Development and psychometric testing of a theory-based tool to measure self-care in diabetes patients: the Self-Care of Diabetes Inventory

Background

Self-care is essential for patients with diabetes mellitus. Both clinicians and researchers must be able to assess the quality of that self-care. Available tools have various limitations and none are theoretically based. The aims of this study were to develop and to test the psychometric properties of a new instrument based on the middle range-theory of self-care of chronic illness: the Self-Care of Diabetes Inventory (SCODI).

Methods

Forty SCODI items (5 point Likert type scale) were developed based on clinical recommendations and grouped into 4 dimensions: self-care maintenance, self-care monitoring, self-care management and self-care confidence based on the theory. Content validity was assessed by a multidisciplinary panel of experts. A multi-centre cross-sectional study was conducted in a consecutive sample of 200 type 1 and type 2 diabetes patients. Dimensionality was evaluated by exploratory factor analyses. Multidimensional model based reliability was estimated for each scale. Multiple regression models estimating associations between SCODI scores and glycated haemoglobin (HbA1c), body mass index, and diabetes complications, were used for construct validity.

Results

Content validity ratio was 100%. A multidimensional structure emerged for the 4 scales. Multidimensional model-based reliabilities were between 0.81 (maintenance) and 0.89 (confidence). Significant associations were found between self-care maintenance and HbA1c (p?=?0.02) and between self-care monitoring and diabetes complications (p?=?0.04). Self-care management was associated with BMI (p?=?0.004) and diabetes complications (p?=?0.03). Self-care confidence was a significant predictor of self-care maintenance, monitoring and management (all p?<?0.0001).

Conclusion

The SCODI is a valid and reliable theoretically-grounded tool to measure self-care in type 1 and type 2 DM patients.

     

Extremely short duration high intensity interval training substantially improves insulin action in young healthy males

Background

Impaired glucose tolerance (IGT) is a prediabetic state. If IGT can be prevented from progressing to overt diabetes, hyperglycemia-related complications can be avoided. The purpose of the present study was to examine whether pioglitazone (ACTOS^®) can prevent progression of IGT to type 2 diabetes mellitus (T2DM) in a prospective randomized, double blind, placebo controlled trial.

Methods/Design

602 IGT subjects were identified with OGTT (2-hour plasma glucose = 140–199 mg/dl). In addition, IGT subjects were required to have FPG = 95–125 mg/dl and at least one other high risk characteristic. Prior to randomization all subjects had measurement of ankle-arm blood pressure, systolic/diastolic blood pressure, HbA_1C, lipid profile and a subset had frequently sampled intravenous glucose tolerance test (FSIVGTT), DEXA, and ultrasound determination of carotid intima-media thickness (IMT). Following this, subjects were randomized to receive pioglitazone (45 mg/day) or placebo, and returned every 2–3 months for FPG determination and annually for OGTT. Repeat carotid IMT measurement was performed at 18 months and study end. Recruitment took place over 24 months, and subjects were followed for an additional 24 months. At study end (48 months) or at time of diagnosis of diabetes the OGTT, FSIVGTT, DEXA, carotid IMT, and all other measurements were repeated. Primary endpoint is conversion of IGT to T2DM based upon FPG ≥ 126 or 2-hour PG ≥ 200 mg/dl. Secondary endpoints include whether pioglitazone can: (i) improve glycemic control (ii) enhance insulin sensitivity, (iii) augment beta cell function, (iv) improve risk factors for cardiovascular disease, (v) cause regression/slow progression of carotid IMT, (vi) revert newly diagnosed diabetes to normal glucose tolerance.

Conclusion

ACT NOW is designed to determine if pioglitazone can prevent/delay progression to diabetes in high risk IGT subjects, and to define the mechanisms (improved insulin sensitivity and/or enhanced beta cell function) via which pioglitazone exerts its beneficial effect on glucose metabolism to prevent/delay onset of T2DM.

Trial Registration

clinical trials.gov identifier: NCT00220961     

Meloidogyne incognita Infested Soil Amended With Chicken Litter

The effects of chicken litter on Meloidogyne incognita in cotton, Gossypium hirsutum cv. DPL50 were determined in field microplots. Litters (manure and pine-shaving bedding) from a research facility and a commercial broiler house were used. Treatments consisted of 0.25%, 0.5%, and 1% litter by dry weight of soil for each kind of litter. Three control treatments consisted of soil not amended with litter, with and without nematodes, and one treatment to which mineral fertilizer was added at a nitrogen rate equivalent to that of the 0.5% litter rate, with nematodes. Microplots were inoculated at planting with 900 eggs/100 cm³ soil in 1993 and 1,000 eggs/100 cm³ soil in 1994. At 92 and 184 days after planting, nematode population densities decreased linearly with increasing rates of litter. Nematode numbers at midseason were larger in plots treated with mineral fertilizer than in plots treated with a rate of litter equivalent to the 0.5% rate. Fungal and bacterial population densities fluctuated throughout the growing season. Bacterial numbers had a positive linear relationship, with increasing rates of litter only in October 1993; however, significant positive relationships were observed throughout the 1994 growing season. In 1994, nematode population density at 92 days after planting decreased linearly with increasing bacterial numbers 30 days after planting. No other significant relationships between nematode densities and microbial densities were observed. Fungi and bacteria isolated from the litter and litter-amended soil were identified. Fungal genera isolated included Acremonium, Aspergillus, Eurotium, Paecilomyces, Petriella, and Scopulariopsis, whereas bacteria genera included Arthrobacter, Bacillus, and Pseudomonus.     

Molecular genetic evidence of formosan subterranean termite (Isoptera: Rhinotermitidae) colony survivorship after prolonged inundation

Levee breaches because of Hurricane Katrina in 2005 inundated 80% of the city of New Orleans, LA. Formosan subterranean termites were observed actively foraging within in-ground monitoring stations within months after this period of flooding. It was unknown if the activity could be attributed to preexisting colonies that survived inundation or to other colonies surviving flooding by being located at higher elevations readily invading these territories. Genotypic profiles of 17 termite colonies collected from eight inundated locations before flooding were compared with termite colonies after flooding from the same locations to determine Formosan subterranean termite survival after sustained flooding. Results indicate that 14 colonies were able to survive inundation for extended periods.