Coping strategies in men and women with type 2 diabetes in Swedish primary care

Social isolation in people with type 2 diabetes: A concept analysis

Objective

To identify the defining attributes, antecedents, consequences and empirical referents to form an operational definition of social isolation in people with type 2 diabetes.

Design

The Walker and Avant approach.

Data source

An electronic search of the literature using China National Knowledge Infrastructure (CNKI), Wanfang database, PubMed, Web of Science, CINAHL, and PsycINFO informed the analysis. The search included both quantitative and qualitative studies related to social isolation in people with type 2 diabetes published in Chinese and English.

Results

Of the 2918 articles identified, 21 ultimately met the inclusion criteria. The analysis identified the defining attributes of social isolation in people with type 2 diabetes as objective and subjective. Antecedents included five aspects: personal characteristics, disease-related physiological factors, and psychological, behavioral, and social factors. Consequences were identified as physiological, psychological, behavioral aspects and quality of life.

Conclusions

The operational definition of social isolation in people with type 2 diabetes is that due to personal characteristics, disease-related physiological factors, and psychological, behavioral, and social factors, people with type 2 diabetes will have limited social networks and social support, reduced social contact and social involvement, and/or negative feelings of disconnection from the outside world, which lead to adverse physiological, psychological, and behavioral outcomes and poor quality of life. Clinicians can further develop tools to measure social isolation in people with type 2 diabetes and analyze the path of the antecedents to social isolation to investigate the interplay between them in order to develop target interventions.

Coping and risk perception during the COVID-19 pandemic in type 2 diabetes: Does it influence metabolic control?

Diabetes and poor glycemic control are significant predictors of severity and death in the COVID-19 disease. The perception of this risk in individuals with type 2 diabetes (T2D) could modify coping styles, leading to behaviors associated with better self-care and metabolic control. Theoretically, active coping is associated with better glycemic control in patients with T2D. Nonetheless, information during extreme risk like the COVID-19 pandemic is still limited. Our objective was to evaluate the association between coping styles and risk perception in the COVID-19 pandemic and the change in metabolic parameters. This is a prospective study that included individuals with T2D treated in a tertiary care center during the COVID-19 outbreak who returned to follow-up one year later. We assessed coping styles and risk perception with the Extreme Risk Coping Scale and the risk perception questionnaire. Clinical characteristics and metabolic parameters were registered in both visits. Groups were compared using Kruskal Wallis tests, and changes in metabolic parameters were assessed with Wilcoxon rank sum tests. Our sample included 177 participants at baseline, and 118 concluded the study. Passive coping was more frequent in women. Low-risk perception was associated with higher age, lower psychiatric comorbidities, and lower frequency of psychiatric treatment compared with other risk perception groups. Patients with active coping plus high-risk perception did not have a change in metabolic parameters at follow-up, whereas patients with other coping styles and lower risk perception had an increase in total cholesterol, LDL-cholesterol, and triglycerides. There were no differences by coping group or by risk perception in glycemic control.

The relationship between self-care, spiritual well-being and coping strategies in patients with type 2 diabetes mellitus

Background

Diabetes is one of the most common diseases in the world. The most important underlying cause of death in diabetic patients is the lack of self-care and management. However, there is little known about the influence of coping strategies and spiritual well-being (SWB) on self-care in diabetic patients.

Aims

This study aimed to investigate the relationship between self-care activities with coping strategies and spiritual well-being (SWB) in patients with type 2 diabetes mellitus (T2DM).

Methods

In this descriptive-analytical study, we selected 236 patients with T2DM referred to the diabetes hospital clinics in the southwest of Iran. Inclusion criteria were patients diagnosed with T2DM, with the age group ranging 20-80 years, literate, not suffering from severe and debilitating complications of diabetes and lacking acute psychological illness. Exclusion criteria included refusing to complete questionnaires and cognitive or emotional impairment. Instruments include the demographic questionnaire, Summary of Diabetes Self-Care Activities, Lazarus and Folkman's Coping Strategies Questionnaire and the Spiritual Well-Being Scale (SWBS; developed by Paloutzian and Ellison). To examine the relationship between variables, the Pearson correlation and multiple stepwise regression analysis were used.

Results

The findings of this study on 236 patients with T2DM (53.25 ± 10.91) including 76 (32.2%) males and 160 (67.8%) females showed the majority of participants were female, the age group was between 41 and 60 years (68.22%), had a Diploma (63.98%), were insured (63.55%) and had a moderate economic situation (55.93%). There was a direct and significant correlation between self-care activities and coping strategies (r = 0.163, p < 0.05), and only a problem-focused coping strategy was considered as a predictor variable of self-care (p < 0.01). There was a direct and significant correlation between self-care and SWB (r = 0.385, p < 0.01).

Conclusion

The results of this study showed that there is a significant relationship between self-care and the problem-focused dimension of coping strategies and SWB in patients with T2DM.

