Nursing Prehabilitation Intervention Supported With Technology for Vascular Surgery in People With Type 2 Diabetes

Time in Range represents the total time per day that the sensor-measured interstitial glucose concentration is between 3.9 and 10.0 mmol/L assessed with the Freestyle Libre.

TAR represents the total time per day that the sensor-measured interstitial glucose concentration value is above 10.0 mmol/L. The TAR will be calculated with algorithms based on the glucose values assessed with the Freestyle Libre.

TBR represents the total time per day that the sensor-measured interstitial glucose concentration is below 3.9 mmol/L assessed with the Freestyle Libre.

Also called the glucose management indicator (GMI) will be calculated from glucose measurements assessed with the Freestyle Libre using accepted algorithms.

The average glucose values over the past 2 weeks calculated by the freestyle libre,in mmol/l

Glycaemic variability (GV) refers to swings in blood glucose levels. It alludes to blood glucose oscillations that occur throughout the day, including hypoglycemic periods and postprandial increases, as well as blood glucose fluctuations that occur at the same time on different days. The glycaemic variability will be expressed as standard deviation, coefficient of variation, high blood glucose index and low blood glucose index.

Clinical outcomes (infections, use of medication including antibiotics, analgetics, insulin (units) and other blood glucose lowering drugs, ICU days, duration of admission) during hospitalization after the VITAAAL intervention via electronic health record data, checked with the patient.

Glucose-lowering medication usage at the start and end of the intervention via electronic health record data, checked with the patient.

Blood pressure will be measured during baseline visit

Peripheral neuropathy will be evaluated with the touch test as part of regular care. This test is performed by pricking the monofilament under the big, middle and small toes of both feet. If the patient does not feel 2 or more of these pricks, this is diagnosed as having peripheral neuropathy.

HbA1c values are obtained from blood samples that are taken as part of regular care from the patient record.

Physical activity will be assessed using the Fitbit or using the manually entered log-data in the Diameter. Steps per minute assessed with de Fitbit will be used provide information on levels of physical activity. In addition, these data can be used to calculate other activity parameters (e.g., moderate to vigorous physical activity bouts, sedentary behavior, step cadence and peak activity index). To this purpose, scripts in Matlab have previously been developed and tested extensively. Steps per minute and total minutes of moderate to vigorous per week will be used to analyse the intervention effects.

Nutritional behavior will be assessed using the food diary in the Diameter. The Diameter logs (number of days logged, and mean number of logs per day), the eaten products at that time and nutritional components (carbohydrates, fat, protein, sugar and kilocalories). To assess the intervention effects, the mean number of carbohydrates, fat, protein, sugar and kilocalories per day will be used. Patients are asked to fill in the food diary for 4 days each week including 2 days in the weekend, as 4 days are required to be able to measure variety in carbohydrabe intake.

Treatment adherence will be assessed using de Beliefs about Medicines Questionnaire (BMQ). The BMQ consists of 19 items and comprises 2 sections: the BMQ-Specific which assesses representations of medication prescribed for personal use. The score for each subscale is between 5 and 20.

Self-efficacy will be assessed with all 20 items of the Diabetes Management Self-Efficacy scale for patients with T2DM (DMSES) using a 5-point Likert scale (1 probably not - 5 definitely yes).

Self-management using the Patient Activation Measure (PAM) a 100-point quantifiable scale determining patient engagement in healthcare. It is a 13-item instrument which assesses patient (or consumer) self-reported knowledge, skills and confidence for self-management of one's health or chronic condition. Based on the PAM score patients can be classified into 4 categories ranging from more passive patients who perceived to have minimal control (1) to having perceived to being absolutely capable of managing their disease (PAM 4).

Stages of change using the single intem questionnaire Self-Assessment Scales (SAS) Stages of Change. It assess a person's adherence to lifestyle guidelines using 5-point likert scale.

Health-related quality of life using the EQ-5D-5L. The EQ-5D-5L is a generic instrument for describing and valuing health. It defines health in terms of 5 dimensions: mobility, self-care, usual activities, pain/comfort, and anxiety/depression. Each dimension has 5 response categories ranging from no problems (1) to extreme problems (5).

HbA1c values are obtained from blood samples that are taken as part of regular care from the patient record.

total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, liver enzymes and eGFR. Blood data not older than one month before baseline will be used and stored as part of this study if available.

Morning void urine will be used to monitor the presence of potential diabetes related complications such as kidney failure. Patients will collect morning void urine as part of regular care, which will be sent to the laboratory for analysis and storage. Morning void data will be derived from the patient record and used for analysis. Urine not older than one months before baseline will be used and stored as part of this study if available.

Cholesterol values are obtained from blood samples that are taken as part of regular care from the patient record.

eGFR values are obtained from blood samples that are taken as part of regular care from the patient record.

Morning void urine will be used to monitor the presence of potential diabetes related complications such as kidney failure. Patients will collect morning void urine as part of regular care, which will be sent to the laboratory for analysis and storage. Morning void data will be derived from the patient record and used for analysis. Urine not older than one months before baseline will be used and stored as part of this study if available.