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Martinez W, Hackstadt AJ, Hickson GB, Knoerl T, Rosenbloom ST, Wallston KA, Elasy TA. The My Diabetes Care Patient Portal Intervention: Usability and Pre-Post Assessment. Appl Clin Inform 2021; 12:539-550. [PMID: 34192774 DOI: 10.1055/s-0041-1730324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND My Diabetes Care (MDC) is a novel, multifaceted patient portal intervention designed to help patients better understand their diabetes health data and support self-management. MDC uses infographics to visualize and summarize patients' diabetes health data, incorporates motivational strategies, and provides literacy level-appropriate educational resources. OBJECTIVES We aimed to assess the usability, acceptability, perceptions, and potential impact of MDC. METHODS We recruited 69 participants from four clinics affiliated with Vanderbilt University Medical Center. Participants were given 1 month of access to MDC and completed pre- and post-questionnaires including validated measures of usability and patient activation, and questions about user experience. RESULTS Sixty participants completed the study. Participants' mean age was 58, 55% were females, 68% were Caucasians, and 48% had limited health literacy (HL). Most participants (80%) visited MDC three or more times and 50% spent a total of ≥15 minutes on MDC. Participants' median System Usability Scale (SUS) score was 78.8 [Q1, Q3: 72.5, 87.5] and significantly greater than the threshold value of 68 indicative of "above average" usability (p < 0.001). The median SUS score of patients with limited HL was similar to those with adequate HL (77.5 [72.5, 85.0] vs. 82.5 [72.5, 92.5]; p = 0.41). Participants most commonly reported the literacy level-appropriate educational links and health data infographics as features that helped them better understand their diabetes health data (65%). All participants (100%) intended to continue to use MDC. Median Patient Activation Measure® scores increased postintervention (64.3 [55.6, 72.5] vs. 67.8 [60.6, 75.0]; p = 0.01). CONCLUSION Participants, including those with limited HL, rated the usability of MDC above average, anticipated continued use, and identified key features that improved their understanding of diabetes health data. Patient activation improved over the study period. Our findings suggest MDC may be a beneficial addition to existing patient portals.
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Affiliation(s)
- William Martinez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Amber J Hackstadt
- Department of Biostatistics, Vanderbilt University Medicine Center, Nashville, Tennessee, United States
| | - Gerald B Hickson
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Thomas Knoerl
- Upstate Medical University, State University of New York, Syracuse, New York, United States
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Kenneth A Wallston
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Tom A Elasy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Bratke H, Sivertsen B. Mental and somatic health in university students with type 1 diabetes: new results from DiaSHoT18, a cross sectional national health and well-being survey. J Pediatr Endocrinol Metab 2021; 34:697-705. [PMID: 33838092 DOI: 10.1515/jpem-2021-0041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/08/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To explore mental and somatic health, quality of life, alcohol-related problems, sleep problems, and diabetes related distress in university students with type 1 diabetes (T1D), compared to students without T1D. Further, we evaluated associations with gender, treatment modalities, and achieved metabolic control. METHODS All fulltime Norwegian students aged 18-35 years pursuing higher education in 2018 (n=162.512) were invited into a comprehensive national survey on health and well-being. Students that stated having diabetes was asked further questions about their diabetes care. RESULTS Of 49,684 participating students, 324 participants stated having T1D. Students with T1D did not show more mental or somatic health symptoms, or report a higher level of loneliness. However, T1D was significantly associated with lower quality of life (QoL). Students with good metabolic control reached the same QoL as students without T1D. Mental disorders and suicidality were associated with lacking metabolic control. The proportion of unhealthy drinking habits was generally low, and even lower in students with T1D. Sleeping patterns were generally good, but students using continuous glucose measurement were awakening more often during sleep. Females with T1D showed higher levels of diabetes related problems and distress, but good metabolic control was associated with lower diabetes distress level. CONCLUSIONS Students with T1D scored equally on most mental and somatic health scales. Their quality of life was significantly worse compared to their healthy peers. Knowledge on the impact of metabolic control, gender and the use of CSII and CGM can be valuable for the caretakers of young adults with T1D.
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Affiliation(s)
- Heiko Bratke
- Section for Pediatrics, Department of Clinical Medicine, Haugesund Hospital, Fonna Health Trust, Haugesund, Norway.,Section for Pediatrics, Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Research and Innovation, Fonna Health Trust, Haugesund, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Department of Research and Innovation, Fonna Health Trust, Haugesund, Norway.,Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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103
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Muijs LT, de Wit M, Knoop H, Snoek FJ. Feasibility and user experience of the unguided web-based self-help app 'MyDiaMate' aimed to prevent and reduce psychological distress and fatigue in adults with diabetes. Internet Interv 2021; 25:100414. [PMID: 34401373 PMCID: PMC8350600 DOI: 10.1016/j.invent.2021.100414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/19/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Psychological distress and fatigue are common in persons with diabetes, adversely affecting quality of life and complicating diabetes self-management. Offering diabetes-specific self-guided cognitive behavioral therapy (CBT) may be helpful for persons with diabetes and mild symptoms of psychological distress and fatigue. We are the first to test the feasibility and user experiences of a web-based self-help app called 'MyDiaMate' in adults with type 1 and type 2 diabetes. METHODS AND MATERIALS MyDiaMate was developed in close collaboration with persons with diabetes and professionals, building on elements from existing (guided) diabetes-specific CBT interventions. The study was advertised, offering free access to the app for adults with diabetes for a period of three months. Feasibility and user experiences were tested in a non-randomized study with pre- and post- measurements and interviews in a small sample.. In addition usage of the app was studied using log-data.. RESULTS In total N = 55 adults with diabetes signed up for the study. Mean age was M = 42.7 (SD = 15.6), mostly women (n = 39, 70.9%), higher educated (n = 36, 65.5%), and diagnosed with type 1 diabetes (n = 37, 67.3%). About half reported current or a history of psychological complaints. All the participants completed baseline assessments, and n = 32 participants (58%) completed the follow-up questionnaire. Main reasons for participating in the study were: to preserve or improve mental fitness (40.6%), curiosity (25.0%) and wanting to contribute to research (34.4%). No major technical issues were encountered in accessing or using the app. The app was opened at least once by n = 51 participants, median use of the modules was 28 min (1-80) within a period of 1 to 92 days (median = 10). Almost all participants (n = 50, 98.0%) opened the basic module 'Diabetes in balance', of whom 32 (62.7%) completed this module. 'My mood' and 'My energy' were opened by n = 40 (78.4%) and n = 32 (62.7%) participants, respectively, and completed by n = 21 (52.5%) and n = 9 (28.1%) of the participants. Of all participants, 40.6% would recommend the app to others living with diabetes. CONCLUSIONS This study confirmed the feasibility of MyDiaMate as a diabetes-specific self-guided app for adults wishing to preserve or improve their psychological health. While user experiences were overall positive, further tailoring the content to individual needs and preferences could enhance uptake, usage and appreciation. Future research should explore its effectiveness in a randomized controlled trial.
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Affiliation(s)
- Linda T. Muijs
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Maartje de Wit
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
- Corresponding author.
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Frank J. Snoek
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, the Netherlands
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Martinez W, Hackstadt AJ, Hickson GB, Rosenbloom ST, Elasy TA. Evaluation of the My Diabetes Care Patient Portal Intervention: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e25955. [PMID: 34032578 PMCID: PMC8188319 DOI: 10.2196/25955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/01/2021] [Accepted: 02/25/2021] [Indexed: 11/29/2022] Open
Abstract
Background My Diabetes Care (MDC) is a multi-faceted intervention embedded within an established patient portal, My Health at Vanderbilt. MDC is designed to help patients better understand their diabetes health data and support self-care. MDC uses infographics to visualize and summarize patients’ diabetes health data, incorporates motivational strategies, provides literacy-level appropriate educational resources, and links to a diabetes online patient support community and diabetes news feeds. Objective This study aims to evaluate the effects of MDC on patient activation in adult patients with type 2 diabetes mellitus. Moreover, we plan to assess secondary outcomes, including system use and usability, and the effects of MDC on cognitive and behavioral outcomes (eg, self-care and self-efficacy). Methods We are conducting a 6-month, 2-arm, parallel-design, pragmatic pilot randomized controlled trial of the effect of MDC on patient activation. Adult patients with type 2 diabetes mellitus are recruited from primary care clinics affiliated with Vanderbilt University Medical Center. Participants are eligible for the study if they are currently being treated with at least one diabetes medication, are able to speak and read in English, are 21 years or older, and have an existing My Health at Vanderbilt account and reliable access to a desktop or laptop computer with internet access. We exclude patients living in long-term care facilities, patients with known cognitive deficits or severe visual impairment, and patients currently participating in any other diabetes-related research study. Participants are randomly assigned to MDC or usual care. We collect self-reported survey data, including the Patient Activation Measure (R) at baseline, 3 months, and 6 months. We will use mixed-effects regression models to estimate potentially time-varying intervention effects while adjusting for the baseline measure of the outcome. The mixed-effects model will use fixed effects for patient-level characteristics and random effects for health care provider variables (eg, primary care physicians). Results This study is ongoing. Recruitment was closed in May 2020; 270 patients were randomized. Of those randomized, most (214/267, 80.1%) were non-Hispanic White, and 13.1% (35/267) were non-Hispanic Black, 43.7% (118/270) reported being 65 years or older, and 33.6% (90/268) reported limited health literacy. We obtained at least 95.6% (258/270) completion among participants through the 3-month follow-up assessment. Conclusions This randomized controlled trial will be one of the first to evaluate a patient-facing diabetes digital health intervention delivered via a patient portal. By embedding MDC into Epic’s MyChart platform with more than 127 million patient records, our intervention is directly integrated into routine care, highly scalable, and sustainable. Our findings and evolving patient portal functionality will inform the continued development of MDC to best meet users’ needs and a larger trial focused on the impact of MDC on clinical end points. Trial Registration ClinicalTrials.gov NCT03947333; https://clinicaltrials.gov/ct2/show/NCT03947333 International Registered Report Identifier (IRRID) DERR1-10.2196/25955
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Affiliation(s)
- William Martinez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Amber J Hackstadt
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Gerald B Hickson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - S Trent Rosenbloom
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tom A Elasy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
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Hadjiconstantinou M, Barker MM, Brough C, Schreder S, Northern A, Stribling B, Khunti K, Davies MJ. Improved diabetes-related distress and self-efficacy outcomes in a self-management digital programme for people with type 2 diabetes, myDESMOND. Diabet Med 2021; 38:e14551. [PMID: 33675068 DOI: 10.1111/dme.14551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 01/09/2023]
Affiliation(s)
| | - Mary M Barker
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Chris Brough
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sally Schreder
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Alison Northern
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Bernie Stribling
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
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To Adapt or Not to Adapt: The Association between Implementation Fidelity and the Effectiveness of Diabetes Self-Management Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084095. [PMID: 33924494 PMCID: PMC8069177 DOI: 10.3390/ijerph18084095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 12/03/2022]
Abstract
Self-management education (SME) is a key determinant of diabetes treatment outcomes. While SME programs are often adapted for implementation, the impact of adaptations on diabetes SME effectiveness is not well documented. This study evaluated the impact of the implementation fidelity of diabetes SME programs on program effectiveness, exploring which factors influence implementation fidelity. Data from 33 type 2 diabetes SME program providers and 166 patients were collected in 8 countries (Austria, Belgium, Germany, Ireland, UK, Israel, Taiwan and USA). Program providers completed a questionnaire assessing their adherence to the program protocol and factors that influenced the implementation. Patients answered a pre–post questionnaire assessing their diabetes-related health literacy, self-care behavior, general health and well-being. Associations between implementation fidelity and outcomes were estimated through logistic regressions and repeated measures MANOVA, controlling for potential confounders. Adaptations of the program protocol regarding content, duration, frequency and/or coverage were reported by 39% of the providers and were associated with better, not worse, outcomes than strict adherence. None of the factors related to the participants, facilitating strategies, provider or context systematically influenced the implementation fidelity. Future research should focus on individual and contextual factors that may influence decisions to adapt SME programs for diabetes.
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107
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Polypharmacy among people living with type 2 diabetes mellitus in rural communes in Vietnam. PLoS One 2021; 16:e0249849. [PMID: 33831073 PMCID: PMC8031303 DOI: 10.1371/journal.pone.0249849] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/25/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives People with diabetes are at high risk of polypharmacy owing to complex treatment of diabetes and comorbidities. Polypharmacy is associated with increased risk of adverse reactions and decreased compliance. Therefore, the objectives of this study were to assess polypharmacy in people with type 2 diabetes (T2D) and associated diabetes-related factors in rural areas in Vietnam. Method People with T2D (n = 806) who had received treatment for diabetes at a district hospital were invited to participate in a questionnaire-based cross-sectional survey. Polypharmacy was defined as ≥5 types of medicine and assessed as a) prescription medicine and non-prescription/over the counter (OTC) medicine and b) prescription medicine and non-prescription/OTC, herbal and traditional medicine, and dietary supplement. Multiple logistic regression was used to investigate the association between polypharmacy and diabetes specific factors: duration, comorbidities and diabetes-related distress. Results Of the people with T2D, 7.8% had a medicine use corresponding to polypharmacy (prescription medicine and non-prescription/OTC), and 40.8% when herbal and traditional medicine, and dietary supplement were included. Mean number of medicine intake (all types of medicines and supplements) were 3.8±1.5. The odd ratios (ORs) of polypharmacy (medicine and supplements) increased with diabetes duration (<1–5 years OR = 1.66; 95%CI: 1.09–2.53 and >5 years OR = 1.74; 95%CI: 1.14–2.64 as compared to ≤1-year duration of diabetes), number of comorbidities (1–2 comorbidities: OR = 2.0; 95%CI: 1.18–3.42; ≥3 comorbidities: OR = 2.63;95%CI: 1.50–4.61 as compared to no comorbidities), and suffering from diabetes-related distress (OR = 1.49; 95%CI: 1.11–2.01) as compared to those without distress. Conclusions In rural northern Vietnam, persons with longer duration of T2D, higher number of comorbidities and diabetes-related stress have higher odds of having a medicine use corresponding to polypharmacy. A high proportion of people with T2D supplement their prescription, non-prescription/OTC medicine with herbal and traditional medicine and dietary supplements.
