{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T16:28:20Z","timestamp":1759336100043,"version":"build-2065373602"},"reference-count":48,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Isra University, Jordan","award":["IU-10\/2-110","IU-10\/2-110"],"award-info":[{"award-number":["IU-10\/2-110","IU-10\/2-110"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Geriatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The SUGAR Handshake is a pharmacist-led educational intervention to prevent hypoglycaemia in elderly people with type 2 diabetes mellitus (T2DM). A process evaluation was conducted alongside the ROSE-ADAM pragmatic randomized controlled trial (RCT) to assess the implementation of the intervention and study procedures, explore mechanisms of impact, and examine future scalability.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This mixed-methods process evaluation was nested within a single-centre RCT conducted at outpatient clinics in a Jordanian hospital. Routine monitoring quantitative data assessed adherence to the intervention components and study activities, and estimated reach. Qualitative data, collected through semi-structured interviews with 12 purposively selected participants on Days 45 and 90 of enrolment, captured experiences with the intervention and usual care. Thematic analysis was used for qualitative data; descriptive statistics and inferential tests were applied to quantitative data.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The intervention was well implemented: 104 of 106 participants (98.11%) continued the full intervention, with a 100% reach to those enrolled in the trial. Participants showed high adherence to study activities (mean\u2009\u00b1\u2009SD: 88.07\u2009\u00b1\u20099.33 documented days on diaries; 77.97\u2009\u00b1\u200918.87 fasting blood glucose measurements). Intervention reach was 100%. Participants described the intervention as informative, easy to follow, and helpful in avoiding hypoglycaemia and the side-effects of antidiabetic medications. Key facilitators included trust in pharmacists, altruism, and social support. Reported barriers were people\u2019s health status, age-related conditions, and stress.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>This process evaluation highlights the SUGAR Handshake\u2019s potential for broader implementation and scale-up. By addressing identified barriers, future educational interventions may enhance adherence, improve patient outcomes, and advance hypoglycaemia management in diabetes care.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Trial registration<\/jats:title>\n            <jats:p>Clinicaltrials.gov (NCT04081766), registration date 4,920,219.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12877-025-06361-2","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T09:28:24Z","timestamp":1759310904000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The SUGAR handshake intervention to prevent hypoglycaemia in elderly people with type 2 diabetes: process evaluation within a pragmatic randomised controlled trial"],"prefix":"10.1186","volume":"25","author":[{"given":"Huda Y.","family":"Almomani","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen M.","family":"Ayre","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard A.","family":"Powell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keivan","family":"Armani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"issue":"10397","key":"6361_CR1","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/S0140-6736(23)01301-6","volume":"402","author":"KL Ong","year":"2023","unstructured":"Ong KL, Stafford LK, McLaughlin SA, Boyko EJ, Vollset SE, Smith AE, et al. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the global burden of disease study 2021. Lancet. 2023;402(10397):203\u201334.","journal-title":"Lancet"},{"issue":"4","key":"6361_CR2","doi-asserted-by":"publisher","first-page":"894","DOI":"10.2337\/dc12-0916","volume":"36","author":"PF Hsu","year":"2013","unstructured":"Hsu PF, Sung SH, Cheng HM, Yeh JS, Liu WL, Chan WL, et al. Association of Clinical Symptomatic Hypoglycemia With Cardiovascular Events and Total Mortality in Type 2 Diabetes: A nationwide population-based study. Diabetes Care. 2013;36(4):894\u2013900. Available from: Cited 2023 Sep 20. https:\/\/doi.org\/10.2337\/dc12-0916","journal-title":"Diabetes Care."