Measurement of psychological adjustment to diabetes with the diabetes acceptance scale

The relationship between hope level and self-management behaviors in Chinese patients with type 2 diabetes mellitus: a chain-mediated role of social support and disease perception

BACKGROUND

Type 2 diabetes mellitus is a chronic disease and one of the fastest- growing global health emergencies of the 21st century. The relationships between hope level, social support, disease perception, and self-management behaviors are still unclear. Therefore, this study aimed to create a structural equation model to investigate the underlying mechanisms of self-management behaviors in patients with type 2 diabetes mellitus and provide a theoretical basis for future interventions.

METHODS

By using cross-sectional studies and convenience sampling methods. A survey was conducted from June 2023 to April 2024 on 404 patients with type 2 diabetes mellitus at the First and Third Hospitals of Jinzhou Medical University. Data were collected using scales, including the General Information Questionnaire, the Herth Hope Scale, the Social Support Rating Scale, the Brief Disease Perception Questionnaire, and the Diabetes Self-Management Behavior Scale. Data were analyzed using descriptive analysis, Harman's one-way analysis of variance, Pearson's correlation test, structural equation modeling, and the bootstrap method to verify mediating effects.

RESULTS

Correlation analyses showed that all four variables were significantly correlated with each other (p < 0.01). Social support had the strongest correlation with self-management behavior (β = 0.554, p < 0.01), followed by hope level (β = 0.543, p < 0.01), and disease perception (β = -0.505, p < 0.01). The structural equation model indicated a strong overall fit (χ2/df = 3.378, GFI = 0.926, CFI = 0.924, IFI = 0.925, TLI = 0.903, RMSEA = 0.077).

CONCLUSION

Overall, the chain mediation of social support and disease perception was significant. In developing targeted intervention strategies, future research should prioritize enhancing hope, optimizing social support, and reducing negative perceptions of disease by patients as key areas of focus. At the same time, strengthening self-management abilities and health behaviors in patients with type 2 diabetes should not be neglected.

Perceived glucose levels matter more than CGM-based data in predicting diabetes distress in type 1 or type 2 diabetes: a precision mental health approach using n-of-1 analyses

AIMS/HYPOTHESIS

Diabetes distress is one of the most frequent mental health issues identified in people with type 1 and type 2 diabetes. Little is known about the role of glucose control as a potential contributor to diabetes distress and whether the subjective perception of glucose control or the objective glycaemic parameters are more important for the experience. With the emergence of continuous glucose monitoring (CGM), this is a relevant question as glucose values are now visible in real-time. We employed a precision monitoring approach to analyse the independent associations of perceived and measured glucose control with diabetes distress on a daily basis. By using n-of-1 analyses, we aimed to identify individual contributors to diabetes distress per person and analyse the associations of these individual contributors with mental health at a 3 month follow-up.

METHODS

In this prospective, observational study, perceived (hypoglycaemia/hyperglycaemia/glucose variability burden) and measured glucose control (time in hypoglycaemia and hyperglycaemia, CV) were assessed daily for 17 days using an ecological momentary assessment (EMA) approach with a special EMA app and CGM, respectively. Mixed-effect regression analysis was performed, with daily diabetes distress as the dependent variable and daily perceived and CGM-measured metrics of glucose control as random factors. Individual regression coefficients of daily distress with perceived and CGM-measured metrics were correlated with levels of psychosocial well-being at a 3 month follow-up.

RESULTS

Data from 379 participants were analysed (50.9% type 1 diabetes; 49.6% female). Perceived glucose variability (t=14.360; p<0.0001) and perceived hyperglycaemia (t=13.637; p<0.0001) were the strongest predictors of daily diabetes distress, while CGM-based glucose variability was not significantly associated (t=1.070; p=0.285). There was great heterogeneity between individuals in the associations of perceived and measured glucose parameters with diabetes distress. Individuals with a stronger association between perceived glucose control and daily distress had more depressive symptoms (β=0.32), diabetes distress (β=0.39) and hypoglycaemia fear (β=0.34) at follow-up (all p<0.001). Individuals with a stronger association between CGM-measured glucose control and daily distress had higher levels of psychosocial well-being at follow-up (depressive symptoms: β=-0.31; diabetes distress: β=-0.33; hypoglycaemia fear: β=-0.27; all p<0.001) but also higher HbA1c (β=0.12; p<0.05).

CONCLUSIONS/INTERPRETATION

Overall, subjective perceptions of glucose seem to be more influential on diabetes distress than objective CGM parameters of glycaemic control. N-of-1 analyses showed that CGM-measured and perceived glucose control had differential associations with diabetes distress and psychosocial well-being 3 months later. The results highlight the need to understand the individual drivers of diabetes distress to develop personalised interventions within a precision mental health approach.

Factors affecting the quality of life in pregnant women with diabetes: the mediating effect of illnesses acceptance

INTRODUCTION

Gestational diabetes, as a disorder of carbohydrate metabolism, is considered one of the most common metabolic complications in pregnancy. The diagnosis of diabetes in pregnancy leads to changes in lifestyle, and the treatments employed can affect various aspects of pregnant women's lives, including their quality of life. The present study aimed to investigate the relationship between self-efficacy and the mediating effect of illness acceptance on the quality of life in pregnant women diagnosed with diabetes during pregnancy.

MATERIALS AND METHODS

This cross-sectional study was conducted on 240 pregnant women diagnosed with diabetes who were selected by convenience sampling method. Quality of life tools (SF12), the Acceptance of Illness Scale (AIS), and the Sherer self-efficacy scale were used to collect data.

