• Fresh Views

    Diabetes Technology and Solution-Focused Practice: Online Peer Support Community Intervention to Address Health Disparities

      “I realized that my sugar was like a rollercoaster. It would go up and down very clearly. So I started to go for walks. Not light walks, but fast-paced ones.” ~Study participant

    Since the COVID-19 pandemic began the disparities in diabetes technology use in underserved populations has risen to the forefront. During the recent American Diabetes Association (ADA) Scientific Sessions data were shared about a novel use of an online peer support community combined with continuous glucose monitoring (CGM) use to educate, engage and empower people with type 2 diabetes. Since Deb was a co-investigator on this study, we reached out to Dr. Michelle Litchman, PI, Assistant Professor, University of Utah, College of Nursing to discuss the study findings and impact.

    The ADA abstract: 151-O Using a CGM plus Online Peer Support Community Intervention to Address Health Disparities

    Dr. Litchman, what makes this study unique and important?

    This study was developed based on two separate PCORI-funded projects that incorporated community-based participatory research principles and community advisory boards (CAB). The first CAB partnered with individuals within the Hispanic community to better understand diabetes technology needs and desires. The second CAB included diabetes online community partners to best understand how online peer support could reinforce diabetes technology use and healthy behaviors.

    What were the components of the study?

    We developed an intervention that combined continuous glucose monitoring (CGM) plus an online peer support community (OPSC). To support the needs of Hispanic and Spanish-speaking adults with type 2 diabetes not using insulin, the CGM+OPSC intervention was optimized to be culturally and linguistically appropriate. Participants wore CGM to visualize their daily glucose patterns and engaged in weekly personal experiments. Personal experiments included health behavior challenges related to general diabetes topics (being active, healthy eating, etc.) and were posted to the OPSC weekly. The OPSC were managed by trained Spanish/English bilingual peer facilitators who also lived with diabetes and used CGM. This mixed method study assessed how participants used the intervention.

    Participants completed a 1-week blinded baseline CGM recording (N=31) then engaged in the CGM+OPSC intervention for 12 weeks. Of those that continued into unblinded phase (n=22) study engagement was excellent (N=21).

    What were some of the key outcomes of the study?

    We analyzed exit interviews and identified 3 themes: (1) CGM “personal experiments” helped participants gain knowledge about how diet, exercise, medications, stress, and sleep impacted glucose levels; (2) the OPSC reinforced healthy behaviors through personal experiments, collective learning and social support; and (3) CGM engagement increased OPSC participation and participation in the OPSC resulted in greater CGM utilization, suggesting a positive feedback loop.

    We also found that self-efficacy levels significantly improved when comparing pre to post intervention.

    Tell us about the figure you presented.

    The figure above describes a positive feedback loop in which CGM could help see how glucose levels changed when they engaged in health behaviors, and the OPSC provided structure (personal experiments) and emotional and informational support to reinforce healthy behaviors. The promise of diabetes technology can only be seen with continued use. This study showed that an OPSC is one way to enhance CGM use. It is possible that OPSC could support other diabetes technologies and in other populations or languages.  

    Tell us more about the peer facilitators.

    We hired and trained five Hispanic Spanish/English bilingual individuals who were living with diabetes and using CGM. Having a group of peers that the participants could relate to was critical to the study’s success. The peer facilitators could provide tips and tricks from their own lived experience while also providing encouragement to those who might be struggling. All peer facilitators were supported by the research team and a bilingual certified diabetes care and education specialist. After the study completed, the peer facilitators helped develop training videos to support future research.

    What is the key message you would like readers to take away today?

    Hispanic, Spanish-speaking adults with type 2 diabetes have a great desire to use diabetes technology. However, diabetes technology must be optimized for language, cultural and social support needs. The CGM+OPSC intervention provided participants with the tools necessary to learn, problem-solve, and make healthy behavior changes and is a promising intervention to address health disparities.

    Is there anything else you would like us to know?

    This study would not have been possible without important community partners. We thank the CABs from both PCORI studies who helped guide us to developing this novel intervention.

    Of note, this abstract was awarded “Best Abstract” in the Glucose Monitoring and Sensing presentation group! We congratulate and thank Dr. Litchman for sharing the ADA presentation with us and look forward to future publications.

