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Liew AYL, Holmes-Truscott E, Flatt AJS, Bennett D, Crookston R, Pimkova M, Birtles L, Casey J, Pernet A, Wood RC, Choudhary P, Forbes S, Rutter MK, Rosenthal M, Johnson P, Shaw JAM, Speight J. Characterization of pre-transplant psychosocial burden in an integrated national islet transplant program. Islets 2020; 12:21-31. [PMID: 32815765 PMCID: PMC7527016 DOI: 10.1080/19382014.2020.1736740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The psychological burden experienced by people with diabetes prior to islet transplantation is recognized but has not been studied comprehensively, especially in relation to glycemia. Therefore, we conducted a rigorous pre-operative psychosocial profile of UK islet transplant recipients, and compared groups with higher/lower HbA1 c to test the null hypothesis that pre-transplant hypoglycemia awareness and psychosocial burden would not be related to baseline HbA1 c in this high-risk cohort. Pre-transplant, recipients (n = 44) completed validated hypoglycemia awareness questionnaires and generic/diabetes-specific measures of psychological traits and states. Scores were compared in groups, dichotomized by HbA1 c (≤8% versus >8%). Participants were aged (mean±SD) 53 ± 10 years; 64% were women; with HbA1 c 8.3 ± 1.7%. Median rate of severe hypoglycemia over the preceding 12 months was 13 events/person-year and 90% had impaired awareness of hypoglycemia (Gold/Clarke score ≥4). Participants had elevated fear of hypoglycemia (HFS-II Worry), impaired diabetes-specific quality of life (DQoL) and low generic health status (SF-36; EQ-5D). One quarter reported scores indicating likely anxiety/depression (HAD). Dispositional optimism (LOT-R) and generalized self-efficacy (GSE) were within published 'norms.' Despite negative perceptions of diabetes (including low personal control), participants were confident that islet transplantation would help (BIPQ). Hypoglycemia awareness and psychosocial profile were comparable in lower (n = 24) and higher (n = 20) HbA1 c groups. Islet transplant candidates report sub-optimal generic psychological states (anxiety/depressive symptoms), health status and diabetes-specific psychological states (fear of hypoglycemia, diabetes-specific quality of life). While their generic psychological traits (optimism, self-efficacy) are comparable with the general population, they are highly optimistic about forthcoming transplant. HbA1 c is not a proxy measure of psychosocial burden, which requires the use of validated questionnaires to systematically identify those who may benefit most from psychological assessment and support.
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Affiliation(s)
- Aaron YL Liew
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Anneliese JS Flatt
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Bennett
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Robert Crookston
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Mirka Pimkova
- Institute of Immunity and Transplantation, Royal Free Hospital, London, UK
| | - Linda Birtles
- Manchester Academic Health Science Centre (MAHSC), Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - John Casey
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew Pernet
- Department of Diabetes, School of Life Course Sciences, King’s College London, London, UK
| | - Ruth C Wood
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Pratik Choudhary
- Department of Diabetes, School of Life Course Sciences, King’s College London, London, UK
| | - Shareen Forbes
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
- BHF Centre for Cardiovascular Sciences, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Martin K Rutter
- Manchester Academic Health Science Centre (MAHSC), Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - Miranda Rosenthal
- Institute of Immunity and Transplantation, Royal Free Hospital, London, UK
| | - Paul Johnson
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - James AM Shaw
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- CONTACT James Am Shaw Translational and Clinical Research Institute, Newcastle University, the Medical School, Framlington Place, Newcastle upon TyneNE2 4HH, UK
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
- AHP Research, Hornchurch, UK
- Jane Speight The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne, VIC3000, Australia
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Sakane N, Murata T, Tone A, Kato K, Kimura M, Kawashima S, Sawaki H, Hirota Y, Okada A, Kuroda A, Matsuhisa M, Watanabe T, Suganuma A, Nirengi S, Toyoda M. Development and Validation of the Continuous Subcutaneous Insulin Infusion-Related Quality-of-Life (CSII-QOL) Scale. Diabetes Technol Ther 2020; 22:216-221. [PMID: 31638420 DOI: 10.1089/dia.2019.0216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Continuous subcutaneous insulin infusion (CSII) is associated with improved glycemic control, a reduced incidence of hypoglycemia, and improved quality of life (QOL). To date, however, there has been no QOL scale specific to CSII. The objective of this study was to develop and validate a scale to measure CSII-QOL for people with type 1 diabetes (T1D). Methods: A total of 50 people with T1D aged ≥15 years who used CSII (28% males; age, 47.6 ± 17.0 years; duration of diabetes, 14.7 ± 9.7 years; duration of CSII use, 6.1 ± 3.3 years; HbA1c, 7.4% ± 0.8%) took part in the CSII-QOL study. Twenty-eight potential CSII-QOL items were developed in a combined approach consisting of semistructured patient interviews, expert input, and a literature search. The resulting CSII-QOL was tested for factor analysis, validity, reliability, and influencing factors. Results: The final 25-item questionnaire had a 3-domain structure ("convenience," "social restriction," and "psychological problems"), high internal consistency (Cronbach's alpha = 0.870), and substantial test-retest reliability (intraclass correlation coefficient = 0.65). The CSII-QOL score was correlated negatively with the Problem Areas in Diabetes score. Conclusion: The CSII-QOL is the first CSII-related QOL scale for people with T1D. This short, validated, and reliable instrument might potentially be useful in future clinical studies and routine clinical patient care. Further validation is required to confirm these issues because of the small and potentially biased sample (UMIN-CTR: UMIN000031595).
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Affiliation(s)
- Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute and National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takashi Murata
- Diabetes Center, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Atsuhito Tone
- Diabetes Center, Okayama University Hospital, Okayama, Japan
| | - Ken Kato
- Diabetes Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Moritsugu Kimura
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | | | - Hideaki Sawaki
- Sawaki Internal Medicine and Diabetes Clinic, Osaka, Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Akira Okada
- Department of Internal Medicine, Okada Clinic, Fukuoka, Japan
| | - Akio Kuroda
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Tomokazu Watanabe
- Diabetes Center, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Akiko Suganuma
- Division of Preventive Medicine, Clinical Research Institute and National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shinsuke Nirengi
- Division of Preventive Medicine, Clinical Research Institute and National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masao Toyoda
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
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53
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Speight J, Holmes-Truscott E, Hendrieckx C, Skovlund S, Cooke D. Assessing the impact of diabetes on quality of life: what have the past 25 years taught us? Diabet Med 2020; 37:483-492. [PMID: 31797443 DOI: 10.1111/dme.14196] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2019] [Indexed: 01/06/2023]
Abstract
Over the past 25 years, there has been significant acknowledgement of the importance of assessing the impact of diabetes on quality of life. Yet, despite the development of several diabetes-specific quality of life measures, the challenges we faced in 1995 remain. There is little consensus on the definition of quality of life because of the complexity and subjectivity of the concept. General quality of life comprises several domains of life, and these are highly individualized. Assessing the impact of diabetes on these life domains adds to the complexity. While comprehensive diabetes-specific quality-of-life measures typically increase respondent burden, brief questionnaires may not capture all relevant/important domains. Today, the lack of resolution of these challenges may explain why the impact of diabetes on quality of life is not systematically assessed in research or clinical care. Few researchers report detailed rationales for assessment, there is often a mismatch between the concept of interest and the measure selected, and data are misinterpreted as assessing the impact of diabetes on quality of life when, in reality, related but distinct constructs have been assessed, such as diabetes distress, treatment satisfaction or health status. While significant efforts are being made to increase routine monitoring of psychological well-being and understand the lived experience, no guidelines currently recommend routine clinical assessment of diabetes-specific quality of life, and there is no consensus on which questionnaire(s) to use. The gaps identified in this review need urgent attention, starting with recognition that assessment of diabetes-specific quality of life is as important as biomedical markers, if we are to improve the lives of people with diabetes.
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Affiliation(s)
- J Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - E Holmes-Truscott
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - C Hendrieckx
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - S Skovlund
- Steno Diabetes Centre Northern Denmark, Aalborg University Hospital, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - D Cooke
- School of Health Sciences, University of Surrey, Guildford, UK
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Kim YJ, Jeong IK, Kim SG, Cho DH, Kim CH, Kim CS, Lee WY, Won KC, Cha JH, Lee J, Kim DM. Changes in the Quality of Life in Patients with Type 2 Diabetes Mellitus According to Physician and Patient Behaviors. Diabetes Metab J 2020; 44:91-102. [PMID: 31701689 PMCID: PMC7043976 DOI: 10.4093/dmj.2018.0251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/17/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is the most common chronic metabolic disorder with an increasing prevalence worldwide. According to a previous study, physicians' treatment patterns or patients' behaviors change when they become aware of the risk for cardiovascular (CV) disease in patients with DM. However, there exist controversial reports from previous studies in the impact of physicians' behaviors on the patients' quality of life (QoL) improvements. So we investigate the changes in QoL according to physicians and patients' behavioral changes after the awareness of CV risks in patients with type 2 DM. METHODS Data were obtained from a prospective, observational study where 799 patients aged ≥40 years with type 2 DM were recruited at 24 tertiary hospitals in Korea. Changes in physicians' behaviors were defined as changes in the dose/type of antihypertensive, lipid-lowering, and anti-platelet therapies within 6-month after the awareness of CV risks in patients. Changes in patients' behaviors were based on lifestyle modifications. Audit of Diabetes Dependent Quality of Life comprising 19-life-domains was used. RESULTS The weighted impact score change for local or long-distance journey (P=0.0049), holidays (P=0.0364), and physical health (P=0.0451) domains significantly differed between the two groups; patients whose physician's behaviors changed showed greater improvement than those whose physician's behaviors did not change. CONCLUSION This study demonstrates that changes in physicians' behaviors, as a result of perceiving CV risks, improve QoL in some domains of life in DM patients. Physicians should recognize the importance of understanding CV risks and implement appropriate management.
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Affiliation(s)
- Young Joo Kim
- Outcomes Research/Real World Data Team, Corporate Affairs and Health & Value Division, Pfizer Pharmaceuticals Korea Ltd., Seoul, Korea
| | - In Kyung Jeong
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sin Gon Kim
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dong Hyeok Cho
- Department of Endocrinology and Metabolism, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Chong Hwa Kim
- Department of Endocrine and Metabolism, Sejong General Hospital, Bucheon, Korea
| | - Chul Sik Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Won Young Lee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Chang Won
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Jin Hye Cha
- Outcomes Research/Real World Data Team, Corporate Affairs and Health & Value Division, Pfizer Pharmaceuticals Korea Ltd., Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Doo Man Kim
- Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
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Kurtalic N, Kurtalic S, Salihbegovic EM. Skin Changes in Patients with Diabetes Melitus Type 2 and their Impact on Quality of Life. Mater Sociomed 2020; 32:283-286. [PMID: 33628131 PMCID: PMC7879440 DOI: 10.5455/msm.2020.32.283-286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Changes in the skin can occur as part of a diabetic, metabolic disorder or diabetic complications. Studies have shown that diabetes has an extremely strong negative impact on quality of life, especially diabetes with complications. Aim: Examine the impact of skin changes in patients with type 2 diabetes mellitus on quality of life. Methods: A prospective study analysed the quality of life in 200 respondents with type 2 diabetes mellitus which had diabetes-related skin changes. Subjects were divided into four groups according to the type of skin changes associated with diabetes mellitus. Group 1 consisted of patients which had skin changes with a greater or lesser association with diabetes mellitus, group 2 patients with infections, group 3 patients with cutaneous manifestations of diabetic complications and group 4 patients with allergic reactions to antidiabetic therapy. Quality of life assessment was performed using the Skindex-29 questionnaire, and the Nijsten categorization was used to assess the impact of skin changes in patients with type 2 diabetes mellitus on quality of life. Results: There were (51.95%) respondents in group 1, group 2 (24.02%), group 3 (22.22%) and group 4 (1.8%) respondents. In the scale of emotions in 84 respondents (43.0%) the impact on quality of life was serious, in the scale of symptoms in 96 (48%) was moderate, and in the scale of social and physical functioning 106 (55%) also had a moderate impact on quality of life, as well as in the total score of 94 respondents (47%). There was a statistically significant difference in the scale of social and physical functioning in the presence of skin changes in group 1 (x2 = 7.95; df = 3, p = 0.045) and group 3 (x2 = 12.48, df = 3; p = 0.006), and in the total score of Skindex-29 when it comes to changes in the skin of group 3 (x2 = 7.26, df = 3, p = 0.05). Conclusion: the quality of life in patients with type 2 diabetes mellitus which have skin changes is significantly reduced.
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Affiliation(s)
- Nermina Kurtalic
- Cantonal Hospital "Dr Irfan Ljubijankic" Bihac, Bosnia and Herzegovina
| | - Sadat Kurtalic
- Cantonal Hospital "Dr Irfan Ljubijankic" Bihac, Bosnia and Herzegovina
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Palamenghi L, Carlucci MM, Graffigna G. Measuring the Quality of Life in Diabetic Patients: A Scoping Review. J Diabetes Res 2020; 2020:5419298. [PMID: 32566680 PMCID: PMC7261342 DOI: 10.1155/2020/5419298] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/10/2020] [Accepted: 04/25/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Diabetes mellitus is a widely diffused chronic condition which impacts on several aspects of patients' lives. In the current clinical practice, the implementation in the clinical routine of monitoring systems of patients' outcomes has led to an increased generation and use of several measures for the assessment of patients' quality of life (QOL). Nevertheless, this construct appears to be particularly complex, and its operationalization is variable across different measures. The purpose of this paper is to offer an updated review of the diabetes-specific QOL measures present in scientific literature with a specific focus on the broad domains assessed. METHODS A scoping review was carried out with the purpose of identifying the existing measures in literature and describing their implicit representation of QOL in diabetes care. Five different databases (Scopus; Web of Science Core Collection; Medline; PsycInfo; and Cochrane Central Register of Controlled Trials) were searched with a string including validation studies of adult-only, diabetes-specific QOL measures. Each measure was then qualified according to its structure, a qualitative assessment of the broad domains of QOL it comprises, and finally an overview of the psychometric properties of its first validation. RESULTS 30 scales were identified and assessed. Theme analysis shows that QOL is operationalized with multidimensional surveys comprising of both mental, physical, and social health components. Some scales also consider the impact of societal attitudes, public policies, and context on QOL. CONCLUSION Several self-report measures of QOL specifically developed for diabetic patients exist in scientific literature. The present scoping review reports scales structure, broad domains of QOL, and development purpose. This may help in understanding the concept of QOL in diabetic patients and may also serve the purpose of guiding the reader in the choice of the most appropriate instrument or in the development of a new one.