RESULTS

The mean (SD) of quality of life, self-efficacy, and disease acceptance were 57.36 (6.63), 51.75 (7.44), and 29.07 (7.69), respectively. In the single-variable regression analysis, self-efficacy and disease acceptance variables could predict 20.6% (β = 0.457, P < 0.001) and 14.4% (β = 0.385, P < 0.001) of the variations in quality of life, respectively. In the multiple regression model, by entering the two main variables (self-efficacy and Acceptance of Illness), demographic characteristics, three disease knowledge variables, health status from an individual perspective, and type of treatment, the variables could explain 25% of the changes of the quality of life (R2adj 0.25, P < 0.001=). Income status and self-efficacy had the highest impact among the variables. According to the results of path analysis, the total effect of self-efficacy on the quality of life of pregnant women with diabetes was 0.711.

CONCLUSION

The overall quality of life in women with diabetes was moderate, and self-efficacy, illness acceptance, and income status were predictors of overall quality of life. Self-efficacy can influence the quality of life by affecting disease acceptance. The findings highlight the importance of designing educational programs and providing midwifery services to increase self-efficacy and illness acceptance to improve the quality of life of pregnant women with diabetes.

Validation of the Portuguese version of the diabetes self-management questionnaire-revised (DSMQ-R) in people with type 2 diabetes mellitus

BACKGROUND

Reflecting people with diabetes' self-management activities is often required in both research and clinical practice. This study evaluated the measurement properties of the Portuguese version of the Diabetes Self-Management Questionnaire-Revised (DSMQ-R) on a sample of people with type 2 diabetes mellitus (T2DM).

METHODS

Translation and cultural adaptation were conducted according to guidelines for cross-cultural adaptation and validation of healthcare measurement instruments. A cross-sectional study was performed including 365 people with T2DM in primary care. Reliability, construct validity, and criterion validity were analyzed.

RESULTS

The total scale of the translated DSMQ-R revealed sufficient internal consistency (alpha = 0.82), and most of the subscales performed adequately. The exploratory factor structure was robust, and confirmatory analysis showed a good model fit with the scale structure of the original scale. The scale scores correlated with the participants' last HbA1c estimates, supporting convergent validity, and convergence was confirmed by the adequate average variance extracted.

CONCLUSIONS

The Portuguese version of the DSMQ-R is a reliable and valid tool for gauging self-management behaviors in people with T2DM and their relationship with glycemic values.

Psychometric Evaluation of the Swedish Acceptance and Action Diabetes Questionnaire: A Rasch Analysis

Background and Purpose: The Acceptance and Action Diabetes Questionnaire (AADQ) is a tool for assessing the acceptance of thoughts and emotions related to diabetes in people living with the disease. This study aimed to examine the psychometric properties of the Swedish version of AADQ (Swe-AADQ) in a sample of adults with type 1 diabetes. Methods: To examine the psychometric properties of the Swe-AADQ, the Rasch model was used. Data for 120 individuals were included. Results: The Swe-AADQ showed an acceptable fit to the Rasch model. A sufficiently high value of the separation index indicated a capacity to distinguish between different levels of acceptance in the sample. The 7-point Likert scale was reduced to three categories suggesting an improvement in the ordering of the item thresholds. Conclusions: The Swe-AADQ possesses reasonable quality in terms of reliability and validity. However, there are some deficiencies regarding the categorization of the response rating that should be addressed.

Hypoglycaemia fear, treatment adherence, and the quality of life in patients with type 2 diabetes and its determinants

AIM

This work aims to evaluate the relationship between the fear of hypoglycaemia, treatment adherence, and the quality of life in patients with type 2 diabetes mellitus (T2DM) and its determinants.

METHODS

This descriptive and cross-sectional study sample recruited 1060 T2DM outpatients in a health centre between January and July 2022. The Hypoglycemia Fear Survey (HFS), Type 2 DM Treatment Patient Compliance Scale, and the 5-Level EuroQol 5-Dimension (EQ-5D-5L) were used for data collection.

RESULTS

There was a positive correlation between age, duration of T2DM, and the scores obtained from the HFS and its subscales (p < 0.001). There was a positive, moderate correlation between the total HFS score and the TCS (p < 0.001). There was a negative correlation between the scores obtained from the HFS and the EQ-5D-5L (p < 0.001). The multiple regression analysis showed that the quality of life scores of the patients were significantly predicted by hypoglycaemia fear, duration of T2DM diagnosis, and age. (F = 91.691, p < 0.001). Hypoglycaemia fear, duration of T2DM diagnosis, and age explained 38.1% of the quality of life of patients.

CONCLUSION

We determined that the increase in hypoglycaemia fear resulted in a decrease in treatment adherence. Besides, hypoglycaemia fear increased with increasing age and duration of T2DM diagnosis.

Explaining improvement in diabetes distress: a longitudinal analysis of the predictive relevance of resilience and acceptance in people with type 1 diabetes

AIMS

To analyze if midterm improvement in diabetes distress can be explained by resilience, diabetes acceptance, and patient characteristics.

METHODS

N = 179 adults with type 1 diabetes were enrolled during their stay at a tertiary diabetes center (monocentric enrolment) and followed up over three months in a prospective, observational study ('DIA-LINK1'). Improvement in diabetes distress was assessed as reduction in the Problem Areas in Diabetes Scale score from baseline to follow-up. Resilience (Resilience Scale-13), acceptance (Diabetes Acceptance Scale), and patient characteristics were analyzed as predictors of improvement in diabetes distress using hierarchical multiple regression.