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108
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Berger B, Jenetzky E, Köblös D, Stange R, Baumann A, Simstich J, Michalsen A, Schmelzer KM, Martin DD. Seven-day fasting as a multimodal complex intervention for adults with type 1 diabetes: Feasibility, benefit and safety in a controlled pilot study. Nutrition 2021; 86:111169. [PMID: 33636417 DOI: 10.1016/j.nut.2021.111169] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/24/2020] [Accepted: 01/16/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Intermittent as well as prolonged fasting are receiving considerable attention and appear favorable in conditions such as metabolic syndrome, type 2 diabetes, and rheumatic diseases. Fasting for individuals with type 1 diabetes (T1D) is generally considered too risky. However, the ability and possibility to change from carbohydrate- to ketone-based fuel supply might be relevant for individuals with T1D. The aim of this patient-led research was to investigate the feasibility, benefit, and safety of a 7-d multimodal fasting intervention in individuals with T1D. METHODS This was a non-randomized controlled pilot study, with 20 participants with T1D and 10 without the disease. Data acquisition took place before, after, and 4 mo after the intervention and daily during intervention. RESULTS Of the individuals with T1D, 19 finished fasting. A mean β-hydroxybutyrate as representative ketone body increased to 2.8 ± 1.9 mmol/L on day 7; whereas average glucose remained between 4.9 (±1.5) and 7.5 (±2.3) mmol/L (89 ± 27 and 136 ± 40 mg/dL). Mean daily insulin dose was adjusted from 24.4 (3-50) IU on the day before fasting to 7.6 (0-26.7) IU on day 7. Quality of life (WHO-5) normalized from 54 (±4.4) to 68.8 (±15; P = 0.01) after fasting. There was a decrease from before until the follow-up 4 mo later of weight from 77.6 (±20.4) to 76.6 (±20.9) kg (P = 0.023) and for body mass index from 27.68 (±7.04) to 26.74 (±7.15) kg/m2 (P = 0.008). Diastolic blood pressure increased from 69.75 (±11.41) to 75.74 (±8.42) mm Hg (P = 0.028) and stayed in a healthy range on average. Fasting-related side effects were all temporary, and slightly more prevalent in those with type 1 diabetes compared with the reference group. CONCLUSIONS This study demonstrated the feasibility, benefits, and safety aspects of a 7-d fast in adults with T1D.
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Affiliation(s)
- Bettina Berger
- Medical Theory, Integrative and Anthroposophic Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany.
| | - Ekkehart Jenetzky
- Medical Theory, Integrative and Anthroposophic Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Diana Köblös
- Medical Theory, Integrative and Anthroposophic Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
| | - Rainer Stange
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany
| | - Andrea Baumann
- Medical Theory, Integrative and Anthroposophic Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
| | | | - Andreas Michalsen
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany
| | | | - David D Martin
- Medical Theory, Integrative and Anthroposophic Medicine, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
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Alexandre K, Vallet F, Peytremann-Bridevaux I, Desrichard O. Identification of diabetes self-management profiles in adults: A cluster analysis using selected self-reported outcomes. PLoS One 2021; 16:e0245721. [PMID: 33481883 PMCID: PMC7822269 DOI: 10.1371/journal.pone.0245721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/06/2021] [Indexed: 11/18/2022] Open
Abstract
The present study describes adult diabetes self-management (DSM) profiles using self-reported outcomes associated with the engagement in diabetes care activities and psychological adjustment to the disease. We used self-reported data from a community-based cohort of adults with diabetes (N = 316) and conducted a cluster analysis of selected self-reported DSM outcomes (i.e., DSM behaviors, self-efficacy and perceived empowerment, diabetes distress and quality of life). We tested whether clusters differed according to sociodemographic, clinical, and care delivery processes variables. Cluster analysis revealed four distinct DSM profiles that combined high/low levels of engagement in diabetes care activities and good/poor psychological adjustment to the disease. The profiles were differently associated with the variables of perceived financial insecurity, taking insulin treatment, having depression, and the congruence of the care received with the Chronic Care Model. The results could help health professionals gain a better understanding of the different realities facing people living with diabetes, identify patients at risk of poor outcomes related to their DSM, and lead to the development of profile-specific DSM interventions.
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Affiliation(s)
- Ketia Alexandre
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Fanny Vallet
- Faculté de Psychologie et des Sciences de l’Education, University of Geneva, Geneva, Switzerland
| | | | - Olivier Desrichard
- Faculté de Psychologie et des Sciences de l’Education, University of Geneva, Geneva, Switzerland
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Brennan MC, Albrecht MA, Brown JA, Leslie GD, Ntoumanis N. Self-Management Group Education to Reduce Fear of Hypoglycemia as a Barrier to Physical Activity in Adults Living With Type 1 Diabetes: A Pilot Randomized Controlled Trial. Can J Diabetes 2021; 45:619-628. [PMID: 33648863 DOI: 10.1016/j.jcjd.2021.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the feasibility, acceptability and preliminary efficacy of a theory-driven group education intervention designed to reduce fear of hypoglycemia (FoH) as a barrier to physical activity (PA) in adults with type 1 diabetes (T1D). METHODS This study was a single-blinded, pilot randomized controlled trial of adults aged 18 to 65 years and living with T1D in Western Australia. Participants were randomized (1:1) to standard care or intervention with self-management education. Primary outcomes were feasibility and acceptability of the study procedures, and change to barriers to PA and FoH. Secondary outcomes were change to attitudes and intentions toward PA, self-reported participation in PA, self-efficacy, diabetes distress and well-being. To calculate effect sizes, we used a Bayesian comparison of the between-group difference scores (i.e. [scoret2 - scoret1]TREATMENT vs [scoret2 - scoret1]CONTROL). RESULTS We randomized 117 participants with T1D, 86 (74%) of whom provided baseline data and attended initial workshops. Of these participants, 81% attended the booster workshop 4 weeks later. They were 45±12 years of age, reported high levels of activity and had been living with T1D for 20±14 years. Small-to-moderate effect sizes [ESs] in favour of the intervention were observed at 12 weeks for overall barriers to PA (ES, -0.38; highest density interval, -0.92 to 0.17]), self-efficacy for blood glucose management after PA (ES, 0.45; highest density interval, 0 to 0.91]), diabetes distress (ES, -0.29; highest density interval, -0.77 to 0.15) and well-being (ES, 0.36; highest density interval, -0.12 to 0.8). CONCLUSIONS Quantitative findings indicate study procedures were acceptable to participants and feasible to deliver. A future definitive trial is justified to replicate preliminary efficacy and to determine the utility of the intervention for improving PA participation.
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Affiliation(s)
- Marian C Brennan
- Curtin School of Nursing/Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; Health Services, Diabetes Western Australia, Perth, Western Australia, Australia; Physical Activity and Well-being Research Group, Curtin University, Perth, Western Australia, Australia.
| | - Matthew A Albrecht
- Curtin School of Nursing/Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Janie A Brown
- Curtin School of Nursing/Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; St John of God Midland Public and Private Hospital, Perth, Western Australia, Australia; Western Australian Group for Evidence Informed Healthcare Practice: A JBI Centre of Excellence, Perth, Western Australia, Australia
| | - Gavin D Leslie
- Curtin School of Nursing/Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Nikos Ntoumanis
- Physical Activity and Well-being Research Group, Curtin University, Perth, Western Australia, Australia; Curtin School of Population Health/Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Coccaro EF, Lazarus S, Joseph J, Wyne K, Drossos T, Phillipson L, de Groot M. Emotional Regulation and Diabetes Distress in Adults With Type 1 and Type 2 Diabetes. Diabetes Care 2021; 44:20-25. [PMID: 33444157 PMCID: PMC8742145 DOI: 10.2337/dc20-1059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/27/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To explore the correlates of diabetes-related distress (DD) with psychometrically valid assessments of emotional regulation in individuals with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS Adults with diabetes (n = 298) were assessed for psychological issues possibly associated with diabetes and were further evaluated with measures of negative emotional experience (ER-Exp) and skill at regulating such experiences (ER-Skill) and measures of DD, perceived psychosocial stress, diabetes literacy, and diabetes self-care. RESULTS ER-Exp was directly related to DD, while ER-Skill was inversely related to DD. Together, these ER variables displayed a medium-size relationship (β = 0.45) with DD. Inclusion of variables related to diabetes self-care and perceived psychosocial stress was associated with only an 18% reduction (i.e., β = 0.45 to β = 0.38) in the strength of this relationship, while the magnitude of relationships between DD and perceived psychosocial stress (β = 0.15) and diabetes self-care (β = -0.09) was relatively small. CONCLUSIONS These data suggest that DD is meaningfully linked with negative emotionality, and skill at regulating such emotions, in adults with diabetes. This relationship appears to be stronger than that between DD and perceived psychological stress or diabetes self-care. If so, DD (and possibly A1C) may be improved in those with diabetes and difficulties with negative emotionality.
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Affiliation(s)
- Emil F Coccaro
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Sophie Lazarus
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Joshua Joseph
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kathline Wyne
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Tina Drossos
- Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Louis Phillipson
- Kovler Diabetes Center, Section of Endocrinology, Department of Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Mary de Groot
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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112
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Cichoń E, Kiejna A, Gondek TM, Obrębski M, Sutkowska E, Lloyd CE, Sartorius N, Kokoszka A. PAID-PL-The Polish Version of the Problem Areas in Diabetes Scale: Perfect Reliability and a One-Factor Structure. Diabetes Metab Syndr Obes 2021; 14:4433-4441. [PMID: 34754208 PMCID: PMC8572026 DOI: 10.2147/dmso.s322850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/01/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The aim of this study was to assess the structure and validate the Polish version of the Problem Areas in Diabetes (PAID) scale, as the current translations of the original English version significantly vary in their psychometric properties. PATIENTS AND METHODS Two hundred and sixteen consecutive Polish outpatients were invited to participate in this international cross-sectional study on depression in diabetes. The research was based on the demographic and clinical characteristics of the study population, including the level of glycated hemoglobin (HbA1c) and scores obtained in the Polish versions of the following questionnaires: PAID, World Health Organization-Five Well-Being Index (WHO-5), Patient Health Questionnaire 9 (PHQ-9). The psychiatric diagnosis was conducted with the use of Mini-International Neuropsychiatric Interview (M.I.N.I.). RESULTS Exploratory factor analyses yielded a 1-factor structure that included all 20 items. The internal consistency of the Polish version of PAID was high (Cronbach α = 0.97). There were significant positive correlation between PAID and PHQ-9 and a negative correlation between PAID and WHO-5. We also observed a negative association between PAID scores and age and a positive correlation between PAID and HbA1c levels. Patients with depression reported significantly higher PAID scores as compared with those without depressive symptoms. CONCLUSION The Polish version of PAID has a one-factor structure and is a reliable, valid outcome measure for Polish outpatients with type 2 diabetes and it may constitute a useful instrument for screening for psychologic issues in diabetic patients during their appointments at the diabetes clinic.
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Affiliation(s)
- Ewelina Cichoń
- Department of Psychology, WSB University in Torun, Torun, Wroclaw, Poland
- Department of Psychology, Faculty of Applied Studies, University of Lower Silesia, Wroclaw, Poland
| | - Andrzej Kiejna
- Department of Psychology, WSB University in Torun, Torun, Wroclaw, Poland
- Department of Psychology, Faculty of Applied Studies, University of Lower Silesia, Wroclaw, Poland
| | - Tomasz M Gondek
- Specialty Training Section, Polish Psychiatric Association, Wroclaw, Poland
- Section on Education, World Psychiatric Association, Wroclaw, Poland
| | - Marcin Obrębski
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Edyta Sutkowska
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Wroclaw, Poland
| | - Cathy E Lloyd
- Faculty of Health and Social Care, The Open University, Milton Keynes, UK
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AIMH), Geneva, Switzerland
| | - Andrzej Kokoszka
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
- Correspondence: Andrzej Kokoszka II Department of Psychiatry, Medical University of Warsaw, 03-242 Kondratowicza 8 street, Warsaw, PolandTel/Fax +48 22 326 58 92 Email
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113
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Charleer S, De Block C, Nobels F, Radermecker RP, Lowyck I, Mullens A, Scarnière D, Spincemaille K, Strivay M, Weber E, Taes Y, Vercammen C, Keymeulen B, Mathieu C, Gillard P. Sustained Impact of Real-time Continuous Glucose Monitoring in Adults With Type 1 Diabetes on Insulin Pump Therapy: Results After the 24-Month RESCUE Study. Diabetes Care 2020; 43:3016-3023. [PMID: 33067260 DOI: 10.2337/dc20-1531] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/16/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In recent years, a growing number of people with type 1 diabetes gained access to real-time continuous glucose monitoring (rtCGM). Long-term benefits of rtCGM are unclear because of a lack of large studies of long duration. We evaluated whether real-world rtCGM use up to 24 months offered benefits, particularly in those living with impaired awareness of hypoglycemia (IAH). RESEARCH DESIGN AND METHODS This 24-month, prospective, observational cohort study followed 441 adults with insulin pumps receiving full reimbursement for rtCGM. Forty-two percent had IAH. The primary end point was evolution of HbA1c, with secondary end points change in acute hypoglycemia complications, diabetes-related work absenteeism, and quality of life scores. Additionally, we evaluated whether people could achieve glycemic consensus targets during follow-up. RESULTS After 24 months, HbA1c remained significantly lower compared with baseline (7.64% [60 mmol/mol] vs. 7.37% [57 mmol/mol], P < 0.0001). Sustained benefits were also observed for the score on the hypoglycemia fear survey and hypoglycemia-related acute complications irrespective of hypoglycemia awareness level. People with IAH had the strongest improvement, especially for severe hypoglycemia (862 events in the year before vs. 119 events per 100 patient-years in the 2nd year, P < 0.0001). Over 24 months, more people were able to meet hypoglycemia consensus targets at the expense of slightly fewer people achieving hyperglycemia consensus targets. Furthermore, the number of people with HbA1c <7% (<53 mmol/mol) without severe hypoglycemia events more than doubled (11.0% vs. 25.4%, P < 0.0001). CONCLUSIONS Use of rtCGM led to sustained improvements in hypoglycemia-related glucose control over 24 months. Lower fear of hypoglycemia, fewer acute hypoglycemia-related events, and fewer diabetes-related days off from work were observed, particularly in those with IAH.