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Affiliation(s)
- Lorenzo Palamenghi
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Department of Psychology, Università Cattolica del Sacro Cuore - Milano, Italy
- Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Piacenza, Italy
| | | | - Guendalina Graffigna
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Department of Psychology, Università Cattolica del Sacro Cuore - Milano, Italy
- Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, Piacenza, Italy
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Katsogiannos P, Randell E, Sundbom M, Rosenblad A, Eriksson JW, Leksell J. Quality of life after gastric bypass surgery in patients with type 2 diabetes: patients' experiences during 2 years of follow-up. Diabetol Metab Syndr 2020; 12:90. [PMID: 33062061 PMCID: PMC7552522 DOI: 10.1186/s13098-020-00597-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/01/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND To examine the effects of gastric bypass surgery on health-related quality of life (HRQoL) in obese patients with type 2 diabetes, and to investigate their experiences of life adjustments using quantitative and qualitative methods. METHODS Thirteen patients with type 2 diabetes and obesity, (body mass index, BMI > 30 kg/m2), participating in a randomized clinical trial, completed this sub-study. HRQoL was evaluated before, and at 6 months and 2 years after gastric bypass surgery, using the RAND- 36-item health survey. At 2 years, interviews for in-depth analysis of HRQoL changes were performed. RESULTS Significant improvement was observed from baseline to 6 months for 2 of the eight health concepts, general health, and emotional well-being. At 2 years, improvements were also seen in physical functioning, energy/fatigue, as well as sustained improvements in general health and emotional well-being. Multiple regression analyses showed mostly non-significant associations between the magnitude of decrease in weight, BMI, and HbA1c during follow-up and improvement in HRQoL. The analyses from qualitative interviews supported a common latent theme "Finding a balance between the experience of the new body weight and self-confidence". CONCLUSIONS The improved HRQoL after gastric bypass surgery in obese patients with type 2 diabetes was not explained specifically by the magnitude of weight loss, but rather by the participants achieving a state of union between body and consciousness.Trial registration ClinicalTrials.gov Identifier NCT02729246. Date of registration 6 April 2016 - Retrospectively registered https://clinicaltrials.gov/ct2/show/NCT02729246?term=bariglykos&draw=2&rank=1.
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Affiliation(s)
- Petros Katsogiannos
- Departments of Medical Science, Clinical Diabetes and Metabolism Sciences, Uppsala University, Uppsala, Sweden
| | - Eva Randell
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Andreas Rosenblad
- Departments of Medical Science, Clinical Diabetes and Metabolism Sciences, Uppsala University, Uppsala, Sweden
| | - Jan W. Eriksson
- Departments of Medical Science, Clinical Diabetes and Metabolism Sciences, Uppsala University, Uppsala, Sweden
| | - Janeth Leksell
- Departments of Medical Science, Clinical Diabetes and Metabolism Sciences, Uppsala University, Uppsala, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Albader AS, Albahlei S, Almishary M. Measuring Quality of Life in Type 2 Diabetic Patients at the Al-Wazarat Healthcare Center in Riyadh. Cureus 2019; 11:e6474. [PMID: 31903311 PMCID: PMC6935742 DOI: 10.7759/cureus.6474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The prevalence of type 2 diabetes in the Saudi population is increasing at an alarming level. Diabetes is characterized by a considerable health and economic burden on the population and affected individuals. Objectives This study aims to assess the level of quality of life in type 2 diabetic patients and to investigate the determinant of quality of life in a primary health care setting. Methods The study used a cross-sectional design to investigate the quality of life among type 2 diabetic patients at the Al-Wazarat Health Care Center (WHC) in Riyadh, Saudi Arabia. The study used the Arabic version of the quality of life 36-items short-form questionnaire (SF-36). Results The study included 482 completed questionnaires out of the 525 distributed. The response rate is 91.8%. The average age of the patients is 56.3 ± 7.8 years. The self-reported average body mass index (BMI) is 31.6 ± 6.6 kg/m2. The duration of diabetes since diagnosis is 9.7± 3.1 years. The most common comorbidity was hypertension 75.9% (366/482). The multivariate regression analysis provided models that explained the role of certain variables in determining the quality of life in type 2 diabetic patients significantly. The most striking results are explaining the factors affecting physical functioning by 41% (R2=0.41) and mental health by 34% (R2=0.34). Conclusion This study can influence the practices of medical practice and promotion in WHC specifically and Riyadh city more generally. The improvement and preservation of HRQoL in diabetic patients required an understanding of the factors that can influence it. The gender disparity is an area that needs further investigation. Changes in the delivery of healthcare in diabetes clinics to account for these factors may provide better results.
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Affiliation(s)
| | - Saleh Albahlei
- Family Medicine, Al-Wazarat Health Care Center, Riyadh, SAU
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Chen YT, Tan YZ, Cheen M, Wee HL. Patient-Reported Outcome Measures in Registry-Based Studies of Type 2 Diabetes Mellitus: a Systematic Review. Curr Diab Rep 2019; 19:135. [PMID: 31748944 DOI: 10.1007/s11892-019-1265-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Patient-reported outcome measures (PROMs) and patient registries both play important roles in assessing patient outcomes. However, no study has examined the use of PROMs among registries involving patients with type 2 diabetes mellitus (T2DM). Our objective is twofold: first, to review the range of PROMs used in registry-based studies of patients with T2DM; second, to describe associations between these PROMs, T2DM and its complications. RECENT FINDINGS The International Consortium for Health Outcomes Measurement (ICHOM) Diabetes Standard Set recommended routine usage of PROMs to assess psychological well-being, diabetes distress, and depression among patients with T2DM. A wide variety of PROMs were used among the 15 studies included in this review. Quality of life, depressive symptoms and treatment adherence were the most common aspects of T2DM that utilised PROMs for assessment. Adoption of PROMs among registries of patients with T2DM remains uncommon, non-routine and with few that are validated before use.
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Affiliation(s)
- Yu Ting Chen
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Yan Zhi Tan
- Department of Health Management and Economics, University of Oslo, Kirkeveien 166, Frederik Holsts hus , 0450, Oslo, Norway
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50 , Rotterdam, PA, 3062, Netherlands
| | - Mcvin Cheen
- Danone Asia Pacific Holdings, 1 Wallich Street, #18-01 Guoco Tower, Singapore, 078881, Singapore
- Medicine Academic Clinical Programme, Duke-NUS Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Hwee-Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore, 117549, Singapore.
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore.
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Lozano-Platonoff A, Contreras-Ruiz J, Dominguez-Cherit J, Cardenas-Sanchez A, Alvarez-Rivero V, Martínez-Regalado JA. Translation, cross-cultural adaptation and validation of the "Cardiff wound impact schedule," a wound-specific quality of life instrument, to the native Spanish of Mexican patients. Int Wound J 2019; 17:167-173. [PMID: 31713315 DOI: 10.1111/iwj.13253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to translate into Mexican Spanish, cross-culturally adapt and validate the wound-specific quality of life (QoL) instrument Cardiff wound impact schedule (CWIS) for Mexican patients. This instrument went through the full linguistic translation process based on the guidelines of Beaton et al (Beaton DE, Bombardier C, Guillemin F, Ferraz MB, Guidelines for the process of cross-cultural adaptation of self-report measures, Spine Phila Pa, 1976, 2000, 318-391). We included a total of 500 patients with chronic leg ulcers. The expert committee evaluated the Face validity and they agreed unanimously that the instrument was adequate to assess the QoL of these patients, covering all relevant areas presented by them. The content validity index obtained was of 0.95. The construct validity demonstrated moderately significant correlations between related sub-scales of CWIS and SF-36 (P = .010 to P < .001). The instrument was able to discriminate between healed and unhealed ulcers. The instrument obtained an overall Cronbach's alpha of .952, corresponding to an excellent internal consistency (.903-.771 alpha range for domains). The CWIS can be appropriately used to assess the health-related QoL of Mexican patients with chronic leg ulcers.
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Affiliation(s)
- Adriana Lozano-Platonoff
- Section of Wound and Ostomy Care Center. Division of Dermatology, "Dr. Manuel Gea González" General Hospital, Mexico City, Mexico
| | - Jose Contreras-Ruiz
- Section of Wound and Ostomy Care Center. Division of Dermatology, "Dr. Manuel Gea González" General Hospital, Mexico City, Mexico
| | - Judith Dominguez-Cherit
- Section of Wound and Ostomy Care Center. Division of Dermatology, "Dr. Manuel Gea González" General Hospital, Mexico City, Mexico.,Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Andrea Cardenas-Sanchez
- Section of Wound and Ostomy Care Center. Division of Dermatology, "Dr. Manuel Gea González" General Hospital, Mexico City, Mexico
| | - Valeria Alvarez-Rivero
- Section of Wound and Ostomy Care Center. Division of Dermatology, "Dr. Manuel Gea González" General Hospital, Mexico City, Mexico
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Diabetes mellitus y trabajo. Valoración y revisión de cuestionarios. ENDOCRINOL DIAB NUTR 2019; 66:520-527. [DOI: 10.1016/j.endinu.2019.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 11/18/2022]
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Hendrieckx C, Ivory N, Singh H, Frier BM, Speight J. Impact of severe hypoglycaemia on psychological outcomes in adults with Type 2 diabetes: a systematic review. Diabet Med 2019; 36:1082-1091. [PMID: 31271669 DOI: 10.1111/dme.14067] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2019] [Indexed: 12/25/2022]
Abstract
AIM Hypoglycaemia affects many people with Type 2 diabetes using insulin and other glucose-lowering therapies. This systematic review examined the impact of severe hypoglycaemia (episodes requiring external assistance) on psychological outcomes (e.g. emotional well-being, health status and quality of life) in adults with Type 2 diabetes. METHODS MEDLINE Complete, PsycINFO and CINAHL databases were searched for peer-reviewed empirical studies, published in English, reporting the occurrence and severity of hypoglycaemia and its relationship with patient-reported outcomes (PROs) in adults with Type 2 diabetes. Data were extracted from published reports and analysed. RESULTS Of 3756 potentially relevant abstracts, 29 studies met the inclusion criteria. Most reported cross-sectional data and sample sizes varied widely (N = 71 to 17 563). Although definitions of mild and severe hypoglycaemia were largely consistent between studies, additional non-standard categorizations (e.g. moderate, very severe) were apparent and recall periods varied. Overall, severe hypoglycaemia was associated with increased fear of hypoglycaemia and decreased emotional well-being, health status and diabetes-specific quality of life. Effect sizes show that the association with fear of hypoglycaemia was stronger than with general health status. CONCLUSIONS Notwithstanding the limitations of the empirical studies, these findings indicate that severe hypoglycaemia in adults with Type 2 diabetes (insulin- and non-insulin-treated) is associated with impaired psychological outcomes. Healthcare professionals should address the psychological impact of severe hypoglycaemia during clinical consultations, to support individuals to minimize exposure to, and the psychological consequences of, severe hypoglycaemia.
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Affiliation(s)
- C Hendrieckx
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - N Ivory
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - H Singh
- Mary & Dick Allen Diabetes Center, Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA
| | - B M Frier
- The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - J Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
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Skovlund SE, Lichtenberg TH, Hessler D, Ejskjaer N. Can the Routine Use of Patient-Reported Outcome Measures Improve the Delivery of Person-Centered Diabetes Care? A Review of Recent Developments and a Case Study. Curr Diab Rep 2019; 19:84. [PMID: 31420754 DOI: 10.1007/s11892-019-1190-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW In recent years, the recommendation for and use of patient-reported outcome measures (PROMs) in routine diabetes care has significantly increased. We review recent evidence and highlight key opportunities and challenges related to the active clinical use of PROMs to support person-centered diabetes care and focus areas for future research in the area. RECENT FINDINGS Recent pragmatic studies support that integration of multi-dimensional PROMs for diabetes in clinical care as part of a care improvement strategy can be acceptable for and valued by people with diabetes (PWD) and healthcare professionals (HCPs) and may improve multiple aspects of quality of care, including screening, medical care monitoring and decision support, individualization of self-management support and goal-setting, and broader benefits related to active patient participation and person-centred diabetes care. We identify multiple intervention, individual, and care setting characteristics, which influence acceptability, feasibility, implementation, and effectiveness of PROMs in routine care. Recent clinical PROM studies highlight the value of mixed methods research and systematic involvement of PWD, clinicians, and other stakeholders in the design and implementation of questionnaires for patient input in routine diabetes care. We identified a new significant trend towards participatory development of multi-dimensional PROMs with the aim of IT-enabled integration into routine diabetes care to facilitate multiple components of person-centered diabetes care and better clinical, quality of life, and cost outcomes. While results from large-scale randomized controlled studies are still limited, a growing number of pragmatic implementation studies support that user-centric PROM interventions have the potential to facilitate significant improvements in care for PWD.
