 09:00:00
- ISSN
- 1652-8220
- ISBN
- 978-91-8021-114-7
- language
- English
- LU publication?
- yes
- id
- e08e9499-efe6-4eff-bea1-6d4d8ad18810
- date added to LUP
- 2021-09-26 19:28:42
- date last changed
- 2023-02-22 11:04:08
@phdthesis{e08e9499-efe6-4eff-bea1-6d4d8ad18810,
abstract = {{Type 2 diabetes is a serious, lifestyle-related condition characterized by insufficient glycemic control resulting in hyperglycemia. Long-term hyperglycemia is a major risk factor for a range of health complications, and type 2 diabetes complications are among the leading causes of morbidity and mortality worldwide. Of all forms of diabetes, type 2 diabetes constitutes around 90% of cases, indicating its impact on both an individual and a societal level. The management of type 2 diabetes is an everyday task, and the main responsibility for healthy glycemic control lies with the individual. Most individuals with type 2 diabetes, however, do not meet recommended treatment targets, implying a need for a better understanding of factors related to glycemic control, as well as for new, cost-effective solutions to support those with the disease. The overall aim of this thesis was to examine patient factors associated with glycemic control, and to develop and evaluate a web-based intervention to support diabetes self-management. Two prospective cohort studies (studies I and II) were conducted to examine the associations between sociodemographic and psychological factors, and glycemic control. A qualitative study utilizing semi-structured interviews (study III) was conducted to explore patients’ needs and expectations regarding support for diabetes self-management, and views on the development of an intervention to support diabetes management. The effect of a new, web-based lifestyle tool for glycemic control in individuals with type 2 diabetes was investigated through a randomized controlled trial (study IV). The effect of the tool was further examined in a subgroup of insulin- resistant and obese individuals, and the cost-effectiveness of the tool was estimated. Results showed that men, individuals with obesity, and participants who reported a more negative appraisal of diabetes, had less stable glycemic control compared to other groups. Patients reported physical and emotional barriers to appropriate diabetes management, as well as a disconnect between their way of life and the lifestyle advice they received from health care professionals, and described a need for accessible and reliable support for diabetes self-management. Based on these results, a web-based lifestyle tool was developed and evaluated. Improved glycemic control was found in participants using the tool, compared to a waitlist control group. The response was further pronounced in a subgroup of insulin-resistant and obese individuals, and the tool was estimated to be cost-effective based on its potential ability to control risk factors for the disease. Men, individuals with obesity, and individuals with a more negative experience of type 2 diabetes may be at greater risk of developing future diabetes complications due to their attenuated glycemic variability. There is a need for personalized and autonomy-supportive interventions that can provide both encouragement and relevant information to the patient group, to support risk factor control. A new, web-based intervention supporting self- reflection and including a personal adaptation of health information can be used to support enhanced glycemic control in individuals with type 2 diabetes, and may be particularly effective in obese and insulin-resistant individuals.}},
author = {{Mellergård, Emelia}},
isbn = {{978-91-8021-114-7}},
issn = {{1652-8220}},
keywords = {{Type 2 diabetes; Glycemic control; HbA1c; Self-management; Psychological adjustment; Health psychology; Web-based interventions}},
language = {{eng}},
number = {{2021:107}},
publisher = {{Lund University, Faculty of Medicine}},
school = {{Lund University}},
series = {{Lund University, Faculty of Medicine Doctoral Dissertation Series 2020:}},
title = {{Stability and change. Glycemic control and lifestyle support in type 2 diabetes.}},
url = {{https://lup.lub.lu.se/search/files/102922212/Kappa_Emelia_Mellerga_rd.pdf}},
year = {{2021}},
}