    Stop back by in 2 weeks to see what we write about as we continue to share about a variety of other technologies that impact and influence diabetes care and education!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients.

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    KEEP FRIENDS CLOSE: Today’s words to jump-start solution-focused practice

    “Friendship is born at that moment when one person says to another, ‘What! You too? I thought I was the only one.” – C.S. Lewis

    With friends in the Mediterranean this time last year (before the days of social distancing)

    As our world begins reopening from the pandemic, we are longing for the day when we can be in close proximity to friends and family again! Some of the most treasured moments for us personally are sharing life adventures, laughter, and good food and drink with friends (can you see that in our smiles in the picture above from our Mediterranean escape a year ago??) Yet in these days of physical distancing, we are reminded how critical it is to keep friends close, and stay connected while being physically away.   

    Today’s words are: KEEP FRIENDS CLOSE

    So with that, today in our series on words to jump-start a solution-focused approach when managing diabetes, we’re again using a few words (rather than just one) to generate thinking about how to focus on being healthy, living healthy, and making healthy choices, as a follow-on to our last blog “YOU CAN BE HEALTHY”.

    We chose today’s words – Keep Friends Close – because they were used frequently during Diabetes Social Media Advocacy (#DSMA) Twitter chats we hosted in 2018, and seem appropriate in these days of physical distancing. It became crystal clear during those Twitter chats that among people with diabetes, friendships are incredibly impactful and important – especially friendships with peers who also live with diabetes.

    Beyond the concept of friendship alone, we want to stress 3 things (maybe it’s 4 things):

    • Truly valuing friendship
    • Understanding how friendships can support one in living their best life
    • How even in crazy times like we are now living, it is possible to maintain friendships, and might we even suggest, strengthen them

    Video chats, calls, and linking up through social media can provide breaks from upsetting news coverage and help reduce feelings of isolation, loneliness, fear, disappointment (missed graduations, delayed weddings, and the list goes on), help cope with stress, and manage diabetes distress. Those who regularly engage in social media and online discussions, like the previously mentioned Twitter chats have some advantage during these pandemic days because they’ve already experienced the benefits of online friendship and support. 

    Deb’s friends and family participating in a Zoom graduation party.

    What does this mean for diabetes care and education specialists (DCES)?

    Here are 6 solution-focused questions you can use in your conversations to focus on VIPs (friends) and identify opportunities to receive support and strength:

    1. Who do you most enjoy spending your time with?
    2. What traits would your VIP say you have that will help you reach your goals?
    3. What do important people in your life consider to be your best qualities?
    4. How can you use those qualities now?
    5. Suppose your friend with diabetes had the same issue you are facing, what solution would he/she find?
    6. What would the important people in your life say that is different about you when you achieve your goal?

    In these days, here are 5 ways you can encourage your clients to Keep Friends (VIPs) Close virtually: 

    1. Talk about concerns, how they’re feeling, and share emotional support.
    2. Swap strategies for coping with changes in sleep or eating patterns.
    3. Do virtual stretching, workouts, or meditations to help care for you mind, body and spirit.
    4. Share ideas on how they’re eating healthy. Since May is National Mediterranean Diet Month, maybe find a Mediterranean-style recipe they and a friend can cook together virtually via Zoom. Or try this favorite of ours from a previous blog here.
    5. Provide an outlet to unwind and laugh.

    THIS WEEK’S SOLUTION-FOCUSED CHALLENGE

    Each week we’re including a solution-focused challenge that can help evolve care and education in a solution-focused manner. Here’s this week’s challenge: When working with clients these next few weeks, try asking at least 3 questions to understand their VIPs and how they are working to Keep Friends Close during this pandemic. Here are some examples:

    1. Who are the most important people in your life?
    2. How have they been helpful for you?
    3. How are you focusing on staying connected with them while we have been staying at home?
    Friends and colleagues from around the world with a connection to diabetes (looking forward to the days we can huddle in for a picture like this again!).

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

  • Fresh Views

    SUPPORT: Today’s word to jump-start solution-focused practice

    The Pont du Gard, a spectacular bridge that supports an ancient Roman aqueduct system built in the first century AD to carry water over 30 miles to Nîmes, Provence, France.