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Affiliation(s)
- Soren E Skovlund
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000, Aalborg, Denmark.
| | | | - D Hessler
- Family & Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - N Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000, Aalborg, Denmark
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Svedbo Engström M, Leksell J, Johansson UB, Borg S, Palaszewski B, Franzén S, Gudbjörnsdottir S, Eeg-Olofsson K. Health-related quality of life and glycaemic control among adults with type 1 and type 2 diabetes - a nationwide cross-sectional study. Health Qual Life Outcomes 2019; 17:141. [PMID: 31412881 PMCID: PMC6694672 DOI: 10.1186/s12955-019-1212-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/07/2019] [Indexed: 01/04/2023] Open
Abstract
Background Health-related quality of life and glycaemic control are some of the central outcomes in clinical diabetes care and research. The purpose of this study was to describe the health-related quality of life and assess its association with glycaemic control in adults with type 1 and type 2 diabetes in a nationwide setting. Methods In this cross-sectional survey, people with type 1 (n = 2479) and type 2 diabetes (n = 2469) were selected at random without replacement from the Swedish National Diabetes Register. Eligibility criteria were being aged 18–80 years with at least one registered test of glycated haemoglobin (HbA1c) the last 12 months. The generic 36-item Short Form version 2 (SF-36v2) was answered by 1373 (55.4%) people with type 1 diabetes and 1353 (54.8%) with type 2 diabetes. Results Correlation analyses showed weak correlations between scores on the SF-36v2 and glycaemic control for both diabetes types. After the participants were divided into three groups based on their levels of HbA1c, multivariate regression analyses adjusted for demographics, other risk factors and diabetes complications showed that among participants with type 1 diabetes, the high-risk group (≥70 mmol/mol/8.6%) had statistically significantly lower means in five out of eight domains of the SF-36v2 and the mental component summary measure, as compared with the well-controlled group (< 52 mmol/mol/6.9%). Among the participants with type 2 diabetes, the high-risk group had the lowest statistically significantly means in seven domains and both summary measures. Conclusions Among people with type 1 and type 2 diabetes, adults with high-risk HbA1c levels have lower levels of health-related quality of life in most but not all domains of the SF-36v2. This finding was not explained by demographics, other risk factors, or diabetes complications. The weak individual-level correlations between HRQOL scores and levels of glycaemic control argues for the need to not focus exclusively on either HbA1c levels or HRQOL scores but rather on both because both are important parts of a complex, life-long, challenging condition. Electronic supplementary material The online version of this article (10.1186/s12955-019-1212-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Svedbo Engström
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, SE-405 30, Gothenburg, Sweden. .,School of Education, Health and Social Studies, Dalarna University, SE-791 88, Falun, Sweden.
| | - Janeth Leksell
- School of Education, Health and Social Studies, Dalarna University, SE-791 88, Falun, Sweden.,Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Unn-Britt Johansson
- Sophiahemmet University, SE-114 86, Stockholm, Sweden.,Department of Clinical Sciences and Education, Karolinska Institutet, Södersjukhuset, SE-118 83, Stockholm, Sweden
| | - Sixten Borg
- Department of Clinical Sciences in Malmö, Health Economics Unit, Lund University, Medicon Village, SE-223 81, Lund, Sweden
| | - Bo Palaszewski
- Department of Data Management and Analysis, Region Västra Götaland, Gothenburg, Sweden
| | - Stefan Franzén
- , Register Center Västra Götaland, SE-413 45, Gothenburg, Sweden
| | - Soffia Gudbjörnsdottir
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, SE-405 30, Gothenburg, Sweden.,, Register Center Västra Götaland, SE-413 45, Gothenburg, Sweden
| | - Katarina Eeg-Olofsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, SE-405 30, Gothenburg, Sweden.,Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden
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Jain S, Rajshekar K, Aggarwal A, Chauhan A, Gauba VK. Effects of cataract surgery and intra-ocular lens implantation on visual function and quality of life in age-related cataract patients: a systematic review protocol. Syst Rev 2019; 8:204. [PMID: 31409420 PMCID: PMC6693150 DOI: 10.1186/s13643-019-1113-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 07/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cataract is the leading cause of blindness and low vision worldwide. Presently, cataract surgery is the only treatment for cataract and is very effective in restoring sight. In cataract surgery, the natural lens of the eye that becomes clouded is removed and replaced with an artificial intraocular lens. There are multiple techniques for removal of lens as well as many types of intraocular lenses available for implantation. For this reason, it becomes imperative to monitor the impact of different surgical techniques and different intraocular lenses on health-related quality of life (HRQoL) of the patients. This systematic review aims to evaluate HRQoL evidences on effects of different types of cataract surgeries and intraocular lenses on visual function and quality of life in age-related cataract patients. METHOD Databases like Cochrane, EMBASE, SCOPUS, NHS Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA) database, MEDLINE, ClinicalTrials.gov , Current Controlled Trials and World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) will be searched systematically. Two reviewers will independently screen studies using predefined inclusion and exclusion criteria along with the extraction of data, and assessment of methodological quality using a standard checklist. DISCUSSION This systematic review will help in understanding how different types of cataract surgeries and intraocular lenses make a difference on quality of life of age-related cataract patients in terms of visual function and health-related quality of life. As the review attempts to bring together all the cataract-related HRQoL evidences pertaining to different cataract surgical techniques, different intraocular lenses and cataract-related complications, it will also identify gaps in evidence. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018092377.
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Affiliation(s)
- Shalu Jain
- Health Technology Assessment in India, Department of Health Research, Ministry of Health and Family Welfare, Indian Red Cross Society Building, 1, Red Cross Road, New Delhi, 110001 India
| | - Kavitha Rajshekar
- Health Technology Assessment in India, Department of Health Research, Ministry of Health and Family Welfare, Indian Red Cross Society Building, 1, Red Cross Road, New Delhi, 110001 India
| | - Anjana Aggarwal
- Health Technology Assessment in India, Department of Health Research, Ministry of Health and Family Welfare, Indian Red Cross Society Building, 1, Red Cross Road, New Delhi, 110001 India
| | - Akshay Chauhan
- Health Technology Assessment in India, Department of Health Research, Ministry of Health and Family Welfare, Indian Red Cross Society Building, 1, Red Cross Road, New Delhi, 110001 India
| | - Vijay Kumar Gauba
- Health Technology Assessment in India, Department of Health Research, Ministry of Health and Family Welfare, Indian Red Cross Society Building, 1, Red Cross Road, New Delhi, 110001 India
- Indian Council of Medical Research, (ICMR), New Delhi, India
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Lygidakis C, Uwizihiwe JP, Kallestrup P, Bia M, Condo J, Vögele C. Community- and mHealth-based integrated management of diabetes in primary healthcare in Rwanda (D²Rwanda): the protocol of a mixed-methods study including a cluster randomised controlled trial. BMJ Open 2019; 9:e028427. [PMID: 31345971 PMCID: PMC6661689 DOI: 10.1136/bmjopen-2018-028427] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/13/2019] [Accepted: 06/25/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In Rwanda, diabetes mellitus prevalence is estimated between 3.1% and 4.3%. To address non-communicable diseases and the shortage of health workforce, the Rwandan Ministry of Health has introduced the home-based care practitioners (HBCPs) programme: laypeople provide longitudinal care to chronic patients after receiving a six-month training. Leveraging technological mobile solutions may also help improve health and healthcare. The D²Rwanda study aims at: (a) determining the efficacy of an integrated programme for the management of diabetes in Rwanda, which will provide monthly patient assessments by HBCPs, and an educational and self-management mHealth patient tool, and; (b) exploring qualitatively the ways the interventions will have been enacted, their challenges and effects, and changes in the patients' health behaviours and HBCPs' work satisfaction. METHODS AND ANALYSIS This is a mixed-methods sequential explanatory study. First, there will be a one-year cluster randomised controlled trial including two interventions ((1) HBCPs' programme; (2) HBCPs' programme + mobile health application) and usual care (control). Currently, nine hospitals run the HBCPs' programme. Under each hospital, administrative areas implementing the HBCPs' programme will be randomised to receive intervention 1 or 2. Eligible patients from each area will receive the same intervention. Areas without the HBCPs' programme will be assigned to the control group. The primary outcome will be changes in glycated haemoglobin. Secondary outcomes include medication adherence, mortality, complications, health-related quality of life, diabetes-related distress and health literacy. Second, at the end of the trial, focus group discussions will be conducted with patients and HBCPs. Financial support was received from the Karen Elise Jensens Fond, and the Universities of Aarhus and Luxembourg. ETHICS AND DISSEMINATION Ethics approval was obtained from the Rwanda National Ethics Committee and the Ethics Review Panel of the University of Luxembourg. Findings will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT03376607; Pre-results.
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Affiliation(s)
- Charilaos Lygidakis
- Institute for Health and Behaviour – Research Unit INSIDE, Universite du Luxembourg, Esch-sur-Alzette, Luxembourg
- College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
| | - Jean Paul Uwizihiwe
- College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
- Centre for Global Health, Department of Public Health, Aarhus Universitet, Aarhus, Denmark
| | - Per Kallestrup
- Centre for Global Health, Department of Public Health, Aarhus Universitet, Aarhus, Denmark
| | - Michela Bia
- Labor Market, Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette, Luxembourg
| | - Jeanine Condo
- College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
- Rwanda Biomedical Center, Kigali, Rwanda
| | - Claus Vögele
- Institute for Health and Behaviour – Research Unit INSIDE, Universite du Luxembourg, Esch-sur-Alzette, Luxembourg
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Torre C, Guerreiro J, Longo P, Raposo JF, Leufkens H, Martins AP. Health-related quality of life in adults with type 2 diabetes mellitus starting with new glucose lowering drugs: An inception cohort study. Prim Care Diabetes 2019; 13:221-232. [PMID: 30573348 DOI: 10.1016/j.pcd.2018.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/06/2018] [Accepted: 11/15/2018] [Indexed: 01/27/2023]
Abstract
AIMS To assess baseline and change after 26-weeks in health-related quality of life (HRQoL) among adults with type 2 diabetes mellitus (T2DM) initiating one of the new glucose lowering drugs (GLD) in daily practice. METHODS Inception cohort of patients who initiated one of dipeptidyl peptidase 4 inhibitors (DPP-4), glucagon-like peptide-1 analogues (GLP-1) or sodium-glucose cotransporter inhibitors (SGLT2) drugs. A baseline questionnaire collected socio-demographic and self-reported clinical data. HRQoL was assessed by the Euroqol-5D. Participants were divided into: (1) incident new users (INU) (who used for the first time one of the monitored GLD and had no current or prior experience with DPP-4/GLP-1/SGLT2) and (2) prevalent new users (PNU) (who had previously used at least one GLD of the monitored drug classes, but not the inception drug). Multivariate regression explored factors associated with a meaningful change in HRQoL. RESULTS 1303 patients. Over 26weeks, a mean positive change in the EQ-5D scores, were observed. No differences between INU and PNU were found. Participants with worse health conditions (e.g. presence and number of chronic diseases, obese) at baseline were more likely to experience larger improvements in HRQoL. CONCLUSIONS Over 26-weeks, T2DM patients starting with, or switching to new GLD maintained or modestly increased their HRQoL.
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Affiliation(s)
- Carla Torre
- Centre for Health Evaluation & Research (CEFAR), National Association of Pharmacies, Lisboa, Portugal; Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal.
| | - José Guerreiro
- Centre for Health Evaluation & Research (CEFAR), National Association of Pharmacies, Lisboa, Portugal
| | - Patrícia Longo
- Centre for Health Evaluation & Research (CEFAR), National Association of Pharmacies, Lisboa, Portugal
| | - João Filipe Raposo
- Nova Medical School, New University of Lisbon, Lisboa, Portugal; Portuguese Diabetes Association (APDP), Lisboa, Portugal
| | - Hubert Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ana Paula Martins
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal; Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
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Rwegerera GM, Moshomo T, Gaenamong M, Oyewo TA, Gollakota S, Rivera YP, Masaka A, Godman B, Shimwela M, Habte D. Health-related quality of life and associated factors among patients with diabetes mellitus in Botswana. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2017.05.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Godfrey Mutashambara Rwegerera
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, BotswanaFaculty of Medicine, Department of Internal Medicine, University of Botswana, Botswana
- Department of Medicine, Princess Marina Hospital, Gaborone, BotswanaDepartment of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Thato Moshomo
- Scottish Livingstone Hospital, Molepolole, BotswanaScottish Livingstone Hospital, Molepolole, Botswana
| | - Marea Gaenamong
- Department of Accident and Emergency, Princess Marina Hospital, Gaborone, BotswanaDepartment of Accident and Emergency, Princess Marina Hospital, Gaborone, Botswana
| | - Taibat Aderonke Oyewo
- Department of Medicine, Princess Marina Hospital, Gaborone, BotswanaDepartment of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Sivasomnath Gollakota
- Department of Medicine, Princess Marina Hospital, Gaborone, BotswanaDepartment of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Yordanka Piña Rivera
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, BotswanaFaculty of Medicine, Department of Internal Medicine, University of Botswana, Botswana
- Department of Medicine, Princess Marina Hospital, Gaborone, BotswanaDepartment of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Anthony Masaka
- Botho University, Gaborone, BotswanaBotho University, Gaborone, Botswana
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, SwedenDepartment of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United KingdomStrathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Meshack Shimwela
- Amana Municipal Hospital, Dar-es-Salaam, TanzaniaAmana Municipal Hospital, Dar-es-Salaam, Tanzania
| | - Dereje Habte
- Management Sciences for Health (MSH), Addis Ababa, EthiopiaManagement Sciences for Health (MSH), Addis Ababa, Ethiopia
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Holmes-Truscott E, Skovlund SE, Hendrieckx C, Pouwer F, Peyrot M, Speight J. Assessing the perceived impact of diabetes on quality of life: Psychometric validation of the DAWN2 Impact of Diabetes Profile in the second Diabetes MILES - Australia (MILES-2) survey. Diabetes Res Clin Pract 2019; 150:253-263. [PMID: 30880093 DOI: 10.1016/j.diabres.2019.03.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/25/2019] [Accepted: 03/07/2019] [Indexed: 12/14/2022]
Abstract
AIMS To investigate the validity and reliability of the 6-item DAWN2 Impact of Diabetes Profile (DIDP), and the modified 7-item DIDP, which includes assessment of dietary freedom. METHODS The online, cross-sectional, Australian MILES-2 survey included the DIDP and other validated measures, to examine convergent, discriminant and known-groups validity. The DIDP was completed by 2207 adults with diabetes (Type 1: n = 1012; Type 2 insulin: n = 504; non-insulin: n = 691). Data were subjected to exploratory factor analysis, internal consistency reliability and univariate statistics, conducted separately by diabetes type/treatment. RESULTS The DIDP was highly acceptable: 99% completion rate. One-factor solutions were supported for the 6-item and 7-item DIDP scales, in all diabetes type/treatment groups (variance explained range: 6-item: 59-67%, 7-item: 55-62%), with satisfactory internal consistency (α = 0.85-0.90). Known-groups validity was demonstrated, by diabetes type and complications presence/absence, as was satisfactory convergent and discriminant validity. CONCLUSIONS The DIDP meets the need for a brief, contemporary, valid and reliable measure of the perceived impact of diabetes on quality of life, suitable for adults with Type 1 or Type 2 diabetes mellitus. The 6-item and 7-item scales have psychometric equivalence. Use of the seventh item can be informed by research questions.