Cognitive illness representation and anxiety in older men and women with type 2 diabetes

AIM

In the elderly, type 2 diabetes is a frequent chronic condition that requires the attention of health care. As patient involvement is a prerequisite for treatment, it seems crucial to assess psychosocial aspects, including patient's cognitive component of attitude towards the condition, as early as upon diagnosis. The aim of this study was to examine whether the cognitive illness representation in older female and male patients with type 2 diabetes is differentiated. Considering disease duration, we determined the effect of cognitive illness representation on older diabetes emotional wellbeing.

METHODS

The study in 99 older adults with type 2 diabetes used Disease-Related Appraisals Scale (Skala Oceny Własnej Choroby; SOWCh) to assess cognitive illness representation and State-Trait Anxiety Inventory (STAI) to assess the severity of state anxiety.

RESULTS

In a subgroup with short-standing diagnosis, women scored significantly higher than men on subscales of Threat, Obstacle/Loss and Profit. In a subgroup with long-standing diagnosis, women scored significantly higher than men on the subscale of Threat and significantly lower than men on the subscale of Value. The associations between the individual dimensions of cognitive illness representation and anxiety were also determined. These correlations differed between sexes and stages of the disease.

CONCLUSION

Both at early and late stages of type 2 diabetes, women perceive their illness as a threat significantly more than men do. This appraisal persists throughout the entire duration of the illness. Men with long-standing diagnosis, attribute higher value to diabetes than women do, perceiving it as an opportunity to appreciate values they did not pay attention to before. Anxiety reported by older women and men can be explained to a significant extent by certain dimensions of their respective cognitive illness representation.

The effects of a supportive-educational intervention on women with type 2 diabetes and diabetic peripheral neuropathy: a randomized controlled trial

Purpose:

To determine the effect of a supportive educational intervention based on the Orem self-care model on women with type 2 diabetes and diabetic peripheral neuropathy.

Design:

A randomized controlled trial.

Setting:

Hospital outpatient diabetes clinic.

Subjects:

Adult women with type 2 diabetes and mild-to-moderate diabetic peripheral neuropathy. Out of 410 patients, 120 diabetic patients were recruited and randomly assigned to trial group ( N = 60) and control group ( N = 60).

Intervention:

The trial group received a designed intervention consist of one-month supportive educational program with three months of follow-up (totally four months), based on self-care requisites according to the Orem self-care regarding diabetic peripheral neuropathy. The control group only received a routine care program in the diabetes clinic.

Main measurements:

The main outcomes were symptoms and severity of diabetic neuropathy. Further outcomes were fasting blood sugar and glycosylated hemoglobin.

Results:

By the end of the intervention, the number of participants reduced from 60 to 58 in the trial group and to 57 in the control group (totally 115). The intervention significantly decreased mean score of diabetic neuropathy symptoms (trial group: 3.26 vs. control group: 9.57, P = 0.001), severity (trial group: 5.86 vs. control group: 9.02, P = 0.001), fasting blood sugar (trial group: 151 vs. control group: 204, P = 0.001), and glycosylated hemoglobin (trial group: 7.85 vs. control group: 8.62, P = 0.004).

Conclusion:

Delivering a supportive-educational intervention based on the Orem self-care model on outpatient diabetes clinic can decrease the symptoms and severity of diabetic peripheral neuropathy.

Trial registration:

It was registered in the Iranian Registry of Clinical Trials (IRCT2015021521095N1).

Diabetes in women and health-related quality of life in the whole family: a structural equation modeling

Background

Although several studies indicate the effects of diabetes type 2 on health-related quality of life (HRQoL) in female subjects, the related impact of the disease on HRQoL in their family members has rarely been the focus of the empirical research. In this study we aim to investigate associations between diabetes in women and the HRQoL in these women and their family members, using the structural equation modeling (SEM).

Methods

This family-based study was conducted on 794 women (11.1% with diabetes) as well as their spouses and children who participated in the Tehran Lipid and Glucose Study (TLGS) from 2014 to 2016. Data on HRQoL were collected using the Iranian version of the Short-Form 12-Item Health Survey version 2 (SF-12v2) and the Pediatric Quality of Life Inventory version™ 4.0 (PedsQL). SEM was conducted to evaluate the network of associations among studied variables. Data were analyzed using IBM SPSS Statistics & AMOS version 23 software.

Results

Mean age of women was 41.37 ± 5.32 years. Diabetes in women significantly affected their mental HRQoL (β = − 0.11, P < 0.01) but showed no significant direct associations with physical and mental HRQoL in their spouses or their children. However, poor mental HRQoL in women with diabetes was associated with decrease in both physical (β = − 0.02, P = 0.013) and mental (β = − 0.03, P < 0.01) HRQoL in their spouses and total HRQoL score in children (β = − 0.02, P < 0.01).

Conclusions

Among women with diabetes type 2, beyond its effect on their mental HRQoL per se, demonstrated a negative association with the self-assessment of health status in their spouses and children. Such familial consequences are mainly attributed to the negative effect of the disease on the mental rather than the physical HRQoL in women with diabetes.