    April is national Stress Awareness month, and around the world stress is at an all-time high amidst the COVID-19 crisis! Since stress during an infectious disease outbreak such as this can worsen chronic health conditions as well as mental health, getting support is essential.

    It’s timely that today’s word is SUPPORT 

    Putting COVID-19 aside for a moment, diabetes is a complex and challenging condition – one that requires attention every minute, every hour, every single day. According to an October 1, 2015 blog posted by Manny Hernandez, people with diabetes (PWD) spend only 0.007% of their time over the course of a year with healthcare providers and emergency departments. They spend the remaining 99.993%  time self-managing their condition on their own. And thus ongoing support is critical. People who have a strong support system in place tend to be healthier (and recover more quickly when they are sick.)

    Asking for and accepting help (support) is a sign of strength.

    In solution-focused practice, it’s vital to step alongside the person with diabetes to guide them in selecting the resources or activities that best suit their needs, and that works for them.

    Support comes in many forms: 5 ways to guide your clients to engage in ongoing diabetes support

    1. Check in with loved ones often. A common reaction during this time of physical and social distancing is feeling socially isolated, especially for those that live alone or are in a community setting that is not allowing visitors because of the outbreak.Virtual communication can help you and your loved ones feel less lonely and isolated. Maybe it’s connecting via video chat, text messages, email, social media, mailing letters or cards, or a good “old fashioned” phone call. It may help for you to share specific ways they can support you (such as “Do join me in making healthy lifestyle changes, but please don’t offer unsolicited advice about my eating.”)
    2. Reach out to your diabetes health-care team. Call on them if stress gets in the way of your daily activities for several days in a row. They are dedicated to helping you take an active role in caring for your diabetes. Due to the COVID-19 pandemic many healthcare providers are using telehealth, so you don’t have to leave your home to get the help you need.
    3. Support yourself by taking care of your own emotional health. Last fall we wrote about a solution-focused approach to healthy copying. You can find 6 ways to deal with stress and cope with life with diabetes in a healthy manner here. This is even more important for those caring for a loved one during this health crisis, which can take an emotional toll. 
    4. Learn about free resources that are available. There are many resources available to support stress management and coping, and some of them are free! There are free versions of mindfulness apps for your phone to help with meditation or sleep. There are many YouTube videos available that are freely available to watch, including videos for self-help as well as videos that just make you smile and laugh. During this COVID-19 crisis there is a wonderful free resource from Livongo called myStrength. Anyone can sign up (no credit card required) to participate in a series of small lessons ranging from coping with stress to learning how to communicate while being physically distant from your friends and family.
    5. Connect with others with diabetes for peer support. Connecting with others in the vibrant online diabetes community is an opportunity to learn from others facing similar issues, available 24 hours a day, 7 days a week, when it is convenient to engage. Peer support using social networking sites improves glucose management, especially in people with type 2 diabetes. Other avenues to gain peer support are through a “support group” or participating in a diabetes program or workshop. The American Diabetes Association has an online discussion board that allows people with diabetes to share their ideas, questions, and opinions on a variety of topics. These settings provide great opportunities to discuss common problems and concerns as well as share helpful advice, offer support, and celebrate success in diabetes self-care. The Association of Diabetes Care and Education Specialists website has lots of resources about online peer support here and you can download a handout here.
    Tami & Deb staying connected via Zoom

    THIS WEEK’S SOLUTION-FOCUSED CHALLENGE

    We often close with inviting readers to participate in a solution-focused challenge. This week we challenge you to incorporate these questions around support into your conversations with clients.

    1. What types of support are helpful to you currently?
    2. What types of support could help you now?
    3. Where will you get it? 
    4. When will you take the step to see this support?
    5. On a scale of 0-10, where 0 means not likely and 10 means very likely, how likely are you to engage in a support resource to help you?

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

  • Fresh Views

    Highlights of #AADE19: Behavioral Health, Language, Peer Support and Social Media

    We’re getting excited for the #AADE19 Annual Meeting in Houston August 9-12!  For us, a little  advance planning and mapping out a schedule with the online planner helps us to successfully navigate the packed meeting, get to the sessions that peak our interest, and catch-up with friends! 

