dissertation on diabetes mellitus

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Impact of knowledge, attitude, and practices of Type 2 diabetic patients: A study in the locality in Vietnam

Nghiep ke le.

Department of Public Health, Faculty of Public Health, Mahasarakham University, Mahasarakham, Thailand

Niruwan Turnbull

Cuong van dam.

1 University Administrators, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho Province, Vietnam

Santisith Khiewkhern

Surasak thiabrithi, background:.

Disease knowledge, appropriate attitude, and proper practices play an important role in disease control and reduction of diabetes-related complications and deaths. This study aims to investigate the impact of knowledge, attitude, and practices (KAPs) of Type 2 diabetic patients' outcomes.

MATERIALS AND METHODS:

A cross-sectional research was conducted on a group of 102 Type 2 diabetic participants in 17 communities in Tam Binh District, Vinh Long Province, Vietnam. The research tool employed the KAP questionnaire using IBM SPSS 22 to analyze the data.

The participants' average age was 57.02 ± 6.323 years. The proportion of women was 76.5% (three times higher than men). The knowledge score of the participants was low (30.04 ± 12.823), the attitude toward score of diabetics was moderate (61.544 ± 29.99), and the practice of self-care score was low (50.59 ± 14.881). There were also some significant relationships between KAPs with ethnicity, marital status, diabetic duration, location, employment status, and treatment method. In addition, there were only significant differences between the self-care practice groups and patients' attitude toward Type 2 diabetes.

CONCLUSION:

There is a significant relationship between KAP with some participants' characteristics. The KAPs of the diabetic patients in Tam Binh district are still low. This result showed that although the patient's attitude towards disease was good, it was not enough for them to practice good self-control due to poor knowledge.

Introduction

Type 2 diabetes mellitus (T2DM) is a long-term metabolic confusion disease that is related to a high rate of complication and mortality in a population.[ 1 , 2 ] The worldwide prevalence of diabetes was 177 million in 2000,[ 3 ] which increased to 422 million in 2014,[ 4 ] and it will be reaching 592 million by 2035.[ 5 ] In 2015, there were over 3.5 million Vietnamese adults living with diabetes. Particularly, T2DM is the most common type, with the incidence doubling in the previous decade (2.7% in 2002–5.4% in 2012).[ 6 , 7 ]

Diabetic treatment is a lifelong process, so self-motivation of the patient is needed. Therefore, patients need a basic knowledge of diabetes, and if they have knowledge about the disease, they will be more positive about the attitude and better practice.[ 8 , 9 ] It can help early disease detection and complication reduction.[ 10 , 11 ] Some authors have assessed the knowledge, attitude, and practice (KAP) of diabetes using the KAP questionnaire and promoted them for better cognizance of how to manage risk factors including program intervention of the diabetes.[ 12 ] They also indicated that diabetes knowledge, attitudes toward disease, and practices of the diabetic self-management are associated with a greater understanding of the prevention, diagnosis, and control of risk factors.[ 13 ] This study assessed the impact of knowledge, attitude toward diabetes, and practice of self-care management of T2DM patients. In spite of that, the knowledge related to diabetic control has globally been realized to be scanty.[ 9 ] Especially, no studies have been conducted on the general population in Tam Binh district, Vinh Long province, Vietnam, to assess the KAP of T2DM.

Therefore, this study aims to ascertain the impact of the knowledge, attitude toward diabetes, and practices of T2DM in Tam Binh district, Vinh Long province, Vietnam, which will further identify the relationship between KAPs in participants.

Materials and Methods

The participants.

This cross-sectional research was conducted on one group including 102 participants at 17 communes (six participants per commune) in Tam Binh district, Vinh Long province, Vietnam, from July to August 2019. The participants were randomly selected based on each local diabetic management list. Sampling criteria were patients aged 35–65 years with T2DM; diabetic duration from 6 months or more; those who were not hospitalized in the past 3 months; and those who did not have neurological abnormalities and malformations.

The knowledge, attitude, practice questionnaire

The KAP questionnaire was created by the researcher in both Vietnamese and English to suit Vietnamese culture [ Supplement Table 1 ]. The KAP questionnaire consists of four parts including (1) the demographic of the participants, (2) the knowledge of individuals with diabetes, (3) participants' attitude toward diabetics, and (4) participants' self-care management of diabetes. The knowledge part contains ten multiple choices with 1 score for each correct answer.

The practice of self-care section has ten questions about diabetic self-management. For a question that is divided into several subtleties, if the participant gives an incorrect answer any of details, the question was considered wrong. Each correct answer is scored “1;” on the other hand, an incorrect answer is scored “0.”

The scores are divided into three levels, namely, low level (<60% of the total points), moderate level (60%–79% of the total points), and high level (≥80% of the total points).[ 16 ]

Data collection

The questionnaire was reviewed by five experts with a doctoral or higher degree in Can Tho University of Medicine and Pharmacy, with an item objective congruence = 1 [ Supplement Table 2 ]. Then, the questionnaire was administered to ten participants in Tam Binh District Health Centre center with Cronbach's alpha = 0.738 [ Supplement Table 3 ]. The questionnaire was sent directly to each patient. The staffs would guide how to answer but they had absolutely no hint of the answer.

Supplement Table 2

The item objective congruence index

IOCI=Item objective congruence index

Supplement Table 3

The reliability and validity of the knowledge, attitude, and practice questionnaire

Statistical analysis

All collected data were coded before they were analyzed by IBM SPSS software version 22, IBM corporation. The descriptive statistics including frequency, mean, and standard deviation were used for evaluating participant characteristics and KAP score. Correlation between variables was assessed using Pearson's correlation coefficients. The relation between knowledge, practice, and attitude sections was analyzed by regression correlation. The significance level for all tests was fixed at α < 0.05.

Besides, age was separated into two groups as Group 1 from 35 to 49 years and Group 2 from 50 to 65 years. In addition, the duration of T2DM was divided into four groups as Group 1 under 10 years, Group 2 from 10 to 20 years, Group 3 from 20 to 30 years, and Group 4 over 30 years. Furthermore, the glycemic levels diverged into three groups such as group 1 under 3.9 mmol/L, Group 2 from 3.9 to 6.4 mmol/L, and Group 3 above 6.4 mmol/L. In addition, the HbA1c levels were divided into three groups as Group 1 below 4%, Group 2 from 4% to 6%, and Group 3 above 6%.

Participant demographic data

All the study patients (102) had an average age of 57.02 ± 6.32 years. The proportion of women accounted for 76.5% (more than three times of men, 23.5%). The ethnicity was Kinh who suffered the most from diabetes, 96.1%; 101 participants (99%) were married and are living with small families for 1–2 generations (73.5%), while 26.5% of the participants are living in large families over three generations. Most of the participants had primary to higher education (94.1%); only 5.9% of them were illiterate. Nearly 76.5% of the patients had jobs, both part time and full time, and the remaining (23.5%) did not work including retirement and unemployment. The majority of participants had a high monthly income of 82.4% (84 participants). The average duration of the diabetics was 4.33 ± 4.56 years, the longest was 22 years, the shortest was 0.5 years. The blood glucose level and HbA1c level of the participants were 9.60 ± 3.77 mmol/L and 7.40 ± 2.46%, respectively [ Table 1 ].

The demographic data and knowledge, attitudes, and practices of the participants

SD=Standard deviation, KAP=Knowledge, attitude, and practice

The participants' knowledge, attitudes, and practices

All patients completed the KAP questionnaire, in which the score was low (50.057 ± 10.644). Specifically, their knowledge score was low (30.04 ± 12.823). In particular, the majority of participants (97 people) had a low knowledge level of 95.1% [ Table 1 ]. Despite this, some knowledge had a quite high patient rate such as: “how many types of diabetes” were 71.6%; “the concept of type 2 diabetes” had 53.9%; “the symptoms of hypoglycemic” occupied 66.7%. However, their attitude score was moderate (61.544 ± 29.99). Among them, those with low attitudes accounted for more than half of the 52% (53 people), followed by those with an average attitude of 25.5% (26 patients), and those with high attitude22.5% (23 participants) [ Table 1 ]. In addition, the practice score was low at 50.59 ± 14.881. In this section, the practice was recorded as an average with 8.8% (14 people), six times lower than patients with a low level of practice of 86.3% (88 people). However, only 5.9% of the people with diabetes practiced high level of practice [ Table 1 ].

Regarding diabetic self-management practice, the highest percentage of patients treated with oral medication constituted 77.5% (77 participants), followed by insulin injections with 6.9% (7 patients) and diet therapy with 5.9% (6 participants); in addition, patients without treatment accounted for 11.8% (12 patients). The majority of patients using one type of drug to treat diabetes each day accounted for 56.9%. Two patients (2%) used six tables of diabetic drug per day. Patients in the study injected the insulin into the abdomen and shoulders [ Table 2 ].

The proportion of the components of practice section

The relation between participants' characteristics and knowledge, attitude, and practice

Table 3 describes the relation between patients' KAP and their characteristics such as age, gender, ethnicity, location, marital status, type of family, education level, employment status, monthly income, diabetic duration, diabetic information, glycemic level, HbA1c status, glycemic checking place, other disease, treatment method, hypoglycemia, smoking history, and drinking history. It showed a significant relationship in diabetic knowledge between Kinh and Khmer ethnic groups, as well as between groups of patients with different diabetic duration ( P = 0.000 and 0.043) [ Table 3 ]. Moreover, the results also described a statistically significant relationship between the patients' attitude to diabetes and different patient groups in terms of location ( P = 0.003) [ Table 3 ], employment status ( P = 0.000), treatment method, hypo-glycemia and diabetic duration. On the other hand, the research results also found a significant association between marital status and diabetic duration with patients' daily disease self-management practices [ Table 3 ].