A systematic review of the relationships among psychosocial factors and coping in adults with type 2 diabetes mellitus

Type 2 diabetes mellitus contributes to poor health outcomes including mortality, yet there is a gap in the literature when seeking to understand the influence of psychosocial factors on coping in this population. The paper presents a systematic review of quantitative studies that examined relationships among psychosocial determinants and coping in adults with type 2 diabetes. This review is the second layer of knowledge discovery for the concept, “Taking on a life-altering change is a rhythmical journey of experiencing ups and downs on the way to acceptance.” The life-altering change was determined to be a diagnosis of type 2 diabetes, the journey is the ups and downs of coping with the diagnosis as people work toward acceptance of type 2 diabetes. The review includes a synthesis of findings from 22 quantitative studies of psychosocial factors and coping in adults with type 2 diabetes. Anxiety, depression, stress, and diabetes distress were identified as key influential psychosocial factors. Increased social support was inversely related to emotional distress and coping styles were related to social well-being, psychological health, and physical health outcomes. The positive coping style of problem-focused coping was linked to improved psychological and physical health. Emotional responses to diagnosis were related to depression and anxiety. Negative coping styles of resignation, protest, or isolation were higher in women and linked to poorer quality of life, while avoidance was linked to increased diabetes-related distress and depressive symptoms.

Family and Couple Variables Regarding Adherence in Type 2 Diabetes Patients in the Initial Stages of the Disease

This study analyzed which family and couple variables predicted adherence to standard care treatment, in patients recently diagnosed with type 2 diabetes. The sample comprised 224 dyads assessed during the first year of diagnosis (T1) and 4 months later (T2). The results showed that family stress, dyadic adjustment, family coping, and positive support assessed by patients at T1 predicted medication adherence and glucose monitoring at T2. Positive support and dyadic adjustment, assessed by partners at T1, predicted patients' adherence to glucose monitoring and diet at T2. This study highlights the important role of the partner in patient`s adherence. Therefore, standard care in type 2 diabetes should be offered in the context of the dyad.

Depressive symptoms are associated with poor glycemic control among women with type 2 diabetes mellitus

Objective

In patients with type 2 diabetes mellitus, depressive symptoms may be associated with metabolic deterioration. The impact of sex on this association is unclear. The aim of this study is to analyze the relationship between depression and metabolic control by sex. The data presented is the side product of the clinical investigation by Rui Duarte, MD, Treatment Response in Type 2 Diabetes Patients with Major Depression from 2007.

Results

A sample of 628 outpatients with type 2 diabetes mellitus was taken from a specialized diabetes outpatient clinic. In a univariate analysis: women’s glycohemoglobin mean levels were 8.99% whereas men’s were 8.41% and the difference was statistically significant. The proportion of women (34.3%) with pathological levels of depression (Hospital Anxiety Depression Scale score ≥ 8) was significantly higher than men’s (15.2%). A linear regression analysis performed by sex and controlling for demographic, clinical and psychological variables, showed poorer metabolic control in women with depressive symptoms. No association was observed in men. These results support depression as a predictor for poor metabolic control in women and the need for detecting depressive symptoms when glycemic levels deteriorate.

Essential parameters and risk factors of the patients for diabetes care and treatment

AIM

The aim was to explore the association between Type 2 Diabetes Mellitus [T2DM] treatment satisfactions of patients regarding their socio-economic, life-style, history medication and clinical outcome in a Turkish population SUBJECT AND METHODS: A cross-sectional study conducted from February 2016 to September 2016. Of the total 1500 diabetic patients approached, 1094 (72.9%) gave their consent. Data analysis included, sociodemographic, serum lipid profiles (LDL, HDL), calcium, uric acid, blood pressure and glycated hemoglobin (HbA1c) at baseline and after six months. The Diabetes Treatment Satisfaction Questionnaire (DTSQ) tools were used to measure the patient satisfaction.

RESULTS

The mean and standard deviation of age among gender, there were significant differences between males (51.81±14.40) and females (49.76±13.99) (p=0.024). There were statistically significant differences between males and females regarding place of living (city 76% vs town 26%) p<0.001) and consanguinity (p=0.040). Almost of the patients with diabetes were overweight (males 44.5% vs females 41.8%) while more than a quarter (31.2%) males were obese. Among patients with diabetes, significantly larger proportion were treated for DM with insulin (females 28.8% vs males 22.5%) and 'insulin & oral anti diabetic drugs' (females 21.6% vs males 18.4%%; p<0.001) in comparison. Reported average sleeping haours was significantly more among males (6.5±1.1 vs. 6.1±1.2; p<0.001) than females. Males and females reported significantly greater improvements in mean values of blood glucose (-2.07 p<0.001; vs. -2.36; p=0.007), HbA1c (-1.72 p<0.001; vs. -1.47 p=0.038), potassium (+0.98 p<0.001; vs. +0.93 p<0.005); albumin (-3.38 p<0.001; vs. -3.60; p<0.001); billirubin (-0.69 p=0.049; vs. -0.98; p<0.001); uric acid (+11.9 p=0.017; vs. +14.3; p<0.001); systolic blood pressure (-3.86 p<0.001; vs. -3.2 p<0.001) and diastolic blood pressure (-3.17 p<0.001; vs. -3.2 p<0.001) in comparison to 6 months before. Multivariate stepwise regression analysis showed that the satisfaction DTSQ scores for HbA1c (p<0.001), h of sleep (p<0.001), neuropathy (p=0.007), diabetic education (p=0.014), SBP (mmHg) (p=0.021) DBP (mmHg) (p=0.028) were identified as significantly associated with higher treatment satisfaction.