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Affiliation(s)
- Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia.
| | - Soren E Skovlund
- Steno Diabetes Center North Jutland, Aalborg University Hospital and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia.
| | - Frans Pouwer
- School of Psychology, Deakin University, Geelong, VIC, Australia; Department of Psychology, University of Southern Denmark, Odense M, Denmark.
| | - Mark Peyrot
- Loyola University Maryland, Baltimore, MD, USA
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia; Department of Psychology, University of Southern Denmark, Odense M, Denmark; AHP Research, Hornchurch, Essex, UK.
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Granado-Casas M, Castelblanco E, Ramírez-Morros A, Martín M, Alcubierre N, Martínez-Alonso M, Valldeperas X, Traveset A, Rubinat E, Lucas-Martin A, Hernández M, Alonso N, Mauricio D. Poorer Quality of Life and Treatment Satisfaction is Associated with Diabetic Retinopathy in Patients with Type 1 Diabetes without Other Advanced Late Complications. J Clin Med 2019; 8:jcm8030377. [PMID: 30889868 PMCID: PMC6462963 DOI: 10.3390/jcm8030377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/10/2019] [Accepted: 03/14/2019] [Indexed: 01/27/2023] Open
Abstract
Diabetic retinopathy (DR) may potentially cause vision loss and affect the patient’s quality of life (QoL) and treatment satisfaction (TS). Using specific tools, we aimed to assess the impact of DR and clinical factors on the QoL and TS in patients with type 1 diabetes. This was a cross-sectional, two-centre study. A sample of 102 patients with DR and 140 non-DR patients were compared. The Audit of Diabetes-Dependent Quality of Life (ADDQoL-19) and Diabetes Treatment Satisfaction Questionnaire (DTSQ-s) were administered. Data analysis included bivariate and multivariable analysis. Patients with DR showed a poorer perception of present QoL (p = 0.039), work life (p = 0.037), dependence (p = 0.010), and had a lower average weighted impact (AWI) score (p = 0.045). The multivariable analysis showed that DR was associated with a lower present QoL (p = 0.040), work life (p = 0.036) and dependence (p = 0.016). With regards to TS, DR was associated with a higher perceived frequency of hypoglycaemia (p = 0.019). In patients with type 1 diabetes, the presence of DR is associated with a poorer perception of their QoL. With regard to TS, these subjects also show a higher perceived frequency of hypoglycaemia.
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Affiliation(s)
- Minerva Granado-Casas
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, University of Lleida, 25198 Lleida, Spain.
| | - Esmeralda Castelblanco
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain.
| | - Anna Ramírez-Morros
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
| | - Mariona Martín
- Department of Endocrinology & Nutrition, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
| | - Nuria Alcubierre
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, University of Lleida, 25198 Lleida, Spain.
| | - Montserrat Martínez-Alonso
- Systems Biology and Statistical Methods for Biomedical Research, IRBLleida, University of Lleida, 25198 Lleida, Spain.
| | - Xavier Valldeperas
- Department of Ophthalmology, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
| | - Alicia Traveset
- Department of Ophthalmology, University Hospital Arnau de Vilanova, 25198 Lleida, Spain.
| | - Esther Rubinat
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain.
| | - Ana Lucas-Martin
- Department of Endocrinology & Nutrition, University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
| | - Marta Hernández
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, University of Lleida, 25198 Lleida, Spain.
- Department of Endocrinology & Nutrition, University Hospital Arnau de Vilanova, 25198 Lleida, Spain.
| | - Núria Alonso
- Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, 08916 Badalona, Spain.
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain.
| | - Didac Mauricio
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, University of Lleida, 25198 Lleida, Spain.
- Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, 08907 Barcelona, Spain.
- Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain.
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71
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Jiang X, Wang J, Lu Y, Jiang H, Li M. Self-efficacy-focused education in persons with diabetes: a systematic review and meta-analysis. Psychol Res Behav Manag 2019; 12:67-79. [PMID: 30774486 PMCID: PMC6357887 DOI: 10.2147/prbm.s192571] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIMS The aims of this study were to assess the effectiveness of self-efficacy-focused education on health outcomes in persons with diabetes and review the strategies employed in the interventions. BACKGROUND The traditional educational interventions for persons with diabetes were insufficient to achieve the desired outcomes. Self-efficacy-focused education has been used to regulate the blood sugar level, behaviors, and psychosocial indicators for persons with diabetes. DESIGN This study is a systematic review and meta-analysis. METHODS Studies on the effectiveness of self-efficacy-focused education in persons with diabetes were searched in six databases from inception until January 2018. The data were extracted and the quality of literature was assessed independently. Review Manager 5.3 was applied for the meta-analysis. Besides, the findings were summarized for narrative synthesis. RESULTS Sixteen trials with 1,745 participants were included in the systematic review and ten trails with 1,308 participants in the meta-analysis. The meta-analysis for A1C, self-efficacy, self-management behaviors, knowledge, and quality of life (QOL) were represented in four, six, six, three, and three studies, respectively. The findings indicated that self-efficacy-focused education would probably reduce A1C, enhance self-efficacy, regulate self-management behaviors, increase knowledge, and improve the QOL for patients with diabetes. Weak quality studies, limited participants, and heterogeneity hindered the results pooled of the other secondary outcomes of fasting blood glucose, 2-hour plasma glucose, weight, weight circumference, body mass index, plasma lipid profile, and other psychological indicators. Goal setting, self-management skills practicing and recording, peer models, demonstration, persuasion by health providers, and positive feedback were the most commonly used strategies in the interventions. However, physiological/emotion arousal strategies were relatively less applied and varied significantly. CONCLUSION Individuals with diabetes may benefit a lot from the self-efficacy-focused education. However, insufficient high-quality studies, short-term follow-up period, relatively deficient physiological/emotion strategies, and incomplete outcome assessments were the drawbacks in most studies. Establishing satisfactory self-efficacy-focused education and better evaluating the effects were required in further studies.
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Affiliation(s)
- Xinjun Jiang
- School of Nursing, Peking University, Beijing, China,
- School of International Nursing, Hainan Medical University, Haikou, China
| | - Jingpin Wang
- School of Nursing, Peking University, Beijing, China,
| | - Yanhui Lu
- School of Nursing, Peking University, Beijing, China,
| | - Hua Jiang
- School of Nursing, Peking University, Beijing, China,
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China,
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Levterova BA, Orbetzova M, Levterov G, Dimitrova D, Todorov P. Assessment of the impact of type 2 diabetes on the quality of life by Audit of Diabetes-Dependent Quality-of-Life (ADDQoL-19). BIOTECHNOL BIOTEC EQ 2018. [DOI: 10.1080/13102818.2018.1532319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Boryana Angelova Levterova
- Department of Health Management and Healthcare Economics, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Maria Orbetzova
- Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Georgi Levterov
- Clinic of Endocrinology and Metabolic Diseases, University Hospital “Kaspela” Ltd., Plovdiv, Bulgaria
| | - Donka Dimitrova
- Department of Health Management and Healthcare Economics, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Plamen Todorov
- Department of Propaedeutics of Internal Diseases, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
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Jespersen LN, Michelsen SI, Holstein BE, Tjørnhøj-Thomsen T, Due P. Conceptualization, operationalization, and content validity of the EQOL-questionnaire measuring quality of life and participation for persons with disabilities. Health Qual Life Outcomes 2018; 16:199. [PMID: 30305098 PMCID: PMC6180454 DOI: 10.1186/s12955-018-1024-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 09/21/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Measurement of quality of life demands thoroughly developed and validated instruments. The development steps from theory to concepts and from empirical data to items are sparsely described in the literature of questionnaire development. Furthermore, there seems to be a need for an instrument measuring quality of life and participation in a population with diverse disabilities. The aim of this paper was to present and discuss the initial steps in the development of the Electronic Quality of Life questionnaire (EQOL). METHODS The development of EQOL included six steps: 1) Establishing conceptual understanding; 2) Development of interview guides which build on the conceptual understanding; 3) Qualitative interviews of 55 participants (10-40 years old) with different types and severities of disabilities; 4) Conceptualization of domains identified in the qualitative data through thematic analysis; 5) Operationalization of the identified domains into items and; 6) Evaluation of content validity of the first version of the EQOL-measure. Content validity was examined by cognitive interviews with participants in the target group as well as by continuous feedback from an advisory board. RESULTS We identified six domains (function and health, environment (physical and social), social network, wellbeing, occupation, and managing strategies) based on themes derived from the qualitative interviews and on conceptual discussions within the author group. These domains were incorporated in a conceptual model and items were generated to measure the content of each domain. Participants expressed satisfaction with EQOL but most participants felt that there were too many items. CONCLUSIONS In total, 191 items were included in the questionnaire. Participants felt that the EQOL-questionnaire was relevant to their quality of life and participation. We have shown that it is possible to include quality of life and participation for people with various disabilities in one instrument. Although capturing less detail than a condition specific instrument, EQOL includes aspects perceived important for people with disabilities who are not included in general surveys. This is relevant when for example evaluating environmental adaptations and when comparing populations with various disabilities.
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Affiliation(s)
- Louise Norman Jespersen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Susan Ishøy Michelsen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Bjørn Evald Holstein
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Pernille Due
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
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Murray E, Ross J, Pal K, Li J, Dack C, Stevenson F, Sweeting M, Parrott S, Barnard M, Yardley L, Michie S, May C, Patterson D, Alkhaldi G, Fisher B, Farmer A, O’Donnell O. A web-based self-management programme for people with type 2 diabetes: the HeLP-Diabetes research programme including RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background
In the UK, 6% of the UK population have diabetes mellitus, 90% of whom have type 2 diabetes mellitus (T2DM). Diabetes mellitus accounts for 10% of NHS expenditure (£14B annually). Good self-management may improve health outcomes. NHS policy is to refer all people with T2DM to structured education, on diagnosis, to improve their self-management skills, with annual reinforcement thereafter. However, uptake remains low (5.6% in 2014–15). Almost all structured education is group based, which may not suit people who work, who have family or other caring commitments or who simply do not like group-based formats. Moreover, patient needs vary with time and a single education session at diagnosis is unlikely to meet these evolving needs. A web-based programme may increase uptake.
Objectives
Our aim was to develop, evaluate and implement a web-based self-management programme for people with T2DM at any stage of their illness journey, with the goal of improving access to, and uptake of, self-management support, thereby improving health outcomes in a cost-effective manner. Specific objectives were to (1) develop an evidence-based theoretically informed programme that was acceptable to patients and health-care professionals (HCPs) and that could be readily implemented within routine NHS care, (2) determine the clinical effectiveness and cost-effectiveness of the programme compared with usual care and (3) determine how best to integrate the programme into routine care.
Design
There were five linked work packages (WPs). WP A determined patient requirements and WP B determined HCP requirements for the self-management programme. WP C developed and user-tested the Healthy Living for People with type 2 Diabetes (HeLP-Diabetes) programme. WP D was an individually randomised controlled trial in primary care with a health economic analysis. WP E used a mixed-methods and case-study design to study the potential for implementing the HeLP-Diabetes programme within routine NHS practice.
Setting
English primary care.
Participants
People with T2DM (WPs A, D and E) or HCPs caring for people with T2DM (WPs B, C and E).
Intervention
The HeLP-Diabetes programme; an evidence-based theoretically informed web-based self-management programme for people with T2DM at all stages of their illness journey, developed using participatory design principles.
Main outcome measures
WPs A and B provided data on user ‘wants and needs’, including factors that would improve the uptake and accessibility of the HeLP-Diabetes programme. The outcome for WP C was the HeLP-Diabetes programme itself. The trial (WP D) had two outcomes measures: glycated haemoglobin (HbA1c) level and diabetes mellitus-related distress, as measured with the Problem Areas in Diabetes (PAID) scale. The implementation outcomes (WP E) were the adoption and uptake at clinical commissioning group, general practice and patient levels and the identification of key barriers and facilitators.
Results
Data from WPs A and B supported our holistic approach and addressed all areas of self-management (medical, emotional and role management). HCPs voiced concerns about linkage with the electronic medical records (EMRs) and supporting patients to use the programme. The HeLP-Diabetes programme was developed and user-tested in WP C. The trial (WP D) recruited to target (n = 374), achieved follow-up rates of over 80% and the intention-to-treat analysis showed that there was an additional improvement in HbA1c levels at 12 months in the intervention group [mean difference –0.24%, 95% confidence interval (CI) –0.44% to –0.049%]. There was no difference in overall PAID score levels (mean difference –1.5 points, 95% CI –3.9 to 0.9 points). The within-trial health economic analysis found that incremental costs were lower in the intervention group than in the control group (mean difference –£111, 95% CI –£384 to £136) and the quality-adjusted life-years (QALYs) were higher (mean difference 0.02 QALYs, 95% CI 0.000 to 0.044 QALYs), meaning that the HeLP-Diabetes programme group dominated the control group. In WP E, we found that the HeLP-Diabetes programme could be successfully implemented in primary care. General practices that supported people in registering for the HeLP-Diabetes programme had better uptake and registered patients from a wider demographic than those relying on patient self-registration. Some HCPs were reluctant to do this, as they did not see it as part of their professional role.