},{"issue":"6","key":"6361_CR3","doi-asserted-by":"publisher","first-page":"S133","DOI":"10.1016\/j.jval.2024.03.711","volume":"27","author":"A Naser","year":"2024","unstructured":"Naser A, Qadus S, AlOsaimi HM, AlFayez A, Huwayshil Hbin, La AH, et al. EE415 cost of hypoglycemia among hospitalized patients with diabetes mellitus. Value Health. 2024;27(6):S133.","journal-title":"Value Health"},{"issue":"4","key":"6361_CR4","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1080\/00325481.2019.1578590","volume":"131","author":"J Freeman","year":"2019","unstructured":"Freeman J. Management of hypoglycemia in older adults with type 2 diabetes. Postgrad Med. 2019;131(4):241\u201350.","journal-title":"Postgrad Med"},{"issue":"4","key":"6361_CR5","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1007\/s00125-017-4334-z","volume":"61","author":"A Iqbal","year":"2018","unstructured":"Iqbal A, Heller SR. The role of structured education in the management of hypoglycaemia. Diabetologia. 2018;61(4):751\u201360.","journal-title":"Diabetologia"},{"key":"6361_CR6","doi-asserted-by":"publisher","first-page":"106683","DOI":"10.1016\/j.cct.2022.106683","volume":"114","author":"D Nguyen","year":"2022","unstructured":"Nguyen D, Mika G, Ninh A. Age-based exclusions in clinical trials: A review and new perspectives. Contemp Clin Trials. 2022;114:106683 Available from: https:\/\/www.sciencedirect.com\/science\/article\/pii\/S155171442200009X. Cited 2023 Sep 20. .","journal-title":"Contemp Clin Trials."},{"issue":"2","key":"6361_CR7","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1016\/j.sapharm.2022.09.017","volume":"19","author":"HY Almomani","year":"2023","unstructured":"Almomani HY, Pascual CR, Grassby P, Ahmadi K. Effectiveness of the SUGAR intervention on hypoglycaemia in elderly patients with type 2 diabetes: A pragmatic randomised controlled trial. Res Soc Adm Pharm. 2023;19(2):322\u201331 Available from: https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1551741122003345.\u00a0Cited 2023 Jun 4 .","journal-title":"Res Soc Adm Pharm."},{"key":"6361_CR8","doi-asserted-by":"publisher","first-page":"h2147","DOI":"10.1136\/bmj.h2147","volume":"350","author":"K Loudon","year":"2015","unstructured":"Loudon K, Treweek S, Sullivan F, Donnan P, Thorpe KE, Zwarenstein M. The PRECIS-2 tool: designing trials that are fit for purpose. BMJ. 2015;350:h2147 Available from: http:\/\/www.bmj.com\/content\/350\/bmj.h2147.\u00a0Cited 2021 Mar 4 .","journal-title":"BMJ."},{"key":"6361_CR9","doi-asserted-by":"publisher","first-page":"h1258","DOI":"10.1136\/bmj.h1258","volume":"350","author":"GF Moore","year":"2015","unstructured":"Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, et al. Process evaluation of complex interventions: medical research council guidance. BMJ. 2015;350:h1258.","journal-title":"BMJ"},{"key":"6361_CR10","unstructured":"NIHR. NIHR publishes new framework on complex interventions to improve health. 2021 . Available from: https:\/\/www.nihr.ac.uk\/news\/nihr-publishes-new-framework-on-complex-interventions-to-improve-health\/28803.\u00a0Cited 2023 Sep 20."},{"issue":"4","key":"6361_CR11","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1177\/1557988317701783","volume":"11","author":"EJ Aguiar","year":"2017","unstructured":"Aguiar EJ, Morgan PJ, Collins CE, Plotnikoff RC, Young MD, Callister R. Process evaluation of the type 2 diabetes mellitus PULSE program randomized controlled trial: recruitment, engagement, and overall satisfaction. Am J Mens Health. 2017;11(4):1055\u201368.","journal-title":"Am J Mens Health"},{"issue":"1","key":"6361_CR12","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1186\/s13063-016-1379-0","volume":"17","author":"A S\u00e1nchez","year":"2016","unstructured":"S\u00e1nchez A, Silvestre C, Campo N, Grandes G, on behalf of the PreDE research group. Type-2 diabetes primary prevention program implemented in routine primary care: a process evaluation study. Trials. 