Perceptions and correlates of distress due to the COVID-19 pandemic and stress management strategies among people with diabetes: a mixed methods study

Resilience in patients and family caregivers living with congenital disorders of glycosylation (CDG): a quantitative study using the brief resilience coping scale (BRCS)

BACKGROUND

Patients and family caregivers living with Congenital Disorders of Glycosylation (CDG) experience a heavy burden, which can impact their resiliency and quality of life. The study's purpose was to measure the resilience levels of patients and family caregivers living with CDG using the brief resilience coping scale.

METHODS

We conducted an observational, cross-sectional study with 23 patients and 151 family caregivers living with CDG. Descriptive analyses were performed to characterize patients with CDG and family caregivers' samples. Additionally, we assessed correlations between resilience and specific variables (e.g., age, academic degree, time until diagnosis) and examined resilience differences between groups (e.g., sex, marital status, occupation, professional and social support).

RESULTS

GNE myopathy was the most prevalent CDG among patients, while in family caregivers was PMM2-CDG. Both samples showed medium levels of resilience coping scores. Individuals with GNE myopathy had significantly higher scores of resilience compared to patients with other CDG. Resilience was positively correlated with educational degree in patients with CDG. Family caregivers had marginally significant higher scores of resilience coping if they received any kind of professional support or had contact with other families or people with the same or similar disease, compared with unsupported individuals.

CONCLUSIONS

Despite the inherited difficulties of living with a life-threatening disease like CDG, patients and family caregivers showed medium resilient coping levels. Resilience scores changed significantly considering the CDG genotype, individual's academic degree and professional and social support. These exploratory findings can empower the healthcare system and private institutions by promoting the development of targeted interventions to enhance individuals` coping skills and improve the overall well-being and mental health of the CDG community.

Prevalence and Correlators of Diabetes Distress in Adults with Type 2 Diabetes: A Cross-Sectional Study

Purpose

To address the prevalence of diabetes distress (DD) and its correlators in adults with type 2 diabetes.

Patients and Methods

During 2021 and 2022, we conducted a cross-sectional study in three Class A tertiary comprehensive hospitals in China, and received 947 participants who completed a printed survey covering DD, demographic, diabetic, physiological, and psychosocial factors. We used Jonckheere-Terpstra, chi-square, and Fisher's exact tests to assess intergroup differences between different levels of DD. We used ordinal logistic regression analysis to analyze correlators of DD further.

Results

The prevalence of DD was 34.64%. In univariate analysis, those with lower satisfaction with financial status, longer durations of diabetes, more complications, higher glycemia, more severe insomnia, treatment by medications only, poorer lifestyle interventions, fewer self-care activities, more types and frequencies of insulin injections, and spending more money and time on treatment were susceptible to DD. Type D personality, negative illness perceptions, negative coping styles, and psychological effects of major life events were related to higher DD. Hope, self-efficacy, positive coping styles, and social support can reduce DD. In ordinal logistic regression analysis, hypoglycemic episode (β=-1.118, p=0.019, "have hypoglycemic" as reference) and Brief Illness Perception Questionnaire (β=0.090, p<0.001) were significant positive correlators for DD, while diet intervention (β=0.803, p=0.022, "have diet intervention" as reference), money spent on diabetes treatment (β<-0.001, p=0.035), and SES (β=-0.257, p<0.001) were significant negative correlators.

Conclusion

More than one-third of Chinese adults with type 2 diabetes experience moderate or high levels of DD. DD was associated with financial, diabetic, physiological, and psychosocial status.

Effectiveness of a nurse-led personalized patient engagement program to promote type 2 diabetes self-management: A randomized controlled trial

PHEinAction® is a theory-based nurse-led patient engagement intervention developed among an Italian older adult population with various chronic diseases to facilitate cognitive, emotional, and behavioral processes in promoting individuals' active roles. This study aims to adapt and evaluate the effectiveness of PHEinAction® on diabetes self-management (DSM) among Turkish type 2 diabetes mellitus patients. First, the generic content of the intervention was customized for diabetes management and adapted for the Turkish population, including back-forward translation and expert panel evaluation; then, a randomized controlled trial was conducted with 51 adult diabetes patients randomly assigned to intervention or the control group receiving the usual care. The intervention consisted of two in-person sessions of 4-week intervals, a telephone consultation, and home-based written exercises, which involved personalized care activities addressing individuals' engagement levels and covering the cognitive, emotional, and behavioral aspects. The scores for treatment adherence, self-efficacy, and patient engagement had significantly improved with a large size effect in the intervention group at the fourth-week follow-up compared with the control group. Findings suggest that the nurse-led personalized patient engagement program could effectively promote DSM.