RESULTS

Greater reductions in diabetes distress were significantly explained by lower diabetes acceptance at baseline (β = -0.34, p < 0.01), while resilience, diabetes complications, and other person-related variables were not significantly related to changes in diabetes distress (all p > 0.05). When change in diabetes acceptance from baseline to follow-up was added to the model, improved diabetes distress was explained by increasing diabetes acceptance (β = 0.41, p < 0.01) and a shorter duration of diabetes (β = -0.18, p = 0.03), while baseline diabetes acceptance was no longer significantly associated (β = -0.14, p > 0.05).

CONCLUSIONS

Diabetes acceptance is inversely related to diabetes distress, and increasing acceptance explained greater improvement in diabetes distress. These findings suggest that increasing diabetes acceptance may facilitate the reduction of diabetes distress. Treatment approaches targeting acceptance might be useful for the mental healthcare of people with type 1 diabetes and clinically elevated diabetes distress.

The Sukaribit Smartphone App for Better Self-Management of Type 2 Diabetes: Randomized Controlled Feasibility Study

BACKGROUND

A new app, Sukaribit, was designed to enable contact between the caregiver and the patient with the intent to improve self-care and glycemic control (hemoglobin A1c [HbA1c]).

OBJECTIVE

This study investigated the feasibility of the study methodology and the intervention in preparation for a larger effectiveness study.

METHODS

Adults with type 2 diabetes were recruited in this randomized controlled feasibility study with a mixed methods design. The intervention group (n=28) tried Sukaribit for 2 months. They were encouraged to report blood glucose levels and medications, and they received feedback from a physician. The control group (n=31) received standard care. Both groups were evaluated with pre and postmeasurements of glycemic control (HbA1c), diabetes distress, physical activity, and self-care. Feasibility was evaluated against 5 progression criteria regarding recruitment, study methods, and active participation.

RESULTS

Of the 5 progression criteria, only 2 were met or partially met. The recruitment process exceeded expectations, and data collection worked well for self-reported data but not for HbA1c measured with a home testing kit. The participants were less active than anticipated, and the effect sizes were small. Only the number of blood glucose tests per day was positively affected by the intervention, with 0.6 more tests per day in the intervention group.

CONCLUSIONS

Recruitment of participants to a future fully powered study may work with minor adjustments. The collection of HbA1c using home testing constituted a major problem, and an alternative strategy is warranted. Finally, the app was not used as intended. In order to proceed with a larger study, the app and study procedures need improvement.

Sexual life experiences of women with diabetes: A systematic review and synthesis of qualitative studies

This study aims to systematically interpret and synthesize the data obtained from qualitative research about the sexual lives of women with diabetes. A thorough literature review was conducted between May and July 2023 across five electronic databases: PubMed, Web of Science, CINAHL, EBSCO, and Science Direct Embase. Eight studies published in English since 2000, which explored the sexual experiences of women with diabetes, were included in this assessment. The sexual experiences of women with diabetes were summarized under five main themes: perception of sexuality, changes in sexual life, adapting to the new normal, unmet care needs, and expectations. This review underlines the intricate nature of diabetic women's sexual experiences, acknowledging the substantial impact of diabetes-related complications and the associated emotional stress on their quality of life and intimate relationships. The study finds that awareness varies among women, with some adapting to the changes brought on by diabetes, while others remain uninformed about its impact on their sexual health. There is a pronounced need for integrating sexual health into diabetes care routines. Many women face unaddressed sexual health concerns and require education and empathetic care from knowledgeable health professionals.

Factors Influencing the Control of Diabetes Measured via Glycated Hemoglobin Concentrations in Adults with Type 1 Diabetes

Numerous complications of type 1 diabetes (T1D) may be prevented through suitable glycemic control. Glycated hemoglobin (HbA1c) may be one of the markers for the early detection of the metabolic imbalance characteristic of the disease. However, optimal control of diabetes is not achieved in a large group of patients. It was demonstrated that numerous factors (sociodemographic, psychological, and clinical) contributed to this condition. The aim of the study was to identify factors influencing the control of diabetes measured via glycated hemoglobin concentrations in people with T1D. Independent factors influencing better diabetes control measured via HbA1c in the study group included higher disease acceptance, higher nutritional adherence, lower BMI, and a lower risk of eating disorders. Describing the determinants will allow for the improvement of the system of care provided to people with T1D and for it to comprise important psychological variables related to self-care and acceptance of the disease.

Severe distress & denial among Asian patients with Type 2 Diabetes Mellitus in the primary care: A prospective, multicentre study

AIMS

To determine the point-prevalence and distribution of diabetes distress among primary care Asians with Type 2 Diabetes Mellitus (T2DM) and evaluate its association with cardiovascular risk.

METHODS

This was a prospective, multicentre study conducted in two outpatient clinics. Patients aged ≥ 21 years with uncontrolled T2DM (HbA1c > 7.0 % [53 mmol/mol]) and polypharmacy were stratified based on their Framingham Risk Score (FRS-high ≥ 10 %, low < 10 %) and matched in accordance to their baseline HbA1c. Cardiovascular risk was estimated using FRS while diabetes distress was measured using Problem Areas in Diabetes (PAID) scale (denial 0-10, severe distress ≥ 40).

RESULTS

Of 1940 patients approached, 210 were recruited. A final 132 (62.9 %) participants were eligible for analysis. Median PAID score was 17.5 (IQR 6.25-41.56), with an even distribution in each distress category. There was no significant difference in PAID scores between the high and low FRS groups (20.00vs13.75, p = 0.446). Additionally, PAID score distribution within each group was similar (McNemar-Bowker test, p = 0.477). However, a high prevalence of severe distress (31.4 %) and denial (33.8 %) was detected. Among those in denial, 58.7 % had accompanying intermediate-high 10-year cardiovascular risk.