The relation between patients’ characteristics and knowledge, attitudes, and practices by one-way ANOVA

The relation between knowledge, attitude, and practice

Table 4 shows the difference in knowledge and attitude of Type 2 diabetic patients between the different practice groups. In this relationship, only the difference in the practice of the attitude groups was statistically significant ( P = 0.014). There were also differences in knowledge between practice groups, but this was not statistically significant.

The relation between patients’ knowledge, attitude, and practice

Diabetes is a chronic metabolic disorder with many different complications.[ 5 ] Therefore, in order to control the disease effectively, patients need to have the right KAP about diabetes.[ 9 ] This study assessed diabetic patients' KAP of diabetes management. It also explored the relationship between KAPs of Type 2 diabetic patients.

The study was conducted on individuals aged between 35 and 65 years because at this age diabetes had been seem to be highly prevalent in Vietnam according to the 2002 National Statistical Survey ,[7 ] and it is also an age group of cognitive maturity. The median age of the patients in this study was 57.02 years, which is consistent with the study of Ng et al .[ 1 ] and Le Roux et al .[ 9 ] Like many other studies, this study had a higher proportion of women with Type 2 diabetes than men.[ 3 , 6 , 9 ] However, some studies report that diabetes is more common in men than in women,[ 5 , 17 ] but the difference was not significant.

Furthermore, Salem et al . also reported that the patients in their study were highly educated from high school and above.[ 13 ] Simultaneously, the study of Saengtipbovorn et al . reported that 76.5% of their participants had completed primary school education.[ 2 ] Similarly, this study found that most patients had primary or higher level of education (93%). Nevertheless, a study in Iran by Mohammadi et al . found that nearly 27 illiterate patients, but the majority (41%) of the study participants, were not attending primary school.[ 18 ] The low levels of education were also found in the study by Al-Maskari et al . with 46% illiteracy.[ 19 ]

Most patients had a job, so their income was high. Concurrently, a study by Saengtipbovorn et al . showed that 37.1% of the study participants earned <1500 baht per month.[ 2 ] In addition, a study by Mohammadi et al . found that only 27% of the patients had jobs and their monthly income was <8,000,000 Rials.[ 18 ] The average duration of diabetes in the study by Al-Maskari et al . was 9 years.[ 19 ] Rahaman et al . also showed that the average duration of diabetes was 9.16 ± 6.03 years.[ 20 ] However, patients in the current study had a significantly lower duration of Type 2 diabetes than the previous two studies (4.33 ± 4.56 years). More than half of the patients have received information about diabetes. However, Rahaman et al . reported that only 38.6% of the patients participated in a diabetes-related education program.[ 20 ] About one-quarter (26%) of the patients in the study by Magbanua and Lim-Alba participated in the diabetes education.[ 21 ]

Most patients had at least one other condition related to diabetes (95.1%) such as hypertension, hypercholesterolemia, heart disease, vision problems, neurological problems, poor sexual desire, and kidney problems. These issues were also found in the study by Mohammadi et al . in Iran.[ 18 ] Participants' blood sugar and HbA1c levels were quite high. High levels of HbA1c were also found in the study by Al-Maskari et al .[ 19 ] and Rahaman et al .[ 20 ] Rahaman et al . also showed that blood glucose levels were also high, although participants tested their own blood glucose levels at home and in the hospital.[ 20 ] However, patients in this study did not self-test their blood glucose and HbA1c level; most of them checked it at government hospitals and a few did at private clinics. Moreover, the results of this study showed that patients with poor glycemic control have a relatively high rate of hypoglycemia (59.8%).

Similar to the research by Karaoui et al .,[ 22 ] most patients in the present study have used oral medications to control the disease. In addition, this result was similar to those of Salem et al .,[ 13 ] with high smoking denial rates. Similar results were found in the study of Saengtipbovorn et al . with the rate of never smokers up to 87.1%.[ 2 ] In contrast, Karaoui et al . reported that more than half of the smoking patients participated in the study.[ 22 ] Correspondingly, the alcohol consumption rate in this study was low.

The related of knowledge within people with diabetes

The analysis showed that participants' knowledge of diabetes was still low. This was because patients had not been provided with basic information about Type 2 diabetes. This problem had also been reported by Cao My Phuong et al .[ 23 ] Nhung and Dao showed that knowledge about diabetes treatment and complications of the patients was low.[ 24 ] In addition, a research by Karaoui et al . showed that the knowledge base of diabetes in the research population was still low.[ 22 ] Indeed, Rahaman et al . reported a lack of diabetic knowledge in the research community.[ 20 ] Indeed, the study by Quang et al . also indicated that the number of participants without knowledge about diabetes was quite high.[ 7 ]

Attitude toward diabetes in Vietnamese culture

Al-Maskari et al . concluded that although patients have poor knowledge, a positive attitude was an important issue in the care and practice of diabetes.[ 19 ] Meanwhile, Salem et al . stated that, although most patients have the knowledge of diabetes, it was not at a high level, and their attitude and practice were not satisfactory.[ 13 ] Similarly, this study also showed that participants had an average attitude level toward diabetes.

Practice of self-care management

The participants' diabetes management practices were generally poor. This showed that a medium attitude score is not enough; it requires good knowledge to lead to the right practices to control diabetes. Ng et al . concluded that factors of proper knowledge and attitude led to good disease control practices.[ 1 ] Saadia et al . also confirmed that the participants' knowledge of diabetes in research was good, but their attitude and practice were poor.[ 25 ]

The relation of participants' components and knowledge, attitude, and practice

Our research shows that most of the relationships between participants' characteristics and their KAPs had a negligible difference. However, there were some significant relational characteristics, such as race and blood sugar that differed significantly in knowledge about Type 2 diabetes; marital status and family type were statistically significantly related to the patient's attitude toward the disease. Moreover, gender, marital status, education, and monthly income were significantly related to diabetes control practices. Similarly, Ghannadi et al . also showed that the relationship between sex and marital status with KAP was not statistically significant.[ 17 ] However, Salem et al . reported that there was a significant relationship between KAP scores and different categories such as location, gender, and education.[ 13 ] Moreover, Ng et al . showed a significant inverse correlation between KAP scores and HbA1c.[ 1 ]

The relation of knowledge and attitude with practice

The results of this study showed that the relationship between patient attitude groups and practical components was statistically significant. However, this was not found in the relationship between knowledge and attitude of diabetic patients. This was due to the culture of the Vietnamese people. Indeed, the study of Al-Maskari et al . also found that there was a significant relationship between practice and attitude of patients, but the authors also reported more meaningful results between attitude and knowledge.[ 19 ] Meanwhile, the study by Ghannadi et al . showed that higher knowledge was significantly correlated with higher attitudes and practices.[ 17 ]

Although KAP of self-control in diabetes are important contributions to the good treatment of the disease, patients in the study had low scores for these issues. Despite the average attitude about Type 2 diabetes, limited knowledge about the disease is not sufficient, the lack of which leads to poor practices of care and control. However, the results showed that there was only significant difference between attitude and practice in patients with Type 2 diabetes. Furthermore, the relationship between KAP with patients' characteristics had different significance.

Financial support and sponsorship

This article is a part of my thesis “The development of health-related quality of life programme among type 2 diabetic patients in Tam Binh District, Vinh Long Province, Vietnam,” which is accepted by the ethical committee for the fieldwork of Mahasarakham University; with the certificate of approval number of 071/2019.

Conflicts of interest

There are no conflicts of interest.

Acknowledgments

We would like to thank the participants and the local Government from Tam Binh District, Vinh Long Province, Vietnam, and Dr. Ngo Van Truyen PhD, MD, Dean of Faculty of Medicine; Dr. Le Van Minh PhD, MD, Vice Dean of Faculty of Medicine and Deputy Head of the Department of Interventional Cardiology-Neurology; Dr. Tran Kim Son PhD, MD, Department of Internal Medicine; Dr. Vo Pham Minh Thu PhD, MD, Head of the Personal Department and Dean of Department of General Medicine; Dr. Nguyen Thi Diem PhD, MD, Faculty of Medicine and ethics committee and public health faculty of Mahasarakham University, Thailand, who had made the study possible, and the health commune staffs and the research sampling groups.

Supplement Table 1: Knowledge, Attitude, and Practice Questionnaire

MAHASARAKHAM UNIVERSITY

DIABETIC KNOWLEDGE, ATTITUDE, PRACTICE

Participant Number (Office use): ___________

Date: ___________________

A. PARTICIPANT INFORMATION

• Full name: ______________________________________________________
• Birth year: __________________
• Gender: □ Male □ Female
• Address: _______________________________________________________
• Glycemia: ______________ mmol/L
• HbA 1 C: ________ %

B. DIABETIC KNOWLEDGE

Please circle in the letter that you think is the best.