CONCLUSION

The study confirms a positive correlation between diabetes patient's satisfaction with care and treatment. Females DM patients compared to males had a better satisfaction score with current treatment, unacceptably low blood glucose level, flexibility in treatment and understanding of DM.

Health-Related Quality of Life, Subjective Health Complaints, Psychological Distress and Coping in Pakistani Immigrant Women With and Without the Metabolic Syndrome : The InnvaDiab-DEPLAN Study on Pakistani Immigrant Women Living in Oslo, Norway

The increasingly high number of immigrants from South-East Asia with The Metabolic Syndrome (MetS) is an important challenge for the public health sector. Impaired glucose is essential in MetS. The blood glucose concentration is not only governed by diet and physical activity, but also by psychological distress which could contribute to the development of MetS. The aim of this study is to describe health-related quality of life, subjective health complaints (SHC), psychological distress, and coping in Pakistani immigrant women, with and without MetS. As a part of an randomized controlled intervention study in Oslo, Norway, female Pakistani immigrants (n = 198) answered questionnaires regarding health related quality of life, SHC, psychological distress, and coping. Blood variables were determined and a standardized oral glucose tolerance test was performed. The participants had a high score on SHC and psychological distress. About 40% of the participants had MetS, and this group showed significantly lower general health, lower physical function, and more bodily pain, than those without MetS. Those with MetS also had more SHC, depressive symptoms, higher levels of somatisation, and scored significantly lower on the coping strategy of active problem solving. Pakistani immigrant women seem to have a high prevalence of SHC and psychological distress, especially those with MetS.

A Randomized Controlled Trial of Acceptance and Commitment Therapy for Type 2 Diabetes Management: The Moderating Role of Coping Styles

Background and Aim

Evidence of the efficacy of existing psychological interventions for self-management in diabetes is limited. The current study aimed at assessing the effects of group-based ACT on self-management of patients with T2DM, considering the moderating role of coping styles.

Methods

One hundred and six patients with type 2 diabetes were randomly assigned either to the education alone (n = 53) or to a combination of education and group-based acceptance and commitment therapy (n = 53) over a period of 10 sessions. In each group, 50 participants completed a 3 month follow-up assessment.

Results

After 3 months, compared to patients who received education alone, those in the group-based acceptance and commitment therapy condition were more likely to use effective coping strategies, reported better diabetes self-care, and optimum glycated hemoglobin (HbA1C) levels in the target range.

Conclusions

Consideration of the role of coping style for a more accurate evaluation of the effects of acceptance and commitment therapy may be a useful addition to services provided for patients with type 2 diabetes.

Depression and anxiety after 2 years of follow-up in patients diagnosed with diabetes or rheumatoid arthritis

We studied emotional health in patients with diabetes mellitus (n = 89) or rheumatoid arthritis (n = 100) aged 18–65 years, at the time of diagnosis and after 24 months. Predictors for depression or anxiety according to the Hospital Anxiety and Depression scale after 2 years were assessed by logistic regression, with psychosocial factors and coping as dependent factors. There were many similarities between patients with diabetes mellitus or rheumatoid arthritis. Having children at home, low score on the Sense of Coherence scale, and high score on the coping strategy “protest” were important risk factors for depression and anxiety after 2 years.

Coping strategies among patients newly diagnosed with diabetes or rheumatoid arthritis at baseline and after 24 months

Patients aged 18-65 years with newly diagnosed diabetes mellitus ( n = 89) or rheumatoid arthritis ( n = 100) were studied by the General Coping Questionnaire at baseline and after 24 months. In total, 34 diabetes mellitus and 46 rheumatoid arthritis patients were diagnosed with psychosocial problems. The use of negative coping strategies, such as protest, isolation, and intrusion, was associated mostly with being classified as having psychosocial problems. With the risk of experiencing a strong impact of the disease at 2 years of follow-up as outcome, intrusion was a significant and independent risk factor, while minimization was a significant and independent protective factor.

Patients' and Spouses' Contribution Toward Adherence to Self-Care Behaviors in Type 2 Diabetes

This article focuses on patients' and partners' variables regarding adherence to self-care, in recently diagnosed patients with Type 2 diabetes. One hundred four patients and partners were included. Instruments answered were Family Inventory of Life Events and Changes (family stress), Family Crisis Oriented Personal Evaluation Scales (family coping), Revised Dyadic Adjustment Scale (dyadic adjustment), Multidimensional Diabetes Questionnaire (partner support) and Hospital Anxiety and Depression Scale (psychological morbidity). Results showed adherence to diet to be positively predicted by patient dyadic adjustment and patient positive support and negatively by partner depression and partner negative support. Adherence to exercise was predicted by patient's family stress and negatively by partner anxiety. Adherence to glucose monitoring was predicted by partner positive support. Psychological variables were not associated with adherence to foot care. Finally, positive partner support moderated the relationship between family stress and dyadic adjustment in patients. The results emphasize the need to treat the patient in the context of the dyad. Future research should focus on partners' specific instrumental behaviors that promote patients' self-care behaviors.