CONCLUSION

In our sample of Asian primary care patients, a high prevalence of severe diabetes distress and denial was detected although no clear association between cardiovascular risk and diabetes distress was found. Future studies should assess the longitudinal changes and impact of other risk factors in diabetes distress. (Abstract: 199 words).

Measuring Self-management Among People with Diabetes Mellitus: A Systematic Review of Patient-Reported Diabetes-Specific Instruments in English and Chinese

INTRODUCTION

Effective behavioral management is critical for people with diabetes to achieve glycemic control. Many instruments have been developed to measure diabetes-specific self-management. This review aimed to retrieve existing self-management-related instruments and identify well-validated instruments suitable for clinical research and practice.

METHODS

First, PubMed, Psych INFO, ERIC, and two Chinese databases (CNKI and Wanfang Data) were searched to identify existing instruments for self-management in diabetes systematically. Second, instruments were screened based on the pre-specified inclusion and exclusion criteria. Third, the psychometric property data of each included instrument were retrieved, and instruments with poor psychometric properties were excluded. Fourth, selected instruments were categorized into four categories: knowledge and health literacy, belief and self-efficacy, self-management behaviors, and composite scales. Finally, recommendations were made according to the application status and quality of the instruments. Instruments in English and Chinese were screened and summarized separately.

RESULTS

A total of 406 instruments (339 English instruments and 67 Chinese instruments) were identified. Forty-three English instruments were included. Five focused on knowledge and literacy, 12 on belief and self-management perception-related constructs, 21 on self-management and behaviors, and 5 on composite measures. We further recommended 19 English scales with relatively good quality and are frequently applied. Twenty-five Chinese instruments were included, but none were recommended because of a lack of sufficient psychometric property data.

CONCLUSION

Many English instruments measuring diabetes self-management have been developed and validated. Further research is warranted to validate instruments adapted or developed in the Chinese population.

The relationship between personality profile and self-care among patients with type 2 diabetes

Background

As a chronic disease, diabetes needs special self-care behaviors until the end of life. Personality traits are considered to be effective psychological factors in controlling diabetes and self-care in patients with diabetes. The present study was conducted to determine the relationship between personality profile and self-care among people with type 2 diabetes.

Methods

In this descriptive-correlational study conducted in 2021, 160 patients with type 2 diabetes referred to the diabetes clinic of Imam Khomeini Educational and Medical Center in Ardabil were selected by convenience sampling method. The data collection tools included the Diabetes Self-Care Activities questionnaire (SDSCA) and the short form of the Millon Multi-Axis Clinical Test (MCMI-3), which were completed through interviews with patients. Data were analyzed by SPSS software using descriptive statistics (mean, SD, and frequency) and inferential statistics (Pearson correlation coefficient and linear regression).

Results

Based on the results, apart from the obsessive personality disorder, which had a positive relationship with self-care behaviors, a significant negative correlation was observed between schizoid, avoidant, depressed, dependent, antisocial, self-harming, borderline, and paranoid personality disorders with self-care behaviors (p < 0.01).

Conclusion

The results showed that there is a significant negative relationship between personality profile and self-care status of patients with type 2 diabetes. In other words, a person's personality profile can predict self-care behaviors. Accordingly, personality traits can be considered as one of the influencing factors on self-care in the educational programs of diabetic patients. Holding educational classes to empower patients using psychological interventions and teaching effective solutions can be an effective step toward increasing the level of mental-physical health and self-care of patients with type 2 diabetes.

Internet-delivered eating disorders prevention program for adolescent girls with type 1 diabetes: Acceptable and feasible

BACKGROUND

Adolescents with type 1 diabetes are at significantly increased risk for eating disorders and few interventions exist.

OBJECTIVE

This study examined the feasibility, acceptability, and preliminary effects of an internet-based eating disorders prevention program adapted specifically for adolescent girls with type 1 diabetes.

PARTICIPANTS AND METHODS

Thirty-five girls (16.2 ± 1.1 years) participated Body Project (T1D Style), a 4-week program consisting of four adolescent sessions focused on promoting illness acceptance, challenging sociocultural body image pressures, increasing social support, and teaching assertive communication. Caregivers participated in one session focused on fostering body image positivity and a healthy relationship with food. Pre-intervention, post-intervention, and 3-month follow-up surveys assessed disordered eating, body dissatisfaction, thin-ideal internalization, diabetes acceptance, diabetes distress, and quality of life. Cohen's d effect sizes were calculated at post-intervention and follow-up. Program acceptability was assessed at post-intervention. Manual fidelity and homework completion were monitored.

RESULTS

High manual fidelity, retention, and homework completion were achieved. Quantitative and qualitative feedback from teens and caregivers suggested high acceptability. Large effects (d = 1.35-0.83) were observed for dieting, body dissatisfaction, diabetes distress, diabetes acceptance, and diabetes-related quality of life at post-intervention, with large-medium effects (d = 1.16-0.58) at follow-up. Medium-small effects (d = 0.49-0.78) at post-intervention were observed for diabetes-specific disordered eating and thin-ideal internalization, with effects maintained at follow-up.

CONCLUSIONS

Results support the acceptability and feasibility of this targeted eating disorders prevention program for adolescent girls with type 1 diabetes. Future clinical trials are warranted to determine its effectiveness compared to a control condition.