    Deb, Karen, Joan and Tami at #AADE18 President’s Reception

    As always, this meeting offers a multitude of cutting edge topics and excellent presenters. So, if you’ll be joining us in (hot) Houston at #AADE19 but haven’t had a chance to check out the sessions, here is the scoop on the 8 we’re excited about on Friday which focus on behavioral health, how to impact behavior change, and the use of peer support. To keep it simple, we pulled out the session descriptions for you and reviewed uploaded slides when available. You can find all of this information in the Online Planner.  

    F06-Friday 9:45-10:45 AM Shame and Diabetes: Practicing Resilience in a Culture of Weight Stigma, Disordered Eating, and Healthism by Nikki Estep 

    Description:

    Nearly 3/4 of people with type 2 diabetes report feeling shame about having diabetes, and shame-based self-talk and behaviors have been correlated with all types of diabetes. Presenters will define shame and how it is exacerbated in a culture of weight stigma and healthism, which can lead to disordered eating and other barriers to diabetes management.

    Our take away:

    Their slides are intriguing, sharing the work of Dr. Brene Brown on shame and vulnerability (love her books). From their slides: “Healthism is a belief system that sees health as the property and responsibility of an individual and ranks the personal pursuit of health above everything else, like world peace or being kind. It ignores the impact of poverty, oppression, war, violence, luck, historical atrocities, abuse and then environment from traffic, pollution to clean water and nuclear contamination and so on. It protects the status quo, leads to victim blaming and privilege, increases health inequalities and fosters internalized oppression.” – Lucy Aphramor

    The concept of “healthism” is new to us and yet the impact on stigma is so clear.  We also love the concept of Weight-Neutral Diabetes Care (WNDC) that “Focuses on establishing self-care behaviors. It DOES NOT promote restriction, endorse unsustainable exercise, or encourage disordered eating as a way to ‘get healthy’.”Looking forward to this one. 

    F07- Friday 11:00-12:00 Bright Spots & Landmines: A Diabetes Toolkit for Meaningful Behavior Change by Adam Brown

    Description:

    Why is changing behavior so difficult in diabetes? Why aren’t more people motivated? Why is there so much negativity in diabetes? Can we do better? Adam Brown will discuss the concepts of Bright Spots & Landmines as a toolkit for diabetes specialists to assist individuals to change behaviors, including specific food, mindset, exercise and sleep strategies. Attendees will learn how to apply “Bright Spots” and “Landmines” thinking to different individuals and scenarios, including easy-to-implement question guides.

    Our take away:

    While there were no slides to review, we are big fans of Bright Spots & Landmines and interviewed Adam Brown in our blog post on April 3, 2019.  Adam’s “Bright Spots” are very similar to “Exceptions” in a solution-focused approach (where one evaluates what’s going well and what they can “do more of” instead of focusing on the problems). Of course, there are obstacles that people face every day, and those are the “landmines” where things are not working as well.  You won’t want to miss his PDF handout of the 42 Factors that Affect Blood Glucose.

    F12-11:00 am-12:00 pm Reducing Stigma to Improve Outcomes: How to Reduce Stigma Effects by Laurie Klipfel , Eileen Rivera and Ann Williams

    Description:

    Health care professionals work with people who experience stigma, such as stigmatized racial/ethnic identities and other stigmatizing conditions. Recently stigma itself has been recognized as a fundamental cause of health disparities, that is, persistently associated with health inequalities across different times, diseases, risk factors, and health interventions. In other words, stigma affects outcomes. This panel presentation will explore what stigma is, how it produces health disparities, and what diabetes specialists can do to decrease its effects. It will include discussion by people from three stigmatized groups: People who are legally blind, transgender individuals, and those experiencing weight stigma.

    Our take away:

    The slide deck revels a presentation on how stigma affects health and how we can decrease the effects of stigma.  Looks like some powerful personal stories will be shared. Unfortunately, this session is the same time as Adam’s Brown’s. So many decisions!

    F23 Friday 3:15-4:15 pm Peer Support Communities for Self-Management Support: Research Trends by Perry Gee

    Description:

    The “S” on the end of DSMES is for support. Peer support is a resource being used by millions of people with diabetes. In this session, you’ll learn the latest research on the impact of social media and peer support communities on the promotion of self-management of diabetes.