A Comparison of Type II Diabetic Patients With Healthy People: Coping Strategies, Hardiness, and Occupational Life Quality

Background

Due to the epidemiologic transition and a rise in the prevalence of non-communicable diseases different coping strategies have been studied and developed. These strategies may help the affected people to conduct a normal life style.

Objectives

This research was conducted in Qazvin, Iran to determine the relationship between coping strategies, hardiness, and occupational life quality in Type II diabetic patients and healthy people.

Patients and Methods

Questionnaires such as Valton’s on “occupational life quality,” Billings and Moos’ examination of “Coping strategies,” and Kobasa’s investigation of “hardiness” were applied to collect the data needed for the present study. In this regard, 80 people were randomly selected from employees of offices in Qazvin, Iran.

Results

The results of this research indicated that there is a significant relationship between problem-focused strategies, emotion-focused strategies, hardiness, and occupational life quality in people suffering from Type II diabetes and healthy people (P ≤ 0.05). These results also indicated that hardiness does not predict occupational life quality of people suffering from Type II diabetes.

Conclusions

The results of the present study give some evidence that allows us to conclude that hardiness and coping strategies affect occupational life quality for both people suffering from Type II diabetes and healthy people. Therefore, it is proposed that people strengthen their hardiness and coping strategies, in order to improve their occupational life quality.

Self-care activities and glycated haemoglobin in Iranian patients with type 2 diabetes: can coping styles and social support have a buffering role?

BACKGROUND

Diabetes self-care is a key element in the overall management of diabetes. However, the importance of psychosocial factors for successful disease management is under investigated. This study aimed at exploring the role of coping styles and social support in the relationship between self-care activities and glycated haemoglobin in patients with type 2 diabetes.

METHODS

One hundred adults (60% female, aged 40-70 years) with type 2 diabetes completed questionnaires assessing self-care activities, coping styles and social support. In addition, a blood test was performed to obtain glycated haemoglobin levels.

RESULTS

Result showed significant relationships of glycated haemoglobin with self-care activities, coping styles and social support. Regression analysis indicated that social support had a moderating role on the relationship between self-care activities and glycated haemoglobin, such that, at very high levels of social support the association, between Self-Care and HbA1c disappears.

CONCLUSIONS

Findings indicate that health care providers, within the context of the Iranian social and cultural situation, should pay more attention to psychosocial factors when addressing self-care activities. Delineation of the role of coping styles and social support might be useful for identifying patients in need of particular counselling and support for improving self-care activities and HbA1c levels.

What predicts negative effects of rheumatoid arthritis? A follow-up two years after diagnosis

We aimed at analyzing important predictive factors for experienced negative emotional and social effects of rheumatoid arthritis (RA) two years after diagnosis in patients aged 18–65 years. The first group included 41 participants, who had psychosocial problems (PSP) already at diagnosis, and who received an intervention by a medical social worker to improve coping capacity and social situation. The second group included 54 patients (NPSP) without such problems at diagnosis. All completed a questionnaire mapping their social situation, the Hospital Anxiety and Depression Scale (HADS), the Sense of Coherence Scale (SOC) and the General Coping Questionnaire (GCQ) at diagnosis and after 24 months. The most pronounced predictive factor for a strong impact of the disease was high scores on HADS depression scale. After 24 months, PSP participants had a more strained life situation, with higher scores on anxiety and depression and lower on SOC, in comparison with NPSP. NPSP participants improved their coping strategies regarding self-trust, cognitive revaluation, protest and intrusion, but deteriorated regarding problem focusing and social trust. PSP patients kept their initial coping strategies, except for intrusion decreasing over time, and seemed to have a more rigid coping pattern. However, the experienced negative impact of the disease increased over time in both groups despite improvement in sickness related data. Mostly influenced areas were economy, leisure time activities and social life. We conclude that psychosocial consequences of RA are more connected to emotional and social vulnerability than are RA-related clinical factors.

Follow-up two years after diagnosis of diabetes in patients with psychosocial problems receiving an intervention by a medical social worker

We followed up the psychosocial situation two years after diabetes diagnosis in patients (n = 82) aged 18-65 years, with psychosocial problems (PSP; n = 27) or not (NPSP; n = 55). We used a social questionnaire, the Hospital Anxiety and Depression scale (HAD), the Sense of Coherence scale (SOC), and the General Coping Questionnaire (GCQ). The PSP group had a more difficult situation with more strained economy, lower social support, more anxiety and depression, and lower SOC on both occasions. Being in the PSP group predicted experiencing a strong negative influence of the disease at follow-up. Regarding coping strategies, "problem focusing" decreased in both PSP and NPSP over time. "Social trust" and "intrusion" decreased only in NPSP. Otherwise the coping pattern was unchanged, with PSP showing lower scores on "self-trust" and "minimization" and higher scores on "protest," "isolation," and "intrusion." The most influenced areas at follow-up in the PSP group were work, relationship to partner and economy, and in the NPSP leisure-time activities, sexual life and work. Our findings underline the need to identify patients with psychosocial problems early.