Psychometric evaluation of Persian version of Diabetes Acceptance Scale (DAS)

BACKGROUND

Acceptance of diabetes is a psychological adaptation to the potential limitations of the disease. Poor acceptance of diabetes impairs effective self-management of diabetes, leading to worsening metabolic control. This study aimed at determining the psychometric properties of the Persian version of the Diabetes Acceptance Scale.

METHODS

This cross-sectional methodological study was performed on diabetic patients in Iran in 2021. The questionnaire consisted of two parts: demographic characteristics and Diabetes Acceptance Scale. The questionnaire was translated into Persian through the forward-backward translation method. The face validity and content validity were performed qualitatively and quantitatively. Exploratory (n = 200) and confirmatory (n = 200) factor analysis were performed to evaluate the validity of the structure. Internal consistency and temporal stability were estimated to determine reliability.

RESULTS

Exploratory factor analysis on the polychoric correlation matrix obtained three factors: Rational dealing, Resentment and Avoidance, which explained 68.8% of the total DAS variance. Confirmatory factor analysis showed that the 3-fractor model had a good fit to a second independent data set. Finally, Ordinal Cronbach's alpha coefficient was 0.96, 0.94 and 0.93, respectively for the Rational dealing, Resentment, and Avoidance factor. Also, using intraclass correlation coefficient, the stability of the instrument was 0.97.

CONCLUSION

Based on the findings of this study, the Persian version of DAS has sufficient validity and reliability to measure the admission of Iranian diabetic patients.

Psychosocial Impact of the COVID-19 Pandemic on People With Type 1 Diabetes: Results of an Ecological Momentary Assessment Study

Aims

Psychological distress due to living with diabetes, demanding self-management tasks, impacts on life, and risks of complications is common among people living with diabetes. COVID-19 could pose a new additional risk factor for psychological distress in this group. This study aimed to analyze levels of COVID-19-related burdens and fears, variables explaining these levels, and associations with the concurrent 7-day COVID-19 incidence in people with type 1 diabetes (T1D).

Methods

A total of 113 people with T1D (58% women; age: 42.3 ± 9.9 years) participated in an ecological momentary assessment (EMA) study between December 2020 and March 2021. The participants reported daily levels of COVID-19-related burdens and fears over 10 consecutive days. Global ratings of COVID-19-related burdens and fears were assessed using questionnaires, as were current and previous levels of diabetes distress (PAID), acceptance (DAS), fear of complications (FCQ), depressive symptoms (CES-D), and diabetes self-management (DSMQ). Current levels of diabetes distress and depressive symptoms were compared with pre-pandemic ratings gained during an earlier study phase. Associations between burdens and fears, psychosocial and somatic aspects, and the concurrent 7-day incidence rate were analyzed using multilevel regression.

Results

Diabetes distress and depressive symptoms reported during the pandemic were comparable to pre-pandemic levels (PAID: p = .89; CES-D: p = .38). Daily EMA ratings reflected relatively low mean COVID-19-related burdens and fears in everyday life. However, there was substantial day-to-day variation per person indicating higher burdens on specific days. Multilevel analyses showed that daily COVID-19-related burdens and fears were significantly predicted by pre-pandemic levels of diabetes distress and diabetes acceptance but were not associated with the concurrent 7-day incidence rate nor with demographic and medical variables.

Conclusions

This study observed no increase in diabetes distress and depressive symptoms during the pandemic in people with T1D. The participants reported low to moderate levels of COVID-19-related burdens. COVID-19-related burdens and fears could be explained by pre-pandemic levels of diabetes distress and acceptance but not by demographic and clinical risk variables. The findings suggest that mental factors may constitute stronger predictors of COVID-19-related burdens and fears than objective somatic conditions and risks in middle-aged adults with T1D.

A Self-Report Measure of Diabetes Self-Management for Type 1 and Type 2 Diabetes: The Diabetes Self-Management Questionnaire-Revised (DSMQ-R) – Clinimetric Evidence From Five Studies

Aims

Measurement tools to evaluate self-management behavior are useful for diabetes research and clinical practice. The Diabetes Self-Management Questionnaire (DSMQ) was introduced in 2013 and has become a widely used tool. This article presents a revised and updated version, DSMQ-R, and evaluates its properties in assessing self-management practices in type 1 diabetes (T1D) and type 2 diabetes (T2D).

Methods

The DSMQ-R is a multidimensional questionnaire with 27 items regarding essential self-management practices for T1D and T2D (including diabetes-adjusted eating, glucose testing/monitoring, medication taking, physical activity and cooperation with the diabetes team). For the revised form, the original items were partially amended and the wording was updated; eleven items were newly added. The tool was applied as part of health-related surveys in five clinical studies (two cross-sectional, three prospective) including a total of 1,447 people with T1D and T2D. Using this data base, clinimetric properties were rigorously tested.

Results

The analyses showed high internal and retest reliability coefficients for the total scale and moderate to high coefficients for the subscales. Reliability coefficients for scales including the new items were consistently higher. Correlations with convergent criteria and related variables supported validity. Responsiveness was supported by significant short to medium term changes in prospective studies. Significant associations with glycemic outcomes were observed for DSMQ-R-assessed medication taking, glucose monitoring and eating behaviors.

Conclusions

The results support good clinimetric properties of the DSMQ-R. The tool can be useful for research and clinical practice and may facilitate the identification of improvable self-management practices in individuals.

