Diabetes Research and Clinical Practice - Volume 120 - Supplement 1 - October 2016

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Methods: The study was part of a nationwide survey con-
ducted by Taiwanese Association of Diabetes Educators for
examining the quality of diabetes care among Diabetes Health
Promotion Institutes from year 2011 to year 2012. A subgroup
of 981 adult diabetic patients were selected by randomized
sampling from the nationwide survey sample and invited to
complete questionnaires including the Diabetes Related
Distress Questionnaire (DRDQ). DRDQ is composed of 15
items with 4-point Likert scale (1 = completely disagree, 4 =
completely agree) and higher score indicate more distress.
This study excluded patients with type 1 diabetes, leaving 947
patients with type 2 diabetes, of whom 486 (51.3%) was male.
We analyzed the data of DRDQ, medical history from chart
reviews and biomedical data (HbA1C) measured in the
nationwide survey.
Results: The mean age of participants was 61.5(±11.9) (mean
± SD) years, with an average duration of 9.9 years of diabetes.
The mean A1C was 7.6% (±1.5), with 27.9% being treated with
insulin, 71.1% being treated with oral hypoglycemic medica-
tion, and 1.0% being controlled by diet only. The mean sum
score of DRDQ was 30.5 (±8.91) with 70% of patients felt
their diabetes was well regulated. The top four higher scoring
items of DRDQ were “…afraid of my disease getting worse”, “…
feel stressed because of my disease ”, “…afraid of burdening
my family/child ”, and “… diet control causes a lots of troubles
to my life ”. DRDQ scores were significantly higher among
insulin treated patients than oral medication treated or diet
treated patients (32.9 vs. 29.7, p < .001). Patients with lower A1C
also had lower DRDQ score (r = .206, p < .001). Age negatively
correlated with DRDQ score (r = −0.176, p < .001). Female
patients had significantly higher score in 8 items of DRDQ
than male, but lower score in one item about reduced
sexual life.
Conclusion: Patients with type 2 diabetes in Taiwan faced
some degree of diabetes related distress. Most of patients
concerned about their disease getting worse. Patients with
insulin treatment, withworse glycemic control, or younger age
had more distress than their counterparts. The results will be
useful for health care providers to understand and improve
quality of life in patients with diabetes.
PF-12
Utilizing transtheoretical model for transforming a
uncooperative diabetes nephropathy patient into a cooperative
patient undergoing hemodialysis
Chia-Wen LIN 1*, Mei-yu TU1, Mei-yuan LIU1. 1Department of
Nutritional Services, Chi Mei Medical Center, Taiwan
Objectives: The most difficult aspect in diabetes education is
behavioral corrections. Often the patients will not accept
changes to their diet. However, inappropriate diet can lead to
high blood glucose levels and that can result in other como-
rbidities. During the care period, the behavioral changes that
resulted from the patients ’ prognosis were compared with the
5 transformative behaviors outlined in the “Transtheoretical
Model” . The case was transformed from pre-and contempla-
tion phase, where they were undecided about diet changes, to
the action phase, where they have started a healthy diet. It is
with hope that the investigation can give us insights on the
effects of behavior based education for nutrition therapy.
Methods: A 61-year-old male patient in a medical center
in southern Taiwan was studies. The patient was emitted to
the hospital due to peritonitis and septic shock that have
resulted from ulcer perforation. The patient had histories of
diabetes, hypertension, and a brain aneurysm surgery that
was performed 20 years ago. The patient assessment included
height, weight, body mass index, blood and urine biomarker
levels, current medication, SGA, and other physiological
examination and treatment. Furthermore, by using 24 hr
regression questioning. The patient was given appropriate
nutrition education and proper diet that is in accordance to his
conditions as well as behavior phase. The patient was follow-
up for the determination of the effect of the interventions.
Results: After underwent hospitalization interview, assess-
ment, and educations, the patient, followed-up for 2 years
after discharge, had improved his diet nutrition. His behavior
changed from pre-contemplation (pre-hospitalization), to
contemplation (during the first interview), and to become
action and maintenance phase (after discharge). The nutrition
diagnosis and education for the patient throughout the
care process are: lack of diet and nutrition related knowledge
in the beginning; familiarized with the six major food
groups after persisting education; and the patient was finally
about to distinguish and select a proper diet. However,
patient’s nephropathy also required a low protein diet; the
miss selection caused his condition to worsen and required
hemodialysis therapy. Therefore, the patient was educated
further on protein adjustment and identifying food with
sodium, sulfur, potassium, iron, and purine. Finally, the
patient has started the habit of daily exercises.
Conclusions: The transtheoretical model emphasized the
complexity of behavioral changes. This case study demon-
strated a patient that was able to change his 20 year habits is a
prime example for nutritionist. Therefore, the actual care
experiences and results from this study are shared for future
references.
PF-13
The co-occurrence of depressive symptoms and cognitive
impairment and its relationship with diabetes self-care
behaviors
Chia-Lin LI1,2*, Hsing-Yi CHANG3 , Yi-Chen CHIU4, Jen-Der LIN 2.
1Department of Health Care Management, College of Management,
2Division of Endocrinology and Metabolism, Departments of Internal
Medicine, Chang Gung Memorial Hospital, Chang Gung University,
Tao-Yuan City, 3Division of Preventive Medicine and Health Service
Research, Institute of Population Health Sciences, National Health
Research Institutes, Maoli, 4School of Nursing, College of Medicine,
Chang Gung University, Tao-Yuan City, Taiwan
Background: Depressive symptoms or cognitive impairment is
prevalent in older adults with diabetes. To date the epidemi-
ology of the coexisting diabetes, depressive symptoms, and
cognitive impairment among older persons has yet to be
adequately characterized. Little is known about how depres-
sive symptoms in combination with cognitive impairment
associated with diabetes self-management.
Aim: The main aim of the present study was to investigate the
co-occurrence of depressive symptoms and cognitive impair-
ment in community dwelling older adults with diabetes and its
relationship with specific diabetes self-care behaviors.
Methods:We analyzed data from two national sample of older
adults (65 years or older) with self-reported physician-diag-
nosed diabetes (N = 1,034), who participated in the 2005 or 2009
National Health Interview Survey in Taiwan. The Mini-Mental
State Examination (MMSE) was used to assess cognitive
function. The Center for Epidemiologic Studies Depression
Scale (CESD) was used to assess depressive symptoms. The
study assessed self-care behaviors including adherence medi-
cation, exercise, healthy diet, and self-monitoring of blood
glucose. We excluded 77 personswho had diagnosed dementia
or depression and 86 persons who had incomplete data for
MMSE or CESD. This resulted in 871 eligible participants for
analysis. We conducted logistic regression on the effects of
cognitive impairment and depressive symptoms on respon-
dents’ self-care behaviors after controlling for demographics,
comorbidities, diabetics-related attributes, and health care
utilization.
Results: We found that among participants with diabetes,
13.4% had depressive symptoms only, 16.4% had cognitive
impairment only, and 8.8% had both depressive symptoms
and cognitive impairment. After adjusted for other factors,
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211 S155