    Our take away:

    The slides for this presentation show a historical look at past AADE presentations as well as published research supporting the #DOC or Diabetes Online Communities.Happy to see iDOCr research council mentioned in the presentation. This is at the same time as the Language  presentation below.

    F24A -3:15 pm-3:45 pm How Language Affects Person and Provider Communication by Jana Wardian

    Description:

    Communication between people with diabetes and providers plays an important role in engagement, conceptualization of diabetes management, treatment outcomes and behavior. Healthcare teams can be more effective through respectful, strengths-based communication. Empowering language can enhance motivation and well-being for people with diabetes. While this skill may take time, it is well worth the effort.

    Our take away:

    The slides are available for this presentation. Jana states she has lived with diabetes for 26 years and wears a pump and CGM. It’s always good to hear the language perspective from a person living with diabetes. If you follow us you know we often speak about person centered, strengths based language, so we’re happy to see several sessions on language at this conference. There was one slide that we would challenge however around the use of “bad vs. unhealthy blood sugar”. We don’t see “unhealthy” as a positive word choice or a biological factor. We’d go with “in range” or “out of range”. 

    F26A-4:30-5:00 pm Applying the Miracle Question in Diabetes Care by Tami Ross and Deborah Greenwood

    Description:

    Managing diabetes is complex and the constant focus on problems can erode confidence. Presenters will introduce “The Miracle Question,” a step-by-step solution-focused approach to work with people with diabetes. Participants will learn to use “exceptions,” the times when life works better or when problems are less likely to take over, to guide them toward attaining a personal action plan and goals. By focusing on abilities and possibilities, there are ready-to-use solutions. This approach assists diabetes specialists to help people strengthen their resilience and confidence.

    Our take away:

    Of course we are really looking forward to our presentation and hope you will join us! We will share one solution-focused tool called “The Miracle Question” as an exercise to move people forward in their thinking and actions when living with diabetes – to create a sense of hope and acknowledge possibilities. You can read our past blog post about the Miracle Question to learn more. If you’d like to further explore the Miracle Question, check out this book we’re fans of! 

    F29-4:30-5:00 F29 – Impact of Diabetes Self-management Education and Support on Psychological Distress among African Americans and Hispanic/Latinos with Diabetes by Ninfa Pena-Purcell

    While it conflicts with our session, this is another interesting topic.

    Description:

    Attention to the emotional side of diabetes is necessary in the delivery of DSMES. This has been found to be particularly critical for diverse racial and ethnic groups that have unique lived experiences. Two culturally appropriate community-based DSMES programs responded to this need, one aimed at African Americans and the other at Hispanic/Latinos with type 2 diabetes. Findings suggest that for both groups psychological distress was reduced and diabetes-related outcomes improved. Participate in this interactive session to dive deep into an exploration of the complexities of culturally appropriate diabetes interventions.

    Our take away:

    The slides for this presentation address the ADA guidelines for psychosocial care, how and when to assess people for diabetes distress, and describes a culturally tailored program to address these issues.

    F26B-5:00-5:30 Peer Support Communities: Data, Resources, Tips and Tricks, Ashley Ng 

    Description:

    People with diabetes and caregivers are increasingly turning towards online peer support communities to share and exchange information and experiences that impacts health behavior outcomes and emotional health. While the popularity of online communities continues to grow, it is crucial that diabetes specialists start to integrate evidence based online peer support networks as part of mainstream diabetes care. This presentation will discuss current challenges that surround people with diabetes and healthcare providers with the widespread sharing of personal data.

    Our take away:

    Ashley a dietitian, researcher, person living with diabetes, and colleague will discuss the privacy, security, and safety concerns of sharing personal data online, along with the role of the healthcare provider in helping people stay safe while online. 

    Wow, Friday is going to be a jam packed day! We’re thinking it may be Saturday before we make it to the Exhibit Hall this year!

    Deb, Tami and our good friend Lorena as we explored the exhibit hall at #AADE18

    We can’t wait to get to Houston to learn and re-energize! We are thrilled to see so many presentations addressing the behavioral side of living with diabetes and the essential component of peer support. Join us in tweeting using the #AADE19 hashtag – share what you are learning along with others in your network. Drop back by next week when we’ll share other  sessions of interest throughout the rest of the conference.

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