2016;17(1):254.","journal-title":"Trials"},{"issue":"3","key":"6361_CR13","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1007\/s12529-014-9445-z","volume":"22","author":"A Ramadas","year":"2015","unstructured":"Ramadas A, Chan CKY, Oldenburg B, Hussien Z, Quek KF. A web-based dietary intervention for people with type 2 diabetes: development, implementation, and evaluation. Int J Behav Med. 2015;22(3):365\u201373.","journal-title":"Int J Behav Med"},{"issue":"4","key":"6361_CR14","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1177\/0145721709335006","volume":"35","author":"K Lorig","year":"2009","unstructured":"Lorig K, Ritter PL, Villa FJ, Armas J. Community-based peer-led diabetes self-management. Diabetes Educ. 2009;35(4):641\u201351.","journal-title":"Diabetes Educ"},{"issue":"2","key":"6361_CR15","doi-asserted-by":"publisher","first-page":"154","DOI":"10.4093\/dmj.2015.39.2.154","volume":"39","author":"YM Yong","year":"2015","unstructured":"Yong YM, Shin KM, Lee KM, Cho JY, Ko SH, Yoon MH, et al. Intensive individualized reinforcement education is important for the prevention of hypoglycemia in patients with type 2 diabetes. Diabetes Metab J. 2015;39(2):154\u201363.","journal-title":"Diabetes Metab J"},{"issue":"9","key":"6361_CR16","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1111\/j.1464-5491.2006.01906.x","volume":"23","author":"TA Deakin","year":"2006","unstructured":"Deakin TA, Cade JE, Williams R, Greenwood DC. Structured patient education: the diabetes X-PERT programme makes a difference. Diabet Med. 2006;23(9):944\u201354.","journal-title":"Diabet Med"},{"issue":"8","key":"6361_CR17","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1111\/dme.13346","volume":"34","author":"N Hermanns","year":"2017","unstructured":"Hermanns N, Ehrmann D, Schall S, Maier B, Haak T, Kulzer B. The effect of an education programme (MEDIAS 2 BSC) of non-intensive insulin treatment regimens for people with type 2 diabetes: a randomized, multi-centre trial. Diabet Med. 2017;34(8):1084\u201391.","journal-title":"Diabet Med"},{"issue":"4","key":"6361_CR18","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1093\/ageing\/afp056","volume":"38","author":"AK Braun","year":"2009","unstructured":"Braun AK, Kubiak T, Kuntsche J, Meier-H\u00f6fig M, M\u00fcller UA, Feucht I, et al. SGS: a structured treatment and teaching programme for older patients with diabetes mellitus\u2014a prospective randomised controlled multi-centre trial. Age Ageing. 2009;38(4):390\u20136 Available from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2699189\/.\u00a0Cited 2021 Nov 1] .","journal-title":"Age Ageing."},{"issue":"4","key":"6361_CR19","doi-asserted-by":"publisher","first-page":"236","DOI":"10.2337\/diaspect.26.4.236","volume":"26","author":"M Reaney","year":"2013","unstructured":"Reaney M, Zorzo EG, Golay A, Hermanns N, Cleall S, Petzinger U, et al. Impact of Conversation Map\u2122 Education Tools Versus Regular Care on Diabetes-Related Knowledge of People With Type 2 Diabetes: A Randomized. Controlled Study Diabetes Spectr. 2013;26(4):236\u201345 Available from: https:\/\/spectrum.diabetesjournals.org\/content\/26\/4\/236.\u00a0Cited 2021 Nov 2 .","journal-title":"Controlled Study. Diabetes Spectr."},{"issue":"5","key":"6361_CR20","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1016\/j.sapharm.2020.07.012","volume":"17","author":"HY Almomani","year":"2021","unstructured":"Almomani HY, Pascual CR, Al-Azzam SI, Ahmadi K. Randomised controlled trial of pharmacist-led patient counselling in controlling hypoglycaemic attacks in older adults with type 2 diabetes mellitus (ROSE-ADAM): A study protocol of the SUGAR intervention. Res Soc Adm Pharm. 2021;17(5):885\u201393 Available from: https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1551741120308354.\u00a0Cited 2021 Dec 29 .","journal-title":"Res Soc Adm Pharm."},{"issue":"6","key":"6361_CR21","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","volume":"19","author":"A Tong","year":"2007","unstructured":"Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349\u201357. https:\/\/doi.org\/10.1093\/intqhc\/mzm042.","journal-title":"Int J Qual Health Care"},{"issue":"10","key":"6361_CR22","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1080\/08870440903194015","volume":"25","author":"JJ Francis","year":"2010","unstructured":"Francis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, et al. What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health. 2010;25(10):1229\u201345.