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Affiliation(s)
- Sara Charleer
- Department of Endocrinology, University Hospitals Leuven-KU Leuven, Leuven, Belgium
| | - Christophe De Block
- Department of Endocrinology, Diabetology and Metabolism, University of Antwerp-Antwerp University Hospital, Antwerp, Belgium
| | - Frank Nobels
- Department of Endocrinology, OLV Hospital Aalst, Aalst, Belgium
| | - Régis P Radermecker
- Department of Diabetes, Nutrition and Metabolic Disorders, CHU Liege-Liege University, Liege, Belgium
| | - Ine Lowyck
- Department of Endocrinology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Denis Scarnière
- Department of Endocrinology-Diabetology, Grand Hôpital de Charleroi, Gilly, Belgium
| | | | - Marie Strivay
- Department of Endocrinology, CHR La Citadelle Liège, Liege, Belgium
| | - Eric Weber
- Department of Endocrinology, Cliniques du Sud Luxembourg-Vivalia, Arlon, Belgium
| | - Youri Taes
- Department of Endocrinology, AZ Sint-Jan Brugge AV, Bruges, Belgium
| | - Chris Vercammen
- Department of Endocrinology, Imelda Hospital Bonheiden, Bonheiden, Belgium
| | - Bart Keymeulen
- Diabetes clinic, University Hospital Brussels-VUB, Brussels, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven-KU Leuven, Leuven, Belgium
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114
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Rutten GEHM, Van Vugt H, de Koning E. Person-centered diabetes care and patient activation in people with type 2 diabetes. BMJ Open Diabetes Res Care 2020; 8:8/2/e001926. [PMID: 33323460 PMCID: PMC7745339 DOI: 10.1136/bmjdrc-2020-001926] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The American Diabetes Association and the European Association for the Study of Diabetes advocate a person-centered approach to enhance patient engagement in self-care activities. To that purpose, people with diabetes need adequate diabetes knowledge, motivation, skills and confidence. These prerequisites are captured by the concept 'patient activation'. The Dutch Diabetes Federation implemented a person-centered consultation model for the annual diabetes review. To assess its relationship with patient activation, we measured the change in patient activation, and in person and disease-related factors in people with type 2 diabetes after their second person-centered annual review. RESEARCH DESIGN AND METHODS Observational study in 47 primary care practices and six outpatient hospital clinics. FOLLOW-UP 1 year. From 2.617 people with diabetes and capable of completing questionnaires (no additional exclusion criteria) 1.487 (56.8%) participated, 1366 with type 2 diabetes. MAIN OUTCOME patient activation (13-item Patient Activation Measure, score 0-100). Before the first and after the second review, participants completed questionnaires. Medical data were retrieved from electronic records. We performed a repeated measure analysis using a linear mixed model in 1299 participants, who completed the first set of questionnaires. RESULTS In 1299 participants (41.6% female, mean age 66 years, median diabetes duration 10 years, median glycated hemoglobin (HbA1c) 6.8%/51 mmol/mol), the mean baseline activation level was 58.9 (SD 11.7). Independent of actual diabetes care, activation levels increased 1.53 units (95% CI 0.67 to 2.39, p=0.001). Several diabetes perceptions improved significantly; diabetes distress level decreased significantly. Body mass index (-0.22, 95% CI -0.33 to -0.10, p<0.001) and low-density lipoprotein cholesterol (-2.71 mg/dL, 95% CI -4.64 to -0.77, p=0.004) decreased, HbA1c increased 0.08% (95% CI 0.03 to 0.12) (p=0.001). CONCLUSIONS Person-centered diabetes care was associated with a slightly higher patient activation level, improved diabetes perception and small improvements in clinical outcomes. Person-centered care may enhance patient engagement, but one should not expect substantial improvement in patient outcomes in the short term.
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Affiliation(s)
- Guy E H M Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Heidi Van Vugt
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Eelco de Koning
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
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115
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Christoffersen LA, Hansen AK, Pals RA, Willaing I, Siersma V, Olesen K. Effect of a participatory patient education programme ( NExt EDucation) in group-based patient education among Danes with type 2 diabetes. Chronic Illn 2020; 16:226-236. [PMID: 30227718 DOI: 10.1177/1742395318799843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the effect of a participatory group-based education programme for individuals with type 2 diabetes, Next Education. METHOD In a quasi-experimental study, individuals with type 2 diabetes were recruited from 14 Danish municipalities with a patient education programme. Eight municipalities using Next Education were intervention sites; six control sites used usual group-based education programmes. Data were collected through questionnaires at baseline and at 3 and 12 months after programmes ended. Changes in quality of life (EQ-5D-5L), diabetes-related emotional distress (PAID-5), physical activity, diet, foot care and sense of coherence (SOC-13) were assessed in generalised linear mixed models. RESULTS At baseline, 310 participants (52.6% females, mean age 62.5 years [SD = 10.7] and a mean duration of type 2 diabetes of 6.9 years [SD = 8.4]) participated in Next Education (n = 234) or group-based education (n = 76) at control sites. Compared with participants at control sites, participants at intervention sites had significantly larger sense of coherence scores at 3 (9.4%, p = 0.03) and 12 (9.8%, p = 0.02) months of follow-up. Other measures did not differ significantly between groups. DISCUSSION It is likely that person-centeredness and high degrees of user participation at the intervention sites improved sense of coherence among Danes with type 2 diabetes.
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Affiliation(s)
| | | | | | | | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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116
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Alessi SM, Foster NC, Rash CJ, Van Name MA, Tamborlane WV, Cengiz E, Polsky S, Wagner J. Alcohol Use and Clinical Outcomes in Adults in the Type 1 Diabetes Exchange. Can J Diabetes 2020; 44:501-506. [PMID: 32792103 DOI: 10.1016/j.jcjd.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Alcohol consumption has serious potential consequences for persons with type 1 diabetes. This cross-sectional study examined associations between drinking status and diabetes-related outcomes. METHODS Participants included 934 adults at Type 1 Diabetes Exchange Registry clinics who responded to an e-mail invitation to complete an electronic survey with items on alcohol consumption; glycated hemoglobin (A1C) and body mass index (BMI) were extracted from medical charts. Participants were an average 38±16 years of age, 61% were women and 90% were non-Hispanic white; A1C was 7.8%±1.5%. The sample was made up of 11% (n=103) never drinkers, 9% (n=89) former drinkers, 61% (n=567) current (past year) nonbinge drinkers and 19% (n=174) current binge drinkers. RESULTS After controlling for covariates, diabetes distress was lower among never drinkers compared with former and nonbinge drinkers (p<0.009). Never drinkers compared with former drinkers had lower odds of past-year severe hypoglycemia (p=0.001) and lower odds of a neuropathy diagnoses (p=0.006). There were omnibus model trends toward associations between drinking status and diabetes self-care (p=0.10) and between drinking status and BMI (p=0.06). Never drinkers did not differ from other groups on daily frequency of blood glucose self-monitoring, A1C or past-year diabetic ketoacidosis (p>0.05). CONCLUSIONS These results suggest complex relationships between drinking and diabetes-related distress, and that recent severe hypoglycemia and the presence of neuropathy may motivate some to stop drinking. Prospective studies may improve understanding of these findings.
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Affiliation(s)
- Sheila M Alessi
- University of Connecticut School of Medicine, Department of Medicine and Calhoun Cardiology Center, Farmington, Connecticut, United States.
| | - Nicole C Foster
- Jael Center for Health Research, Tampa, Florida, United States
| | - Carla J Rash
- University of Connecticut School of Medicine, Department of Medicine and Calhoun Cardiology Center, Farmington, Connecticut, United States
| | - Michelle A Van Name
- Yale University School of Medicine, Department of Pediatrics, New Haven, Connecticut, United States
| | - William V Tamborlane
- Yale University School of Medicine, Department of Pediatrics, New Haven, Connecticut, United States
| | - Eda Cengiz
- Yale University School of Medicine, Division of Pediatric Endocrinology, Department of Pediatrics, New Haven, Connecticut, United States; Bahcesehir University School of Medicine, Instanbul, Turkey
| | - Sarit Polsky
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, Colorado, United States
| | - Julie Wagner
- University of Connecticut School of Dental Medicine, Farmington, Connecticut, United States
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117
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Salvy SJ, Carandang K, Vigen CL, Concha-Chavez A, Sequeira PA, Blanchard J, Diaz J, Raymond J, Pyatak EA. Effectiveness of social media (Facebook), targeted mailing, and in-person solicitation for the recruitment of young adult in a diabetes self-management clinical trial. Clin Trials 2020; 17:664-674. [PMID: 32627589 DOI: 10.1177/1740774520933362] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Research is needed to identify promising recruitment strategies to reach and engage diverse young adults in diabetes clinical research. The aim of this study was to examine the relative strengths and weaknesses of three recruitment strategies used in a diabetes self-management clinical trial: social media advertising (Facebook), targeted mailing, and in-person solicitation of clinic patients. METHODS Strategies were compared in terms of (1) cost-effectiveness (i.e. cost of recruitment/number of enrolled participants), (2) ability to yield participants who would not otherwise be reached by alternative strategies, and (3) likelihood of participants recruited through each strategy to adhere to study procedures. We further explored the appeal (overall and among age and gender subgroups) of social media advertisement features. RESULTS In-person recruitment of clinic patients was overall the most cost-effective strategy. However, differences in demographic, clinical, and psychosocial characteristics of participants recruited via different strategies suggest that the combination of these approaches yielded a more diverse sample than would any one strategy alone. Once successfully enrolled, there was no difference in study completion and intervention adherence between individuals recruited by the three recruitment strategies. CONCLUSIONS Ultimately, the utility of a recruitment strategy is defined by its ability to effectively attract people representative of the target population who are willing to enroll in and complete the study. Leveraging a variety of recruitment strategies appears to produce a more representative sample of young adults, including those who are less engaged in diabetes care.
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Affiliation(s)
- Sarah-Jeanne Salvy
- Research Center for Health Equity, Cedars-Sinai Medical Center, West Hollywood, CA, USA
| | | | - Cheryl Lp Vigen
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | | | | | - Jeanine Blanchard
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Jesus Diaz
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | | | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
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118
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van Vugt HA, Heijmans MJWM, de Koning EJP, Rutten GEHM. Factors that influence the intended intensity of diabetes care in a person-centred setting. Diabet Med 2020; 37:1167-1175. [PMID: 31278874 DOI: 10.1111/dme.14072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2019] [Indexed: 12/15/2022]
Abstract
AIMS To assess the intended intensity of Type 2 diabetes care and the factors associated with that intensity of care after the annual monitoring visit in which a new person-centred diabetes consultation model including shared decision making was used. METHODS We conducted an observational study in 1284 people from 47 general practices and six hospital outpatient clinics. Intensity of care (more, no/minimal change, less) was based on monitoring frequency and referral to other care providers. We used multivariable analyses to determine the factors that were independently associated with intensity of care. Care providers also reported three factors which, in their opinion, determined the intensity of care. RESULTS After the consultation, 22.8% of people chose more intensive care, 70.6% chose no/minimal change and 6.6% chose less intensive care. Whether care became more intensive vs not/minimally changed was associated with a high educational level (odds ratio 1.65, CI 1.07 to 2.53; P=0.023), concern about illness (odds ratio 1.08; CI 1.00 to 1.17; P=0.045), goal-setting (odds ratio 6.53, CI 3.79 to 11.27; P<0.001), comorbidities (odds ratio 1.12, CI 1.00 to 1.24; P=0.041) and use of oral blood glucose lowering medication (odds ratio 0.59, CI 0.39 to 0.89; P=0.011). Less intensive care vs no/minimal change was associated with lower diabetes distress levels (odds ratio 0.87, CI 0.79 to 0.97; P=0.009). According to care providers, quality of life, lifestyle, person's preferences and motivation, glycaemic control, and self-management possibilities most frequently determined the intended care. CONCLUSIONS In person-centred diabetes care, the intended intensity of care was associated with both disease- and person-related factors.
