Discussion
type-2 diabetes, HbA1C ≤, depressive, type-2 diabetesBased, diabetes distress, diabetes
DISEASE, DIABETES
The present study showed that the OTDSM can significantly improve blood glucose levels in people with type-2 diabetes. The protocol achieves this by emphasizing people's participation in self-management activities and by integrating them into their daily routines. Previous studies have highlighted the effect of self-management on improving blood glucose in people with type-2 diabetesSimilar protocols introduced previously by Rovner et al. and Schepens Niemiec et al. improved blood glucose levels in elderly people and adults with type-2 diabetesBased on our findings, the effects of our proposed protocol on self-management behaviors were observable. The self-management behaviors are important determinants of the disease control in diabetes. According to previous studies, the participation of people with diabetes in activities, such as blood glucose monitoring and recording, are the distinct differences between poorly managed (HbA1C ≥ 9.0%), moderately controlled (7.6 < HbA1C < 8.9%), and optimal (HbA1C ≤ 7.5%) blood glucose levels. Also, the extent to which an individual participates in dietary management activities distinguishes between poorly managed and moderately controlled diabetes. Furthermore, regular participation in exercise and physical activity distinguishes between moderately managed and optimal blood glucose levelsOur proposed self-management protocol also improved the participants' performance and satisfaction with their daily activities. In line with these results, earlier studies have also emphasized the effect of occupational therapy self-management interventions on daily activities in people with different chronic diseasesThe present study demonstrated that our self-management protocol significantly improved self-efficacy in people with type-2 diabetes, especially with respect to consuming healthy foods.Self-efficacy is a mental concept that is dependent on the situation and associated with the better achievement of desired outcomes in one’s life. Peer modeling, receiving social or individual support and encouragement from others, and emotional and physiological arousal are also significant factors in enhancing people's self-efficacy in performing desired tasksPrevious studies have reported conflicting information about the effectiveness of occupational therapy interventions on self-management and self-efficacy of people with diabetes. In line with our findings, some studies have acknowledged that occupational therapy self-management interventions can impact self-efficacy positively in the management of other chronic diseases including type-2 diabetesThe current study showed that the OTDSM could not improve diabetes distress and depressive symptoms, as compared to general self-management education. However, the variables’ scores in those who received the protocol decreased over time, with a significant between-group differences at the T3 time-point. Consistent with our results, occupational therapy self-management interventions in previous studies also failed to lower diabetes distress in their study populationsTo date, little research has been conducted to incorporate DSM with people's daily routines. The present study is one of the pioneers in integrating DSM with the daily activities of adults with type-2 diabetes based on a robust, evidence-based intervention. The other strengths of this study include its methodological design, randomization, the high attendance rate of the participants, and the consideration of a wide range of outcomes. However, the study's small sample size causes some uncertainty in interpreting the findings. Future studies can conduct further investigations with a larger sample size. The other limitation of this study is the participants being from a single center which limits the generalizability of the results. Also, the study did not have the resources to plan a long-term follow-up to assess the lasting effect of the findings. Furthermore, the outbreak of COVID-19 limited the number of group sessions and the possibility of conducting face-to-face interventions.