\u00a0Available from:\u00a0https:\/\/doi.org\/10.1080\/08870440903194015. Cited 2024 Jan 29.","journal-title":"Psychol Health."},{"issue":"4","key":"6361_CR23","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1007\/s11135-017-0574-8","volume":"52","author":"B Saunders","year":"2018","unstructured":"Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893\u2013907.","journal-title":"Qual Quant"},{"key":"6361_CR24","unstructured":"QSR International Pty Ltd. Qualitative Data Analysis Software | NVivo. 2020. Available from: https:\/\/www.qsrinternational.com\/nvivo-qualitative-data-analysis-software\/home.\u00a0Cited 2020 Apr 17."},{"issue":"4","key":"6361_CR25","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1111\/j.1464-5491.2004.01449.x","volume":"22","author":"G Reach","year":"2005","unstructured":"Reach G. Role of habit in adherence to medical treatment. Diabet Med. 2005;22(4):415\u201320.","journal-title":"Diabet Med"},{"issue":"1","key":"6361_CR26","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-019-0744-9","volume":"19","author":"S Potthoff","year":"2019","unstructured":"Potthoff S, Presseau J, Sniehotta FF, Breckons M, Rylance A, Avery L. Exploring the role of competing demands and routines during the implementation of a self-management tool for type 2 diabetes: a theory-based qualitative interview study. BMC Med Inform Decis Mak. 2019;19(1):23.","journal-title":"BMC Med Inform Decis Mak"},{"issue":"4","key":"6361_CR27","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1016\/j.dsx.2014.09.001","volume":"9","author":"RA Wishah","year":"2015","unstructured":"Wishah RA, Al-Khawaldeh OA, Albsoul AM. Impact of pharmaceutical care interventions on glycemic control and other health-related clinical outcomes in patients with type 2 diabetes: randomized controlled trial. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2015;9(4):271\u20136.","journal-title":"Diabetes & Metabolic Syndrome: Clinical Research & Reviews"},{"issue":"5","key":"6361_CR28","first-page":"573","volume":"23","author":"EI Korcegez","year":"2017","unstructured":"Korcegez EI, Sancar M, Demirkan K. Effect of a pharmacist-led program on improving outcomes in patients with type 2 diabetes mellitus from Northern Cyprus: a randomized controlled trial. J Manag Care Spec Pharm. 2017;23(5):573\u201382.","journal-title":"J Manag Care Spec Pharm"},{"issue":"2","key":"6361_CR29","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1080\/13548506.2016.1147055","volume":"22","author":"YC Kueh","year":"2017","unstructured":"Kueh YC, Morris T, Ismail AAS. The effect of diabetes knowledge and attitudes on self-management and quality of life among people with type 2 diabetes. Psychol Health Med. 2017;22(2):138\u201344. https:\/\/doi.org\/10.1080\/13548506.2016.1147055.","journal-title":"Psychol Health Med"},{"issue":"9","key":"6361_CR30","doi-asserted-by":"publisher","first-page":"11304","DOI":"10.3390\/ijerph120911304","volume":"12","author":"X Luo","year":"2015","unstructured":"Luo X, Liu T, Yuan X, Ge S, Yang J, Li C, et al. Factors Influencing Self-Management in Chinese Adults with Type 2 Diabetes: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2015;12(9):11304\u201327 Available from: https:\/\/www.mdpi.com\/1660-4601\/12\/9\/11304.\u00a0Cited 2021 Dec 3 .","journal-title":"Int J Environ Res Public Health."},{"issue":"1","key":"6361_CR31","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-018-5114-5","volume":"18","author":"SJ Sebire","year":"2018","unstructured":"Sebire SJ, Toumpakari Z, Turner KM, Cooper AR, Page AS, Malpass A, et al. I\u2019ve made this my lifestyle now: a prospective qualitative study of motivation for lifestyle change among people with newly diagnosed type two diabetes mellitus. BMC Public Health. 2018;18(1):204.","journal-title":"BMC Public Health"},{"issue":"3","key":"6361_CR32","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/j.jsps.2018.01.013","volume":"26","author":"AS Jarab","year":"2018","unstructured":"Jarab AS, Mukattash TL, Al-Azayzih A, Khdour M. A focus group study of patient\u2019s perspective and experiences of type 2 diabetes and its management in Jordan. Saudi Pharm J. 2018;26(3):301\u20135.","journal-title":"Saudi Pharm J"},{"issue":"1","key":"6361_CR33","doi-asserted-by":"publisher","DOI":"10.1186\/s40900-016-0050-y","volume":"2","author":"S Estcourt","year":"2016","unstructured":"Estcourt S, Epton J, Epton T, Vaidya B, Daly M. Exploring the motivations of patients with type 2 diabetes to participate in clinical trials: a qualitative analysis. Res Involv Engagem. 