Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. In rural communities, children with Type 1 diabetes can struggle to get care matching current diabetes guidelines, potentially resulting in increased health complications. focus-group findings indicated that families may experience dramatic family and lifestyle changes after diagnosis and lack of access to specialized care but that isolation improved resourcefulness in health management, and technology improved health management and flexibility. Primary Author and Speaker: Vanessa Jewell Additional Authors and Speakers: Benjamin Feiten Contributing Authors: Emily Knezevich, Amy Abbott, Kameran Ulferts, and Shelby Hoffmann

Importance: Self-management programs (facilitated by mobile devices) may improve health and prevent secondary complications for older adults with diabetes. However, older adults may have difficulties using mobile devices because of neuropathy or cognitive dysfunction. Objective: To identify sensorimotor and cognitive abilities associated with touchscreen tablet app performance to support self-management of diabetes in older adults. Design: Cross-sectional study. Setting: Outpatient Center for Successful Aging With Diabetes. Participants: Forty-five older adults with Type 2 diabetes. Outcomes and Measures: Dexterity (Purdue Pegboard Test), touch sensation (Semmes–Weinstein monofilaments), pinch strength (pinch gauge), cognition (Montreal Cognitive Assessment), and executive functioning (Trail Making Test) were assessed. Two apps were then used: Dexteria and SuCare. Demographic data, prior mobile device use, and diabetes severity (hemoglobin A1C [HbA1C]) were collected. Results: Age and HbA1C accounted for 29.8% and 9.7%, respectively, of the total variance of Dexteria performance time (dominant hand). Dexterity (dominant hand) accounted for an additional 5.4% of the total variance of 45.1%, F(4, 40) = 10.021, p < .001. Prior mobile device use, age, and diabetes severity accounted for 6.4%, 11.8%, and 26.4%, respectively, of the total variance of SuCare performance time. Executive functioning and dominant-hand dexterity accounted for an additional 9.5% and 9.4%, respectively, of the total variance of 61.0%, F(5, 39) = 14.75, p < .001. Conclusions and Relevance: Beyond age and diabetes severity, executive functioning and dominant-hand dexterity contributed to app performance, highlighting the importance of diabetes self-management. These findings may help determine suitable candidates for tablet use for self-management. What This Article Adds: App performance is explained by the executive functioning and dexterity of older adults with Type 2 diabetes. These factors, in addition to age and diabetes severity, should be taken into consideration by occupational therapy practitioners in future mobile self-management programs.

OBJECTIVE. We investigated the feasibility and acceptability of an occupational therapy intervention targeting diabetes management for underserved young adults. METHOD. Eight participants completed the intervention and a battery of assessments at baseline and after the intervention. At completion, the participants and occupational therapist were interviewed about their experiences with the study. Four categories of assessment questions were used to guide the study: process, resource, management, and scientific. RESULTS. Successes included recruitment; fulfillment of tasks by staff and partnering clinics; adequate space, financial support, and equipment; and meaningfulness of the intervention for participants. Challenges included scheduling participants for the intervention and follow-up focus groups and providing client centeredness and flexibility while reducing burden on the intervener. CONCLUSION. This feasibility study allowed us to make necessary revisions to our study protocol before implementing a larger pilot study.

As children and youth with diabetes grow up, they become increasingly responsible for controlling and monitoring their condition. We conducted a scoping review to explore the research literature on self-management interventions for children and youth with diabetes. Eleven studies met the inclusion criteria. Some of the studies reviewed combined the participant population so that children with Type 1 as well as children with Type 2 diabetes were included. The majority of the studies focused on children age 14 yr or older and provided self-management education, self-management support, or both. Parent involvement was a key component of the majority of the interventions, and the use of technology was evident in 3 studies. The findings highlight factors that occupational therapy practitioners should consider when working with pediatric diabetes teams to select self-management interventions.

Diabetes affects 5.2% of the population; many of those persons experience loss of vision as one complication of the disease. Occupational therapists are treating these persons, often for other resulting complications (such as stroke or amputations), or are being asked to adapt techniques or equipment (such as insulin-drawing devices) needed for diabetes management. Because no guidelines exist for occupational therapy with persons with diabetes or vision loss or both, occupational therapists may be unsure of appropriate treatment approaches. Among the approaches described in the occupational therapy literature, common ones include collaboration with other professionals and incorporation of one or more aspects of the diabetes regimen into the person’s life-style. When addressing persons who have both diabetes and vision loss, therapists consider their own knowledge base as well as the persons’ needs in managing their diabetes. Treatment ideas include enhancing the visual environment or incorporating tactile and auditory feedback with self-management tasks such as testing blood glucose levels. Collaboration with and referral to diabetes and low-vision professionals are adjuncts to therapy and ensure a comprehensive and ongoing diabetes management program.

Effective communication with patients and their family members forms the foundation of a therapeutic relationship. This is particularly important when the occupational therapist, other health professionals, and the patient are from different cultural backgrounds. This paper describes one aspect of the findings of a ethnographic study of chronic diabetes among the Navajo people (referred to here as Dine’). It focuses on the dominant metaphorical images that were used by the informants to describe their illness experiences. The data suggest that diabetes can be considered a metaphor for larger social changes in the life-style and traditions (e.g., away from sheepherding as a means of basic subsistence to obtaining urban-centered employment) of native Americans and their effects on the Dine’. Implications of our findings include the importance of metaphorical communication for perceptions of compliance, powerlessness, and patient and therapist satisfaction with the therapeutic relationship.