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Affiliation(s)
- H A van Vugt
- Julius Centre for Health Sciences and Primary Care, Department of General Practice, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M J W M Heijmans
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - E J P de Koning
- Department of Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - G E H M Rutten
- Julius Centre for Health Sciences and Primary Care, Department of General Practice, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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119
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Zhang X, Foo S, Majid S, Chang YK, Dumaual HTJ, Suri VR. Self-Care and Health-Information-Seeking Behaviours of Diabetic Patients in Singapore. HEALTH COMMUNICATION 2020; 35:994-1003. [PMID: 31303050 DOI: 10.1080/10410236.2019.1606134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Patients in Singapore with chronic conditions such as diabetes are encouraged to participate in patient-professional partnership activities because of rising health care costs and a shortage of infrastructure and human resources. This study explores the self-care and health information seeking behaviors of diabetic patients in Singapore, as well as factors related to health and information carriers that might influence those behaviors. A pilot-tested online survey was developed based on the Comprehensive Model of Information Seeking (CMIS) and notified to the members of the Diabetic Society of Singapore (DSS) through their newsletter in January 2016. In total, 60 usable responses from the DSS members were collected. The survey revealed that more than 30% of the patients did not strictly follow doctors' instructions to regularly exercise, self-monitor blood sugar, and pay attention to type of food prepared at home. However, it was found that the majority of them had consciously limited their sugar intake. It was also revealed that respondents' most frequently used sources of health information were authoritative sources such as doctors/nurses and pamphlets/leaflets from hospitals/clinics. Understandably, respondents experiencing less distress caused by diabetes tended to report better health status, less worries, and stronger beliefs in the efficacy of their methods for diabetes control.
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Affiliation(s)
- Xue Zhang
- Wee Kim Wee School of Communication & Information', Nanyang Technological University
| | - Schubert Foo
- Wee Kim Wee School of Communication & Information', Nanyang Technological University
| | - Shaheen Majid
- Wee Kim Wee School of Communication & Information', Nanyang Technological University
| | - Yun-Ke Chang
- Computer Information Sciences Division, Higher College of Technology
| | | | - Venkata Ratnadeep Suri
- Department of Social Sciences and Humanities, Indraprastha Institute of Information Technology Delhi
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Hansen UM, Olesen K, Willaing I. Diabetes stigma and its association with diabetes outcomes: a cross-sectional study of adults with type 1 diabetes. Scand J Public Health 2020; 48:855-861. [PMID: 32338563 DOI: 10.1177/1403494819862941] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: The aim of this study was to investigate the relationship between diabetes stigma as experienced by adults with type 1 diabetes and diabetes outcomes using the novel, validated measure of the Type 1 Diabetes Stigma Assessment Scale. Methods: A total of 1594 adults with type 1 diabetes completed a questionnaire on socio-economic factors, psychosocial health, and diabetes stigma and these self-reported data were linked with data from electronic clinical records on glycaemic control, diabetes duration, age, and diabetes-related complications. Bivariate analyses and multivariate linear regressions were performed to assess the relationship between diabetes stigma as measured by three subscales, Identity concern, Blame and judgement, and Treated differently on the one hand, and patient characteristics and diabetes outcomes on the other. Results: Endorsement of the stigma statements ranged from 3.6-78.3% of respondents. Higher stigma scores in relation to Identity concern and Blame and judgement were significantly associated with being female, of lower age, lower diabetes duration, and having at least one complication. Those who reported higher levels of perceived stigma reported significantly higher levels of diabetes distress (β = 0.37 (95% CI: 0.33-0.40), 0.35 (95% CI: 0.30-0.39), 0.41 (95% CI: 0.35-0.46)), and HbA1c levels (β = 0.11 (95% CI: 0.02-0.21), 0.28 (95% CI: 0.16-0.40), 0.26 (95% CI: 0.14-0.42) for Identity concern, Blame and judgement, and Treated differently, respectively). Conclusions: The findings demonstrated that diabetes stigma is negatively associated with both diabetes distress and glycaemic control and should be considered part of the psychosocial burden of adults with type 1 diabetes.
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Wentzell K, Vessey JA, Laffel LMB. How Do the Challenges of Emerging Adulthood Inform our Understanding of Diabetes Distress? An Integrative Review. Curr Diab Rep 2020; 20:21. [PMID: 32323022 DOI: 10.1007/s11892-020-01301-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Emerging adulthood (ages 18-29) presents many emotional, social, and developmental challenges that can contribute to an increased sense of burden when managing type 1 diabetes (T1D). Diabetes distress (DD) is the concept that captures the emotional burden, frustrations, and worries resulting from living with T1D. This integrative review sets out to examine the impact of developmental context by answering this question: How do the challenges of emerging adulthood inform our understanding of DD? RECENT FINDINGS DD is highly prevalent in emerging adults and occurs at higher rates than in other age groups. Qualitative studies reveal that DD is embedded within the developmental challenges specific to living with T1D during this stage. Quantitative studies reveal the prevalence and correlates of DD in this age group, and qualitative studies augment these findings by capturing the scope and complexity of the emotional burden of living with T1D as an emerging adult.
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Affiliation(s)
- Katherine Wentzell
- William F Connell School of Nursing, Boston College, Chestnut Hill, Boston, MA, USA.
- Pediatric, Adolescent & Young Adult Section, Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215, USA.
| | - Judith A Vessey
- William F Connell School of Nursing, Boston College, Chestnut Hill, Boston, MA, USA
| | - Lori M B Laffel
- Pediatric, Adolescent & Young Adult Section, Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215, USA
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Saßmann H, Dehn-Hindenberg A, Jördening M, Huhn F, Landgraf R, Lange K. Gestörtes Essverhalten und psychosoziale Versorgungssituation
junger Menschen mit Typ 1 Diabetes. Psychother Psychosom Med Psychol 2020; 70:449-456. [DOI: 10.1055/a-1142-6705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Zusammenfassung
Einleitung Gestörtes Essverhalten oder klinisch relevante
Essstörungen in Verbindung mit Typ 1 Diabetes haben schwerwiegende
Folgen für die Qualität der Stoffwechseleinstellung und die
langfristige gesundheitliche Prognose Betroffener. Eine frühzeitige
Diagnose und qualifizierte therapeutische Interventionen können bereits
bei gestörtem Essverhalten dazu beitragen, vorzeitige
mikrovaskuläre Schädigungen zu vermeiden. In dieser Studie
wurden für eine Gruppe junger Menschen mit Typ 1 Diabetes, die an einem
4-tägigen Camp teilnahmen, die Prävalenz essgestörten
Verhaltens und die spezifische psychosoziale Versorgungssituation
untersucht.
Material und Methoden Während eines bundesweit ausgeschriebenen
Diabetescamps für junge Menschen (16–29 Jahre) beantworteten die
Teilnehmenden Fragen zu ihrer aktuellen Diabetesbehandlung, zu
diabetesspezifischen Belastungen (PAID-5) sowie zur psychosozialen Versorgung im
Rahmen der ambulanten Langzeittherapie. Symptome gestörten Essverhaltens
wurden mit einem diabetesspezifischen Screeningfragebogen, dem Diabetes Eating
Problem Survey-Revised (DEPS-R), erhoben. Eine lineare multiple Regression wurde
berechnet, um Prädiktoren gestörten Essverhaltens zu
identifizieren.
Ergebnisse An der Umfrage beteiligten sich 308 junge Menschen mit Typ 1
Diabetes (Alter 21,4±3,4 Jahre; 73% weiblich; Diabetesdauer
10,2±5,9 Jahre; 74% in internistischer Behandlung). Bei
28,2% der Befragten ergaben sich Hinweise auf ein gestörtes
Essverhalten (17% der Männer, 32% der Frauen).
Teilnehmende mit einem auffälligen Summenwert im DEPS-R wurden nur zu
7% entsprechend psychologisch betreut. Das HbA1c, der BMI, die
diabetesspezifischen Belastungen, das Alter, die Diabetesdauer sowie das
Geschlecht erwiesen sich als signifikante Prädiktoren für das
Ausmaß gestörten Essverhaltens.
Diskussion Unter den Teilnehmenden eines Diabetescamps für junge
Menschen zeigten sich bei über einem Viertel Hinweise auf ein
gestörtes Essverhalten. Insgesamt waren davon junge Frauen
häufiger betroffen, weitere relevante Risikofaktoren waren ein
erhöhter BMI, ein höheres HbA1c und stärkere
diabetesspezifische Belastungen. Nur ein sehr geringer Anteil der jungen
Menschen mit Typ 1 Diabetes und gestörtem Essverhalten erhielt
psychologische Unterstützung.
Schlussfolgerung In der ambulanten diabetologischen Versorgung sollten
diabetesspezifische Screeninginstrumente und/oder gezielte
Screeningfragen insbesondere bei jungen Frauen regelmäßig
eingesetzt und die Ergebnisse mit den Betroffenen im Hinblick auf eine
weiterführende Behandlung besprochen werden.
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Affiliation(s)
- Heike Saßmann
- Forschungs- und Lehreinheit Medizinische Psychologie, Medizinische
Hochschule Hannover
| | | | - Mia Jördening
- Forschungs- und Lehreinheit Medizinische Psychologie, Medizinische
Hochschule Hannover
| | - Friederike Huhn
- Forschungs- und Lehreinheit Medizinische Psychologie, Medizinische
Hochschule Hannover
| | - Rüdiger Landgraf
- Bevollmächtigter des Vorstands, Deutsche Diabetes Stiftung,
München
| | - Karin Lange
- Forschungs- und Lehreinheit Medizinische Psychologie, Medizinische
Hochschule Hannover
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Stühmann LM, Paprott R, Heidemann C, Ziese T, Hansen S, Zahn D, Scheidt-Nave C, Gellert P. Psychometric properties of a nationwide survey for adults with and without diabetes: the "disease knowledge and information needs - diabetes mellitus (2017)" survey. BMC Public Health 2020; 20:192. [PMID: 32028928 PMCID: PMC7006078 DOI: 10.1186/s12889-020-8296-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In order to close existing information gaps on diabetes-related health perceptions, diabetes knowledge, and information-seeking behaviors among adults in Germany, a representative population-based survey targeting the German-speaking population 18 years and older with and without diabetes was conducted. The aim of the present work was to analyze the psychometric properties of the multi-item scales, applied in the survey in order to provide guidance for decisions on the use of these measurements for future research. METHODS Based on data from participants who completed the final survey (N = 1479 with known diabetes; N = 2327 without known diabetes) reliability and unidimensionality of multi-item scales were tested using Cronbach's Alpha and confirmatory factor analysis (CFA). RESULTS Psychometric properties and model fit varied across scales. Cronbach's alpha values ranged from very good to unacceptable. Model fit indices suggested evidence of a single underlying factor in some but not all scales. Adequate reliability and at least mediocre model fit were found for diabetes distress and patient-provider-relationship in people with diabetes and for perceived level of information in individuals without diabetes. Scales revealing inacceptable reliability values or not suggesting unidimensionality were e.g. diabetes-related stigmatization in both individuals with and without diabetes, self-efficacy in individuals with diabetes, and perceived personal control in those without diabetes. CONCLUSION Based on results of the current study, some of the scales applied in the survey can be recommended for present and future analyses of the survey data and for future surveys (e.g. diabetes distress, patient-provider-relationship in people with diabetes). Other scales should be interpreted and used with caution (e.g. depressive symptoms in people with diabetes) while others should be reformulated, interpreted only as single items, or need further investigation (e.g. diabetes-related stigmatization in people with and without diabetes). Findings provide researchers the opportunity to evaluate diabetes-specific scales in population-based studies of adults with and without diabetes.
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Affiliation(s)
- Lena M Stühmann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Institute for Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Rebecca Paprott
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Thomas Ziese
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Sylvia Hansen
- Ceres - Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health, Cologne, Germany
| | - Daniela Zahn
- Federal Centre for Health Education (BZgA), Office for National Education and Communication on Diabetes Mellitus, Cologne, Germany
- Preventive Cardiology and Medical Prevention, Department of Cardiology, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Paul Gellert
- Charité - Universitätsmedizin Berlin, Institute for Medical Sociology and Rehabilitation Science, Berlin, Germany.
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Charleer S, De Block C, Van Huffel L, Broos B, Fieuws S, Nobels F, Mathieu C, Gillard P. Quality of Life and Glucose Control After 1 Year of Nationwide Reimbursement of Intermittently Scanned Continuous Glucose Monitoring in Adults Living With Type 1 Diabetes (FUTURE): A Prospective Observational Real-World Cohort Study. Diabetes Care 2020; 43:389-397. [PMID: 31843948 DOI: 10.2337/dc19-1610] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/16/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In 2016, nationwide reimbursement of intermittently scanned continuous glucose monitoring (isCGM) for people living with type 1 diabetes treated in specialist diabetes centers was introduced in Belgium. We undertook a 12-month prospective observational multicenter real-world study to investigate impact of isCGM on quality of life and glycemic control. RESEARCH DESIGN AND METHODS Between July 2016 and July 2018, 1,913 adults with type 1 diabetes were consecutively recruited in three specialist diabetes centers. Demographic, metabolic, and quality of life data were collected at baseline, 6 months, and 12 months of standardized clinical follow-up. The primary end point was evolution of quality of life from baseline to 12 months. Secondary outcome measures were, among others, change in HbA1c, time spent in different glycemic ranges, occurrence of acute diabetes complications, and work absenteeism. RESULTS General and diabetes-specific quality of life was high at baseline and remained stable, whereas treatment satisfaction improved (P < 0.0001). Admissions for severe hypoglycemia and/or ketoacidosis were rare in the year before study (n = 63 out of 1,913; 3.3%), but decreased further to 2.2% (n = 37 out of 1,711; P = 0.031). During the study, fewer people reported severe hypoglycemic events (n = 280 out of 1,913 [14.6%] vs. n = 134 out of 1,711 [7.8%]; P < 0.0001) or hypoglycemic comas (n = 52 out of 1,913 [2.7%] vs. n = 18 out of 1,711 [1.1%]; P = 0.001) while maintaining HbA1c levels. Fewer people were absent from work (n = 111 out of 1,913 [5.8%] vs. n = 49 out of 1,711 [2.9%]; P < 0.0001). Time spent in hypoglycemia significantly decreased in parallel with less time in range and more time in hyperglycemia. Eleven percent (n = 210) of participants experienced skin reactions, leading to stopping of isCGM in 22 participants (1%). CONCLUSIONS Nationwide unrestricted reimbursement of isCGM in people with type 1 diabetes treated in specialist diabetes centers results in higher treatment satisfaction, less severe hypoglycemia, and less work absenteeism, while maintaining quality of life and HbA1c.