• Diabetes is a chronic metabolic disorder characterized by hyperglycemia
• Diabetes is a chronic metabolic disorder with a manifestation of hypoglycemia
• Diabetes is a disease spread in the community
• Because the body produces lack or does not produce insulin
• Because the body is resistant to insulin (usually occurs in obese people and >40 years old)
• Occurs in pregnant women (no previous diabetes)
• People who are obese, sedentary, eat a lot of fat, sweet, starch, alcohol, tobacco, family history of diabetes
• Muscular people, exercise regularly, eat well, do not smoke, do not drink alcohol
• Thin people, eat normally, have no family history of diabetes
• Eat a lot, drink a lot, lose weight a lot, urinate a lot
• Eating normally, losing little weight, moderate urination
• Eat less, lose weight, urinate often
• One type: acute complications
• Two types: acute complications and chronic complications
• Three types: acute complication, subacute complication and chronic complication
• Hyperglycemia and foot ulcer
• Insomnia, anxiety and weight loss
• Hypoglycemia and coma due to hyperglycemia, ketoacidosis and lactic infections
• Hypoglycemia and coma
• Cardiovascular complications, decreased vision, kidney failure, impotence, foot ulcers
• Insomnia, anxiety, difficulty breathing
• Routine blood glucose testing, prescription medication, reasonable eating, proper exercise
• There is no need for routine blood glucose testing, no need for food, no medication, and limited movement
• Test whenever you want, just taking the medicine is enough without don't need the well eating and exercise
• High fever, cold shaking
• Uncomfortable, sweating, dizziness
• Abdominal pain, difficulty breathing

C. DIABETIC ATTITUDE

Please circle the answer you choose

1. Do you agree that blood glucose testing for you and your family is necessary?

2. Do you agree that diabetes can be well controlled?

3. Do you agree that blood sugar can be controlled by exercise, sports and medicine?

4. Do you agree with a reasonable diet that can control blood sugar?

5. Do you agree with the need to have regular medical checkups and blood sugar checks?

6. Do you agree that complications of diabetes are a very serious problem?

7. Do you agree that prevention of complications is important in treating diabetes?

8. Do you agree that daily exercise can control diabetes complications?

9. Do you agree about worrying about hypoglycemic complications?

10. Do you agree with taking care of your feet while treating diabetes?

D. DIABETIC PRACTICE

Please answer all the questions below

1. Which method do you treat diabetes with?

 □ Oral medicine. How many tablets per day? ____ tablets. How many times

per day? ____ times

 □ Insulin injection. How many times of injection? ____________ times.

Injection site? ___________________

2. Do you have regular blood sugar tests? ___ yes ___ no

Where do you check? ______________________ How often? ____________

3. Do you have an HbA1C test? _____ has _____ no

Where do you check? ______________________ How often? _________

4. Do you exercise regularly? ______ yes _______ no

How long is a day? ___________ How many days per week? ____________

Which method do you exercise? ___________________________________

Do you know exercise can lower blood sugar? ___ yes ___ no

5. How many meals do you eat a day? _______________________________

Should you skip meals? ______ yes _______ no

6. What kind of foods do you need to limit or reduce?

______________________________________________________________

7. Do you smoke cigarettes? _______ has ________ no

How many cigarettes per day? _________________ cigarettes

How long have you smoked? __________________________

8. Do you drink alcohol? ________ yes ________ no

If yes, what is the level of drinking? _______________________________

9. Have you ever had hypoglycemia? _____ has _______ not yet

If so, how did you handle it? __________________________________

10. How do you take care of your feet?

THANK YOU FOR YOUR ANSWERS!

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Latest List of Best Diabetes Dissertation Topics

Published by Owen Ingram at January 2nd, 2023 , Revised On May 16, 2024

The prevalence of diabetes among the world’s population has been increasing steadily over the last few decades, thanks to the growing consumption of fast food and an increasingly comfortable lifestyle. With the field of diabetes evolving rapidly, it is essential to base your dissertation on a trending diabetes dissertation topic that fills a gap in research. 

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List of Diabetes Dissertation Topics

• Why do people recently diagnosed with diabetes have such difficulty accepting reality and controlling their health?
• What are the reactions of children who have recently been diagnosed with diabetes? What can be done to improve their grasp of how to treat the disease?
• In long-term research, people getting intensive therapy for the condition had a worse quality of life. What role should health professionals have in mitigating this effect?
• Why do so many individuals experience severe depression the months after their diagnosis despite displaying no other signs of deteriorating health?
• Discuss some of the advantages of a low-carbohydrate, high-fat diet for people with diabetes
• Discuss the notion of diabetes in paediatrics and why it is necessary to do this research regularly.
• Explain the current threat and difficulty of childhood obesity and diabetes, stressing some areas where parents are failing in their position as guardians to avoid the situation
• Explain some of the difficulties that persons with diabetes have, particularly when obtaining the necessary information and medical treatment
• Explain some of the most frequent problems that people with diabetes face, as well as how they affect the prevalence of the disease. Put out steps that can be implemented to help the problem.
• Discuss the diabetes problem among Asian American teens
• Even though it is a worldwide disease, particular ethnic groups are more likely to be diagnosed as a function of nutrition and culture. What can be done to improve their health literacy?
• Explain how self-management may be beneficial in coping with diabetes, particularly for people unable to get prompt treatment for their illness
• Discuss the possibility of better management for those with diabetes who are hospitalised
• What current therapies have had the most influence on reducing the number of short-term problems in patients’ bodies?
• How have various types of steroids altered the way the body responds in people with hypoglycemia more frequently than usual?
• What effects do type 1, and type 2 diabetes have on the kidneys? How do the most widely used monitoring approaches influence this?
• Is it true that people from specific ethnic groups are more likely to acquire heart disease or eye illness due to their diabetes diagnosis?
• How has the new a1c test helped to reduce the detrimental consequences of diabetes on the body by detecting the condition early?
• Explain the difficulty of uncontrolled diabetes and how it can eventually harm the kidneys and the heart
• Discuss how the diabetic genetic strain may be handed down from generation to generation
• What difficulties do diabetic people have while attempting to check their glucose levels and keep a balanced food plan?
• How have some individuals with type 1 or type 2 diabetes managed to live better lives than others with the disease?
• Is it true that eating too much sugar causes diabetes, cavities, acne, hyperactivity, and weight gain?
• What effect does insulin treatment have on type 2 diabetes?
• How does diabetes contribute to depression?
• What impact does snap participation have on diabetes rates?
• Why has the number of persons who perform blood glucose self-tests decreased? Could other variables, such as social or environmental, have contributed to this decrease?
• Why do patients in the United States struggle to obtain the treatment they require to monitor and maintain appropriate glucose levels? Is this due to increased healthcare costs?
• Nutrition is critical to a healthy lifestyle, yet many diabetic patients are unaware of what they should consume. Discuss
• Why have injuries and diabetes been designated as national health priorities?
• What factors contribute to the growing prevalence of type II diabetes in adolescents?
• Does socioeconomic status influence the prevalence of diabetes?
• Alzheimer’s disease and type 2 diabetes: a critical assessment of the shared pathological traits
• What are the effects and consequences of diabetes on peripheral blood vessels?
• What is the link between genetic predisposition, obesity, and type 2 diabetes development?
• Diabetes modifies the activation and repression of pro- and anti-inflammatory signalling pathways in the vascular system.
• Understanding autoimmune diabetes through the tri-molecular complex prism
• Does economic status influence the regional variation of diabetes caused by malnutrition?
• What evidence is there for using traditional Chinese medicine and natural products to treat depression in people who also have diabetes?
• Why was the qualitative method used to evaluate diabetes programs?
• Investigate the most common symptoms of undiagnosed diabetes
• How can artificial intelligence help diabetes patients?
• What effect does the palaeolithic diet have on type 2 diabetes?
• What are the most common causes of diabetes and what are the treatments?
• What causes diabetes mellitus, and how does it affect the United Kingdom?
• The impact of sociodemographic factors on the development of type II diabetes
• An examination of the link between gut microbiome and diabetes risk
• The effectiveness of lifestyle interventions in preventing type II diabetes
• The role of maternal diabetes in offspring’s risk of developing diabetes
• Artificial intelligence in diabetes diagnosis and management
• Continuous glucose monitoring
• Telehealth interventions for improving diabetes self-management
• The role of wearable technology in diabetes management
• Personalised medicine approaches for diabetes treatment
• The impact of diabetes on mental health and well-being
• The link between diabetes and cognitive decline
• The potential of stem cell therapy for diabetes treatment
• Advances in closed-loop insulin delivery systems
• The use of glucagon-like peptide-1 (GLP-1) receptor agonists in diabetes treatment
• Investigating the efficacy of new oral medications for type II diabetes
• The role of bariatric surgery in the management of type II diabetes
• Improving patient adherence to diabetes treatment regimens
• The role of social support in diabetes management
• Developing culturally sensitive diabetes education programs
• The role of dietary patterns in diabetes prevention and management
• Low-carbohydrate vs. Mediterranean diet for diabetes: A comparative study
• The use of artificial sweeteners in diabetes management: Benefits and risks
• The impact of the gut microbiome on dietary interventions for diabetes
• The role of exercise in improving glycemic control
• Developing effective exercise programs for individuals with diabetes
• The impact of physical activity on diabetic complications
• Promoting physical activity adherence in people with diabetes
• The use of exercise gamification to increase physical activity in diabetes
• The potential of CRISPR gene editing for diabetes treatment
• The role of the microbiome in the development and treatment of diabetes
• An analysis of the artificial Pancreas systems
• The use of big data analytics in diabetes research
• The impact of environmental factors on diabetes risk
• Cost-effectiveness of different diabetes treatment strategies
• Developing effective diabetes prevention programs for communities
• The role of government policies in addressing the diabetes epidemic
• Improving access to diabetes care in underserved populations
• The impact of social determinants of health on diabetes risk
• Management of diabetes in children and adolescents
• The unique challenges of diabetes management in older adults
• Diabetes in ethnic minorities: Disparities in prevalence and care
• The impact of diabetes on LGBTQ+ populations