Psychometric evaluation of a coping questionnaire in two independent samples of people with diabetes

The study examines internal item/scale structure and concurrent validity of a newly developed 48-item questionnaire [General Coping Questionnaire (GCQ)] that measures 10 aspects of coping with chronic illness (self-trust, problem-reducing actions, change of values, social trust, minimization, fatalism, resignation, protest, isolation and intrusion). The tests were performed in two independent samples of persons with diabetes mellitus. The first sample consisted of 119 subjects with type I diabetes and the second sample of 184 subjects with type II diabetes. Concurrent validity was examined by comparisons with measures of health-related quality of life (SF-36), a measure of metabolic control (HbA1c) and incidence of diabetic complications. The item/scale structure was found to be similar and very good in both samples. The 10 dimensions correlated as expected with the measure of mental health, although the 'negative' dimensions of the GCQ correlated higher compared with the 'positive' dimensions. Weaker relations with metabolic control were also found in one of the samples. These tests provide further evidence that GCQ is a well-structured, relevant and reliable instrument for assessing coping reactions in chronic somatic conditions.

A systematic review of the experience of older women living and coping with type 2 diabetes

This paper reports on a systematic review that sought to answer the research question: what is the experience of women living and coping with type 2 diabetes? A range of relevant terms were identified and electronic databases were searched. Only qualitative studies that explored the meaning of living and coping with type 2 diabetes and that included adult women aged ≥ 18 years were considered. We found evidence that women are challenged by their multi-caregiving roles and the complexities of managing their diabetes simultaneously. For female patients with diabetes, holistic care and individual psycho-education programmes appear to be facilitate more effective and successful diabetes management. In addition, carer programmes that provide information so that family and friends can support and assist the woman with diabetes are required.

Does good clinical practice at the primary care improve the outcome care for diabetic patients? Gender differences

BACKGROUND

The Middle East region is predicted to have one of the highest prevalence of diabetes mellitus (DM) in the world. This is the first study in the region to assess treatment outcome of DM according to gender.

OBJECTIVE

To assess the quality and effectiveness of diabetes care provided to patients attending primary care settings according to gender in the State of Qatar.

DESIGN

It is an observational cohort study.

SETTING

The survey was carried out in primary health care (PHC) centers in the State of Qatar.

SUBJECTS AND METHODS

The study was conducted from January 2010 to August 2010 among diabetic patients attending (PHC) centers. Of the 2334 registered with diagnosed diabetes, 1705 agreed and gave their consent to take part in this study, thus giving a response rate of 73.1%. Face to face interviews were conducted using a structured questionnaire including socio-demographic, clinical and satisfaction score of the patients.

RESULTS

Majority of subjects were diagnosed with type 2 DM (84.9%). A significantly larger proportion of females with DM were divorced or widowed (9.1%) in comparison to males with DM (3.4%; p<0.001). A significantly larger proportion of females were overweight (46.5%; p=0.009) and obese (29.5%; p=0.003) in comparison to males. Males reported significantly greater improvements in mean values of blood glucose (mmol/l) (-2.11 vs. -0.66; p=0.007), HbA1c (%) (-1.44 vs. -0.25; p=0.006), cholesterol (mmol/l) (-0.16 vs. 0.12; p=0.053) and systolic blood pressure (mmHg) (-9.04 vs. -6.62; p<0.001) in comparison to females. While there was a remarkable increase in male patients with normal range of fasting blood glucose (FBG; 51.6%) as compared to the FBG measurement 1 year before (28.5%: p<0.001) there was only a slight increase in females normal range FBG during this period from 28.0% to 30.4% (p=0.357).

CONCLUSION

The present study revealed that the current form of PHC centers afforded to diabetic patients provided significantly improved outcomes for males, but only minor improved outcomes for females. This study reinforces calls for a gender-specific approach to diabetes care.

Improvement of primary health care of patients with poorly regulated diabetes mellitus type 2 using shared decision-making--the DEBATE trial

BACKGROUND

Since 2004, a national Disease Management Program (DMP) has been implemented in Germany, which includes educational measures aimed at patients with type-2 diabetes (T2D). However, about 15-20% of T2D patients remain in poor metabolic control. Qualitative research shows that one reason for this might be an increasing frustration of general practitioners (GPs) with the management of their poorly regulated T2D patients over time. We aim at approaching this problem by improving the GP-patient-communication and fostering shared decision-making.