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Affiliation(s)
- Sara Charleer
- Department of Endocrinology, University Hospitals Leuven-KU Leuven, Leuven, Belgium
| | - Christophe De Block
- Department of Endocrinology, Diabetology and Metabolism, University of Antwerp-Antwerp University Hospital, Antwerp, Belgium
| | | | - Ben Broos
- Department of Endocrinology, Diabetology and Metabolism, University of Antwerp-Antwerp University Hospital, Antwerp, Belgium
| | - Steffen Fieuws
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Interuniversity Institute for Biostatistics and Statistical Bioinformatics, University of Leuven and University of Hasselt, Leuven, Belgium
| | - Frank Nobels
- Department of Endocrinology, OLV Hospital Aalst, Aalst, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven-KU Leuven, Leuven, Belgium
| | - Pieter Gillard
- Department of Endocrinology, University Hospitals Leuven-KU Leuven, Leuven, Belgium
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125
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Öberg U, Orre CJ, Hörnsten Å, Jutterström L, Isaksson U. Using the Self-Management Assessment Scale for Screening Support Needs in Type 2 Diabetes: Qualitative Study. JMIR Nurs 2020; 3:e16318. [PMID: 34345780 PMCID: PMC8279441 DOI: 10.2196/16318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 05/10/2020] [Accepted: 08/10/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Globally, most countries face a common challenge by moving toward a population-based structure with an increasing number of older people living with chronic conditions such as type 2 diabetes. This creates a considerable burden on health care services. The use of digital tools to tackle health care challenges established views on traditional nursing, based on face-to-face meetings. Self-management is considered a key component of chronic care and can be defined as management of the day-to-day impact of a condition, something that is often a lifelong task. The use of a screening instrument, such as the Self-Management Assessment Scale (SMASc), offers the potential to guide primary health care nurses into person-centered self-management support, which in turn can help people strengthen their empowerment and self-management capabilities. However, research on self-management screening instruments is sparse, and no research on nurses' experiences using a digitalized scale for measuring patients' needs for self-management support in primary health care settings has been found. OBJECTIVE This paper describes diabetes specialist nurses' (DSNs) experiences of a pilot implementation of the SMASc instrument as the basis for person-centered digital self-management support. METHODS This qualitative study is based on observations and interviews analyzed using qualitative content analysis. RESULTS From the perspectives of DSNs, the SMASc instrument offers insights that contribute to strengthened self-management support for people with type 2 diabetes by providing a new way of thinking and acting on the patient's term. Furthermore, the SMASc was seen as a screening instrument with good potential that embraces more than medical issues; it contributed to strengthening person-centered self-management support, and the instrument was considered to lead both parts, that is, DSNs and patients, to develop together through collaboration. CONCLUSIONS Person-centered care is advocated as a model for good clinical practice; however, this is not always complied with. Screening instruments, such as the SMASc, may empower both nurses and patients with type 2 diabetes with more personalized care. Using a screening instrument in a patient meeting may also contribute to a role change in the work and practice of DSNs.
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Affiliation(s)
- Ulrika Öberg
- Department of Nursing Umeå University Umeå Sweden
| | - Carl Johan Orre
- Department of Computer Science and Media Technology DVMT, Malmö University Malmö Sweden
| | - Åsa Hörnsten
- Department of Nursing Umeå University Umeå Sweden
| | | | - Ulf Isaksson
- Department of Nursing Umeå University Umeå Sweden
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126
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Cipponeri E, Blini C, Lamera C, De Mori V, Veronesi G, Bossi AC. Insulin Management for Type 1 Diabetic Patients During Social Alcohol Consumption: The SPRITZ Study. Curr Diabetes Rev 2020; 16:619-627. [PMID: 32552634 DOI: 10.2174/1573399815666190507121332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/20/2019] [Accepted: 04/23/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is no data available on the best insulin treatment to counteract the effects of glucose excursions due to a moderate alcohol intake associated with portions of slight fat and protein-containing food, as often the case during social happenings or "happy hours". INTRODUCTION This study analyzes the glycemic control and quality of life in 8 adult type 1 diabetic (T1D) patients on insulin-pump therapy which were invited to consume a traditional Italian aperitif ("Spritz" and chips). METHODS Patients consumed Spritz aperitif twice: using their habitual bolus, based on carbohydrates (CHO) counting (V1), or with a personalized, advanced bolus (V2) calculated from insulin/Kcal derived from Fats and Proteins (FPU). Post-prandial glucose was continuously monitored; glucose incremental areas (iAUC), glucose peak and time to peak, and estimated change from V1 to V2 from repeated- measures models were computed. Each patient fulfilled validated questionnaires on quality of life, knowledge about diabetes and CHO counting. RESULTS After the educational program, a reduced iAUC (0-80 min: -306, p=ns; 40-80 min: -400, p=0.07) due to greater (p=0.03) and prolonged double-wave insulin boluses was observed. Blood glucose peak and time to peak were also reduced. Moreover, improvements in the psycho-affective dimension, as well as in the alimentary knowledge were detected. CONCLUSION Therefore, a personalized educational program on CHO + FPU counting together with insulin bolus management can improve glycemic control during social consumption of alcohol, with positive reflections on the psycho-affective dimension. Further studies are mandatory to confirm such preliminary results.
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Affiliation(s)
- Elisa Cipponeri
- Endocrine Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio (Bg), Italy
| | - Cesare Blini
- Endocrine Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio (Bg), Italy
| | - Christian Lamera
- Endocrine Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio (Bg), Italy
| | - Valentina De Mori
- Endocrine Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio (Bg), Italy
| | - Giovanni Veronesi
- Research Centre EPIMED - Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Antonio Carlo Bossi
- Endocrine Unit, Diabetes Regional Centre, ASST Bergamo Ovest, Treviglio (Bg), Italy
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127
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Xu J, Luo D, Zhu M, Wang H, Shi Y, Ya D, Lin Z, Gu Z. Translation and its Psychometric Characteristic of the Diabetes Strengths and Resilience Measure among Chinese Adolescents with type 1 Diabetes. J Pediatr Nurs 2020; 50:e2-e7. [PMID: 31526592 DOI: 10.1016/j.pedn.2019.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE This study is designed to develop a Chinese version of the Diabetes Strengths and Resilience Measure for Adolescents (DSTAR-Teen) and evaluate its psychometric characteristics. DESIGN AND METHODS One hundred and twenty adolescents with type 1 diabetes (Mean age = 16.3 ± 5.1, 51.7% male, Mean HbA1c = 7.6 ± 2.2%) were enrolled from one national endocrine center in China. Participants were administered with the DSTAR-Teen and the related psychosocial instruments to evaluate the reliability and validity. The DSTAR-Teen was adapted into Chinese version prior to data collection. RESULTS The Chinese DSTAR-Teen demonstrated adequate reliability (Cronbach's α coefficients = 0.90, intraclass correlation coefficient = 0.98). A minimum detectable change at the 95% confidence level was 5.8 points. In exploratory and confirmatory factorial analyses, a three-factor structure emerged with a variance of 67.4%, demonstrating construct validity. Moreover, resilience was significantly associated with glycated hemoglobin, diabetes distress and self-care behavior as hypothesized, further supporting validity. CONCLUSION The Chinese version of the DSTAR-Teen is a psychometrically sound instrument that may capture the adaptive attitudes and behaviors associated with diabetes management. PRACTICE IMPLICATIONS This scale can be used in both clinical and research settings with the aim of identifying diabetes specific strengths and improving the health outcomes in adolescents with type 1 diabetes.
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Affiliation(s)
- Jingjing Xu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
| | - Dan Luo
- School of Nursing, Peking University, Beijing, China
| | - Min Zhu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
| | - Hong Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
| | - Yun Shi
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
| | - Dan Ya
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
| | - Zheng Lin
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Nursing, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China.
| | - Zejuan Gu
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Nursing, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China.
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128
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Luciani M, Fabrizi D, Rebora P, Rossi E, Di Mauro S, Kohl Malone S, Ausili D. Self-care in People with Type 2 Diabetes Mellitus Research Protocol of a Multicenter Mixed Methods Study (SCUDO). PROFESSIONI INFERMIERISTICHE 2019; 72:203-12. [PMID: 31884779 DOI: 10.7429/pi.2019.723203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
About 11% of the adult global populations is estimated to be living with type 2 diabetes mellitus (T2DM) by 2040. T2DM requires people to make decisions regarding complex therapeutic regimes, to maintain their well-being and quality of life, to manage symptoms and to reduce disease complications. All these behaviours, requiring knowledge, motivation, experience, and skills, have been referred to the concept of self-care. The intricacy and multidimensionality of T2DM self-care requires a complex approach to its overall comprehension. This Embedded Mixed Method study aims to investigate the experience of self-care in Type 2 Diabetes Mellitus adult patients. It comprises a prospective observational design, and an interpretive description. Quantitative data will be collected with validated questionnaires from 300 patients at baseline and once a year for two years on: diabetes self-care, quality of life, diabetes related distress, and sleep quality. Socio-demographic and clinical data will be collected from medical records. Qualitative data will be collected using semi-structured interviews on circa 10-20 patients, at baseline and once a year for two years, analysed according to interpretive description. Quantitative and qualitative data will be analysed separately and then merged and interpreted. This study will expand our understanding of self-care in people with T2DM. The expected outcome will be a better understanding of the effect of self-care on glycaemic control and therefore clinical outcomes and costs.
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Affiliation(s)
- Michela Luciani
- RN, MSc, PhD. Università di Milano – Bicocca, Dipartimento di Medicina e
Chirurgia. Monza, Italy
| | - Diletta Fabrizi
- RN, MSc, PhDs. Università di Milano – Bicocca, Dipartimento di Medicina e Chirurgia. Monza, Italy. Corrispondence e-mail:
| | - Paola Rebora
- PhD. Università di Milano Bicocca, Centro di Biostatistica ed Epidemiologia Clinica, Dipartimento di Medicina e Chirurgia. Monza, Italy
| | - Emanuela Rossi
- PhD. Università di Milano Bicocca, Centro di Biostatistica ed Epidemiologia Clinica, Dipartimento di Medicina e Chirurgia. Monza, Italy
| | - Stefania Di Mauro
- RN, MSc. Università di Milano – Bicocca, Dipartimento di Medicina e Chirurgia. Monza, Italy
| | - Susan Kohl Malone
- PhD. New York University, Rory Meyers College of Nursing. New York, USA
| | - Davide Ausili
- RN, MSc, PhD. Università di Milano – Bicocca, Dipartimento di Medicina e Chirurgia. Monza, Italy
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129
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Varming AR, Rasmussen LB, Husted GR, Olesen K, Grønnegaard C, Willaing I. Improving empowerment, motivation, and medical adherence in patients with poorly controlled type 2 diabetes: A randomized controlled trial of a patient-centered intervention. PATIENT EDUCATION AND COUNSELING 2019; 102:2238-2245. [PMID: 31239180 DOI: 10.1016/j.pec.2019.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 06/05/2019] [Accepted: 06/12/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To test whether an intervention consisting of four patient-centered consultations improves glycemic control and self-management skills in patients with poorly regulated type 2 diabetes (T2DM), compared to a control group receiving usual care. METHODS Unblinded parallel randomized controlled trial including 97 adults diagnosed with T2DM ≥ 1 year and hemoglobin A1c (HbA1c) levels ≥ 8.0% (64 mmol/mol). Consultations incorporated tools supporting self-reflection, learning processes, and goal setting. Primary outcome was HbA1c. Secondary outcomes were autonomy support, motivation, self-management skills, and well-being. RESULTS Average HbA1c decreased slightly in both groups. Autonomy support and frequency of healthy eating were significantly higher in the intervention group. Most participants in the intervention group chose to set goals related to diet and physical exercise. Implementation of the intervention was inconsistent. CONCLUSION Despite increased autonomy support and individual goal-setting, the intervention was not superior to usual care in terms of glycemic control. More research is needed on how individual preferences and goals can be supported in practice to achieve sustainable behavior changes. PRACTICE IMPLICATIONS The intervention promoted participant engagement and supported exploration of participants' challenges and preferences. Further exploration of more flexible use of tools adapted to individual contexts is recommended.
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Affiliation(s)
- Annemarie R Varming
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, DK-2820, Gentofte, Denmark.
| | - Lone Banke Rasmussen
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, DK-2820, Gentofte, Denmark.
| | | | - Kasper Olesen
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, DK-2820, Gentofte, Denmark.
| | - Cecilia Grønnegaard
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, DK-2820, Gentofte, Denmark.
| | - Ingrid Willaing
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, DK-2820, Gentofte, Denmark.
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130
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Tovilla-Zárate CA, Pérez-Mandujano A, Ramírez-González IR, Fresan A, Suarez-Mendez S, Martínez-Villaseñor E, Rodríguez-Sánchez E, Villar-Soto M, López-Narváez ML, González-Castro TB, Ble-Castillo JL, Juárez-Rojop IE. Vortioxetine versus sertraline in metabolic control, distress and depression in Mexican patients with type 2 diabetes. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:656. [PMID: 31930057 DOI: 10.21037/atm.2019.10.56] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Depression in patients with type 2 diabetes (T2D) is often undiagnosed and remains untreated, leading to poor therapy adherence and ill health-related outcomes. We evaluated the effect of vortioxetine versus sertraline in the treatment of depression, distress and metabolic control in subjects with T2D and depression. Methods Participants were selected from the Clinic for Diabetes, diagnosed with depression when the score was ≥14 in the Hamilton Depression Rating Scale, and verified by a psychiatrist in agreement with the DSM-5 instrument (Diagnostic and Statistical Manual of Mental Disorders, fifth edition). The criteria for recruitment also included glycosylated hemoglobin ≥7.5%, 18 to 60 years of age, and written informed consent. Pharmacological treatment for depression was assigned randomly: vortioxetine (10 mg/day) or sertraline (75 mg/day) for 8 weeks. Biochemical parameters, anthropometric measures and depression symptoms were evaluated after antidepressant treatment. This was a randomized singled-blind study. Results Subjects that met the inclusion criteria were 50, of which only 21 patients with T2D and depression finished the treatment. Vortioxetine and sertraline showed partial remission of depression. Vortioxetine showed a major effect size in glycosylated hemoglobin and a moderate effect size on weight loss, fasting plasma glucose (FPG), cholesterol and triacylglycerol levels. On the other hand, patients treated with sertraline presented a slight increase in body weight, body mass index (BMI), and in all biochemical markers. Conclusions Vortioxetine may ameliorate depressive symptoms and metabolic control in patients with T2D and depression. Trial registration number: NCT03978286.