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• Published: 09 May 2024

Prevalence and factors associated with diabetes-related distress in type 2 diabetes patients: a study in Hong Kong primary care setting

• Man Ho Wong 1 ,
• Sin Man Kwan 1 ,
• Man Chi Dao 1 ,
• Sau Nga Fu 1 &
• Wan Luk 1  

Scientific Reports volume  14 , Article number:  10688 ( 2024 ) Cite this article

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• Endocrine system and metabolic diseases

Diabetes-related distress (DRD) refers to the psychological distress specific to living with diabetes. DRD can lead to negative clinical consequences such as poor self-management. By knowing the local prevalence and severity of DRD, primary care teams can improve the DRD evaluation in our daily practice. This was a cross-sectional study conducted in 3 General Out-patient Clinics (GOPCs) from 1 December 2021 to 31 May 2022. A random sample of adult Chinese subjects with T2DM, who regularly followed up in the selected clinic in the past 12 months, were included. DRD was measured by the validated 15-item Chinese version of the Diabetes Distress Scale (CDDS-15). An overall mean score ≥ 2.0 was considered clinically significant. The association of DRD with selected clinical and personal factors was investigated. The study recruited 362 subjects (mean age 64.2 years old, S.D. 9.5) with a variable duration of living with T2DM (median duration 7.0 years, IQR 10.0). The response rate was 90.6%. The median HbA1c was 6.9% (IQR 0.9). More than half (59.4%) of the subjects reported a clinically significant DRD. Younger subjects were more likely to have DRD (odds ratio of 0.965, 95% CI 0.937–0.994, p  = 0.017). Patients with T2DM in GOPCs commonly experience clinically significant DRD, particularly in the younger age group. The primary care clinicians could consider integrating the evaluation of DRD as a part of comprehensive diabetes care.

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Introduction.

It is estimated that the prevalence of type 2 diabetes mellitus (T2DM) in adults in Hong Kong (HK) is approximately 10% of the population 1 . The Hospital Authority of Hong Kong provides public healthcare services to around 400,000 diabetic patients, with the General Out-patient Clinics (GOPCs) offering primary care to over 60% of these individuals 2 . People living with T2DM are affected by this chronic and progressive condition not only physically, but also emotionally. Diabetes-related distress (DRD) refers to the psychological distress specific to living with diabetes. It includes a wide range of emotions, such as feeling overwhelmed by the demands of self-management and restrictions. People with T2DM have to control diet, regularly do exercise and take medications 3 . Many of them may have fears of existing or future diabetes complications, concerns about hypoglycaemia and frustration with care providers 4 .

DRD involves emotional symptoms that may overlap with some psychological conditions, such as depression. However, a previous literature has demonstrated that DRD and depression are different constructs that need different assessment and management approaches 5 . Compared to depression, DRD is peculiar to the emotional distress caused by relentless self-management of diabetes and it does not imply underlying psychopathology. Also, DRD is more closely associated with diabetes-related behavioural and biomedical outcomes than depression. Particularly, it has been shown that DRD influences glycaemic control whereas the impact of depression appears to be equivocal 5 , 6 , 7 . Compared to depression, DRD is highly responsive to clinical intervention 4 . A systemic review has shown that interventions delivered by primary care clinicians, psychoeducation and motivational interviewing resulted in significant DRD reduction 8 .

DRD is prevalent among patients with T2DM, in which a meta-analysis demonstrated the overall prevalence of DRD was 36% 2 . Also, studies in China found that 42.5–77.2% of Chinese people with T2DM experienced DRD 9 , 10 , 11 , 12 . The occurrence of DRD may be influenced by age, gender, culture, type of diabetes, use of insulin, number of complications and duration of diabetes 13 . DRD can lead to negative clinical consequences as studies have shown that a high level of DRD was associated with poor self-management, suboptimal glycaemic control and poor quality of life 14 , 15 , 16 , 17 . The American Diabetes Association recommended that DRD should be routinely monitored, particularly when treatment targets are not met and/or at the onset of diabetes complications 18 . However, DRD is not assessed or recognized in most of the primary care practices in Hong Kong. Since the local prevalence and severity of DRD remain unknown, it is difficult to determine whether DRD assessment should be routinely included in local DM care.

The primary objective of this study was to study the proportion of clinically significant DRD among patients with T2DM in GOPCs in HK. The secondary objective was to identify the associated factors of DRD.

There are 2 hypotheses in this study. (1) The proportion of clinically significant DRD among patients with T2DM in GOPC in HK is common, which is at least 36%, according to existing literature. (2) There is a significant association of DRD with demographic and clinical parameters.

Methodology

Study design.

This was a cross-sectional and prospective study conducted in three GOPCs in HK from 1 December 2021 to 31 May 2022. The three GOPCs include South Kwai Chung Jockey Club GOPC, Ha Kwai Chung GOPC and Cheung Sha Wan Jockey Club GOPC. The inclusion criteria were all adult Chinese patients, who had known diagnosis of T2DM and had at least two regular follow-ups for T2DM in the selected clinic in the past 12 months.

The exclusion criteria were patients diagnosed with type 1 diabetes, patients who had active follow-up of T2DM or were prescribed DM medications in Medicine Department specialist out-patient clinic, patients with known psychiatric illnesses who had active follow-up in either Psychiatry specialists or mental health services, patients who did not have diabetes related blood tests in the past 12 months from the study period, pregnant women, patients who did not understand written Chinese and mentally incapacitated persons.

A list of patients assigned with the International Classification of Primary Care (ICPC) code T90 (Diabetes; non-insulin-dependent) in the selected clinic was drawn from the Hospital Authority’s Clinical Data Analysis and Reporting System (CDARS) 2 weeks prior to the scheduled follow-up appointment with a corresponding appointment number. Up to 5 patients were selected from the list using random number table each day during the study period. A reminder was set in the computer system to identify those selected patients. The patients were invited and asked for consent to participate the study by the attending doctors. Information sheets about the study were given. Patients would complete the questionnaire individually and return it to the healthcare assistant in the clinic. Patients who refused to participate or give consent in this study were regarded as non-responders. Patients who had incomplete questionnaires or missing data were excluded from the statistical analysis. This study follows the principles of Declaration of Helsinki.

Sample size

The sample size was calculated by using the sample size formula:

where the desired precision was taken to be within 5% at 95% confidence interval.

Z = value from standard normal distribution corresponding to desired confidence level (Z = 1.96 for 95% CI)

P is expected true proportion

e is desired precision (margin of error).

The expected proportion in the study population was set to be 36% based on the overall prevalence in the previous meta-analysis study 2 .

Assuming the response rate was 90%, the sample size was estimated to be 355/0.9 = 395 patients, which would round up to 400 patients. Thus, we would aim at recruiting at least 400 patients.

Measurement

Diabetes Distress Scale (DDS) is one of the most commonly used and validated self-report measures to evaluate DRD internationally. The DDS is specific to patients with T2DM and provides a more comprehensive assessment to overcome the psychometric limitations of other measures such as Problems Areas in Diabetes (PAID) scale 2 . Another strength is that DDS also allows healthcare providers to identify the key sources of DRD 4 . The Chinese version of the Diabetes Distress Scale (CDDS-15) was validated in Hong Kong with consistent factor structure and good internal reliability (Cronbach’s alpha 0.902), which is specific for clinical use in Hong Kong Chinese type 2 diabetic patients 19 . There are 3 categories of CDDS-15, consisting of emotional burden (6 items), regimen- and social support- related distress (6 items), and physician-related distress (3 items) 19 . Each item was rated by patients using a 6-point Likert scale from 1 for “not a problem” to 6 for “a very serious problem.” The total mean item score was determined by adding the responses for all items and dividing by 15. Each subscale mean score was calculated by summing item responses in that subscale and dividing by the corresponding number of items. As reported by the study “When is diabetes distress clinically meaningful?: establishing cut points for the Diabetes Distress Scale”, an overall mean score ≥ 2.0 is considered clinically significant 17 . DRD was regarded as a dichotomous variable in this study, with subjects considered to have clinically significant DRD if CDDS-15 mean score ≥ 2.0.

We collected the data by using a printout questionnaire, consisting of three components: (1) The score of the CDDS-15; (2) demographic characteristics such as age, gender, education level, employment status, need of financial assistance to support basic living with Comprehensive Social Security Assistance (CSSA), living arrangement, and smoking status; (3) clinical parameters were obtained by reviewing participants’ medical records, including duration of T2DM, number of oral hypoglycaemic agent, use of insulin, latest Haemoglobin A1c (HbA1c) level, body mass index (BMI), diabetes complications and frequency of hypoglycaemic episodes in the past month. (see Appendix).

The primary outcome was the proportion of DRD among patients with T2DM in the selected study centres. The secondary outcome was the associated factors of DRD including demographic characteristics and clinical parameters as mentioned above.

Statistical analysis

The collected data was analyzed using the IBM Statistical Product and Service Solutions (SPSS) version 25 software. Qualitative variables were presented as frequencies and percentages. Quantitative variables were described as mean and standard deviation (SD), or median and interquartile range (IQR), as appropriate.