2016;2(1):34. https:\/\/doi.org\/10.1186\/s40900-016-0050-y.","journal-title":"Res Involv Engagem"},{"issue":"4","key":"6361_CR34","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1080\/23294515.2014.910282","volume":"5","author":"C Geppert","year":"2014","unstructured":"Geppert C, Candilis P, Baker S, Lidz C, Appelbaum P, Fletcher K. Motivations of patients with diabetes to participate in research. AJOB Empir Bioeth. 2014;5(4):14\u201321. https:\/\/doi.org\/10.1080\/23294515.2014.910282.","journal-title":"AJOB Empir Bioeth"},{"key":"6361_CR35","doi-asserted-by":"crossref","unstructured":"Mann C, Anderson C, Boyd M, Karsan Y, Emerson T. Perspectives of pharmacists in general practice from qualitative focus groups with patients during a pilot study. BJGP Open. ;6(2):BJGPO.2021.0112. Available from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC9447328\/.\u00a0Cited 2023 Sep 24.","DOI":"10.3399\/BJGPO.2021.0112"},{"issue":"3","key":"6361_CR36","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1016\/j.jsps.2020.01.001","volume":"28","author":"E Gogazeh","year":"2020","unstructured":"Gogazeh E. Dispensing errors and self-medication practice observed by community pharmacists in Jordan. Saudi Pharm J. 2020;28(3):233\u20137 Available from: http:\/\/www.sciencedirect.com\/science\/article\/pii\/S1319016420300025.\u00a0Cited 2020 Dec 9 .","journal-title":"Saudi Pharm J."},{"issue":"1","key":"6361_CR37","doi-asserted-by":"publisher","first-page":"1","DOI":"10.35516\/jjps.v16i1.1030","volume":"16","author":"N Amara","year":"2023","unstructured":"Amara N, Naser AY, Taybeh EO. Patient satisfaction with pharmaceutical services in Jordan: a cross-sectional study. Jordan J Pharm Sci. 2023;16(1):1\u201310.","journal-title":"Jordan J Pharm Sci"},{"issue":"1","key":"6361_CR38","first-page":"18","volume":"15","author":"G Lovely","year":"2019","unstructured":"Lovely G, Pr DK, Y L. Factors determining the success of therapeutic lifestyle interventions in Diabetes - Role of partner and family support. Eur Endocrinol. 2019;15(1):18\u201324.","journal-title":"Eur Endocrinol"},{"issue":"3","key":"6361_CR39","doi-asserted-by":"publisher","DOI":"10.3390\/bs7030062","volume":"7","author":"RA Pamungkas","year":"2017","unstructured":"Pamungkas RA, Chamroonsawasdi K, Vatanasomboon PA. Systematic review. Family support integrated with diabetes self-management among uncontrolled type II diabetes mellitus patients. Behav Sci. 2017;7(3):62.","journal-title":"Behav Sci"},{"issue":"3","key":"6361_CR40","doi-asserted-by":"publisher","first-page":"245","DOI":"10.2337\/ds18-0033","volume":"31","author":"E Leung","year":"2018","unstructured":"Leung E, Wongrakpanich S, Munshi MN. Diabetes management in the elderly. Diabetes Spectr. 2018;31(3):245\u201353.","journal-title":"Diabetes Spectr"},{"key":"6361_CR41","doi-asserted-by":"crossref","unstructured":"American Diabetes Association. 12. Older Adults: Standards of Medical Care in Diabetes\u20142021. Diabetes Care. 2021;44(1):S168\u201379. Available from: https:\/\/care.diabetesjournals.org\/content\/44\/Supplement_1\/S168.\u00a0Cited 2021 Apr 9","DOI":"10.2337\/dc21-S012"},{"issue":"5","key":"6361_CR42","doi-asserted-by":"publisher","first-page":"696","DOI":"10.4103\/ijem.IJEM_579_17","volume":"22","author":"S Kalra","year":"2018","unstructured":"Kalra S, Jena BN, Yeravdekar R. Emotional and psychological needs of people with diabetes. Indian J Endocrinol Metab. 2018;22(5):696\u2013704.","journal-title":"Indian J Endocrinol Metab"},{"issue":"7","key":"6361_CR43","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1037\/a0040388","volume":"71","author":"JS Gonzalez","year":"2016","unstructured":"Gonzalez JS, Tanenbaum ML, Commissariat PV. Psychosocial Factors in Medication Adherence and Diabetes Self-Management: Implications for Research and Practice. Am Psychol. 2016;71(7):539\u201351 Available from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5792162\/.Cited 2020 Dec 8 .","journal-title":"Am Psychol."