Patient-Reported Experience and Outcome Measures in People Living with Diabetes: A Scoping Review of Instruments

BACKGROUND

Diabetes mellitus is a global public health concern, with over 463 million people living with this chronic disease. Pathology complexity, management difficulty, and limited participation in care has resulted in healthcare systems seeking new strategies to engage people living with diabetes. Patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) were developed to address the gap between the healthcare system expectation and patient preference.

OBJECTIVE

This study aimed to review the existing literature on PREMs and PROMs specific to type 1 and 2 diabetes, and report the dimensions report the dimensions they have measured.

METHODS

A scoping review was conducted from January 1985 to March 2020 of six databases, MEDLINE, EMBASE, PsycINFO, CINHAL, Scopus, and BiblioPro, to identify PREM and PROM instruments specific for type 1 and 2 diabetes.

RESULTS

Overall, 34 instruments were identified, 32 PROMs and two PREMs. The most common instrument included outcomes related to quality of life at 44% (n = 15), followed by satisfaction (whether with treatment, device, and healthy habits) at 26% (n = 9). Furthermore, instruments regarding personal well-being accounted for 15% (n = 5). For instruments that measure experiences of persons with diabetes, there were two scales of symptoms, and one related to the attitude patients have toward the disease.

CONCLUSIONS

Diabetes-specific validated instruments mainly focus on quality of life, education, and treatment, and sometimes overlap each other, in their subscales and assessment dimensions. Constructs such as cultural and religious beliefs, leisure, and work life may need more attention. There appears to be a gap in instruments to measure experiences of individuals who "live with diabetes" and seek to lead a "normal life."

Health-Related Quality of Life in Patients With Different Diseases Measured With the EQ-5D-5L: A Systematic Review

Background: The EQ-5D-5L is a generic preference-based questionnaire developed by the EuroQol Group to measure health-related quality of life (HRQoL) in 2005. Since its development, it has been increasingly applied in populations with various diseases and has been found to have good reliability and sensitivity. This study aimed to summarize the health utility elicited from EQ-5D-5L for patients with different diseases in cross-sectional studies worldwide.

Methods: Web of Science, MEDLINE, EMBASE, and the Cochrane Library were searched from January 1, 2012, to October 31, 2019. Cross-sectional studies reporting utility values measured with the EQ-5D-5L in patients with any specific disease were eligible. The language was limited to English. Reference lists of the retrieved studies were manually searched to identify more studies that met the inclusion criteria. Methodological quality was assessed with the Agency for Health Research and Quality (AHRQ) checklist. In addition, meta-analyses were performed for utility values of any specific disease reported in three or more studies.

Results: In total, 9,400 records were identified, and 98 studies met the inclusion criteria. In the included studies, 50 different diseases and 98,085 patients were analyzed. Thirty-five studies involving seven different diseases were included in meta-analyses. The health utility ranged from 0.31 to 0.99 for diabetes mellitus [meta-analysis random-effect model (REM): 0.83, (95% CI = 0.77–0.90); fixed-effect model (FEM): 0.93 (95% CI = 0.93–0.93)]; from 0.62 to 0.90 for neoplasms [REM: 0.75 (95% CI = 0.68–0.82); FEM: 0.80 (95% CI = 0.78–0.81)]; from 0.56 to 0.85 for cardiovascular disease [REM: 0.77 (95% CI = 0.75–0.79); FEM: 0.76 (95% CI = 0.75–0.76)]; from 0.31 to 0.78 for multiple sclerosis [REM: 0.56 (95% CI = 0.47–0.66); FEM: 0.67 (95% CI = 0.66–0.68)]; from 0.68 to 0.79 for chronic obstructive pulmonary disease [REM: 0.75 (95% CI = 0.71–0.80); FEM: 0.76 (95% CI = 0.75–0.77)] from 0.65 to 0.90 for HIV infection [REM: 0.84 (95% CI = 0.80–0.88); FEM: 0.81 (95% CI = 0.80–0.82)]; from 0.37 to 0.89 for chronic kidney disease [REM: 0.70 (95% CI = 0.48–0.92; FEM: 0.76 (95% CI = 0.74–0.78)].

Conclusions: EQ-5D-5L is one of the most widely used preference-based measures of HRQoL in patients with different diseases worldwide. The variation of utility values for the same disease was influenced by the characteristics of patients, the living environment, and the EQ-5D-5L value set.

Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42020158694.

Sustained type 1 diabetes self-management: Specifying the behaviours involved and their influences

AIMS

Sustained engagement in type 1 diabetes self-management behaviours is a critical element in achieving improvements in glycated haemoglobin (HbA1c) and minimising risk of complications. Evaluations of self-management programmes, such as Dose Adjustment for Normal Eating (DAFNE), typically find that initial improvements are rarely sustained beyond 12 months. This study identified behaviours involved in sustained type 1 diabetes self-management, their influences and relationships to each other.

METHODS

A mixed-methods study was conducted following the first two steps of the Behaviour Change Wheel framework. First, an expert stakeholder consultation identified behaviours involved in self-management of type 1 diabetes. Second, three evidence sources (systematic review, healthcare provider-generated 'red flags' and participant-generated 'frequently asked questions') were analysed to identify and synthesise modifiable barriers and enablers to sustained self-management. These were characterised according to the Capability-Opportunity-Motivation-Behaviour (COM-B) model.

RESULTS

150 distinct behaviours were identified and organised into three self-regulatory behavioural cycles, reflecting different temporal and situational aspects of diabetes self-management: Routine (e.g. checking blood glucose), Reactive (e.g. treating hypoglycaemia) and Reflective (e.g. reviewing blood glucose data to identify patterns). Thirty-four barriers and five enablers were identified: 10 relating to Capability, 20 to Opportunity and nine to Motivation.