Disruptions in Lifestyle Habits and Access to Social Support in the Time of COVID-19: Associations With Diabetes Distress and Depression Among Adults With Type 1 Diabetes Living in British Columbia

OBJECTIVES

In this study, we examined rates of diabetes distress and depressive symptoms in adults with type 1 diabetes (T1D) during the COVID-19 lockdown and its association with disruptions in lifestyle habits and access to social support.

METHODS

This cross-sectional investigation included a convenience sample of 60 adults with T1D who completed a survey assessing diabetes distress (Type 1 Diabetes Distress Scale), depressive symptoms (Personal Health Questionnaire-9), and disruptions in lifestyle habits (sleep patterns, dietary patterns, exercise routine) and access to support from family/friends. Linear regression analyses examined COVID-19 disruption variables as predictors of diabetes distress and depressive severity.

RESULTS

Seventy-three percent and 38% of participants reported elevated diabetes distress and depressive symptoms, respectively. Greater eating disruption predicted higher depressive symptom severity (β=1.33, p=0.045) and eating distress (β=0.28, p=0.045). Greater social support disruption predicted higher eating distress (β=0.36, p=0.019).

CONCLUSIONS

Findings revealed high rates of diabetes distress and depressive symptoms in this T1D sample during the COVID-19 lockdown. Moreover, disruptions in some lifestyle habits and access to social support were associated with worse mental health outcomes.

Sustained Improvement in Glycemic Control in Emerging Adults with Type 1 Diabetes 2 Years After the Start of the COVID-19 Pandemic

INTRODUCTION

Although there were initial concerns that the public health response to the COVID-19 pandemic would adversely affect glycemic control in people with type 1 diabetes, several early continuous glucose monitor (CGM) studies reported an unexpected slight improvement in glucose metrics. Early emerging adulthood (roughly spanning the ages of 18-24 years) is often a vulnerable time in the life of a person with type 1 diabetes. Here, we set out to determine how the care and glucose management of emerging adults with type 1 diabetes changed over a period of approximately 2 years from the start of the COVID-19 pandemic.

METHODS

This was a retrospective study of a tertiary referral, multidisciplinary young adult diabetes clinic, spanning before and after the 777-day state of emergency in the City of Toronto.

RESULTS

Of 130 emerging adults with type 1 diabetes (80 male, 50 female; mean age 21.0 ± 2.1 years), baseline pre-pandemic HbA_1c values were available for 120 individuals. During 24.9 ± 5.4 months of follow-up before and after the start of the COVID-19 pandemic, HbA_1c fell from 8.5 ± 1.7% (69.3 ± 18.8 mmol/mol) to 8.1 ± 1.9% (65.2 ± 20.5 mmol/mol) (P < 0.05), with change in HbA_1c from pre-lockdown levels being sustained throughout the second year of the pandemic. Over the same period, CGM use rose from 43% to 83%, primarily through increased uptake of intermittently scanned CGM, which is covered through the Ontario Drug Benefit program. Change in HbA_1c was most evident in Dexcom G6 real-time CGM users - 0.7 ± 1.2% (- 9.8 ± 17.1 mmol/mol) (P < 0.01 vs. self-monitoring of blood glucose).

CONCLUSION

Among emerging adults with type 1 diabetes attending a multidisciplinary clinic in a high-income country, glycated hemoglobin levels are on average 0.4% (4.1 mmol/mol) lower than they were before the pandemic. This reduction in HbA_1c is unlikely to be a consequence of early strict lockdowns given the length of time of follow-up. Rather, improved glycemic control coincided with increased utilization of wearable diabetes devices.