Limitations
We were unable to link the HeLP-Diabetes programme with the EMRs or to determine the effects of the HeLP-Diabetes programme on users in the implementation study.
Conclusions
The HeLP-Diabetes programme is an effective self-management support programme that is implementable in primary care.
Future work
The HeLP-Diabetes research team will explore the following in future work: research to determine how to improve patient uptake of self-management support; develop and evaluate a structured digital educational pathway for newly diagnosed people; develop and evaluate a digital T2DM prevention programme; and the national implementation of the HeLP-Diabetes programme.
Trial registration
Research Ethics Committee reference number 10/H0722/86 for WPs A–C; Research Ethics Committee reference number 12/LO/1571 and UK Clinical Research Network/National Institute for Health Research (NIHR) Portfolio 13563 for WP D; and Research Ethics Committee 13/EM/0033 for WP E. In addition, for WP D, the study was registered with the International Standard Randomised Controlled Trial Register as reference number ISRCTN02123133.
Funding details
This project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 6, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jamie Ross
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kingshuk Pal
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jinshuo Li
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Charlotte Dack
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Fiona Stevenson
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Michael Sweeting
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Maria Barnard
- Whittington Hospital, Whittington Health NHS Trust, London, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
| | - Susan Michie
- Centre for Behaviour Change, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Carl May
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - David Patterson
- Whittington Hospital, Whittington Health NHS Trust, London, UK
| | - Ghadah Alkhaldi
- Research Department of Primary Care and Population Health, University College London, London, UK
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Brian Fisher
- Patient Access to Electronic Records Systems Ltd (PAERS), Evergreen Life, Manchester, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Orla O’Donnell
- Research Department of Primary Care and Population Health, University College London, London, UK
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Jorgetto JV, Franco LJ. The impact of diabetes mellitus on quality of life - differences between genders. J Diabetes Metab Disord 2018; 17:11-17. [PMID: 30288381 PMCID: PMC6154518 DOI: 10.1007/s40200-018-0333-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/18/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether there are gender differences in the impact of the disease in the quality of life of individuals with Diabetes Mellitus type 2. METHODS The sample consisted of 192 individuals distributed in equal numbers by gender. Data were collected between the months of August 2013 to May 2014, by sociodemographic and clinical questionnaires and instruments for assessing quality of life (PAID) and adherence to treatment. RESULTS The age of the patients ranged from 30 to 80 years old with a mean of 61 years of age (± 11). B-PAID scores were higher in men except in issues related to social support, but the differences were not statistically significant; 51.7% of the patients with good adherence to treatment were women and 48.3% were men. CONCLUSIONS The perception of the impact of diabetes in the quality of life of individuals in the present study, measured by the B-PAID instrument, showed that the highest scores predominate in men, that is, they have a higher degree of emotional distress than women. In the group with good adherence to treatment, there is a greater number of individuals with higher PAID scores, especially in men. In the group with poor adherence to treatment, the number of individuals with a high degree of emotional distress was similar in both sexes. This research was approved by the Research Ethics Committee of UNIFESP, through Plataforma Brasil (Protocol number 103,384).
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Affiliation(s)
- Juliana Vallim Jorgetto
- Post Graduate Program in Clinical Encocrinology - Federal University of São Paulo - UNIFESP, São Paulo, Brazil
- Salvador, Brazil
| | - Laercio Joel Franco
- Post Graduate Program in Clinical Encocrinology - Federal University of São Paulo - UNIFESP, São Paulo, Brazil
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Behzadifar M, Sohrabi R, Mohammadibakhsh R, Salemi M, Moghadam ST, Taheri Mirghaedm M, Behzadifar M, Baradaran HR, Bragazzi NL. General health status in Iranian diabetic patients assessed by short-form-36 questionnaire: a systematic review and meta-analysis. BMC Endocr Disord 2018; 18:34. [PMID: 29855368 PMCID: PMC5984362 DOI: 10.1186/s12902-018-0262-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/22/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diabetes mellitus is one of the most prevalent diseases worldwide. Diabetes is a chronic disease associated with micro- and macro-vascular complications and deterioration in general health status. Therefore, the aim of this study was to estimate general health status among Iranian diabetic patients through a systematic review and meta-analysis of study utilizing the Short-Form-36 questionnaire. METHODS Searching the EMBASE, PubMed, ISI/Web of Sciences (WOS), MEDLINE via Ovid, PsycoINFO, as well as Iranian databases (MagIran, Iranmedex, and SID) from January 2000 to December 2017. The methodological quality of the studies was evaluated using the "A Cochrane Risk of Bias Assessment Tool: for Non-Randomized Studies of Interventions" (ACROBAT-NRSI). Random-effect model was used and the means were reported with their 95% confidence interval (CI). To evaluate the heterogeneity between studies, I2 test was used. Egger's regression test was used to assess the publication bias. RESULTS Fourteen studies were retained in the final analysis. The mean general health status using SF-36 in diabetic patients of Iran was 51.9 (95% CI: 48.64 to 53.54). The mean physical component summary was 52.92 [95% CI: 49.46-56.38], while the mean mental component summary was 51.02 [95% CI: 46.87-55.16]. CONCLUSION The findings of this study showed that general health status in Iranian diabetic patients is low. Health policymakers should work to improve the health status in these patients and take appropriate interventions.
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Affiliation(s)
- Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Rahim Sohrabi
- Iranian Social Security Organization, Zanjan Province Health Administration, Zanjan, Iran
| | - Roghayeh Mohammadibakhsh
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Salemi
- Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Sharare Taheri Moghadam
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Masood Taheri Mirghaedm
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Meysam Behzadifar
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Endocrine Research Center Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Use of Diabetes Treatment Satisfaction Questionnaire in Diabetes Care: Importance of Patient-Reported Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15050947. [PMID: 29747423 PMCID: PMC5981986 DOI: 10.3390/ijerph15050947] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 02/07/2023]
Abstract
The efficacy of diabetes treatment should not be evaluated solely by HbA1c levels as they should also focus on patient-reported outcomes (PROs), such as patient satisfaction, wellbeing and quality of life. The Diabetes Treatment Satisfaction Questionnaire (DTSQ) has been developed to assess patient satisfaction with diabetes treatment. DTSQ has been translated into more than 100 languages and is widely used in many countries, since it is relatively easy to answer and is used for both patients with and without medical therapy. Novel therapeutic options, such as insulin analogs, incretin-based therapy and sodium-glucose cotransporter 2 (SGLT2) inhibitors, have been shown to improve patient satisfaction using DTSQ for assessments. DTSQ is not only used for comparisons between different medications or treatment strategies, but also can be used to assess the quality of diabetes care in clinical settings. This is important as an improvement in treatment satisfaction may enhance patients’ self-efficacy and adherence to therapy, leading to the achievement of long-term stable glycemic control and reduced risk of diabetic complications. In this review, we summarize the current topics in DTSQ, introducing our own experience, and discuss the role of PROs in diabetes treatment.
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78
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Finch AP, Brazier JE, Mukuria C. What is the evidence for the performance of generic preference-based measures? A systematic overview of reviews. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:557-570. [PMID: 28560520 PMCID: PMC5913394 DOI: 10.1007/s10198-017-0902-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 05/18/2017] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To assess the evidence on the validity and responsiveness of five commonly used preference-based instruments, the EQ-5D, SF-6D, HUI3, 15D and AQoL, by undertaking a review of reviews. METHODS Four databases were investigated using a strategy refined through a highly sensitive filter for systematic reviews. References were screened and a search for grey literature was performed. Identified citations were scrutinized against pre-defined eligibility criteria and data were extracted using a customized extraction template. Evidence on known group validity, convergent validity and responsiveness was extracted and reviewed by narrative synthesis. Quality of the included reviews was assessed using a modified version of the AMSTAR checklist. RESULTS Thirty reviews were included, sixteen of which were of excellent or good quality. The body of evidence, covering more than 180 studies, was heavily skewed towards EQ-5D, with significantly fewer studies investigating HUI3 and SF-6D, and very few the 15D and AQoL. There was also lack of head-to-head comparisons between GPBMs and the tests reported by the reviews were often weak. Where there was evidence, EQ-5D, SF-6D, HUI3, 15D and AQoL seemed generally valid and responsive instruments, although not for all conditions. Evidence was not consistently reported across reviews. CONCLUSIONS Although generally valid, EQ-5D, SF-6D and HUI3 suffer from some problems and perform inconsistently in some populations. The lack of head-to-head comparisons and the poor reporting impedes the comparative assessment of the performance of GPBMs. This highlights the need for large comparative studies designed to test instruments' performance.
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Affiliation(s)
- Aureliano Paolo Finch
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, West Court, 1 Mappin Street, Sheffield, S1 4DT, UK.
| | - John Edward Brazier
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, West Court, 1 Mappin Street, Sheffield, S1 4DT, UK
| | - Clara Mukuria
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, West Court, 1 Mappin Street, Sheffield, S1 4DT, UK
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Bradley C, Eschwège E, de Pablos-Velasco P, Parhofer KG, Simon D, Vandenberghe H, Gönder-Frederick L. Predictors of Quality of Life and Other Patient-Reported Outcomes in the PANORAMA Multinational Study of People With Type 2 Diabetes. Diabetes Care 2018; 41:267-276. [PMID: 29183910 DOI: 10.2337/dc16-2655] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 10/22/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE PANORAMA, a nine-country cross-sectional type 2 diabetes study, investigated factors associated with quality of life (QoL), health status, and other patient-reported outcome measures (PROMs). RESEARCH DESIGN AND METHODS Patients were randomly or consecutively selected from primary/secondary care. PROMs included the Audit of Diabetes-Dependent Quality of Life (ADDQoL) (generic QoL item and average weighted impact [AWI] scores), Diabetes Treatment Satisfaction Questionnaire (DTSQ) (patient- and physician-completed), Hypoglycemia Fear Survey-II worry subscale, and the EuroQoL-5 Dimension visual analog scale (EQ-VAS) measuring patient-reported health. Multivariable linear regression analyses determined predictors of each PROM including patient characteristics, physician-reported adherence, complications, and glycosylated hemoglobin. RESULTS In 5,813 patients, mean PROM scores indicated that generic QoL approximated "good" (0.93); perceived impact of diabetes on QoL was negative (AWI -1.69). Treatment satisfaction exceeded physicians' estimates (patient-reported: 29.76; physician-estimated: 27.75), but so did patients' perceived frequency of hypo-/hyperglycemia. Worry about hypoglycemia (13.27) was apparent. Intensifying treatments to three oral agents or insulin regimens predicted worse QoL (AWI P < 0.01). Insulin alone use predicted worse QoL (generic P < 0.02; AWI P < 0.001) and hypoglycemia worry (P < 0.007). No treatment had significant associations with EQ-VAS health status. CONCLUSIONS Predictors for different PROMs differed markedly and provided insights for understanding and improving these important outcomes. Intensive treatment regimens had significant negative associations with all PROMs, except the EQ-VAS health status measure. The findings demonstrate the importance of measuring QoL alongside health status and other patient-reported outcomes when evaluating diabetes treatments with a view to protecting QoL and facilitating adherence and long-term glycemic control.
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Affiliation(s)
- Clare Bradley
- Health Psychology Research Unit, Royal Holloway, University of London, Egham, U.K.
| | | | - Pedro de Pablos-Velasco
- Dr. Negrin Hospital, Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Klaus G Parhofer
- Medical Department 4, Grosshadern, Klinikum der Universität München, Munich, Germany
| | - Dominique Simon
- Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Paris, France.,Diabetes Department, Hôpital de la Pitié-Salpêtrière, Paris, France
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80
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Vallis M, Willaing I, Holt RIG. Emerging adulthood and Type 1 diabetes: insights from the DAWN2 Study. Diabet Med 2018; 35:203-213. [PMID: 29171084 DOI: 10.1111/dme.13554] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 12/20/2022]
Abstract
AIMS To compare clinical, psychological, education and social variables in emerging adults (aged 18-30 years) with Type 1 diabetes with their adult counterparts aged >30 years. METHODS A single assessment multinational sample was surveyed as part of the larger second Diabetes Attitudes, Wishes and Needs (DAWN2) study. Participants completed a series of surveys incorporating demographic as well as clinical questions (comorbidities, hypoglycaemia) and validated self-report scales concerning psychosocial (health impact, quality of life, beliefs and attitudes, self-management behaviours, healthcare experience and family support) and diabetes education factors. RESULTS Emerging adults differed from adults aged >30 years with regard to a number of psychosocial variables. Emerging adults reported better overall quality of life, social support and support from their healthcare team compared with adults aged >30 years of age; however, emerging adults experienced greater diabetes-specific distress and were less engaged in self-management. Diabetes education was related to a number of indicators, while experience of discrimination was harmful, but these impacts did not differ between emerging adults and adults aged >30 years. An analysis of geographical regions suggested that emerging adults in North America and Europe had better well-being than older adults, while the opposite was observed in Asia. CONCLUSIONS Emerging adults, particularly those in the later phase (ages 25-30 years) are especially at risk in terms of diabetes-specific distress. There is a need for novel interventions to meet the needs of these vulnerable emerging adults more effectively.