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Affiliation(s)
- Carlos Alfonso Tovilla-Zárate
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, México
| | - Antonia Pérez-Mandujano
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México
| | - Iris Rubí Ramírez-González
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México
| | - Ana Fresan
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Ciudad de México, México
| | - Samuel Suarez-Mendez
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México
| | - Esteban Martínez-Villaseñor
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México.,Hospital Civil de Guadalajara, Guadalajara, México
| | - Ester Rodríguez-Sánchez
- Hospital de Alta Especialidad Gustavo A. Rovirosa Pérez, Secretaría de Salud, Villahermosa, Tabasco, México
| | - Mario Villar-Soto
- Hospital de Alta Especialidad Gustavo A. Rovirosa Pérez, Secretaría de Salud, Villahermosa, Tabasco, México
| | | | - Thelma Beatriz González-Castro
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México.,Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Jalpa de Méndez, Jalpa de Méndez, Tabasco, México
| | - Jorge L Ble-Castillo
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México
| | - Isela Esther Juárez-Rojop
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, México
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131
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Gillanders DT, Barker E. Development and initial validation of a short form of the diabetes acceptance and Action Scale: The DAAS-Revised (DAAS-R). JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Luo D, Xu JJ, Cai X, Zhu M, Wang H, Yan D, Li MZ. The effects of family functioning and resilience on self-management and glycaemic control among youth with type 1 diabetes. J Clin Nurs 2019; 28:4478-4487. [PMID: 31410916 DOI: 10.1111/jocn.15033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/24/2019] [Accepted: 08/03/2019] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES To examine the effects of family functioning and resilience on self-management and glycaemic control among youth with type 1 diabetes and to determine whether resilience mediates the effects of family functioning on self-management and glycaemic control. BACKGROUND Poor self-management and glycaemic control are common in youth with type 1 diabetes. Family functioning and resilience are known to be important psychosocial factors that contribute to individual health and development. However, no studies have explored the effects of family functioning and resilience on self-management and glycaemic control among youths with type 1 diabetes in mainland China. DESIGN This study was conducted using a survey with a convenience sample following the STROBE guidelines. METHODS A total of 204 Chinese youth who had been diagnosed with type 1 diabetes for at least 6 months were recruited. Family functioning, resilience, self-management and diabetes distress were measured using self-reports and standard measurement tools. Glycaemic control was assessed by glycated haemoglobin (HbA1C ) levels. A structural equation model was used to test the hypothesised model. RESULTS The final model accounted for 52.1% and 19.5% of the total variance of self-management and HbA1C level, respectively. Resilience had a direct effect on self-management and an indirect effect on control of HbA1C . Family functioning had an indirect effect on both self-management and control of HbA1C through resilience. The model remained invariant across the mild-distress and severe-distress groups. CONCLUSION In Chinese youth with type 1 diabetes, resilience positively affected self-management and ultimately optimised glycaemic control, even in the presence of diabetes distress. Family functioning positively affected self-management and glycaemic control by promoting resilience. RELEVANCE TO CLINICAL PRACTICE This study found that family functioning and resilience had positive effects on self-management and glycaemic control in youth. This study confirms the importance of incorporating resilience assessments and family-based resilience interventions into clinical nursing practice with youth with type 1 diabetes.
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Affiliation(s)
- Dan Luo
- School of Nursing, Peking University, Beijing, China
| | - Jing-Jing Xu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xue Cai
- School of Nursing, Peking University, Beijing, China
| | - Min Zhu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hong Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dan Yan
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ming-Zi Li
- School of Nursing, Peking University, Beijing, China
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Wagner JA, Feinn R, Lampert R, Bermúdez-Millán A, Pérez-Escamilla R. Changes in negative affect and changes in heart rate variability among low-income latinos with type 2 diabetes in a randomized, controlled stress management trial. J Psychosom Res 2019; 124:109774. [PMID: 31443815 DOI: 10.1016/j.jpsychores.2019.109774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Structural equation modeling examined the relationship between change in negative affect (NA) and change in heart rate variability (HRV) among 121 Latinos with type 2 diabetes. METHODS This study leveraged data from the Community Health Workers Assisting Latinos Manage Stress and Diabetes (CALMSD) study which compared diabetes education vs diabetes education plus stress management. Participants completed surveys of NA at baseline and again 8-10 weeks later. They also wore 7‑lead, 3-channel ambulatory ECG monitors for 24 h at both time points. The latent variable NA was modeled by observed scores on symptoms of depression, anxiety, diabetes distress, and wellbeing (reversed). The latent variable HRV was modeled by observed scores in the time domain (the standard deviation of the R-R interval [SDNN] and the root mean square of the successive differences [RMSSD]) and in the frequency domain, i.e., log-transformed ultra-low frequency, very-low frequency, low frequency, and high frequency. RESULTS At baseline, there were strong, negative cross-sectional associations between NA and HRV. Baseline NA predicted change in HRV, whereas baseline HRV did not predict change in NA. Controlling for fasting glucose and treatment assignment did not meaningfully alter the findings. Stress management improved NA but not HRV. At followup, a greater reduction (improvement) in NA was associated with a larger increase (improvement) in HRV, with a small-to-medium negative association that approached statistical significance. CONCLUSIONS Findings indicate a longitudinal relationship between NA and HRV, and suggest that improvement in one may be associated with improvement in the other.
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Affiliation(s)
- Julie A Wagner
- University of Connecticut Schools of Medicine and Dental Medicine, United States of America.
| | - Richard Feinn
- Quinnipiac University School of Medicine, United States of America
| | - Rachel Lampert
- Yale University School of Medicine, United States of America
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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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Gómez-Pimienta E, González-Castro TB, Fresan A, Juárez-Rojop IE, Martínez-López MC, Barjau-Madrigal HA, Ramírez-González IR, Martínez-Villaseñor E, Rodríguez-Sánchez E, Villar-Soto M, López-Narváez ML, Tovilla-Zárate CA, Genis-Mendoza AD. Decreased Quality of Life in Individuals with Type 2 Diabetes Mellitus Is Associated with Emotional Distress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152652. [PMID: 31349552 PMCID: PMC6695823 DOI: 10.3390/ijerph16152652] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 01/01/2023]
Abstract
Background: individuals with type 2 diabetes show emotional distress as they learn how to cope with the disease. The emotional distress increases the possibility of complications in these patients. The aims of the present study were to evaluate the impact of the emotional distress in the quality of life of individuals with diabetes, and to investigate the demographic and clinical characteristics associated with the emotional distress of living with diabetes in a Mexican population. Methods: a total of 422 Mexican individuals with type 2 diabetes were recruited from the outpatient Diabetes Clinic of the Hospital Regional de Alta Especialidad Dr. Gustavo A. Rovirosa of Villahermosa, Tabasco. Demographic and clinical characteristics along with quality of life (SF-36) were assessed in these individuals. The emotional distress of living with diabetes was measured using the 5-item Problem Areas in Diabetes. Patients were divided according to the presence of high or low distress. Results: we identified that 31.8% (n = 134) of patients presented high diabetes-related emotional distress. We observed that hepatic diseases as comorbidities (p = 0.008) and diagnosis of major depression (p = 0.04) are factors associated with the emotional distress of living with diabetes. These patients showed a reduced quality of life in all dimensions (p < 0.001); the most affected dimensions were physical role (d = 0.37) and general health (d = 0.89) showing lower scores in comparison with patients with low emotional distress. Conclusions: our results suggest that Mexican individuals with type 2 diabetes mellitus show high emotional distress living with the disease and have a decreased quality of life. Therefore, it is necessary to decrease factors associated with the high emotional distress of living with diabetes in patients with type 2 diabetes.
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Affiliation(s)
- Elena Gómez-Pimienta
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco P.C. 86650, Mexico
| | - Thelma Beatriz González-Castro
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco P.C. 86100, Mexico
| | - Ana Fresan
- Subdirección de Investigaciones clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México P.C. 14370, Mexico
| | - Isela Esther Juárez-Rojop
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco P.C. 86100, Mexico.
| | - Miriam Carolina Martínez-López
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco P.C. 86100, Mexico
| | - Hugo Adrián Barjau-Madrigal
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco P.C. 86650, Mexico
| | - Iris Rubí Ramírez-González
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco P.C. 86100, Mexico
| | - Esteban Martínez-Villaseñor
- Hospital Civil de Guadalajara, Guadalajara, Jalisco P.C. 44280, Mexico
- Hospital de Alta Especialidad "Gustavo A Rovirosa Pérez", Secretaría de Salud. Villahermosa, Tabasco P.C. 86020, Mexico
| | - Esther Rodríguez-Sánchez
- Hospital de Alta Especialidad "Gustavo A Rovirosa Pérez", Secretaría de Salud. Villahermosa, Tabasco P.C. 86020, Mexico
| | - Mario Villar-Soto
- Hospital de Alta Especialidad "Gustavo A Rovirosa Pérez", Secretaría de Salud. Villahermosa, Tabasco P.C. 86020, Mexico
| | - María Lilia López-Narváez
- Hospital General de Yajalón "Dr. Manuel Velasco Suarez", Secretaría de Salud. Yajalón, Chiapas P.C. 29930, Mexico
| | - Carlos Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco P.C. 86650, Mexico.
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Association between person and disease related factors and the planned diabetes care in people who receive person-centered type 2 diabetes care: An implementation study. PLoS One 2019; 14:e0219702. [PMID: 31339929 PMCID: PMC6655662 DOI: 10.1371/journal.pone.0219702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/29/2019] [Indexed: 11/20/2022] Open
Abstract
AIMS To assess the planned diabetes care for the coming year and its associated factors in patients with Type 2 diabetes who have a person-centered annual consultation. METHODS Implementation study of a new consultation model in 47 general practices (primary care) and 6 outpatient clinics (secondary care); 1200 patients from primary and 166 from secondary care participated. Data collection took place between November 2015 and February 2017. Outcomes: preferred monitoring frequency; referral to other health care provider(s); medication change. One measurement at the end of the consultation. We performed logistic regression analyses. Differences between primary and secondary care were analyzed. RESULTS Many patients arranged a monitoring frequency <4 times per year (general practices 19.5%, outpatient clinics 40%, p < .001). Type of provider (physician/nurse, OR 3.83, p < .001), baseline HbA1c (OR 1.02, p = .017), glucose lowering medication; and setting treatment goals (OR .65, p = .048) were associated with the chosen frequency. Independently associated with a referral were age (OR .99, p = .039), baseline glucose lowering medication and patients' goal setting (OR 1.52, p = .016). Medication change was associated with type of provider, baseline HbA1c, blood glucose lowering medication, quality of life (OR .80, p = .037) and setting treatment goals (OR 2.64, p = .001). CONCLUSIONS Not only disease but also person related factors, especially setting treatment goals, are independently associated with planned care use in person-centered diabetes care.
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Ueno H, Ishikawa H, Suzuki R, Izumida Y, Ohashi Y, Yamauchi T, Kadowaki T, Kiuchi T. The association between health literacy levels and patient-reported outcomes in Japanese type 2 diabetic patients. SAGE Open Med 2019; 7:2050312119865647. [PMID: 31384463 PMCID: PMC6651654 DOI: 10.1177/2050312119865647] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 07/01/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES The aim of this study is to empirically examine a full pathway model of health literacy, and health and well-being outcomes among patients with type 2 diabetes. METHODS A three-wave longitudinal survey was administered to 148 patients with diabetes. Covariance structure analysis was conducted to create a path diagram, with health literacy and burden of medical expenses included as independent variables and with psychosocial factors, behaviors, and health and well-being outcomes included as dependent variables. RESULTS The model fit indices showed a comparative fit index of 0.985 at baseline, 0.959 after 3 months, and 0.948 after 6 months, with a root mean square error of approximation of 0.040 at baseline, 0.079 after 3 months, and 0.085 after 6 months. There were 14 significant paths across the three time points between health literacy and understanding of diabetes care, self-efficacy, communication with doctors, and medication adherence. CONCLUSION The model fitness index showed an adequate result. Health literacy was significantly positively associated with understanding of diabetes care, self-efficacy, communication with doctors, and medication adherence. Health literacy had a direct positive influence on medication adherence and possibly an indirect positive influence on exercise/diet via self-efficacy. The results were generally consistent across the three time points, suggesting good reliability of the models. Improving health literacy may lead to better self-management of diabetes and favorable health outcomes.