},{"key":"6361_CR44","doi-asserted-by":"publisher","first-page":"589","DOI":"10.2147\/DMSO.S197159","volume":"12","author":"M Rezaei","year":"2019","unstructured":"Rezaei M, Valiee S, Tahan M, Ebtekar F, Ghanei Gheshlagh R. Barriers of medication adherence in patients with type-2 diabetes: a pilot qualitative study. Diabetes Metab Syndr Obes Targets Ther. 2019;12:589\u201399 Available from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6507070\/. Cited 2020 Dec 8 .","journal-title":"Diabetes Metab Syndr Obes Targets Ther."},{"issue":"8","key":"6361_CR45","doi-asserted-by":"publisher","first-page":"1329","DOI":"10.2337\/dc15-2763","volume":"39","author":"A Cahn","year":"2016","unstructured":"Cahn A, Raz I, Mosenzon O, Leibowitz G, Yanuv I, Rozenberg A, et al. Predisposing Factors for Any and Major Hypoglycemia With Saxagliptin Versus Placebo and Overall: Analysis From the SAVOR-TIMI 53 Trial. Diabetes Care. 2016;39(8):1329\u201337 Available from: https:\/\/care.diabetesjournals.org\/content\/39\/8\/1329.\u00a0Cited 2021 Apr 17 .","journal-title":"Diabetes Care."},{"issue":"1","key":"6361_CR46","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.jcjd.2015.10.004","volume":"40","author":"M Sircar","year":"2016","unstructured":"Sircar M, et al. Review of hypoglycaemia in the older adult: clinical implications and management. Can J Diabetes. 2016;40(1):66\u201372.","journal-title":"Can J Diabetes"},{"issue":"2","key":"6361_CR47","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1007\/s13300-018-0380-x","volume":"9","author":"S Kalra","year":"2018","unstructured":"Kalra S, Sharma SK. Diabetes in the elderly. Diabetes Ther. 2018;9(2):493\u2013500. https:\/\/doi.org\/10.1007\/s13300-018-0380-x.","journal-title":"Diabetes Ther"},{"issue":"1","key":"6361_CR48","doi-asserted-by":"publisher","first-page":"29","DOI":"10.2337\/diaspect.27.1.29","volume":"27","author":"K Stanley","year":"2014","unstructured":"Stanley K. Nutrition Considerations for the Growing Population of Older Adults With Diabetes. Diabetes Spectr Publ Am Diabetes Assoc. 2014;27(1):29\u201336 Available from: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4522893\/.\u00a0Cited 2021 Jan 2 .","journal-title":"Diabetes Spectr Publ Am Diabetes Assoc."}],"container-title":["BMC Geriatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12877-025-06361-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12877-025-06361-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12877-025-06361-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T09:28:27Z","timestamp":1759310907000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgeriatr.biomedcentral.com\/articles\/10.1186\/s12877-025-06361-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":48,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6361"],"URL":"https:\/\/doi.org\/10.1186\/s12877-025-06361-2","relation":{},"ISSN":["1471-2318"],"issn-type":[{"value":"1471-2318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,1]]},"assertion":[{"value":"21 June 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The ethical approval for the process evaluation was obtained together with the parent trial from The Institutional Review Board of King Abdullah University Hospital, Jordan (approval number: 13\/3\/1376) and the Human Research Ethics Committee of the University of Lincoln, United Kingdom (approval number: 2019\u2009\u2212\u20090170). All methods were performed based on this approval and in accordance with the relevant guidelines and regulations.\u00a0Eligible patients were provided with a written participant information sheet and an oral explanation outlining the purpose and details of both the RCT and the process evaluation. They were informed of their right to withdraw consent at any point during the study without any negative consequences. Participants were also assured that their participation would remain anonymous. Those who agreed to take part signed a written consent form. For participants selected for interviews, verbal consent was obtained again by phone at the time of contact. The study was carried out in compliance with the Helsinki Declaration.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Correspondence to Keivan Armani.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Corresponding author"}}],"article-number":"753"}}