Pearson’s Chi-squared test was performed to compare the qualitative variables between participants without clinically significant DRD (DDS < 2) and participants with clinically significant DRD (DDS ≥ 2). Student’s t- test and Mann–Whitney U test was applied for quantitative variables with normal and non-normal distribution, respectively. When variables showed a p -value < 0.2 in the univariate analysis, they would be incorporated into the multivariate analysis. It was done to assure that all potentially associated variables were studied. Logistic regression analysis was used to adjust the confounding effect between variables and to identify the associated factors of DRD in those participants. Findings were considered statistically significant when the p -value < 0.05.

Ethics approval and consent to participate

Informed consent in written form was obtained from all patients. The study was approved by the Hospital Authority Kowloon West Cluster Research Ethics Committee (KWC REC Reference: KW/EX-21-121(162-06)). The CDDS-15 questionnaire was granted permission for use in this study by American Diabetes Association (Permission Request Number: KL072021-MHW). This study follows the principles of Declaration of Helsinki.

Patients’ demographic and clinical characteristics

We distributed 408 questionnaires, thirty-eight patients refused to participate in the study and the response rate was 90.6%. Eight questionnaires were found to have incomplete data and were discarded. Therefore, the total number of questionnaires included in the statistical analysis was 362.

Among the 362 participants, the mean age was 64.2 years old (SD 9.5) and male to female ratio was approximately 1:1. Fewer than 8% of participants (n = 27) had attained tertiary education. Approximately 40% of the participants (n = 146) were retired. The median HbA1c was 6.9% (IQR 0.9). The median duration of living with T2DM since diagnosis was 7.0 years (IQR 10.0). The mean BMI was 26.0 (SD 3.9). For the regimen type, approximately 90% of the participants (n = 324) were taking oral hypoglycaemic agents with or without insulin. The participants’ demographic and clinical characteristics were presented in Table 1 .

Proportion of DRD

A total of 59.4% of the study participants were found to have clinically significant DRD according to the total mean item score (DDS ≥ 2). Among the 3 subscales of DRD, emotional burden was observed in 64.9% of participants, followed by regimen- and social support-related distress (64.1%). Physician-related distress (33.7%) was relatively less affected. This is illustrated in Fig.  1 .

The proportion of clinically significant DRD among patients with T2DM in different subscales (n = 362).

Factors associated with DRD

In the univariate analysis, age and employment status were found to be significantly associated with DRD (unadjusted p  < 0.05). These factors, together with other variables with unadjusted p  < 0.2 including BMI, HbA1c level and regimen type, were further analyzed in the multivariate logistic regression, as shown in Table 2 . Only age was significantly associated with the occurrence of DRD among patients with T2DM, in which the adjusted odds ratio was 0.965 (95% CI 0.937–0.994, adjusted p  = 0.017).

In our study, 59.4% of patients with T2DM in the GOPC setting in HK suffered from clinically significant DRD. It is comparable to the studies in China with a reported prevalence 42.5–77.2% 9 , 10 , 11 , 12 . However, it is much higher than the overall prevalence 36% in the meta-analysis, in which the majority of the studies involved were from Western countries 2 . In Asia, the prevalence of DRD was reported to be 32%, 49%, and 53% in Singapore, Malaysia, and India, respectively 20 , 21 , 22 . The prevalence varies substantially across countries. This could be explained by the difference in the healthcare system, demographics, and cultural background.

Among the 3 subscales of DRD, the proportion of physician-related distress was the lowest in this study, which is similar to the findings in other studies 17 , 23 . Participants might not attribute their distress to physicians if they could obtain sufficient expertise and direction from physicians regarding their T2DM management. Nonetheless, healthcare professionals should pay more attention to the emotional side of diabetes care as more than 60% of subjects in this study had clinically significant emotional burden and regimen- and social support-related distress.

Our study showed that older age was associated with lower odds of DRD (OR 0.965). This is consistent with the results of other studies 24 , 25 , 26 . One study showed that the relation of DRD to psychological and behavioral outcomes is attenuated in older adults, regardless of the duration of T2DM 27 . One hypothesis is that older adults react less to stress because their previous experiences in coping with stress have led to better emotion regulation strategies 28 . On the other hand, younger patients usually have more responsibilities at work and family such as supporting their children and elderly family members 26 . These stressors can worsen the burden associated with the self-management of T2DM.

The HbA1c level was not significantly associated with DRD in our study. This is in line with the results of various international studies 2 , 16 , 23 . In contrast, a study conducted in a specialist clinic in HK using the CDDS-15 questionnaire showed that DRD had a positive relationship with HbA1c level 29 . The disparity may be explained by the difference in the healthcare setting and patients’ demographics. Also, only a minority of patients (7.5%) were prescribed insulin in the GOPC setting in our study, whereas 48% of the subjects were prescribed insulin in the specialist clinic in that study. In fact, there is mixed evidence in the literature regarding the relationship between glycaemic control and DRD 4 . Although DRD is modestly associated with poor glycaemic control, patients with good glycaemic control can also experience high DRD 4 , 16 . Achieving the HbA1c target may require intensive efforts that are potentially impacting other areas of their life such as social activities. This implies patients with T2DM may have an ongoing fear of disease complications or encounter challenges of self-management regardless of their latest glycaemic control.

The strengths of this study were that it was a multi-center study and there was a relatively high response rate. Measures such as invitations by healthcare providers could help reduce the number of non-responders. Moreover, it was one of the pioneer studies regarding DRD in the primary care setting in HK.

However, there are several limitations of this study. First, the use of a self-reported instrument in this study was influenced by social desirability bias. Physician-related distress might be underestimated in this study as patients might worry about negative effects on their treatment process if they declare a lack of confidence in the physician’s expertise in their diabetes management 30 . Second, the causality of the relationships could not be determined due to the study’s cross-sectional design. Further longitudinal studies are suggested to delineate causal relationships. Third, this study was conducted in three GOPCs only and there could be selection bias, therefore the study findings cannot be generalized to all patients with T2DM in HK. Fourth, it is important to acknowledge the restricted scope of this study on assessing other comorbidities such as hypertension and hyperlipidaemia. This study focused primarily on the clinical conditions directly associated with diabetes, including macrovascular and microvascular complications. Future studies could consider incorporating a boarder range of comorbidities to gain a more comprehensive understanding of the impact of diabetes-related distress. Lastly, as the study period coincided with the fifth wave of COVID-19 in HK, it could be a particularly stressful time for patients with T2DM to comply with their diet plan and exercise routine.

There are some clinical implications drawn from this study. Family physicians are on the frontlines responsible for the diagnosis and management of patients with T2DM and this study showed that a high proportion of patients with T2DM experience psychological distress. This finding alerts family physicians about the importance of a holistic approach in T2DM management. Regular evaluation of DRD by a self-reported instrument could be considered to incorporate with the annual assessment of T2DM in the GOPC setting. DRD does not typically disappear when left unaddressed, but DRD interventions do not require the expertise of a mental health professional 4 . In most cases, interventions offered by family physicians including motivational interviewing can help relieve DRD and thus improve the self-management of T2DM 4 , 8 . A practical guide on addressing DRD in clinical care is also available 4 . Further research on monitoring and addressing DRD in primary care in HK is warranted.

The psychological component of diabetes is not routinely assessed in most of the primary care practices in HK. This study demonstrated that a high proportion of patients with T2DM in GOPCs experience clinically significant DRD. Younger age was identified as an associated factor. Evaluation of DRD is suggested to integrate as a part of comprehensive diabetes care in the primary care setting.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

I would like to thank American Diabetes Association for granting us permission to use the CDDS-15 questionnaire in our study. In addition, I would like to thank all the doctors, nurses and staff for supporting this study.

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Man Ho Wong, Sin Man Kwan, Man Chi Dao, Sau Nga Fu & Wan Luk

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Wong, M.H., Kwan, S.M., Dao, M.C. et al. Prevalence and factors associated with diabetes-related distress in type 2 diabetes patients: a study in Hong Kong primary care setting. Sci Rep 14 , 10688 (2024). https://doi.org/10.1038/s41598-024-61538-w

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ORIGINAL RESEARCH article

Enhancing diabetes therapy adherence: a comprehensive study on glucometer usability for type 2 diabetes patients.

• 1 Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
• 2 Personalive srl, Milan, Italy
• 3 Unità Operativa Semplice Diabetologia - Distretto Del Perugino - Usl Umbria 1, Perugia, Italy
• 4 Struttura Semplice Dipartimentale di Diabetologia e Malattie Metaboliche, Azienda Sanitaria Locale (ASL) TO4, Ospedale Civico di Chivasso, Chivasso, Italy
• 5 Struttura complessa Diabetologia, Ospedale Cesare Zonchello, Nuoro, Italy
• 6 Servizio Territoriale di Diabetologia Polo Sanitario Reggio Calabria Sud, Reggio Calabria, Italy

Background: Self-monitoring of blood glucose (SMBG) is a vital practice for type 2 diabetes (T2DM), and glucometers have the potential to improve therapy adherence. However, characteristics of glucometers improving their usability are underexplored. A knowledge gap exists regarding patients under 65, warranting further research for diabetes care improvement. Thus, this study aims to gather insights on glucometer accessibility, by analyzing the case of the Accu-Chek ® Instant glucometer by Roche Diabetes Care GmbH.

Methods: Starting from a previous study having the objective of investigating devices’ features able to improve SMBG in over 65 T2DM patients, using the same device, we enlarged the scale, designing a survey that collected answers from 1145 patients of the Center and South of Italy, both under and over 65. 957 answers were analyzed, according to a threshold of 50% completion of the answers.