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Affiliation(s)
- Haruka Ueno
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirono Ishikawa
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Graduate School of Public Health, Teikyo University, Tokyo, Japan
| | - Ryo Suzuki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Division of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases Tokyo Medical University, Tokyo, Japan
| | - Yoshihiko Izumida
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yumiko Ohashi
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Prevention of Diabetes and Life-style Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Metabolism and Nutrition, Mizonokuchi Hospital, Teikyo University, Kawasaki, Kanagawa, Japan
| | - Takahiro Kiuchi
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Schmidt CB, Voorhorst I, van de Gaar VHW, Keukens A, Potter van Loon BJ, Snoek FJ, Honig A. Diabetes distress is associated with adverse pregnancy outcomes in women with gestational diabetes: a prospective cohort study. BMC Pregnancy Childbirth 2019; 19:223. [PMID: 31269913 PMCID: PMC6610799 DOI: 10.1186/s12884-019-2376-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/24/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Around 12% of pregnant women develop gestational diabetes mellitus (GDM), which is associated with increased health risks for both mother and child and pre- and postpartum depression. Little is known about the relationship of GDM with diabetes-specific emotional distress (diabetes distress). The aims of this study are to assess the prevalence of diabetes distress in GDM and its association with adverse pregnancy outcomes. METHODS A prospective cohort study was carried out in an Amsterdam based teaching hospital with an ethnic diverse population. Women diagnosed with GDM completed a set of questionnaires at three time points. Questionnaires consisted of Problem Areas in Diabetes Scale 5 (PAID-5) for diabetes distress (T0-T1), Patient Health Questionnaire 9 (PHQ-9) for depressive symptoms (T0-T2), and questions to assess adverse pregnancy outcomes (T2). Adverse pregnancy outcomes (collected via self-report and if feasible from the medical records) were defined as hypertension, pre-eclampsia, caesarean section, severe perineal tearing, postpartum hemorrhage, postpartum depression, shoulder dystocia, neonatal hospitalization, macrosomia, jaundice, hypoglycemia and other (among which low heart rate, fever, hypoxia). Adverse pregnancy outcomes were dichotomized into none and 1 or more. Additional information was collected from the medical charts. Missing data were imputed via predictive mean matching and a multivariable logistic regression analysis was performed with diabetes distress, depressive symptoms, socioeconomic status, parity and ethnicity as predictors and age, HbA1c, and BMI as covariates. RESULTS A total of 100 women were included, mean age 32.5 (4.1), mean BMI 26.7 (4.8), 71% were of non-Dutch ethnic background. Elevated diabetes distress (PAID score ≥ 8) was reported by 36% of the women. Multivariable logistic regression analyses revealed that both high diabetes distress (OR 4.70, p = .02) and parity (OR 0.21, p = .02) but not antepartum depressive symptoms were related to adverse pregnancy outcomes. CONCLUSIONS Diabetes distress is likely in women with GDM and our findings suggest an association between both diabetes distress, parity and adverse pregnancy outcomes in women with GDM. This warrants replication and further research into the underlying mechanisms explaining the impact of diabetes distress in GDM and potential interventions to reduce distress.
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Affiliation(s)
- Charlotte B. Schmidt
- Department of Psychiatry, OLVG, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Ilse Voorhorst
- Department of Psychiatry, OLVG, Amsterdam, the Netherlands
| | | | - Anne Keukens
- Department of Gynaecology, OLVG, Amsterdam, the Netherlands
| | | | - Frank J. Snoek
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, OLVG, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Rossi MC, Nicolucci A, Ozzello A, Gentile S, Aglialoro A, Chiambretti A, Baccetti F, Gentile FM, Romeo F, Lucisano G, Giorda CB. Impact of severe and symptomatic hypoglycemia on quality of life and fear of hypoglycemia in type 1 and type 2 diabetes. Results of the Hypos-1 observational study. Nutr Metab Cardiovasc Dis 2019; 29:736-743. [PMID: 31153746 DOI: 10.1016/j.numecd.2019.04.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/04/2019] [Accepted: 04/25/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Hypoglycemia represents a relevant burden in people with diabetes. Consequences of hypoglycemia/fear of hypoglycemia on quality of life (QoL) and behaviors of patients with T1DM and T2DM were assessed. METHODS AND RESULTS HYPOS-1 was an observational retrospective study. Fear of hypoglycemia (Fear of Hypoglycemia Questionnaire, FHQ), general health status (visual analog scale of EuroQol questionnaire, EQ5D-VAS) psychological well-being (WHO-5 well being index, WHO-5), diabetes related distress (Problem Areas in Diabetes 5, PAID-5), and corrective/preventive behaviors following hypoglycemia were compared between people with and without previous experience of severe and symptomatic hypoglycemia and by tertiles of FHQ scores. A multivariate analysis was performed to identify factors associated with the likelihood of being in the third tertile of FHQ score. Overall, 2229 patients were involved. Severe hypoglycemia had statistically significant and clinically relevant (measured as effect sizes) negative impact on EQ5D-VAS, WHO-5, PAID-5, and FHQ both in T1DM and T2DM. In T2DM, symptomatic episodes had similar impact of severe hypoglycemia. Moving from the first to the third FHQ tertile, lower scores of EQ-5D VAS and WHO-5, and higher levels of PAID-5 were found. Patients in the third tertile performed more frequently corrective/preventive actions that negatively impact on metabolic control. Previous hypoglycemia, insulin treatment, female gender, age, and school education were the independent factors associated with increased likelihood to be in the third tertile. CONCLUSION Not only severe but also symptomatic hypoglycemia negatively affect patient QoL, especially in T2DM. Addressing fear of hypoglycemia should be a goal of diabetes education.
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Affiliation(s)
- Maria Chiara Rossi
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Alessandro Ozzello
- Departmental Service of Diabetology and Metabolic Diseases, ASL TO3, Pinerolo, TO, Italy
| | - Sandro Gentile
- Campania University "Luigi Vanvitelli", Naples, Italy; Nefrocenter Research Network, Naples, Italy
| | | | | | - Fabio Baccetti
- Metabolism and Diabetes Unit, ASL 1, Massa, Carrara, Italy
| | | | | | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Carlo B Giorda
- Metabolism and Diabetes Unit, ASL TO5, Chieri, TO, Italy
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Gilani F, Majumdar SR, Johnson JA, Simpson SH. Factors associated with pneumococcal vaccination in 2040 people with type 2 diabetes: A cross-sectional study. DIABETES & METABOLISM 2019; 46:137-143. [PMID: 31255692 DOI: 10.1016/j.diabet.2019.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/03/2019] [Accepted: 06/16/2019] [Indexed: 01/10/2023]
Abstract
AIMS Pneumococcal vaccination is recommended in diabetes because of the high risk for invasive pneumococcal disease and mortality; however, vaccination rates are below recommended targets. This study was conducted to identify possible reasons behind the low rate of vaccine uptake. METHODS We examined baseline information from the Alberta Caring for Diabetes study, a prospective cohort study of 2040 adults with type 2 diabetes. Patients were recruited between December 2011 and December 2013. The baseline survey collected information on a wide range of socio-demographic characteristics, disease and management information, as well as health status measurements and health service utilization. Multivariable logistic regression analyses were conducted to identify factors associated with self-reported pneumococcal vaccination status. RESULTS Mean age was 64 (SD 11) years, 45% were women, mean duration of diabetes was 12 (SD 10) years, and 1090 (53%) were vaccinated. Age≥65 years (adjusted odds ratio [aOR] 2.52; 95% CI: 1.98-3.20), respiratory disease (aOR 1.50; 95% CI: 1.17-1.93), and cancer (aOR 1.45; 95% CI: 1.08-1.94) were independently associated with pneumococcal vaccination. In addition, women, retirees, people with diabetes≥10 years, people using antihypertensive medications or insulin, and those who had their HbA1c, kidney function, or their weight or waist circumference measured by a healthcare professional in the past year were more likely to have been vaccinated. CONCLUSION Based on this information, future programs aimed at people aged<65 years old, men, those who are currently working, those recently diagnosed with diabetes, and those with few comorbidities could have the most potential for improving pneumococcal vaccine uptake in people with diabetes.
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Affiliation(s)
- F Gilani
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - S R Majumdar
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - J A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - S H Simpson
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
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Fisher L, Polonsky WH, Hessler D. Addressing diabetes distress in clinical care: a practical guide. Diabet Med 2019; 36:803-812. [PMID: 30985025 DOI: 10.1111/dme.13967] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2019] [Indexed: 01/09/2023]
Abstract
Addressing the emotional side of diabetes and its management has received considerable attention in recent years. At the centre of most of these efforts is the concept of 'diabetes distress', a generic term that captures the primary sources and intensity of emotional distress associated with diabetes and its management over time. As interest in diabetes distress has grown, however, it has been difficult to integrate and translate the various strands of clinical research in a manner that can guide diabetes distress intervention efforts in the real world of clinical care. The aim of this paper is to fill this gap by outlining practical strategies for intervention in clinical settings and to assist diabetes healthcare professionals in thinking through how diabetes distress might be addressed practically in their clinics. To address these goals, this review is divided into five sections: a definition of diabetes distress, ways diabetes distress can be assessed and monitored, information about diabetes distress for use in intervention planning, topics to be considered for inclusion in diabetes distress interventions, and alternatives for where in the care process a diabetes distress intervention might be considered. We focus on diabetes distress experienced by adults with both Type 1 and Type 2 diabetes.
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Affiliation(s)
- L Fisher
- Department of Family & Community Medicine, University of California, San Francisco, Ca, USA
| | - W H Polonsky
- University of California, San Diego, Behavioral Diabetes Institute, San Diego, Ca, USA
| | - D Hessler
- Department of Family & Community Medicine, University of California, San Francisco, Ca, USA
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Naqvi JB, Helgeson VS, Gary-Webb TL, Korytkowski MT, Seltman HJ. Sex, race, and the role of relationships in diabetes health: intersectionality matters. J Behav Med 2019; 43:69-79. [PMID: 31102104 DOI: 10.1007/s10865-019-00057-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/10/2019] [Indexed: 01/05/2023]
Abstract
Previous research has seldom used an intersectionality framework to consider how sex and race affect diabetes health, nor has it examined the role of sex and race in the well-established link between romantic relationship quality and health. This study targeted 200 adults with type 2 diabetes (46% Black; 45% female) and examined whether sex, race, and the interaction between sex and race predicted behavioral and psychological health, or moderated the link between relationship quality and health outcomes. Black women reported poorer diabetes self-care and lower self-efficacy compared to other groups. Relationship quality was associated with better self-care, increased self-efficacy, and lower depressive symptoms. The association between relationship quality and medication adherence was stronger for Black women, and the association between relationship quality and self-efficacy was stronger for both Black women and White men. Results suggest that Black women with diabetes experience more health disadvantages than other groups, but some of these disadvantages might be attenuated by supportive romantic relationships.
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Affiliation(s)
- Jeanean B Naqvi
- Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA.
| | - Vicki S Helgeson
- Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA.
| | - Tiffany L Gary-Webb
- University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Mary T Korytkowski
- University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213, USA
| | - Howard J Seltman
- Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA
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143
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Hansen UM, Skinner T, Olesen K, Willaing I. Diabetes Distress, Intentional Hyperglycemia at Work, and Glycemic Control Among Workers With Type 1 Diabetes. Diabetes Care 2019; 42:797-803. [PMID: 30765430 DOI: 10.2337/dc18-1426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 01/21/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim was to explore relationships between work-related factors, work-related diabetes distress (WRDD), diabetes distress (measured by Problem Areas in Diabetes [PAID]-5 scale), intentional hyperglycemia at work (IHW), and glycemic control. RESEARCH DESIGN AND METHODS A cross-sectional survey was conducted with 1,030 working adults with type 1 diabetes and linked with electronic health record data from a specialist diabetes clinic in Denmark. With use of structural equation modeling, two alternative models were compared, based on fit indices, statistical significance, and theoretical meaningfulness. RESULTS A combined model provided the best fit to the data. WRDD was more strongly affected by work ability, opportunity to self-manage at work, being treated differently, and job demands. PAID-5 was more strongly affected by identity concern and blame and judgment. Both PAID-5 and WRDD were associated with more frequent IHW, which was associated in turn with worse glycemic control. CONCLUSIONS Work-related factors are associated with WRDD and PAID-5. Distress increases the frequency of IHW, which is, in turn, associated with worse glycemic control. Future studies should investigate ways to balance diabetes management and work life without compromising diabetes care.
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Affiliation(s)
- Ulla M Hansen
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Timothy Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Olesen
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Ingrid Willaing
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
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144
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Vaughan EM, Naik AD, Lewis CM, Foreyt JP, Samson SL, Hyman DJ. Telemedicine Training and Support for Community Health Workers: Improving Knowledge of Diabetes. Telemed J E Health 2019; 26:244-250. [PMID: 30839244 DOI: 10.1089/tmj.2018.0313] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Community health workers (CHWs) are a well-established source to improve patient health care, yet their training and support remain suboptimal. This limits program expansion and potentially compromises patient safety. The objective of the study was to evaluate the feasibility and acceptability of weekly training and support by telemedicine (videoconferencing). Materials and Methods: CHWs (n = 6) who led diabetes group visits for low-income Latinos met weekly with a health care professional for training and support. Feasibility and acceptability outcome measures included telemedicine usability, knowledge of diabetes (baseline to 6 months), and program satisfaction. Results: Telemedicine training and support were found to be feasible and acceptable as measured by usability (Telehealth Usability Questionnaire: average 4.7/5.0, ±0.4), knowledge (Diabetes Knowledge Test: pretest 15.8 ± 1.3, posttest 21.8 ± 1.2, p < 0.001, respectively), and satisfaction (Texas Department of State Health Services survey: average 5.8/6.0, ±0.5). All CHWs preferred telemedicine to in-person training. Conclusions: Telemedicine is a feasible and acceptable modality to train and support CHWs.