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Affiliation(s)
- M Vallis
- Behaviour Change Institute, Nova Scotia Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
| | - I Willaing
- Diabetes Management Research, Health Promotion Research, Steno Diabetes Centre, Copenhagen, Denmark
| | - R I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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81
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Svedbo Engström M, Leksell J, Johansson UB, Eeg-Olofsson K, Borg S, Palaszewski B, Gudbjörnsdottir S. A disease-specific questionnaire for measuring patient-reported outcomes and experiences in the Swedish National Diabetes Register: Development and evaluation of content validity, face validity, and test-retest reliability. PATIENT EDUCATION AND COUNSELING 2018; 101:139-146. [PMID: 28736071 DOI: 10.1016/j.pec.2017.07.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To describe the development and evaluation of the content and face validity and test-retest reliability of a disease-specific questionnaire that measures patient-reported outcomes and experiences for the Swedish National Diabetes Register for adult patients who have type 1 or type 2 diabetes. METHODS In this methodological study, a questionnaire was developed over four phases using an iterative process. Expert reviews and cognitive interviews were conducted to evaluate content and face validity, and a postal survey was administered to evaluate test-retest reliability. RESULTS The expert reviews and cognitive interviews found the disease-specific questionnaire to be understandable, with relevant content and value for diabetes care. An item-level content validity index ranged from 0.6-1.0 and a scale content validity/average ranged from 0.7-1.0. The fourth version, with 33 items, two main parts and seven dimensions, was answered by 972 adults with type 1 and type 2 diabetes (response rate 61%). Weighted Kappa values ranged from 0.31-0.78 for type 1 diabetes and 0.27-0.74 for type 2 diabetes. CONCLUSIONS This study describes the initial development of a disease-specific questionnaire in conjunction with the NDR. Content and face validity were confirmed and test-retest reliability was satisfactory. PRACTICE IMPLICATIONS With the development of this questionnaire, the NDR becomes a clinical tool that contributes to further understanding the perspectives of adult individuals with diabetes.
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Affiliation(s)
- Maria Svedbo Engström
- University of Gothenburg, Sahlgrenska Academy, Institute of Medicine, SE-413 46 Gothenburg, Sweden; Dalarna University, School of Education, Health and Social Studies, SE-791 88 Falun, Sweden
| | - Janeth Leksell
- Dalarna University, School of Education, Health and Social Studies, SE-791 88 Falun, Sweden; Uppsala University, Department of Medical Sciences, SE-751 85 Uppsala, Sweden.
| | - Unn-Britt Johansson
- Sophiahemmet University, SE-114 86 Stockholm, Sweden; Karolinska Institutet, Department of Clinical Sciences and Education, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Katarina Eeg-Olofsson
- University of Gothenburg, Sahlgrenska Academy, Institute of Medicine, SE-413 46 Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sixten Borg
- Lund University, Department of Clinical Sciences in Malmö, Health Economics Unit, Medicon Village, SE-223 81 Lund, Sweden
| | - Bo Palaszewski
- Region Västra Götaland, Department of Data Management and Analysis, Gothenburg, Sweden
| | - Soffia Gudbjörnsdottir
- University of Gothenburg, Sahlgrenska Academy, Institute of Medicine, SE-413 46 Gothenburg, Sweden; Register Center Västra Götaland, SE-413 45 Gothenburg, Sweden
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82
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Panisch S, Johansson T, Flamm M, Winkler H, Weitgasser R, Sönnichsen AC. The impact of a disease management programme for type 2 diabetes on health-related quality of life: multilevel analysis of a cluster-randomised controlled trial. Diabetol Metab Syndr 2018; 10:28. [PMID: 29643940 PMCID: PMC5892002 DOI: 10.1186/s13098-018-0330-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/28/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a chronic disease associated with poorer health outcomes and decreased health related quality of life (HRQoL). The aim of this analysis was to explore the impact of a disease management programme (DMP) in type 2 diabetes on HRQoL. A multilevel model was used to explain the variation in EQ-VAS. METHODS A cluster-randomized controlled trial-analysis of the secondary endpoint HRQoL. Our study population were general practitioners and patients in the province of Salzburg. The DMP "Therapie-Aktiv" was implemented in the intervention group, and controls received usual care. Outcome measure was a change in EQ-VAS after 12 months. For comparison of rates, we used Fisher's Exact test; for continuous variables the independent T test or Welch test were used. In the multilevel modeling, we examined various models, continuously adding variables to explain the variation in the dependent variable, starting with an empty model, including only the random intercept. We analysed random effects parameters in order to disentangle variation of the final EQ-VAS. RESULTS The EQ-VAS significantly increased within the intervention group (mean difference 2.19, p = 0.005). There was no significant difference in EQ-VAS between groups (mean difference 1.00, p = 0.339). In the intervention group the improvement was more distinct in women (2.46, p = 0.036) compared to men (1.92, p = 0.063). In multilevel modeling, sex, age, family and work circumstances, any macrovascular diabetic complication, duration of diabetes, baseline body mass index and baseline EQ-VAS significantly influence final EQ-VAS, while DMP does not. The final model explains 28.9% (EQ-VAS) of the total variance. Most of the unexplained variance was found on patient-level (95%) and less on GP-level (5%). CONCLUSION DMP "Therapie-Aktiv" has no significant impact on final EQ-VAS. The impact of DMPs in type 2 diabetes on HRQoL is still unclear and future programmes should focus on patient specific needs and predictors in order to improve HRQoL.Trial registration Current Controlled trials Ltd., ISRCTN27414162.
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Affiliation(s)
- Sigrid Panisch
- Department of Mathematics, University of Salzburg, Hellbrunner Str. 34, 5020 Salzburg, Austria
| | - Tim Johansson
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Strubergasse 21, 5020 Salzburg, Austria
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Strubergasse 21, 5020 Salzburg, Austria
| | - Henrike Winkler
- Paris Lodron University, Kapitelgasse 4-6, 5020 Salzburg, Austria
| | - Raimund Weitgasser
- Department of Internal Medicine, Wehrle-Diakonissen Hospital, Haydnstrasse 18, 5020 Salzburg, Austria
- Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria
| | - Andreas C. Sönnichsen
- Institute of General Practice and Family Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Oxford Rd, Manchester, M13 9PL UK
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ViDa1: un nuevo cuestionario para medir calidad de vida relacionada con la salud en la diabetes tipo 1. ENDOCRINOL DIAB NUTR 2017; 64:506-509. [DOI: 10.1016/j.endinu.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/23/2017] [Indexed: 11/23/2022]
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84
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Provost S, Pineault R, Grimard D, Pérez J, Fournier M, Lévesque Y, Desforges J, Tousignant P, Borgès Da Silva R. Implementation of an integrated primary care cardiometabolic risk prevention and management network in Montréal: does greater coordination of care with primary care physicians have an impact on health outcomes? HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2017; 37:105-113. [PMID: 28402799 DOI: 10.24095/hpcdp.37.4.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Chronic disease management requires substantial services integration. A cardiometabolic risk management program inspired by the Chronic Care Model was implemented in Montréal for patients with diabetes or hypertension. One of this study's objectives was to assess the impact of care coordination between the interdisciplinary teams and physicians on patient participation in the program, lifestyle improvements and disease control. METHODS We obtained data on health outcomes from a register of clinical data, questionnaires completed by patients upon entry into the program and at the 12-month mark, and we drew information on the program's characteristics from the implementation analysis. We conducted multiple regression analyses, controlling for patient sociodemographic and health characteristics, to measure the association between interdisciplinary team coordination with primary care physicians and various health outcomes. RESULTS A total of 1689 patients took part in the study (60.1% participation rate). Approximately 40% of patients withdrew from the program during the first year. At the 12-month follow-up (n = 992), we observed a significant increase in the proportion of patients achieving the various clinical targets. The perception by the interdisciplinary team of greater care coordination with primary care physicians was associated with increased participation in the program and the achievement of better clinical results. CONCLUSION Greater coordination of patient services between interdisciplinary teams and primary care physicians translates into benefits for patients.
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Affiliation(s)
- Sylvie Provost
- Direction de santé publique du Centre intégré universitaire de santé et services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.,Institut de recherche en santé publique de l'Université de Montréal, Montréal, Quebec, Canada
| | - Raynald Pineault
- Direction de santé publique du Centre intégré universitaire de santé et services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.,Institut de recherche en santé publique de l'Université de Montréal, Montréal, Quebec, Canada.,Institut national de santé publique du Québec, Montréal, Quebec, Canada
| | - Dominique Grimard
- Direction de santé publique du Centre intégré universitaire de santé et services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - José Pérez
- Direction de santé publique du Centre intégré universitaire de santé et services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Michel Fournier
- Direction de santé publique du Centre intégré universitaire de santé et services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - Yves Lévesque
- Direction de santé publique du Centre intégré universitaire de santé et services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - Johanne Desforges
- CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Groupe de médecine de famille et Unité de médecine familiale de Verdun, Montréal, Quebec, Canada
| | - Pierre Tousignant
- Direction de santé publique du Centre intégré universitaire de santé et services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.,Institut de recherche en santé publique de l'Université de Montréal, Montréal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - Roxane Borgès Da Silva
- Institut de recherche en santé publique de l'Université de Montréal, Montréal, Quebec, Canada.,Faculté des sciences infirmières de l'Université de Montréal, Montréal, Quebec, Canada
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Granado-Casas M, Martínez-Alonso M, Alcubierre N, Ramírez-Morros A, Hernández M, Castelblanco E, Torres-Puiggros J, Mauricio D. Decreased quality of life and treatment satisfaction in patients with latent autoimmune diabetes of the adult. PeerJ 2017; 5:e3928. [PMID: 29062603 PMCID: PMC5650726 DOI: 10.7717/peerj.3928] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/26/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Our main aim was to assess the quality of life (QoL) and treatment satisfaction (TS) of subjects with LADA (latent autoimmune diabetes of the adult) and compare these measures with those of patients with other diabetes types, i.e., type 1 (T1DM) and type 2 diabetes mellitus (T2DM). METHODS This was a cross-sectional study with a total of 48 patients with LADA, 297 patients with T2DM and 124 with T1DM. The Audit of Diabetes-Dependent Quality of Life (ADDQoL-19) questionnaire and the Diabetes Treatment Satisfaction Questionnaire (DTSQ) were administered. Relevant clinical variables were also assessed. The data analysis included comparisons between groups and multivariate linear models. RESULTS The LADA patients presented lower diabetes-specific QoL (p = 0.045) and average weighted impact scores (p = 0.007) than the T2DM patients. The subgroup of LADA patients with diabetic retinopathy (DR) who were treated with insulin had a lower ADDQoL average weighted impact score than the other diabetic groups. Although the overall measure of TS was not different between the LADA and T2DM (p = 0.389) and T1DM (p = 0.091) groups, the patients with LADA showed a poorer hyperglycemic frequency perception than the T2DM patients (p < 0.001) and an improved frequency of hypoglycemic perception compared with the T1DM patients (p = 0.021). CONCLUSIONS The current findings suggest a poorer quality of life, especially in terms of DR and insulin treatment, among patients with LADA compared with those with T1DM and T2DM. Hyperglycemia frequency perception was also poorer in the LADA patients than in the T1DM and T2DM patients. Further research with prospective studies and a large number of patients is necessary.
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Affiliation(s)
- Minerva Granado-Casas
- Department of Endocrinology and Nutrition, Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain
- Biomedical Research Institute of Lleida, University of Lleida, Lleida, Spain
| | | | - Nuria Alcubierre
- Biomedical Research Institute of Lleida, University of Lleida, Lleida, Spain
| | - Anna Ramírez-Morros
- Department of Endocrinology and Nutrition, Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Marta Hernández
- Biomedical Research Institute of Lleida, University of Lleida, Lleida, Spain
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Esmeralda Castelblanco
- Department of Endocrinology and Nutrition, Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Joan Torres-Puiggros
- Nursing School, University of Lleida, Lleida, Spain
- Catalan Department of Health, Lleida, Spain
| | - Didac Mauricio
- Department of Endocrinology and Nutrition, Centre for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain
- Biomedical Research Institute of Lleida, University of Lleida, Lleida, Spain
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86
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Jannoo Z, Wah YB, Lazim AM, Hassali MA. Examining diabetes distress, medication adherence, diabetes self-care activities, diabetes-specific quality of life and health-related quality of life among type 2 diabetes mellitus patients. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2017; 9:48-54. [PMID: 29067270 PMCID: PMC5651286 DOI: 10.1016/j.jcte.2017.07.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/17/2017] [Accepted: 07/21/2017] [Indexed: 01/22/2023]
Abstract
A five-factor theoretical model is proposed. The SEM model evaluated relationships among three endogenous and two exogenous variables. Higher levels of medication adherence had a significant direct effect on diabetes distress. Self-care activities had significant direct effect on diabetes distress and HRQoL. Diabetes-specific QoL had a significant effect on HRQoL.
Aims Health-Related Quality of Life (HRQoL) has been increasing attention in health outcome studies. Factors that individually influence HRQoL, diabetes self-care behaviors, and medication adherence have been widely investigated; however, most previous studies have not tested an integrated association between multiple health outcomes. The purpose of this study was to formulate a hypothetical structural equation model linking HRQoL, diabetes distress, diabetes self-care activities, medication adherence and diabetes-dependent QoL in patients with Type 2 Diabetes Mellitus (T2DM). Methods A cross-sectional study design was employed, and 497 patients with T2DM were recruited from outpatient clinics in three public hospitals and one government clinic. The patients completed a series of questionnaires. The hypothetical model was tested using Structural Equation Modeling (SEM) analysis. Results The values of the multiple fit indices indicated that the proposed model provided a good fit to the data. SEM results showed that medication adherence (MMAS) had a significant direct effect on diabetes distress (PAID) (Beta = −0.20). The self-care activities (SDSCA) construct was significantly related to PAID (Beta = −0.24). SDSCA was found to have a significant relationship with HRQoL (SF-36) (Beta = 0.11). Additionally, diabetes distress had a significant effect (Beta = −0.11) on HRQoL of patients. Finally, ADDQoL had a significant effect on HRQoL (Beta = 0.12). Conclusions The various health outcome indicators such as self-care behaviors, diabetes distress, medication adherence and diabetes-dependent QoL need to be considered in clinical practice for enhancing HRQoL in those patients.