Results: Our results show the major characteristics presented in Accu-Chek ® Instant are appreciated differently between patients under 65 and over 65, and between patients with or without previous experience with a glucometer.

Discussions and conclusions: It emerged how Accu-Chek ® was perceived as more user-friendly among individuals under 65 compared to those aged 65 and over, where more people had prior experience, indicating how such a glucometer can be particularly helpful for naive patients. The study provides valuable insights to the academic discourse on glucometer features and their influence on therapy adherence.

Introduction

A significant number of individuals with diabetes fail to attain their treatment objectives ( 1 ) primarily because they encounter obstacles in performing effective self-care. The practice of self-monitoring of blood glucose (SMBG) plays a pivotal role in safeguarding physical and mental well-being, especially for individuals suffering from type 2 diabetes mellitus (T2DM) ( 2 ). The appropriate use of glucometers can significantly enhance treatment adherence among T2DM patients, related clinical outcomes as well as quality of life ( 3 ).

While literature is proliferating about novel mHealth solutions for diabetes management and their design ( 4 ), the characteristics of glucometers improving their usability are barely investigated. Nevertheless, a substantial segment of T2DM patients contend with adverse perceptions pertaining to the management of their status ( 5 ).

A previous study investigated the physical and cognitive issues that over 65 years T2DM patients undergo when using glucometers for SMBG ( 6 ). From existing literature, it is evident that the primary physical issues patients face with healthcare devices include visual impairment and reduced tactile sensitivity ( 7 , 8 ). As a result, devices or screens should not be too small ( 9 , 10 ), and buttons should be metallic and it should be easy to understand if patients press them or not ( 10 – 12 ). Cognitive challenges such as memory deficits and decision-making difficulties can arise ( 13 ). To address them, devices should incorporate auditory or tactile features and enhance user-friendliness ( 14 – 16 ).

Two primary issues arise in self-monitoring of blood glucose (SMBG) practice: difficulty interpreting blood glucose (BG) results ( 17 ) and consequent lack of awareness regarding necessary actions, leading to reduced therapy adherence ( 18 ). The Target Range Indicator (TRI), utilizing a color spectrum, offers a solution by aiding in understanding and responding to BG results ( 17 ). Numerous studies have shown that the Color Range Indicator (CRI) improves diabetes management ( 18 – 22 ).

In the study mentioned before ( 6 ), authors investigated characteristics of devices supporting SMBG in patients over 65, interviewing 30 T2DM early adopters using the Accu-Chek ® Instant glucometer. This device features a backlit display, automatic strip ejector, wide dosing area, and CRI. Results showed enhanced user-friendliness with the backlit display and wide dosing area, while automatic strip ejection was deemed more hygienic. However, only half of the patients utilized and appreciated the CRI, with some unaware of its existence. Half found learning to use the glucometer easy, but some suggested healthcare personnel training. The pricking pen posed challenges due to toughened skin in elderly users. Attitudes toward BG results saved in the glucometer app varied based on technological literacy.

A recent RWE study investigated the degree of glycemic control by patients who used a blood glucose monitoring device linked to a mobile app through a Bluetooth connection. As a result, they denoted an improvement in glycemic monitoring thanks to the engagement with the app ( 23 ).

While that study focused only on patients aged 65 years and over, it is important to study also the opinions of patients aged under 65.

Indeed, extant literature has partially explored the results obtained from different age clusters. Patients from 16 years old were included in two studies ( 17 , 18 ), patients from 30 to 70 years old were included in one study ( 19 ), patients aged more than 12 years old were considered in another study ( 21 ) and patients from 18 to 70 years old were involved in further research ( 22 ). However, there is still a lack of systematic assessment of the performance of the characteristics among those clusters, as well as scant evidence about how such characteristics are appreciated by different characteristics of the patients. Enhanced comprehension of the obstacles, requirements, and choices of people with T2DM is expected to enhance the development, execution, practical efficacy, and long-term adoption of such devices and consequently enhance clinical outcomes. Therefore, our aim is to conduct a survey to gather insights from patients with Type 2 Diabetes Mellitus (T2DM) regarding their experiences in managing glucose levels and the challenges they face in accessing, selecting, understanding, and optimally using diabetes technologies. We specifically focus on assessing the performance of the glucometer across various patient demographics. Starting from the explorative research conducted on over 65 patients ( 6 ), in this research we wanted to include also under 65 early-adopter patients, to evaluate the accessibility of the device. Our goal is to provide new insights into the accessibility of the device, particularly among patients who have encountered difficulties with previous devices and those who are new to using a glucometer. By validating these initial findings on a larger scale, we aim to enhance their reliability and applicability. Throughout this research, the Accu-Chek ® Instant glucometer produced by Roche Diabetes Care GmbH has been consistently utilized for data collection and analysis.

Materials and methods

In order to examine the varying perceptions of glucometer features among diverse patient groups, the Accu-Chek ® Instant glucometer serves as an illustrative case study. This study further investigates the preliminary results of the usability of the glucometer Accu-Chek ® Instant, with a specific reference to the role of the above-mentioned characteristics. For this purpose, data about the experience with the device were widely collected from early adopters. Accordingly, a questionnaire was developed and submitted to 1145 patients in the Center-South of Italy. These patients have been identified thanks to the support of nurses in some hospitals. Patients with T2DM were provided with glucometers, and after one month, these patients were contacted by a third-party interviewer to schedule and carry out the interview. The interview was carried out through a phone call, so patients could answer properly to all the questions, being helped by the interviewer in providing relevant and appropriate answers. Eventually, all the data collected were cleaned and coded with ex-ante labels, so they could be analyzed and recurrency figures could be computed.

Participants

Through the survey, 1145 answers were collected. Among the respondents, 957 answers were included in the analysis, as a threshold of 50% was set for the completion of the answers to be included. Participants were eligible if they were adults (aged ≥18 years) with T2CM, presently living in Italy, with current or prior experience with a glucometer device. Among all the collected answers, 749 (79%) people had prior experience and therefore their answers were analyzed.

The majority of the sample (55%) is represented by over 65 people, followed by people aged between 55-64 for 34%, while the remaining part of the sample is aged 45-54 (9%), 35-44 (2%), 25-34 (1%). The sample is well-balanced in terms of gender, as 56% of the respondents are male while females stand for 44%. Additionally, respondents come from regions in the Center and South of Italy. The data collection was geographically limited due to the fact that these regions have the highest concentration of early adopters. In Table 1 the sample characteristics are summarized.

Table 1 Sample characteristics in terms of age, gender and origin.

Survey content and design

The survey was divided into two parts: the first gathered socio-demographic and personal information about the patients, while the second focused on gathering insights into the most relevant themes regarding the technology used. The questions of the second part of the questionnaire was validated by a team of physicians. The initial part of the survey collected demographic and personal information such as age, gender, and location. Additionally, respondents were queried about their diagnosis, including diabetes type, treatment regimen, frequency of glycemic level measurement, and the presence of a caregiver, along with the caregiver’s identity. If a caregiver was assisting the patient in self-monitoring of blood glucose (SMBG), subsequent questions about glucometers were directed towards the caregiver, as they were considered the primary users of the device and could provide more pertinent insights into its actual usage. As a result, 94 interviews (10%) were conducted with caregivers.

Questions regarding the usability of glucometers focused on investigating their most common features. Respondents were asked about both the major problems and pain points, as well as strengths, related to their usage of previous glucometers. These questions allowed respondents to choose from options derived from the literature, including pricking fingers, the dosing area of the strip, reading or interpreting results, drawing blood, or reporting other pain points. Furthermore, respondents were asked if they experienced difficulty in handling the previous device overall, and if so, they were prompted to report the major limitations.

Subsequently, respondents were asked about their experience with Accu-Chek ® Instant. In this section, there was a higher focus on the diverse characteristics of the device and how those could influence its usability. First, they were asked if they could easily read results in terms of the size of both the display and the font. Subsequently, the arrow and colored scale were tested for their support in reading and interpreting more easily results and thus how they affect patients’ corrective behaviour. Two questions were related to the difficulties related to drawing blood and the impact of the wide dosing area and of the strip ejector on this action. Additionally, respondents were asked if they found Accu-Chek ® Instant easy to use with respect to prior glucometers. Respondents were eventually asked to pick the characteristics they like most about Accu-Chek ® Instant also considering those which have been majorly studied in past literature ( 17 – 23 ).

Data analysis

Upon completion of the survey, the data underwent meticulous recording in a dedicated database. Prior to commencing the analysis, a rigorous data-cleaning process was conducted. Various analytical approaches were employed, including descriptive statistics such as frequency, percentage, and, where applicable, means, to compute all survey variables, particularly to elucidate the most common responses. Furthermore, an analysis was conducted to discern differences in responses between interviews conducted with patients and those with caregivers.

Subsequently, respondents were categorized into two clusters based on age, with one cluster comprising individuals under 65 and the other comprising those aged 65 and over. These analyses yielded pertinent insights into how diverse characteristics exhibited partially divergent results across the two age clusters, indicating varying roles in enhancing disease management based on patients’ age.

In the third phase of the analysis, attention was directed towards individuals who reported encountering difficulties with previous devices, with a comparative analysis of their responses concerning Accu-Chek ® Instant. The objective of this phase was to ascertain whether and to what extent the novel characteristics of the glucometer could alleviate some of the challenges patients encounter in executing SMBG.