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Affiliation(s)
| | - Aanand D Naik
- Department of Medicine, Houston, Texas.,Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E DeBakey VA Medical Center, Houston, Texas
| | - Courtney M Lewis
- School of Health Professions Baylor College of Medicine, Houston, Texas
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145
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Goff LM, Moore AP, Rivas C, Harding S. Healthy Eating and Active Lifestyles for Diabetes (HEAL-D): study protocol for the design and feasibility trial, with process evaluation, of a culturally tailored diabetes self-management programme for African-Caribbean communities. BMJ Open 2019; 9:e023733. [PMID: 30826792 PMCID: PMC6398623 DOI: 10.1136/bmjopen-2018-023733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Black British communities are disproportionately burdened by type 2 diabetes (T2D) and its complications. Tackling these inequalities is a priority for healthcare providers and patients. Culturally tailored diabetes education provides long-term benefits superior to standard care, but to date, such programmes have only been developed in the USA. The current programme of research aims to develop the Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) culturally tailored T2D self-management programme for black British communities and to evaluate its delivery, acceptability and the feasibility of conducting a future effectiveness trial of HEAL-D. METHODS AND ANALYSIS Informed by Medical Research Council Complex Interventions guidance, this research will rigorously develop and evaluate the implementation of the HEAL-D intervention to understand the feasibility of conducting a full-scale effectiveness trial. In phase 1, the intervention will be developed. The intervention curriculum will be based on existing evidence-based T2D guidelines for diet and lifestyle management; codesign methods will be used to foster community engagement, identify the intervention's underpinning theory, identify the optimal structure, format and delivery methods, ascertain adaptations that are needed to ensure cultural sensitivity and understand issues of implementation. In phase 2, the intervention will be delivered and compared with usual care in a feasibility trial. Process evaluation methods will evaluate the delivery and acceptability of HEAL-D. The effect size of potential primary outcomes, such as HbA1c and body weight, will be estimated. The feasibility of conducting a future effectiveness trial will also be evaluated, particularly feasibility of randomisation, recruitment, retention and contamination. ETHICS AND DISSEMINATION This study is funded by a National Institute of Health Research Fellowship (CDF-2015-08-006) and approved by National Health Service Research Ethics Committee (17-LO-1954). Dissemination will be through national and international conferences, peer-reviewed publications and local and national clinical diabetes networks. TRIAL REGISTRATION NUMBER NCT03531177; Pre-results.
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Affiliation(s)
- Louise M Goff
- Diabetes and Nutritional Sciences, Kings College London, London, UK
| | - Amanda P Moore
- Diabetes and Nutritional Sciences, Kings College London, London, UK
| | - Carol Rivas
- Faculty of Health Sciences, University of Southamptom, Southamptom, UK
| | - Seeromanie Harding
- Diabetes & Nutritional Sciences Division, King's College London, London, UK
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146
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Stanulewicz N, Mansell P, Cooke D, Hopkins D, Speight J, Blake H. PAID-11: A brief measure of diabetes distress validated in adults with type 1 diabetes. Diabetes Res Clin Pract 2019; 149:27-38. [PMID: 30710656 DOI: 10.1016/j.diabres.2019.01.026] [Citation(s) in RCA: 4] [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] [Received: 08/29/2018] [Revised: 01/05/2019] [Accepted: 01/21/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The Problem Areas In Diabetes (PAID) questionnaire is widely used to assess emotional distress related to living with diabetes, although it is lengthy for routine clinical use. Our aim was to determine whether the original 20-item PAID questionnaire can be abbreviated, whilst maintaining its reliability, validity and utility. METHODS We analysed data from the UK DAFNE (Dose Adjustment For Normal Eating) education programme for adults with Type 1 diabetes. Data were analysed at baseline (n = 1547) and 1-year post intervention (n = 846). Exploratory factor analysis (EFA) with principal axis factoring method was used to examine PAID responses within a random half of the baseline data (n = 746). Then, two confirmatory factor analyses (CFA) were conducted using the remaining baseline (n = 801) and 1-year data. Reliability, predictive validity, convergent validity and responsiveness were also examined. RESULTS Based on the EFA results, which were corroborated by CFA, an 11-item PAID questionnaire was identified with a cut-off score of 18 indicating severe diabetes distress. In the current sample, this brief version had high internal consistency (Cronbach's α = 0.93). Predictive validity was demonstrated with the PAID-11 identifying severe diabetes distress from the original 20-item measure, with 95% sensitivity and 96% specificity. Convergent validity was demonstrated by strong positive correlations with HADS anxiety and depressive symptoms (average r = 0.65 and r = 0.55, respectively), while divergent validity was shown with weaker correlations with EQ5D health status (average r = 0.37). CONCLUSIONS Based on present results, PAID-11 appears to be a valid and reliable measure, which seems suitable for use as a brief tool for the detection of diabetes distress in adults with type 1 diabetes. Importantly, this tool may reduce participant burden in multi-measure studies. However, further studies are urgently needed to determine the validity and utility of PAID-11 beyond the UK DAFNE population.
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Affiliation(s)
| | - Peter Mansell
- Department of Diabetes and Endocrinology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Debbie Cooke
- School of Health Sciences, University of Surrey, UK
| | - David Hopkins
- King's Health Partners' Institute of Diabetes, Endocrinology and Obesity, London, UK
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia; AHP Research, Hornchurch, UK
| | - Holly Blake
- School of Health Sciences, University of Nottingham, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, Nottingham, UK
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147
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Vislapuu M, Broström A, Igland J, Vorderstrasse A, Iversen MM. Psychometric properties of the Norwegian version of the short form of The Problem Areas in Diabetes scale (PAID-5): a validation study. BMJ Open 2019; 9:e022903. [PMID: 30796115 PMCID: PMC6398631 DOI: 10.1136/bmjopen-2018-022903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To assess the psychometric properties of the short form of The Problem Areas in Diabetes scale (PAID-5) in Norwegian adult patients with type 1 or type 2 diabetes. DESIGN Cross-sectional survey design. METHODS Participants (n=143) were included from three Western-Norway endocrinology outpatient clinics. Demographic and clinical data were collected in addition to questionnaires concerning diabetes-related distress, fear of hypoglycaemia, symptoms of depression, emotional well-being and perception of general health. Psychometric evaluation of the PAID-5 included confirming its postulated one-factor structure using confirmatory factor analysis (CFA) and assessing convergent validity, discriminant validity, internal consistency and test-retest reliability. The retest questionnaire was sent out 35±15 days after the initial assessment to those who agreed (n=117). RESULTS The CFA for the PAID-5 scale showed excellent one-factor structure, and there was high internal consistency (α=0.89) and good test-retest reliability (Intraclass Correlation Coefficient, ICC=0.81). The PAID-5 correlated positively with fear of hypoglycaemia (r=0.598) and depression (r=0.380) and negatively with emotional well-being (r=-0.363) and perception of general health (r=-0.420), thus satisfying convergent validity. Patients who had experienced episodes of serious hypoglycaemia in the past 6 months had a significantly higher PAID-5 mean score (7.5, SD=4.95) than those who had not had these episodes (5.0, SD=4.2 (p=0.043)). CONCLUSION The Norwegian PAID-5 was shown to be a reliable and valid short questionnaire for assessing diabetes-related distress among people with type 1 or type 2 diabetes. However, its ability to discriminate between groups needs to be tested further in larger samples. The PAID-5 scale can be a particularly valuable screening instrument in outpatient clinics, as its brevity makes it easy to use as a tool in patient-provider encounters. This short questionnaire is useful in the national diabetes registry or population cohort studies as it enables increased knowledge regarding the prevalence of diabetes-related distress.
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Affiliation(s)
- Maarja Vislapuu
- Department of Health and Social Sciences, Institute of Health and caring Science, Western Norway University of Applied Sciences, Bergen, Norway
| | - Anders Broström
- Department of Health and Social Sciences, Institute of Health and caring Science, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Nursing, School of Health and Welfare, Jonkoping University, Jonkoping, Sweden
- Department of Clinical Neurophysiology, University Hospital Linköping, Linköping, Sweden
| | - Jannicke Igland
- Department of Health and Social Sciences, Institute of Health and caring Science, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Marjolein M Iversen
- Department of Health and Social Sciences, Institute of Health and caring Science, Western Norway University of Applied Sciences, Bergen, Norway
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148
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Schlicker S, Weisel KK, Buntrock C, Berking M, Nobis S, Lehr D, Baumeister H, Snoek FJ, Riper H, Ebert DD. Do Nonsuicidal Severely Depressed Individuals with Diabetes Profit from Internet-Based Guided Self-Help? Secondary Analyses of a Pragmatic Randomized Trial. J Diabetes Res 2019; 2019:2634094. [PMID: 31218230 PMCID: PMC6536948 DOI: 10.1155/2019/2634094] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 04/11/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Diabetes mellitus type 1 and type 2 are linked to higher prevalence and occurrences of depression. Internet-based depression- and diabetes-specific cognitive behavioral therapies (CBT) can be effective in reducing depressive symptom severity and diabetes-related emotional distress. The aim of the study was to test whether disease-specific severity indicators moderate the treatment outcome in a 6-week minimally guided web-based self-help intervention on depression and diabetes (GET.ON Mood Enhancer Diabetes (GET.ON M.E.D.)) and to determine its effectiveness in a nonsuicidal severely depressed subgroup. METHODS Randomized controlled trial- (RCT-) based data (N = 253) comparing GET.ON M.E.D. to an online psychoeducation control group was used to test disease-specific severity indicators as predictors/moderators of a treatment outcome. Changes in depressive symptom severity and treatment response were examined in a nonsuicidal severely depressed subgroup (CES - D > 40; N = 40). RESULTS Major depressive disorder diagnosis at the baseline (p prf6 = 0.01), higher levels of depression (Beck Depression Inventory II; p prpo = 0.00; p prf6 = 0.00), and lower HbA1c (p prpo = 0.04) predicted changes in depressive symptoms. No severity indicator moderated the treatment outcome. Severely depressed participants in the intervention group showed a significantly greater reduction in depressive symptom severity (d prpo = 2.17, 95% Confidence Interval (CI): 1.39-2.96) than the control condition (d prpo = 0.92; 95% CI: 0.001-1.83), with a between-group effect size of d prpo = 1.05 (95% CI: 0.11-1.98). Treatment response was seen in significantly more participants in the intervention (4/20; 20%) compared to the control group (0/20, 0%; χ 2 (2)(N = 40) = 4.44; p < 0.02). At the 6-month follow-up, effects were maintained for depressive symptom reduction (d pr6f = 0.71; 95% CI: 0.19-1.61) but not treatment response. CONCLUSION Disease-specific severity indicators were not related to a differential effectiveness of guided self-help for depression and diabetes. Clinical meaningful effects were observed in nonsuicidal severely depressed individuals, who do not need to be excluded from web-based guided self-help. However, participants should be closely monitored and referred to other treatment modalities in case of nonresponse.
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Affiliation(s)
- Sandra Schlicker
- Friedrich-Alexander University Erlangen-Nürnberg, Germany
- Philipps-University Marburg, Germany
| | | | | | | | | | - Dirk Lehr
- Leuphana University Lüneburg, Germany
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149
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van Vugt HA, Boels AM, de Weerdt I, de Koning EJ, Rutten GE. Patient activation in individuals with type 2 diabetes mellitus: associated factors and the role of insulin. Patient Prefer Adherence 2018; 13:73-81. [PMID: 30643392 PMCID: PMC6314047 DOI: 10.2147/ppa.s188391] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM This study explored the relationship between insulin use and patient activation (a person's internal readiness and capabilities to undertake health-promoting actions) in individuals with type 2 diabetes mellitus and aimed to identify demographic, clinical and psychosocial factors involved in patient activation. METHODS In this cross-sectional study, baseline data from a Dutch nationwide study were analyzed. Patient activation was assessed with the Patient Activation Measure 13. A linear mixed model was used to take clustering into account. RESULTS In total, 1,189 persons were included (310 of whom were on insulin), enrolled via 47 general practices and six hospitals. Their mean Patient Activation Measure 13 score was 59±12. We found no association between insulin therapy and patient activation. In the multivariable analysis, individuals with a better health status, very good or very poor social support (vs good social support), individuals who felt they had greater control over their illness and those with a better subjective understanding of their illness showed higher patient activation. Individuals with a lower educational level and those who expected their illness to continue showed a lower activation level. CONCLUSION Patient activation does not differ between individuals with type 2 diabetes mellitus on insulin therapy and those on other therapies.
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Affiliation(s)
- Heidi A van Vugt
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, Utrecht, the Netherlands,
- Dutch Diabetes Federation, Amersfoort 3818 LE, the Netherlands
| | - Anne Meike Boels
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, Utrecht, the Netherlands,
| | - Inge de Weerdt
- Dutch Diabetes Federation, Amersfoort 3818 LE, the Netherlands
| | - Eelco Jp de Koning
- Department of Medicine, Leiden University Medical Center, 2300 RC Leiden, the Netherlands
| | - Guy Ehm Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, Utrecht, the Netherlands,
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150
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Messina R, Due-Christensen M, Keller-Senn A, Polek E, Fantini MP, Sturt J. Couples living with type 1 diabetes: An integrative review of the impacts on health and wellbeing. J Health Psychol 2018; 26:412-437. [PMID: 30574793 DOI: 10.1177/1359105318817356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Impacts of type 1 diabetes and relationship factors on health and wellbeing of both persons with diabetes and partners (T1D partners) have not been investigated. Integrative review methods evaluated the evidence. From 323 titles, we included 24 studies involving 16,083 persons with diabetes and 1020 T1D partners. Studies were quantitative (n = 13), qualitative (n = 9) and mixed methods (n = 2). Maintaining resilient, good quality, intimate relationships optimises physical and psychological outcomes for persons with diabetes. Partners experience disturbed sleep and while general psychological health is maintained, distress surrounding hypoglycaemia is overwhelming for over a third of partners. Nurturing quality relationships could reap significant health benefits.
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Affiliation(s)
- Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Italy
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
| | - Mette Due-Christensen
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
- Steno Diabetes Centre Copenhagen, Denmark
| | - Anita Keller-Senn
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
- Cantonal Hospital Winterthur, Switzerland
- Zurich University of Applied Sciences, Switzerland
| | | | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Italy
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
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