CONCLUSIONS

Multiple behaviours within three self-management cycles are involved in sustained type 1 diabetes self-management. There are a wide range of barriers and enablers that should be addressed to support self-management behaviours and improve clinical outcomes. The present study provides an evidence base for refining and developing type 1 diabetes self-management programmes.

Involving patients' perspective in the development of an internet- and mobile-based CBT intervention for adolescents with chronic medical conditions: Findings from a qualitative study

OBJECTIVE

A user-centered approach is critical for increasing the adherence to and effectiveness of an internet- and mobile-based intervention program. Therefore, potential future intervention users were involved in the development of an internet- and mobile-based cognitive behavioral therapy program (iCBT) for adolescents and young adults (AYA) with chronic medical conditions and comorbid symptoms of anxiety or depression. We aimed to identify challenges and coping strategies of the intended target group, as well as their needs and preferred intervention characteristics for an iCBT program.

METHODS

Twenty AYA (aged 14-20, 60% females) with either type 1 diabetes (55%), juvenile idiopathic arthritis (25%) or cystic fibrosis (20%) were interviewed in condition-specific focus groups (4-11 participants per group) either via videoconferencing or face-to-face. Transcript verbatim data was analyzed using content analysis.

RESULTS

Frequently reported disease-specific burdens were among others fear of disease progression, non-acceptance of disease and stressful incidents related to and aversions against medical therapy. Most frequently reported coping strategies included, seeking social support and accepting the disease. Recommendations for the content of an iCBT for comorbid symptoms of anxiety and depression comprised: dealing with disease-related fears and getting advice on health-promoting lifestyles. iCBT characteristics considered preferable by participants were: providing individual feedback by a real-person; implementation of a feature to monitor treatment progress; youthful and varied content presentation; time per session not exceeding 1 h; non-involvement of parents. A mobile-based reminder feature was considered useful, and individual tailoring and self-determination of iCBT content was considered desirable.

CONCLUSIONS

The findings highlight important patient perspectives and age-specific recommendations which can help design more optimal iCBT interventions for AYA with chronic medical conditions.

Diabetes burnout among emerging adults with type 1 diabetes: a mixed methods investigation

Feeling overwhelmed, exhausted, and frustrated by the daily demands of diabetes management has been referred to as diabetes burnout. The goal of the study was to develop a measure of diabetes burnout and to link this measure to psychological health and diabetes outcomes. Emerging adults with type 1 diabetes (n = 88, average age 27) completed an online questionnaire and an HbA1c assessment; a subset was interviewed by phone to obtain a more in-depth understanding of burnout. Exploratory factor analysis revealed three burnout domains: exhaustion, detachment, and powerlessness. Burnout was related to higher psychological distress, higher diabetes distress, and poorer diabetes outcomes. Burnout independently predicted higher HbA1c, independent of diabetes distress. Qualitative interviews revealed that participants defined burnout in terms of exhaustion and powerlessness and resolved burnout by acceptance and utilization of social resources. Prevention and intervention efforts might target resilience as a way to mitigate burnout.

Psychological well-being and adjustment among type 2 diabetes patients: the role of psychological flexibility

Elevated rates of psychological disorders are reported among those with type 2 diabetes (T2D). Thus, research into factors enhancing psychological aspects of well-being is critical in T2D. We examine the association between a multifaceted measure of Psychological Flexibility (PF), and its relationship to adjustment and well-being, among this population. Adults with T2D (N = 102) completed an online battery of self-reported questionnaires and were asked for demographics, general T2D features, treatment adherence, PF, adjustment, and well-being. We examined the association between PF (Psychological Flexibility Questionnaire, PFQ), adjustment to diabetes (ATT-39) and well-being (Mental Health Inventory), among adults with T2D. Greater PF was significantly associated with greater well-being, but unrelated to adjustment, which was positively associated with well-being. In a hierarchical regression analysis, perception of change as positive (one of the five PFQ factors) significantly contributed to the explained variance in well-being, beyond the contribution of adjustment. These findings indicate that positive perception of change may enhance well-being independently from adjustment to diabetes since these two constructs are distinct and independent. Such an association between PF and well-being may apply to other medical conditions. Implications for psychological intervention are discussed.

The relationship between health-related quality of life, acceptance of illness and characteristics of pregnant women with hyperglycemia

Background

The study was performed to evaluate the association between socio-demographic factors on the one hand, and quality of life and illness acceptance on the other, in pregnant women with hyperglycemia.

Methods

The study was performed in the years 2016–2017 in south-eastern Poland. The study included 676 women: 339 pregnant women with hyperglycemia in the case group, and 337 healthy pregnant women in the control group. The research instruments applied included the WHOQOL-BREF quality of life questionnaire, the Acceptance of Illness Scale (AIS), and a general questionnaire.

Results

Factors associated with quality of life in women with hyperglycemia include: relationship status, residence, professional activity, living conditions, number of pregnancies, self-reported knowledge of diabetes treatment and lifestyle and also of the potential pregnancy complications and fetal health impact associated with the disease, as well as the type of diabetes treatment (p < 0.05).The mean illness acceptance score among the patients is near the lower boundary of “moderate”, 31.37 points. Factors associated with illness acceptance in women with hyperglycemia include: professional activity, living conditions, and self-reported knowledge of diabetes treatment and lifestyle and of the potential pregnancy complications and fetal health impact associated with the disease (p < 0.05).