The final phase of the analysis delved deeper into the differences in preferences between patients with prior experience and those utilizing a glucometer for the first time. This phase aimed to discern whether and how certain characteristics are beneficial for naïve adopters. The ensuing results of these analyses are delineated below.

In this section, the primary findings of the data analysis are presented. The first paragraph provides an overview of the descriptive analysis conducted. Subsequently, the second paragraph delves into the disparities observed between individuals aged under 65 and those aged 65 and above. The third paragraph entails an examination of patient experiences pertaining to previous devices encountered. Lastly, the fourth paragraph elucidates the contrasting responses between experienced and inexperienced patients. Additionally, we explored potential distinctions between responses provided directly by users and those communicated by caregivers on behalf of users. Nonetheless, no statistically significant differences were identified in this comparison.

Descriptive analysis

The descriptive analysis encompasses both the analysis of the characteristics of the sample and of the experience with Accu-Chek ® Instant and previous glucometers.

For what concerns the sample description, most of the respondents have been diagnosed with T2DM for more than 5 years, while the remaining part of the sample has a diagnosis time between 1 and 5 years and less than one year. Check-up visits are planned by 89% of respondents once or twice per year while 10% plan examinations more than three times per year and only 1% check-up visits are scheduled with a frequency lower than once per year. Patients measure their glycemic level mostly once or twice a day, at least once a week or more than three times a day, while only around 2% measure only once a month. The vast majority is self-sufficient, and the remaining part is mostly helped by the son or daughter, the husband or wife or other relatives or caregivers. The pharmaceutical treatment was investigated too. Among the respondents to this question (86% of the sample answered), 80% are treated through oral and noninsulin injectable drugs, 22% are insulin-treated, 1% are based on oral secretagogues and 1% through lifestyle modification. In Table 2 , the detailed percentages regarding disease management are reported.

Table 2 Disease Management approaches.

We conducted an analysis of the prevalent characteristics among various glucometers, specifically focusing on how previous glucometers performed. Furthermore, we scrutinized participants’ opinions regarding previous glucometers and their experiences with the Accu-Chek ® Instant model.

The major problems respondents reported in handling previous glucometers are pricking fingers (42%), interpreting results (8%), drawing blood (8%), using the dosing area (7%), and reading results (5%). Although it is the most diffused problem, pricking fingers does not generate difficulties in 90% of respondents.

With respect to opinions related to Accu-Chek ® Instant, the vast majority found it very easy to use. The screen is easy to read for the majority of the sample, either as it is big enough (94%) or because the font size is easily readable (87%). The arrow and the colorimeter scale were highly appreciated by the vast majority of the respondents, as they eased the understanding of the results (65%) and eased the undertaking of corrective actions (62%). Additionally, the wide dosing area eases drawing blood and the automatic strip ejector makes the procedure more hygienic. In Table 3 a summary of patients’ opinions related to Accu-Chek ® Instant is represented.

Table 3 Patients’ opinions related to Accu-Chek ® Instant.

Among the most appreciated device characteristics, the most voted ones are the wide screen (65%), ease of reading results (63%), its shape that makes it easy to handle (57%), the arrow and the colorimetric scale (42%) and the wide dosing area (37%).

Results comparison based on age clusters

Respondents were categorized into two age groups: those under 65 and those aged 65 and over. This division aimed to discern notable disparities in the evaluation of characteristics between the clusters. Key insights were derived from this analysis, particularly regarding prior experiences with other glucometers. The majority of both under and over 65 had previously utilized other glucometers, with a higher percentage for the latter. Despite both groups indicating pricking fingers as the most discomforting activity, a notable disparity was observed. Specifically, 56% of individuals under 65 reported discomfort compared to 31% among those aged 65 and over. Additionally, among those under 65, drawing blood was the second most common discomfort, whereas interpreting results was reported as the second most frequent issue among those over 65. However, there are notable differences between the two age groups in their perceptions of certain glucometer characteristics. Individuals under 65 greatly appreciate the dosing area compared to those aged 65 and over, as it addresses one of their primary concerns.

Similarly, a higher percentage of respondents under 65 report difficulty in reading results compared to those over 65. Additionally, among individuals under 65, both the size of the screen and font were identified as facilitators for screen readability, while the arrow and colored scale were cited as aids for understanding results and taking corrective actions. Conversely, respondents aged 65 and over indicated somewhat different preferences. Although a majority acknowledged that the size of the screen and font contribute to screen readability, fewer respondents in this group found the arrow and colored scale helpful, for their capacity to assist in understanding results and undertaking corrective actions. Notably, a significant portion of respondents in both age groups reported not perceiving a difference in reading results through the arrow and colored scale.

In Table 4 these data are summarized.

Table 4 Feedbacks comparison based on age clusters.

Results comparison based on prior major problems

Building upon the findings of the previous analysis, which suggested that the appreciation of the novel characteristics of Accu-Chek ® Instant was not contingent upon age but rather on previous experience, a subsequent investigation was conducted to ascertain whether individuals who reported difficulties with prior glucometers experienced an improvement with Accu-Chek ® Instant.

For instance, out of the 56 respondents (7%) who reported encountering issues with using the strip for blood drop collection before transitioning to Accu-Chek ® Instant, 91% indicated that they no longer faced difficulties in collecting blood samples with Accu-Chek ® Instant. Additionally, 78% explicitly acknowledged the dosing area as significantly facilitating the blood sample collection process.

Similarly, among the 40 respondents (5%) who reported challenges in reading results, 97.5% stated that they encountered no issues with Accu-Chek ® Instant, attributing their ease in reading the device’s screen to its dimensions. Furthermore, 90% of these respondents affirmed the adequacy of the font size for facilitating result comprehension.

Furthermore, among the 66 respondents who identified interpreting results as a significant challenge, 95% reported finding the arrow and colored scale useful or very useful in comprehending results. Moreover, 93% of these individuals stated that these features aided in undertaking appropriate actions based on the results.

Results comparison based on past experience

Regarding the characteristics of Accu-Chek ® Instant, notable differences emerged between the two groups. Experienced patients expressed appreciation for the screen dimensions (60%), ease of reading results (60%), and the device’s shape (53%). Conversely, for naïve patients, the same characteristics were valued, albeit with slight variations. Specifically, the most appreciated feature among naïve adopters was reading results (66%). However, both groups exhibited very similar levels of appreciation for screen dimensions (97% for naïve adopters and 98% for experienced adopters) and font size (91% for naïve adopters and 89% for experienced adopters) when it came to reading results. Similarly, Accu-Chek ® Instant shape is widely appreciated by naïve adopters (57%), as well as screen size (51%).

Additionally, the majority of inexperienced people (60%) think that the arrow and the colored scale are very or extremely useful for interpreting results, and all the naïve respondents think that they are useful for undertaking corrective actions.

We reported the results of a questionnaire shared with 1145 T2DM with past or current experience with glucometers. The objective of this shed novel light on the under-researched topic of the characteristics fostering the usability of such devices in order to increase adherence to the therapy. Indeed, prior studies have demonstrated a positive impact of structured SMBG on confidence in self-managing diabetes, which in turn leads to improvement in HbA1c (glycated haemoglobin) ( 24 ). Additionally, some evidence has shown that structured SMBG can provide psychosocial benefits to patients, fostering ongoing relevant debates about the most appropriate tools and methods ( 25 ). Therefore, it is paramount to discern the most suitable tools and their inherent characteristics for promoting Self-Monitoring of Blood Glucose (SMBG).

Therefore, this study deepens the preliminary insights gathered about the usability and accessibility of glucometers ( 6 ), engaging in the ongoing discourse, while incorporating perspectives from individuals under the age of 65 as well. The major focus of this paper is on the role characteristics have in increasing usability, especially in relation to some specific patients’ characteristics. From the first exploratory study, some characteristics emerged as particularly relevant for patients aged over 65, such as the automatic strip ejector and the backlit display, while some other characteristics remained with unclear opinions, such as the TRI. In this study, more clear results emerged.

The initial analysis revealed discernible differences between the two age cohorts. Specifically, a greater proportion of individuals under 65 reported discomfort in finger pricking compared to those aged 65 and over. This discrepancy may be attributed to the greater familiarity of this challenging task among older patients. Furthermore, while drawing blood emerged as the second most significant discomfort among those under 65, interpreting results ranked second among individuals aged 65 and over. This divergence could be reflective of the differing approaches to task engagement shaped by routine among the older demographic.

These disparities in discomfort experiences may influence the assessment of glucometer characteristics, which extends beyond patients aged 65 and over to encompass individuals under 65. For instance, the larger screen size is notably favored among the younger cohort compared to their older counterparts. Moreover, insights gleaned from the initial analysis, coupled with the initially reported challenges in result interpretation, suggest the utility of features such as arrows and colored scales for individuals grappling with result comprehension. However, as patients become more adept at interpreting results over time, the significance of these features diminishes.

Notably, Accu-Chek ® was perceived as more user-friendly among individuals under 65 (85%) compared to those aged 65 and over (70%).

Moreover, from the second set of analyses, our findings reveal that several features of these glucometers effectively address the primary challenges encountered by patients with previous glucometers. For example, the dosing area is widely praised among individuals who previously experienced difficulties in blood sample collection. Similarly, respondents who encountered challenges in result comprehension appreciated the screen and font size, while those struggling with result interpretation found the arrow and colored scale particularly helpful.