METHODS/DESIGN

An educative intervention will be tested within a multi-centred cluster-randomized controlled trial (RCT) in Germany. We include 20 GPs in three regions. Each of the 60 GPs will recruit about 13 patients meeting the inclusion criteria (total of 780 patients). GPs allocated to the intervention group will receive a peer-visit from a specifically trained GP-colleague who will motivate them to apply patient-centred communication techniques including patient-centred decision aids. GPs allocated to the control group will not take part in any intervention program, but will provide care as usual to their patients. The primary inclusion criterion for patients at the time of the recruitment is an HbA1c-level of over 8.0. Primary outcome is the change of HbA1c at 6, 12, 18, and 24 months compared to HbA1c at baseline. Secondary outcomes include patient's participation in the process of shared decision-making and quality of life.

DISCUSSION

If this intervention proves to be effective it may be integrated into the existing Disease Management Program for T2D in Germany.

Disability in inflammatory bowel disease

Disability can include different aspects of patient’s quality of life from physical to psychosocial to employment. Disability in IBD patients contributes to loss of workplace personnel, increased sick leave, and other indirect costs to society. Considerations for more expensive treatment regimens should include their potential to reduce indirect costs to the individual patients and to society in general. The recently developed tool could help establish specific criteria in a set of these diseases that have varied effects and severity.

Psychosocial problems among newly diagnosed rheumatoid arthritis patients

We identified patients with newly diagnosed rheumatoid arthritis (RA) in the ages 18-65 years who needed psychosocial interventions. A total of 123 patients (90 women) were asked to participate, but 19 declined and 4 dropped out early in the study, leaving a total of 100 patients (75 women) in the sample. Questionnaires used were the Epidemiological Investigation on Rheumatoid Arthritis study questionnaire, the Hospital Anxiety and Depression Scale, the Sense of Coherence (SOC) scale, and the General Coping Questionnaire. Interviews showed that 46% of the included 100 patients had psychosocial problems (PSP). One third of them had problems directly related to RA. The rest had problems with their life situation in general, without or reinforced by RA. Compared to patients without psychosocial problems, PSP patients lived in more strained social situations, especially regarding personal finances and social support. More of the PSP patients were anxious, showed lower SOC scores, and also used more emotion-based coping strategies (resignation, protest, isolation and intrusion) and less problem-oriented (minimization). They also had higher scores on depression and more frequently expected that RA would negatively affect their future. PSP patients also experienced a more negative impact of the disease, a finding not confirmed by the sickness activity score judged by the rheumatologist. Thus, early in the course of RA, screening instruments should be used to identify PSP patients. Psychosocial treatment and support by medical social workers skilled in RA care should be offered.

Self-classification as an adult in patients with type 1 diabetes: relationships with glycemic control and illness coping

OBJECTIVE

Previous community research has demonstrated the link between adult self-classification and health behaviors. The present study investigated the extent to which individuals with type 1 diabetes (ages 18-30 years) classified themselves as adults as compared with individuals without diabetes. Adult self-classification was examined in relation to illness coping and glycemic control.

METHODS

A total of 194 patients and 287 control individuals participated. Adult self-classification was assessed using a single item, coping was assessed using the Diabetes Coping Measure, and glycemic control was determined by HbA(1c) values.

RESULTS

Compared with control participants, more patients classified themselves as adults. Furthermore, adult self-classification was positively related to glycemic control. Structural equation modeling indicated that coping mediated the relationship between adult self-classification and glycemic control.

CONCLUSION

Individuals with diabetes classified themselves as adults more often than did their peers without diabetes, possibly due to their need to master their lives when confronted with diabetes. Adult self-classification appeared to function as a resource for glycemic control through its relationship with specific coping strategies.

PRACTICE IMPLICATIONS

The present study underscores the need to assess adult self-classification in individuals with diabetes. Our findings call for a developmentally tailored transition from pediatric to adult care.

Psychosocial problems in patients with newly diagnosed diabetes: number and characteristics

Early in the course of diabetes, it is important to identify and support patients whose psychosocial situations and reactions to the diagnosis may affect their ability to adjust or take adequate responsibility for self-care. We aimed to identify (a) the number and characteristics of patients, 18-65 years, newly diagnosed with diabetes, who needed psychosocial interventions and (b) the type of psychosocial problems they had. A total of 106 patients (72 men) were included in the study. Interviews showed that 41.5% had psychosocial problems. Fifteen dropped out early in the study; 38% of those remaining had psychosocial problems (PSP). More than half had problems with their life situation; most commonly in relationships. About a third had problems related to diabetes, most commonly, work-related. Compared to other participants, PSP patients lived in more strained social situations, especially regarding personal finances and social support. More of the PSP patients were anxious and depressed. They used negative coping strategies more often and more frequently expected that diabetes would negatively affect their future. In conclusion, early in the course of diabetes, screening instruments should be used to identify PSP patients. Treatment by medical social workers skilled in diabetes care should be offered.

Gender differences in self-rated health, quality of life, quality of care, and metabolic control in patients with diabetes

BACKGROUND

Because the projected increase in the number of diabetic patients is expected to strain the capabilities of health care providers worldwide, we are challenged to find ways of reducing the burden of diabetes. Maintaining and improving health-related quality of life (QoL) for diabetic patients may be viewed as public health goals.