Conclusion

Better overall quality of life, general perceived health, and quality of life in all specific domains was found among healthy pregnant women compared to those with hyperglycemia. A higher level of illness acceptance has a positive effect on overall quality of life, general perceived health, and quality of life in all specific domains. General Quality of Life is positively correlated with reported living conditions and self-reported knowledge on glucose tolerance disorder treatment and lifestyle recommendations. AIS is positively correlated with living conditions, self-reported knowledge on glucose tolerance disorder treatment and lifestyle recommendations, and self-reported knowledge on possible pregnancy complications and infant health impact associated with glucose tolerance disorders.

Development and Preliminary Validation of a New Type 1 Diabetes Adjustment Scale (DAS-1)

BACKGROUND

This study focuses on the development and validation of a new Type 1 Diabetes Adjustment Scale (DAS-1).

METHOD

A total of 204 participants aged 15-65 with type 1 diabetes completed the self-report measures of the DAS-1, which includes clinical and psychological variables.

RESULTS

Robust confirmatory factor analysis detected a unidimensional structure of the item scores. The omega coefficient was 0.91 and test-retest reliability was 0.87. Classifying subjects as in a Positive or Negative mood state, ROC analysis yielded an optimal cut-off of 50 for the DAS-1 scores, with a clinical accuracy of AUC = 0.85. The DAS-1 demonstrated evidence of good reliability and acceptable construct validity.

CONCLUSION

The DAS-1 demonstrated good clinical utility, good sensitivity and adequate specificity. Clinical and theoretical implications of these results are discussed.

Quality of Life, Social Support, Acceptance of Illness, and Self-Efficacy among Pregnant Women with Hyperglycemia

Carbohydrate metabolism disorders resulting in hyperglycemia are among the most common metabolic complications of pregnancy. According to 2017 data from the International Diabetes Federation (IDF), 16.2% of pregnancies are complicated with hyperglycemia, of which gestational diabetes mellitus (GDM) accounts for 86.4% of cases. Carbohydrate metabolism disorders developing during pregnancy require the patient to change her lifestyle or, in some cases, to undergo pharmaceutical treatment, which may affect various aspects of the patient's life, including her perceived quality of life (QoL). The purpose of the present study was to evaluate levels of QoL, social support, acceptance of illness, and self-efficacy among pregnant patients with hyperglycemia. The study was performed between July 2016 and September 2017 in a group of hyperglycemic pregnant women. The following instruments were used: the World Health Organization Quality of Life-BREF (WHOQOL-BREF), the Berlin Social Support Scales (BSSS), the Acceptance of Illness Scale (AIS), the Generalized Self-Efficacy Scale (GSES) and a standardized interview questionnaire. Participants rated their overall QoL (3.64 points) higher than their overall perceived health (3.43). In terms of social support, the highest scores were obtained in terms of actually received support (3.53) and perceived available instrumental support (3.52), while the lowest in terms of support seeking (2.99) and the need for support (2.95). The mean acceptance of illness score among the hyperglycemic pregnant women that were studied was 31.37, and the mean generalized self-efficacy score was 31.58. Participants' reported QoL in the various WHOQOL-BREF domains was associated with specific social support scales, acceptance of illness, and generalized self-efficacy.

As Time Goes by: Anxiety Negatively Affects the Perceived Quality of Life in Patients With Type 2 Diabetes of Long Duration

INTRODUCTION

Age-related medical conditions are increasing worldwide. Type 2 Diabetes mellitus (T2DM) represents a chronic disease, which affects a large amount of general population, accounting for over 90% of diabetes mellitus (DM) cases.

PURPOSE

As psychopathological symptoms frequently occur in medical conditions, our study aimed at exploring whether psychological factors and metabolic control may affect health related quality of life (HRQoL).

METHODS

Forty five patients with T2DM were consecutively recruited and assessed with a psychodiagnostic battery: Hamilton Anxiety Rating Scale (HAM-A), Beck Depression Inventory II edition (BDI-II) and the 36-Item Short Form Health Survey (SF-36), including indexes Physical and Mental Component Summary (PCS, MCS). Moreover, time since DM diagnosis and glycated hemoglobin (HbA1c) values were detected.

RESULTS

Participants (mean age 65.3 ± 5.9 years) had a mean time since diagnosis of 11.6 ± 6.7 years, and showed a good metabolic control as highlighted by mean HbA1c values 7.1 ± 0.9%. Median HAM-A score [25(20.7-30.6)], represented high prevalence of anxious symptoms. A moderate expression of depressive symptoms was observed [BDI-II score: 13(8.3-21.4)]. A multiple regression analysis, after correcting for age, BMI, HbA1c value and BDI-II score, showed the perceived quality of life relative to PCS was significantly related to both disease duration (β = -0.55, p = 0.03, SE = 0.25) and HAM-A scores (β = -0.52, p = 0.04, SE = 0.24). Moreover, both HAM-A (β = -0.67, p = 0.01, SE = 0.26) and BDI-II (β = -0.48, p = 0.02, SE = 0.20) scores were independently predictive of MCS. Metabolic control, instead, was not a significant predictor.

CONCLUSION

Our study suggests a predictive role of both anxiety levels and time since diagnosis in perceived HRQoL in T2DM patients. PCS was associated with anxiety and time since diagnosis and MCS was associated with anxiety and depressive symptoms but not with diabetes duration or metabolic control. These data could be useful to plan T2DM training programs focused on psychological health concerns, possibly leading to a healthy self-management and a better perceived HRQoL, even assisting patients in reducing the negative effect due to the chronicization of T2DM.