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Affiliation(s)
- Zeinab Jannoo
- University of Mauritius, Faculty of Social Studies and Humanities, Department of Economics and Statistics, Réduit, Mauritius
| | - Yap Bee Wah
- Universiti Teknologi MARA, Faculty of Computer and Mathematical Sciences, Centre of Statistical and Decision Science Studies, Sek 1, Shah Alam, Malaysia
| | - Alias Mohd Lazim
- Universiti Teknologi MARA, Faculty of Computer and Mathematical Sciences, Centre of Statistical and Decision Science Studies, Sek 1, Shah Alam, Malaysia
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Hernar I, Haltbakk J, Broström A. Differences in depression, treatment satisfaction and injection behaviour in adults with type 1 diabetes and different degrees of lipohypertrophy. J Clin Nurs 2017; 26:4583-4596. [DOI: 10.1111/jocn.13801] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Ingvild Hernar
- Department of Medicine; Haukeland University Hospital; Bergen Norway
- Faculty of Health and Social Sciences; Department of Nursing; Western Norway University of Applied Sciences; Bergen Norway
| | - Johannes Haltbakk
- Faculty of Health and Social Sciences; Department of Nursing; Western Norway University of Applied Sciences; Bergen Norway
| | - Anders Broström
- Faculty of Health and Social Sciences; Department of Nursing; Western Norway University of Applied Sciences; Bergen Norway
- Department of Nursing Science; Jönköping University; Jönköping Sweden
- Department of Clinical Neurophysiology; University Hospital Linköping; Linköping Sweden
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88
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Alvarado-Martel D, Ruiz Fernández MA, Cuadrado Vigaray M, Carrillo A, Boronat M, Expósito Montesdeoca A, Nattero Chávez L, Pozuelo Sánchez M, López Quevedo P, Santana Suárez AD, Hillman N, Subias D, Martin Vaquero P, Sáez de Ibarra L, Mauricio D, de Pablos-Velasco P, Nóvoa FJ, Wägner AM. ViDa1: The Development and Validation of a New Questionnaire for Measuring Health-Related Quality of Life in Patients with Type 1 Diabetes. Front Psychol 2017; 8:904. [PMID: 28620331 PMCID: PMC5450776 DOI: 10.3389/fpsyg.2017.00904] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/16/2017] [Indexed: 01/07/2023] Open
Abstract
This study describes the development of a new questionnaire to measure health-related quality of life (HRQoL) in patients with type 1 diabetes (the ViDa1 questionnaire) and provides information on its psychometric properties. For its development, open interviews with patients took place and topics relevant to patients' HRQoL were identified and items were generated. Qualitative analysis of items, expert review, and refinement of the questionnaire followed. A pilot study (N = 150) was conducted to explore the underlying structure of the 40-item ViDa1 questionnaire. A Principal Component Analysis (PCA) was performed and six of the items that did not load on any of the factors were eliminated. The results supported a four-dimensional structure for ViDa1, the dimensions being Interference of diabetes in everyday life, Self-care, Well-being, and Worry about the disease. Subsequently, the PCA was repeated in a larger sample (N = 578) with the reduced 34-item version of the questionnaire, and a Confirmatory Factor Analysis (CFA) was performed (N = 428). Overall fit indices obtained presented adequate values which supported the four-factor model initially proposed [([Formula: see text] 2601.93) (p < 0.001); Root Mean Square Error of Approximation = 0.060 (CI = 0.056 -0.064)]. As regards reliability, the four dimensions of the ViDa1 demonstrated good internal consistency, with Cronbach's alphas ranging between 0.71 and 0.86. Evidence of convergent-discriminant validity in the form of high correlations with another specific HRQoL questionnaire for diabetes and low correlations with other constructs such as self-efficacy, anxiety, and depression were presented. The ViDa1 also discriminated between different aspects of clinical interest such as type of insulin treatment, presence of chronic complications, and glycemic control, temporal stability, and sensitivity to change after an intervention. In conclusion, the ViDa1 questionnaire presents adequate psychometric properties and may represent a good alternative for the evaluation of HRQoL in type 1 diabetes.
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Affiliation(s)
- Dácil Alvarado-Martel
- Department of Endocrinology and Nutrition, Complejo Hospitalario Univesitario Insular Materno-Infantil de Gran CanariaLas Palmas de Gran Canaria, Spain
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran CanariaLas Palmas de Gran Canaria, Spain
| | | | - Maribel Cuadrado Vigaray
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Hospital Universitario Germans Trias i PujolBadalona, Spain
| | - Armando Carrillo
- Department of Endocrinology and Nutrition, Complejo Hospitalario Univesitario Insular Materno-Infantil de Gran CanariaLas Palmas de Gran Canaria, Spain
| | - Mauro Boronat
- Department of Endocrinology and Nutrition, Complejo Hospitalario Univesitario Insular Materno-Infantil de Gran CanariaLas Palmas de Gran Canaria, Spain
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran CanariaLas Palmas de Gran Canaria, Spain
| | - Ana Expósito Montesdeoca
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran CanariaLas Palmas de Gran Canaria, Spain
| | - Lía Nattero Chávez
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y CajalMadrid, Spain
| | - Maite Pozuelo Sánchez
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y CajalMadrid, Spain
| | - Pino López Quevedo
- Department of Endocrinology and Nutrition, Hospital Universitario de Gran Canaria Doctor NegrínLas Palmas de Gran Canaria, Spain
| | - Ana D. Santana Suárez
- Department of Endocrinology and Nutrition, Hospital Universitario de Gran Canaria Doctor NegrínLas Palmas de Gran Canaria, Spain
| | - Natalia Hillman
- Unit of Diabetes, Hospital Universitario La PazMadrid, Spain
| | - David Subias
- Department of Endocrinology and Nutrition, Hospital Universitario Parc TaulíSabadell, Spain
| | | | | | - Didac Mauricio
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Hospital Universitario Germans Trias i PujolBadalona, Spain
| | - Pedro de Pablos-Velasco
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran CanariaLas Palmas de Gran Canaria, Spain
- Department of Endocrinology and Nutrition, Hospital Universitario de Gran Canaria Doctor NegrínLas Palmas de Gran Canaria, Spain
| | - Francisco J. Nóvoa
- Department of Endocrinology and Nutrition, Complejo Hospitalario Univesitario Insular Materno-Infantil de Gran CanariaLas Palmas de Gran Canaria, Spain
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran CanariaLas Palmas de Gran Canaria, Spain
| | - Ana M. Wägner
- Department of Endocrinology and Nutrition, Complejo Hospitalario Univesitario Insular Materno-Infantil de Gran CanariaLas Palmas de Gran Canaria, Spain
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran CanariaLas Palmas de Gran Canaria, Spain
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89
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Levterova BA, Levterov GE, Dragova EA, Grudeva TS, Kostourkov YL. Bulgarian version of the Audit of Diabetes-Dependent Quality of Life (ADDQoL-19). BIOTECHNOL BIOTEC EQ 2017. [DOI: 10.1080/13102818.2017.1297689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Boryana Angelova Levterova
- Department of Health Management and Healthcare Еconomics, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
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Schunk M, Reitmeir P, Rückert-Eheberg IM, Tamayo T, Schipf S, Meisinger C, Peters A, Scheidt-Nave C, Ellert U, Hartwig S, Kluttig A, Völzke H, Holle R. Longitudinal change in health-related quality of life in people with prevalent and incident type 2 diabetes compared to diabetes-free controls. PLoS One 2017; 12:e0176895. [PMID: 28467489 PMCID: PMC5415190 DOI: 10.1371/journal.pone.0176895] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/24/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The objective of this analysis is to compare people with prevalent type 2 diabetes, incident type 2 diabetes and without diabetes with respect to longitudinal change in health-related quality of life (HRQOL) when adjusting for baseline determinants of HRQOL. RESEARCH DESIGN AND METHODS Primary baseline and follow-up data from three regional and one national population-based cohort studies in Germany were pooled for analysis. HRQOL was measured using physical and mental health summary scores (PCS and MCS) from the German version of the Short Form Health Survey with 36 or 12 items. Mean score change per observation year was compared between the three groups (prevalent diabetes, incident diabetes, no diabetes) based on linear regression models. RESULTS The analysis included pooled data from 5367 people aged 45-74 years at baseline. Of these, 85.5% reported no diabetes at baseline and follow-up, 6.3% reported diabetes at both baseline and follow-up (prevalent diabetes), and 8.2% reported diabetes only at follow-up (incident diabetes). Over a mean observation period of 8.7 years, annual decline in HRQOL scores is pronounced at 0.27-0.32 (PCS) and 0.34-0.38 (MCS) in the group with prevalent diabetes compared with people without diabetes. Those with incident diabetes showed intermediate values but did not differ significantly from people without diabetes after adjustment for covariates in the full model. CONCLUSION Compared with data from cross-sectional analysis, the HRQOL loss associated with prevalent diabetes appears to be much larger than previously assumed.
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Affiliation(s)
- Michaela Schunk
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Partner Site Helmholtz Zentrum München, Germany
| | - Peter Reitmeir
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Partner Site Helmholtz Zentrum München, Germany
| | - Ina-Maria Rückert-Eheberg
- German Center for Diabetes Research (DZD), Partner Site Helmholtz Zentrum München, Germany
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany
| | - Teresa Tamayo
- Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Site DDZ Düsseldorf, Germany
| | - Sabine Schipf
- Institute for Community Medicine, Ernst Moritz Arndt-University, Greifswald, Germany
- German Center for Diabetes Research (DZD), Project Partner Site Uni Greifswald, Greifswald, Germany
| | - Christa Meisinger
- German Center for Diabetes Research (DZD), Partner Site Helmholtz Zentrum München, Germany
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany
| | - Annette Peters
- German Center for Diabetes Research (DZD), Partner Site Helmholtz Zentrum München, Germany
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert-Koch-Institute, Berlin, Germany
- German Center for Diabetes Research (DZD), Project Partner Site RKI, Berlin, Germany
| | - Ute Ellert
- Department of Epidemiology and Health Monitoring, Robert-Koch-Institute, Berlin, Germany
- German Center for Diabetes Research (DZD), Project Partner Site RKI, Berlin, Germany
| | - Saskia Hartwig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- German Center for Diabetes Research (DZD), Project Partner Site Uni Halle-Wittenberg, Halle, Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- German Center for Diabetes Research (DZD), Project Partner Site Uni Halle-Wittenberg, Halle, Germany
| | - Henry Völzke
- Institute for Community Medicine, Ernst Moritz Arndt-University, Greifswald, Germany
- German Center for Diabetes Research (DZD), Project Partner Site Uni Greifswald, Greifswald, Germany
- German Center for Cardiovascular Research, Partner Site Greifswald, Germany
| | - Rolf Holle
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Partner Site Helmholtz Zentrum München, Germany
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91
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Dennick K, Sturt J, Speight J. What is diabetes distress and how can we measure it? A narrative review and conceptual model. J Diabetes Complications 2017; 31:898-911. [PMID: 28274681 DOI: 10.1016/j.jdiacomp.2016.12.018] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/21/2016] [Accepted: 12/23/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Diabetes distress is the negative emotional impact of living with diabetes. It has tangible clinical importance, being associated with sub-optimal self-care and glycemic control. Diabetes distress has been operationalized in various ways and several measures exist. Measurement clarity is needed for both scientific and clinical reasons. OBJECTIVES To clarify the conceptualization and operationalization of diabetes distress, identify and distinguish relevant measures, and evaluate their appropriateness for this purpose. RESULTS Six measures were identified: Problem Areas in Diabetes (PAID) scale, Diabetes Distress Scale (DDS); Type I Diabetes Distress Scale (T1-DDS), Diabetes-specific Quality of Life Scale-Revised (DSQoLs-R) 'Burden and Restrictions-Daily Hassles' sub-scale, Well-being Questionnaire 28 (W-BQ 28) 'Diabetes Well-being' sub-scale, and Illness Perceptions Questionnaire-Revised (IPQ-R) 'Emotional Representations' sub-scale. Across these measures a broad spectrum of diabetes distress is captured, including distress associated with treatment regimen, food/eating, future/complications, hypoglycemia, social/interpersonal relationships, and healthcare professionals. No single measure appears fully comprehensive. Limited detail of the qualitative work informing scale design is reported, raising concerns about content validity. CONCLUSIONS Across the available measures diabetes distress is seemingly comprehensively assessed and measures should be considered in terms of their focus and scope to ensure the foci of interventions are appropriately targeted.
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MESH Headings
- Combined Modality Therapy/adverse effects
- Combined Modality Therapy/psychology
- Cost of Illness
- Diabetes Complications/prevention & control
- Diabetes Complications/psychology
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/psychology
- Diabetes Mellitus, Type 2/therapy
- Humans
- Models, Psychological
- Psychosocial Support Systems
- Quality of Life
- Self-Management/psychology
- Stress, Psychological/complications
- Stress, Psychological/etiology
- Stress, Psychological/psychology
- Validation Studies as Topic
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Affiliation(s)
- Kathryn Dennick
- Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, 57 Waterloo Road, London, SE1 8WA, UK.
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, 57 Waterloo Road, London, SE1 8WA, UK
| | - Jane Speight
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia; The Australian Centre for Behavioral Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne, Victoria 3000, Australia; AHP Research, 16 Walden Way, Hornchurch, Essex, UK
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92
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Baptista LC, Machado-Rodrigues AM, Martins RA. Exercise but not metformin improves health-related quality of life and mood states in older adults with type 2 diabetes. Eur J Sport Sci 2017; 17:794-804. [PMID: 28394739 DOI: 10.1080/17461391.2017.1310933] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The aim of this cohort study is to analyse the effect of three types of treatment: (i) exercise training with multicomponent exercise (E); (ii) pharmacologic treatment with oral hypoglycaemic drug - metformin (M); and (iii) a combined therapy - exercise and metformin (E + M) on health-related quality of life (HRQoL) and mood states in older adults with type 2 diabetes (T2D) with comorbidity in an early stage of the disease. Participants (n = 284) underwent 1 of the following 3 conditions: (i) E (n = 59) trained three times/week; (ii) M (n = 30) used 850 mg of metformin twice daily; and (iii) E + M (n = 195) combined exercise and metformin. Furthermore, participants completed baseline and 2-year follow-up evaluations including a Shortform Health Survey 36, Profile of Mood States - Short-form, the health history questionnaires, anthropometric, and blood biochemistry. E and E + M revealed improved mood states, with large effect size on the vigour domain, and moderate effect size in the anger and total mood disturbance (TMD) domains (P < 0.05), in comparison with the M group. After 24 months' intervention, the E and E + M groups perceived better physical and mental HRQoL than the M group. The M group unchanged HRQoL domains (P > 0.05). Metformin had no significant effect on the self-referred HRQoL in T2D participants aged above 60 years, in an early stage of the disease. The E and E + M were the most effective long-term therapies to improve mood states and HRQoL in older adults with T2D.