OBJECTIVE

The aim of this cross-sectional study was to compare different aspects of health, QoL, and quality of care (QoC) between men and women with diabetes as a basis for planning and managing diabees care.

METHODS

All patients in 2 age groups (aged 20-30 years [younger age group] and aged 50-60 years [middle-aged group]) who were registered with the Department of Endocrinology, Metabolism, and Diabetes at Karolinska University Hospital, Stockholm, Sweden, in October 2004, were recruited for a survey. Questions were included about self-rated health (SRH), QoL, QoC, diabetes-related worries, occupational status, physical activity level, living arrangements, and educational background. Glycosylated hemoglobin (HbA1c) values were obtained from medical records.

RESULTS

Of the 223 eligible patients (109 men, 114 women) in the younger age group, 49 men and 74 women responded to the questionnaire; of the 300 eligible patients (170 men, 130 women) in the middle-aged group, 120 men and 93 women responded. Middle-aged women rated their mental well-being and QoL as worse compared with men (P < 0.001 and P < 0.05, respectively). In both age groups, women reported more diabetes-related worries and less ability to cope (P < 0.05 for the younger age group and P < 0.001 for the middle-aged group for both variables), thus the differences were more marked for middleaged women. Although there were no gender differences in metabolic control, middle-aged women reported less satisfaction with diabetes care (P < 0.001). Higher HbA1c was related to worse SRH in both men and women when analyzing the age groups together (P < 0.05). This association was most prominent in young women, in whom having more diabetes-related worries was also related to higher HbA1c (P < 0.01).

CONCLUSION

In this study, women with diabetes appeared to have worse QoL and mental well-being compared with men with diabetes. Therefore, identifying strategies to improve SRH and QoL among diabetic patients, especially among women, is of great importance.

Coping strategies in immigrant men and women with type 2 diabetes

The aim of this study was to assess coping strategies of foreign-born men and women with type 2 diabetes in relation to demographic (sex, age, time in Sweden), medical, and socio-economic situation, and as compared with Swedish-born patients. Participants were foreign-born type 2 diabetic patients of European and non-European origin in primary health care in Stockholm County, comprising 41 men and 36 women aged 35-64 years, compared with Swedish-born type 2 diabetes patients, 121 men and 111 women. The General Coping Questionnaire, which measures five main orientations, dichotomised into "positive" and "negative" factors, i.e. 10 coping strategies, was used in the assessment. Medical and socio-economic data were obtained from medical records and postal questionnaires. Foreign-born men showed an impact on 6 of 10 coping strategies, and foreign-born women on 2 of 10 coping strategies, as compared to Swedish-born subjects. Longer time since migration and higher educational level were associated with lower scores for stressful coping strategies, while having financial problems and receiving a disability pension were associated with higher scores. In conclusion, the most stressful coping strategies were found among foreign-born men. It seems to be essential to improve and adjust diabetes care for immigrants, also including the psycho-social perspective.

Relationship between sick leave, unemployment, disability, and health-related quality of life in patients with inflammatory bowel disease

BACKGROUND

The goal of this study was to determine the rate of work disability, unemployment, and sick leave in an unselected inflammatory bowel disease (IBD) cohort and to measure the effect of working status and disability on the patient's health-related quality of life (HRQOL).

MATERIALS AND METHODS

All eligible patients were clinically examined and interviewed at the 5-year follow-up visit. In addition, they completed the 2 HRQOL questionnaires, the Short Form-36 Health Survey (SF-36) and the Inflammatory Bowel Disease Questionnaire validated for use in Norway (N-IBDQ). Data regarding sick leave, unemployment, and disability pension (DP) also were collected.

RESULTS

All together, 495 patients were or had been in the workforce during the 5-year follow-up period since diagnosis. Forty-two patients (8.5%) were on DP compared with 8.8% in the background population. Women with Crohn's disease (CD) had the highest probability of receiving DP (24.6%). A total of 58 patients (11.7%) reported they were unemployed at 5 years. This was equally distributed between men and women but was more frequent in patients with ulcerative colitis. Sick leave for all causes was reported in 47% with ulcerative colitis and 53% with CD, whereas IBD-related sick leave was reported in 18% and 23%, respectively. A majority (75%) had been sick <4 weeks, and a relatively small number of patients (25%) contributed to a large number of the total sick leave days. Both unemployment and DP reduced HRQOL scores, but the most pronounced effect on HRQOL was found in patients reporting IBD-related sick leave, measured with SF-36 and N-IBDQ. The observed differences also were highly clinically significant. Multiple regression analysis confirmed that IBD-related sick leave was the independent variable with the strongest association to the observed reduction in HRQOL scores.

CONCLUSIONS

Unemployment or sick leave is more common in IBD patients than in the Norwegian background population. The number of patients receiving DP is significantly increased in women with CD but not in the other patient groups. Unemployment, sick leave, and DP are related to the patient's HRQOL in a negative way, but this effect is most pronounced in patients reporting IBD-related sick leave.