However, in the final step of the analysis, it became evident how these characteristics prove beneficial in addressing major issues even for naïve adopters. The findings indicate that Accu-Chek ® Instant facilitates the task of reading results for individuals who have no prior experience in this regard, as well as for those who compare Accu-Chek ® Instant with other glucometers based on their experience. Consequently, these results bolster the hypothesis that glucometer characteristics are advantageous not only for individuals aged 65 and over but also for a broader spectrum of patients, encompassing both inexperienced users and those encountering various difficulties in self-monitoring of blood glucose (SMBG). Hence, such a device should be targeted not solely at individuals aged 65 and over, but also at patients new to glucometers and those grappling with the aforementioned challenges.

This study contributes to the evolving academic discourse by investigating the features of glucometers that are predominantly favored by patients and have the potential to enhance their adherence to therapy. This study has several strengths, being a comprehensive assessment of glucometer characteristics and performing an analysis of the appreciation of such characteristics among different clusters of patients. Indeed, such study has generated further evidence in this field which can be exploited for generating proper recommendations on how to focus and leverage on these aspects to improve SMBG. This paper also contributes to the literature by evaluating its usability and compare it in patients aged over 65 in comparison to under 65 patients, differently from previous studies that had the goal to do a comparative analysis between Accu-Chek ® Instant and other glucometers. Indeed, while the literature shows evidence of over 65 patients ( 6 ), a comprehensive assessment of glucometer characteristics and its usability for a wider set of patients is still missing.

However, this study is subject to several limitations. Firstly, as we focused exclusively on the case of Accu-Chek ® Instant, certain minor features of other glucometers may have been overlooked, limiting the generalizability of our findings. Additionally, our study captured results at a specific point in time, potentially overlooking any evolving perceptions over time. Therefore, future research could explore how perceptions change after several months from initial usage, providing further insights. Moreover, a significant limitation pertains to the selected sample, which was confined to the centre and south of Italy. Consequently, expanding the sample to encompass other regions within Italy and even extending the study to include participants from other countries would enhance the generalizability and robustness of our findings.

Conclusions

The conclusion of this study underscores the pivotal role of glucometers in facilitating self-monitoring of blood glucose (SMBG) among Type 2 Diabetes Mellitus (T2DM) patients, where therapy adherence is significantly influenced by the characteristics and usability of these devices. Through a comprehensive survey encompassing 957 responses from both under and over 65 early adopter patients, this paper aimed to elucidate the features of glucometers capable of enhancing their usability.

Overall, the findings offer valuable insights into the target patients for the Accu-Chek ® Instant glucometer. However, these insights are not limited to this specific device and could be extrapolated to inform the design and usage of other glucometers. The study highlights characteristics appreciated by both under and over 65 early adopter patients, shedding light on their preferences compared to patients with previous experience using glucometers.

Consequently, this study serves as a foundational resource, providing practical guidelines for healthcare professionals involved in diabetes management. As suggested in the Discussion section, future research endeavors could incorporate additional regions within Italy to offer a comprehensive nationwide perspective. Moreover, exploring this topic in other countries could reveal potential cross-cultural variations. Finally, replication of the study with the same population in the future could elucidate any changes in responses over time as patients gain experience.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics statement

Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.

Author contributions

GT: Writing – original draft, Writing – review & editing, Conceptualization, Investigation, Methodology. AB: Writing – original draft, Writing – review & editing, Conceptualization, Formal analysis, Investigation, Methodology. CD: Validation, Writing – review & editing. RF: Validation, Writing – review & editing. AG: Validation, Writing – review & editing. GP: Validation, Writing – review & editing.

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study received funding from Roche Diabetes Care Italy S.p.A. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication. All authors declare no other competing interests.

Conflict of interest

Author AB was employed by company Personalive srl.

The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: self-monitoring of blood glucose (SMBG), diabetes, glucose monitoring, glucometer, usability, early adopters, device characteristics

Citation: Toletti G, Boaretto A, Di Loreto C, Fornengo R, Gigante A and Perrone G (2024) Enhancing diabetes therapy adherence: a comprehensive study on glucometer usability for type 2 diabetes patients. Front. Clin. Diabetes Healthc. 5:1328181. doi: 10.3389/fcdhc.2024.1328181

Received: 26 October 2023; Accepted: 22 April 2024; Published: 14 May 2024.

Reviewed by:

Copyright © 2024 Toletti, Boaretto, Di Loreto, Fornengo, Gigante and Perrone. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Andrea Boaretto, [email protected]

† ORCID : Giovanni Toletti, orcid.org/0000-0003-2579-9683 Andrea Boaretto, orcid.org/0009-0003-8279-8385 Chiara di Loreto, orcid.org/0009-0003-4834-5761 Riccardo Fornengo, orcid.org/0009-0008-2559-2002

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Metabolomics in Diabetes and Diabetic Complications: Insights from Epidemiological Studies

Affiliations.

• 1 Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.
• 2 Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China.
• 3 Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China.
• 4 Chinese University of Hong Kong-Shanghai Jiao Tong University Joint Research Centre in Diabetes Genomics and Precision Medicine, The Chinese University of Hong Kong, Hong Kong, China.
• PMID: 34831057
• PMCID: PMC8616415
• DOI: 10.3390/cells10112832

The increasing prevalence of diabetes and its complications, such as cardiovascular and kidney disease, remains a huge burden globally. Identification of biomarkers for the screening, diagnosis, and prognosis of diabetes and its complications and better understanding of the molecular pathways involved in the development and progression of diabetes can facilitate individualized prevention and treatment. With the advancement of analytical techniques, metabolomics can identify and quantify multiple biomarkers simultaneously in a high-throughput manner. Providing information on underlying metabolic pathways, metabolomics can further identify mechanisms of diabetes and its progression. The application of metabolomics in epidemiological studies have identified novel biomarkers for type 2 diabetes (T2D) and its complications, such as branched-chain amino acids, metabolites of phenylalanine, metabolites involved in energy metabolism, and lipid metabolism. Metabolomics have also been applied to explore the potential pathways modulated by medications. Investigating diabetes using a systems biology approach by integrating metabolomics with other omics data, such as genetics, transcriptomics, proteomics, and clinical data can present a comprehensive metabolic network and facilitate causal inference. In this regard, metabolomics can deepen the molecular understanding, help identify potential therapeutic targets, and improve the prevention and management of T2D and its complications. The current review focused on metabolomic biomarkers for kidney and cardiovascular disease in T2D identified from epidemiological studies, and will also provide a brief overview on metabolomic investigations for T2D.

Keywords: biomarkers; cardiovascular disease; chronic kidney disease; metabolomics; type 2 diabetes.

Publication types

• Research Support, Non-U.S. Gov't
• Biomarkers / metabolism
• Diabetes Complications / epidemiology*
• Diabetes Complications / metabolism*
• Diabetes Complications / microbiology
• Diabetes Mellitus, Type 2 / metabolism*
• Diabetes Mellitus, Type 2 / microbiology
• Gastrointestinal Microbiome
• Metabolomics*
• Systems Biology

Grants and funding

• R4012-18/the Research Grants Council Research Impact Fund

Lab on a Chip

Omef biochip for evaluating red blood cell deformability using dielectrophoresis as a diagnostic tool for type 2 diabetes mellitus †.

* Corresponding authors

a Division of Engineering, New York University Abu Dhabi (NYUAD), Abu Dhabi, United Arab Emirates E-mail: [email protected]

b Department of Mechanical and Aerospace Engineering, New York University, New York, USA

c Cleveland Clinic Abu Dhabi (CCAD), Abu Dhabi, United Arab Emirates

d The Malta College of Arts, Science & Technology, Paola, Malta

e Department of Biomedical Engineering, New York University, New York, USA

Type 2 diabetes mellitus (T2DM) is a prevalent and debilitating disease with numerous health risks, including cardiovascular diseases, kidney dysfunction, and nerve damage. One important aspect of T2DM is its association with the abnormal morphology of red blood cells (RBCs), which leads to increased blood viscosity and impaired blood flow. Therefore, evaluating the mechanical properties of RBCs is crucial for understanding the role of T2DM in cellular deformability. This provides valuable insights into disease progression and potential diagnostic applications. In this study, we developed an open micro-electro-fluidic (OMEF) biochip technology based on dielectrophoresis (DEP) to assess the deformability of RBCs in T2DM. The biochip facilitates high-throughput single-cell RBC stretching experiments, enabling quantitative measurements of the cell size, strain, stretch factor, and post-stretching relaxation time. Our results confirm the significant impact of T2DM on the deformability of RBCs. Compared to their healthy counterparts, diabetic RBCs exhibit ∼27% increased size and ∼29% reduced stretch factor, suggesting potential biomarkers for monitoring T2DM. The observed dynamic behaviors emphasize the contrast between the mechanical characteristics, where healthy RBCs demonstrate notable elasticity and diabetic RBCs exhibit plastic behavior. These differences highlight the significance of mechanical characteristics in understanding the implications for RBCs in T2DM. With its ∼90% sensitivity and rapid readout (ultimately within a few minutes), the OMEF biochip holds potential as an effective point-of-care diagnostic tool for evaluating the deformability of RBCs in individuals with T2DM and tracking disease progression.

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OMEF biochip for evaluating red blood cell deformability using dielectrophoresis as a diagnostic tool for type 2 diabetes mellitus

D. S. Ali, S. O. Sofela, M. Deliorman, P. Sukumar, M. Abdulhamid, S. Yakubu, C. Rooney, R. Garrod, A. Menachery, R. Hijazi, H. Saadi and M. A. Qasaimeh, Lab Chip , 2024, Advance Article , DOI: 10.1039/D3LC01016C

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