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Affiliation(s)
- Liliana C Baptista
- a Faculdade de Ciências do Desporto e Educação Física , Universidade de Coimbra , Coimbra , Portugal
| | | | - Raul A Martins
- a Faculdade de Ciências do Desporto e Educação Física , Universidade de Coimbra , Coimbra , Portugal
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93
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Tang TS, Yusuf FLA, Polonsky WH, Fisher L. Assessing quality of life in diabetes: II - Deconstructing measures into a simple framework. Diabetes Res Clin Pract 2017; 126:286-302. [PMID: 28190527 DOI: 10.1016/j.diabres.2016.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/13/2016] [Indexed: 12/19/2022]
Abstract
A growing number of instruments measuring diabetes-specific health-related quality of life (HRQOL) have been identified in previous systematic reviews, the most recent being published in 2008. The purpose of this paper is report on an updated systematic review of diabetes-specific HRQOL measures highlighting the time period 2006-2016; to deconstruct existing diabetes-specific HRQOL measures into a simple framework for evaluating the goodness-of-fit between specific research needs and instrument characteristics; and to present core characteristics of measures not yet reported in other reviews to further facilitate scale selection. Using the databases Medline, Pubmed, CINAHL, OVID Embase, and PsycINFO, we identified 20 diabetes-specific HRQOL measures that met our inclusion criteria. For each measure, we extracted eight core characteristics for our measurement selection framework. These characteristics include target population (type 1 vs. type 2), number and type of HRQOL dimensions measured and scored, type of score and calculation algorithm, sensitivity to change data reported in subsequent studies, number of survey items, approximate time length to complete, number of studies using the instrument in the past 10years, and specific languages instruments is translated. This report provides a way to compare and contrast existing diabetes-specific HRQOL measures to aid in appropriate scale selection and utilization.
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Affiliation(s)
| | | | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA; University of California, San Diego, CA, USA
| | - Lawrence Fisher
- University of California, San Francisco, San Francisco, CA, USA
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94
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Fisher L, Tang T, Polonsky W. Assessing quality of life in diabetes: I. A practical guide to selecting the best instruments and using them wisely. Diabetes Res Clin Pract 2017; 126:278-285. [PMID: 28153545 DOI: 10.1016/j.diabres.2016.10.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/28/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
The rapid development of new medications and devices in diabetes research and clinical care has led to an increased need to assess their impact on health-related quality of life (HRQOL). Unfortunately, the lack of consensus definitions and guidelines has led to the use of HRQOL measures that are often imprecise and inappropriate. The goal of this report is to provide a practical structure to the definition and measurement of HRQOL in diabetes research and clinical care. Following a brief historical background to provide context, we define HRQOL and provide a three-step framework for scale selection: identify the specific, proximal intervention targets; decide how reaching these targets will affect HRQOL; and select appropriate measures based on sample diversity, the intervention and the targets using a 2×2 grid (generic vs. diabetes specific measures; global vs. component measures). Practical tips for scale selection include: gaining patient input to document important potential HRQOL effects, varying scale selection by patient characteristics, considering common HRQOL measurement problems, and considering the timing of HRQOL assessment. We emphasize the importance of a careful, planned evaluation of HRQOL in diabetes, rather than an "off the shelf" approach.
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Affiliation(s)
| | - Tricia Tang
- University of British Columbia, Vancouver, Canada.
| | - William Polonsky
- Behavioral Diabetes Institute, University of California, San Diego, CA, USA.
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95
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Abstract
Type 1 diabetes mellitus (T1DM), also known as autoimmune diabetes, is a chronic disease characterized by insulin deficiency due to pancreatic β-cell loss and leads to hyperglycaemia. Although the age of symptomatic onset is usually during childhood or adolescence, symptoms can sometimes develop much later. Although the aetiology of T1DM is not completely understood, the pathogenesis of the disease is thought to involve T cell-mediated destruction of β-cells. Islet-targeting autoantibodies that target insulin, 65 kDa glutamic acid decarboxylase, insulinoma-associated protein 2 and zinc transporter 8 - all of which are proteins associated with secretory granules in β-cells - are biomarkers of T1DM-associated autoimmunity that are found months to years before symptom onset, and can be used to identify and study individuals who are at risk of developing T1DM. The type of autoantibody that appears first depends on the environmental trigger and on genetic factors. The pathogenesis of T1DM can be divided into three stages depending on the absence or presence of hyperglycaemia and hyperglycaemia-associated symptoms (such as polyuria and thirst). A cure is not available, and patients depend on lifelong insulin injections; novel approaches to insulin treatment, such as insulin pumps, continuous glucose monitoring and hybrid closed-loop systems, are in development. Although intensive glycaemic control has reduced the incidence of microvascular and macrovascular complications, the majority of patients with T1DM are still developing these complications. Major research efforts are needed to achieve early diagnosis, prevent β-cell loss and develop better treatment options to improve the quality of life and prognosis of those affected.
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96
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Wang HF, Bradley C, Chang TJ, Chuang LM, Yeh MC. Assessing the impact of diabetes on quality of life: validation of the Chinese version of the 19-item Audit of Diabetes-Dependent Quality of Life for Taiwan. Int J Qual Health Care 2017; 29:335-342. [DOI: 10.1093/intqhc/mzx028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/22/2017] [Indexed: 12/19/2022] Open
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97
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Baptista LC, Dias G, Souza NR, Veríssimo MT, Martins RA. Effects of long-term multicomponent exercise on health-related quality of life in older adults with type 2 diabetes: evidence from a cohort study. Qual Life Res 2017; 26:2117-2127. [PMID: 28303367 DOI: 10.1007/s11136-017-1543-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE To establish the effect of a long-term multicomponent exercise (LTMEX) intervention (24 months) on health-related quality of life (HRQoL), in older adults with type 2 diabetes (T2D). METHODS This longitudinal retrospective cohort study analyzes the effects of a supervised LTMEX program on HRQoL in older adults with T2D (n = 279). Participants underwent one of two conditions: LTMEX (n = 241) trained three times per week; and unchanged lifestyle-the control group (CO; n = 38). Participants completed baseline, and 2-year follow-up evaluations including the Short Form Health Survey 36 (SF-36), anthropometric, hemodynamic components, and cardiorespiratory fitness (VO2 peak). RESULTS LTMEX improves HRQoL, specifically physical functioning (P < 0.001), general health (P < 0.05), vitality (P < 0.001), mental health (MH; P < 0.05), physical component score (P < 0.001), mental component score (P < 0.001), and total SF-36 (P < 0.001). LTMEX group also decreased body weight (BW; P < 0.005), waist circumference (WC; P < 0.001), waist-to-hip ratio (WHR; P < 0.001), and systolic blood pressure (SBP; P < 0.001), and increased VO2 peak (P < 0.001). CO group increased WC (P = 0.012), BMI (P = 0.024), waist-to-hip ratio (WHR; P = 0.003) and SBP (P < 0.001), and decreased vitality (P < 0.001) and MH (P < 0.05). CONCLUSIONS A LTMEX intervention improves physical and mental HRQoL in older adults with T2D, and also anthropometric, hemodynamic profile, and cardiorespiratory fitness.
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Affiliation(s)
| | - Gonçalo Dias
- Estádio Universitário de Coimbra, Pavilhão 3, 3000, Coimbra, Portugal
| | - Nelba R Souza
- Estádio Universitário de Coimbra, Pavilhão 3, 3000, Coimbra, Portugal
| | | | - Raul A Martins
- Estádio Universitário de Coimbra, Pavilhão 3, 3000, Coimbra, Portugal
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98
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Frøkjær JB, Graversen C, Brock C, Khodayari-Rostamabad A, Olesen SS, Hansen TM, Søfteland E, Simrén M, Drewes AM. Integrity of central nervous function in diabetes mellitus assessed by resting state EEG frequency analysis and source localization. J Diabetes Complications 2017; 31:400-406. [PMID: 27884662 DOI: 10.1016/j.jdiacomp.2016.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 09/24/2016] [Accepted: 11/02/2016] [Indexed: 12/12/2022]
Abstract
Diabetes mellitus (DM) is associated with structural and functional changes of the central nervous system. We used electroencephalography (EEG) to assess resting state cortical activity and explored associations to relevant clinical features. Multichannel resting state EEG was recorded in 27 healthy controls and 24 patients with longstanding DM and signs of autonomic dysfunction. The power distribution based on wavelet analysis was summarized into frequency bands with corresponding topographic mapping. Source localization analysis was applied to explore the electrical cortical sources underlying the EEG. Compared to controls, DM patients had an overall decreased EEG power in the delta (1-4Hz) and gamma (30-45Hz) bands. Topographic analysis revealed that these changes were confined to the frontal region for the delta band and to central cortical areas for the gamma band. Source localization analysis identified sources with reduced activity in the left postcentral gyrus for the gamma band and in right superior parietal lobule for the alpha1 (8-10Hz) band. DM patients with clinical signs of autonomic dysfunction and gastrointestinal symptoms had evidence of altered resting state cortical processing. This may reflect metabolic, vascular or neuronal changes associated with diabetes.
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Affiliation(s)
- Jens B Frøkjær
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Carina Graversen
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Christina Brock
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Søren S Olesen
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Tine M Hansen
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Eirik Søfteland
- Department of Medicine, Haukeland University Hospital and Institute of Medicine, University of Bergen, Bergen, Norway
| | - Magnus Simrén
- Institute of Medicine, Department of Internal Medicine & Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Asbjørn M Drewes
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
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99
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Switching from Biphasic Human Insulin to Premix Insulin Analogs: A Review of the Evidence Regarding Quality of Life and Adherence to Medication in Type 2 Diabetes Mellitus. Adv Ther 2017; 33:2091-2109. [PMID: 27739002 DOI: 10.1007/s12325-016-0418-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Indexed: 10/20/2022]
Abstract
Diabetes is a growing public health concern. Effective use of therapies for this chronic disease is necessary to improve long-term prognosis, but treatment adherence can be difficult to promote in clinical practice, and insulin, in particular, can impact both positively and negatively on patients' quality of life (QoL). Currently, guidelines advocate for QoL as a treatment goal in its own right, with treatment decisions based on patient concerns regarding injection frequency and adverse events, as well as glycemic control. Successful insulin management ideally requires a regimen to replicate normal endogenous insulin release, and this was a key driver in the development of insulin analogs. These analogs have also been associated with lower hypoglycemia risk, lower levels of postprandial glucose excursions, better adherence, improved QoL, and higher patient satisfaction with treatment. Premixed insulin is prescribed for many patients with type 2 diabetes mellitus (T2D), as it combines both prandial and basal treatment, reducing the number of injections. Evidence suggests that premixed insulin analogs have advantages over conventional premixed human insulin for T2D treatment, but the objective of this review was to assess the evidence that switching from a biphasic human insulin to a biphasic insulin analog regimen improves patient QoL. FUNDING Novo Nordisk.
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100
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Cheng L, Sit JWH, Choi KC, Chair SY, Li X, He XL. Effectiveness of Interactive Self-Management Interventions in Individuals With Poorly Controlled Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. Worldviews Evid Based Nurs 2016; 14:65-73. [PMID: 27984672 DOI: 10.1111/wvn.12191] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2016] [Indexed: 12/01/2022]
Abstract
AIMS To identify, assess, and summarize available scientific evidence on the effectiveness of interactive self-management interventions on glycemic control and patient-centered outcomes in individuals with poorly controlled type 2 diabetes. METHODS Major English and Chinese electronic databases including Medline, EMBASE, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and WanFang Data were searched to identify randomized controlled trials that reported the effectiveness of interactive self-management interventions in individuals with poorly controlled type 2 diabetes (glycated hemoglobin [HbA1c] ≥ 7.5% or 58 mmol/mol), from inception to June 2015. Data extraction and risk-of-bias assessment were performed by two reviewers independently. Meta-analysis was performed using Review Manager 5.3. RESULTS A total of 16 trials with 3,545 participants were included in the meta-analysis. Interactive self-management interventions could have a beneficial effect in individuals with poorly controlled type 2 diabetes in reducing HbA1c (mean difference: -0.43%, 95% CI: -0.67% to -0.18%), improving diabetes knowledge (standardized mean difference [SMD]: 0.30, 95% CI: 0.03 to 0.58), enhancing self-efficacy (SMD: 0.29, 95% CI: 0.14 to 0.44), and reducing diabetes-related distress (SMD: -0.21, 95% CI: -0.39 to -0.04). Self-management interventions supported with theory and structured curriculum showed desirable results in glycemic control. The behavioral change techniques, including providing feedback on performance, problem-solving, and action planning, were associated with a significant reduction in HbA1c. LINKING EVIDENCE TO ACTION Individuals with poorly controlled type 2 diabetes could benefit from interactive self-management interventions. Interventions targeting patients with poorly controlled diabetes, those who are at the greatest risk of developing complications, should be prioritized. Our findings indicate that providing feedback on performance, problem-solving, and action planning are promising behavioral change techniques specifically for individuals with poor glycemic control.
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Affiliation(s)
- Li Cheng
- Postdoctoral Fellow, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Janet W H Sit
- Associate Professor, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Kai-Chow Choi
- Senior Research Fellow, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Sek-Ying Chair
- Professor, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Xiaomei Li
- Professor, The School of Nursing, The Xi'an Jiaotong University, Xi'an, China
| | - Xiao-le He
- Student, The School of Nursing, Xi'an Jiaotong University, Xi'an, China
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