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Fisher L, Guzman S, Polonsky W, Hessler D. Bringing the assessment and treatment of diabetes distress into the real world of clinical care: Time for a shift in perspective. Diabet Med 2024; 41:e15446. [PMID: 39393003 DOI: 10.1111/dme.15446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 08/01/2024] [Accepted: 09/19/2024] [Indexed: 10/13/2024]
Abstract
AIMS Diabetes distress (DD) refers to the emotional and behavioural challenges associated with managing this demanding chronic disease over time. DD is alarmingly common and it has a significant impact on self-management behaviours and clinical outcomes. Thus, there is growing recognition that DD is a pressing problem that deserves careful attention in clinical care. Translating the application of validated DD assessment and intervention protocols from the research to the clinical setting, however, presents challenges that require a reconsideration of some common assumptions about what DD is, how prevalent it is, how it presents itself clinically, how it might best be assessed and by whom. METHODS We employed data from six large-scale studies using five common DD measures. Using these data, we review and challenge several common assumptions about DD. RESULTS These data suggest that, because of its relative ubiquity, DD should not be viewed as a 'co-morbidity' or 'complication' of diabetes and it should not be seen as a mental health/illness 'condition'. Furthermore, we argue that DD assessment should: (1) be accepted as a standard part of comprehensive diabetes care, (2) occur regularly using broad rather than brief screening measures and (3) be addressed directly by diabetes clinicians, rather than exclusively by behavioural specialists. CONCLUSIONS The results form the basis of a series of suggestions to enhance the translation, adoption and implementation of DD knowledge derived from the research setting directly into the real world of clinical care.
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Affiliation(s)
| | - Susan Guzman
- Behavioral Diabetes Institute, San Diego, California, USA
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Zheng C, Yin J, Wu L, Hu Z, Zhang Y, Cao L, Qu Y. Association between depression and diabetes among American adults using NHANES data from 2005 to 2020. Sci Rep 2024; 14:27735. [PMID: 39532999 PMCID: PMC11557951 DOI: 10.1038/s41598-024-78345-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 10/30/2024] [Indexed: 11/16/2024] Open
Abstract
Depression impairs self-management in diabetic patients, exacerbates insulin resistance, and elevates glycated hemoglobin (HbA1c) levels, thereby increasing diabetes risk. This study analyzed data from 30,386 participants in the National Health and Nutrition Examination Survey (NHANES), assessing depression severity using the 9-item Patient Health Questionnaire (PHQ-9) and evaluating diabetes status through clinical markers such as HbA1c, random blood glucose, and fasting blood glucose. Participants were stratified by depression severity and diabetes status to examine the relationship between depression and diabetes risk. We applied descriptive statistics, logistic regression models, subgroup analyses, and restricted cubic spline (RCS) modeling to explore this association. The results revealed that greater depression severity was significantly associated with increased diabetes incidence, elevated HbA1c, fasting glucose, and insulin levels. Multivariate regression analysis confirmed a consistent positive correlation between depression severity and diabetes risk. Subgroup analyses further identified significant relationships between depression and various demographic and behavioral factors, including gender, race, BMI, smoking status, and prediabetic conditions. Additionally, the RCS model demonstrated a clear increase in diabetes risk with rising PHQ-9 scores. In conclusion, our study demonstrates that the severity of depression is positively correlated with the risk of diabetes, and this association may be closely linked to various glycemic and lipid metabolic parameters.
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Affiliation(s)
- Chuanjie Zheng
- School of Basic Medicine, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310053, China
| | - Jianming Yin
- School of Basic Medicine, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310053, China
| | - Linyue Wu
- School of Basic Medicine, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310053, China
| | - Zhanhui Hu
- School of Basic Medicine, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310053, China
| | - Yikai Zhang
- School of Basic Medicine, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310053, China
| | - Lingyong Cao
- School of Basic Medicine, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310053, China.
| | - Yiqian Qu
- School of Basic Medicine, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310053, China.
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3
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Zhang Y, Zhang D, Long T, Wu Y, Huang J, Zhang Y, Li M. Diabetes distress profiles and health outcomes of individuals with type 2 diabetes and overweight/obesity: A cluster analysis. Diabetes Res Clin Pract 2024; 217:111863. [PMID: 39304135 DOI: 10.1016/j.diabres.2024.111863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 08/14/2024] [Accepted: 09/16/2024] [Indexed: 09/22/2024]
Abstract
AIMS To determine the prevalence and patterns of diabetes distress, and evaluate the differences in health outcomes between profiles. METHODS This cross-sectional study included 330 adults with T2DM and overweight/obesity. The participants completed questionnaires on diabetes distress, sleep quality, self-efficacy, depression, anxiety and positive and negative affect. A cluster analysis was performed to identify different patterns of diabetes distress and one-way ANOVA was used to investigate the differences in physical and psychological outcomes between profiles. RESULTS 30.6% of patients were identified as moderately to highly distressed, with the regimen-related distress found to be the most prominent. The Cluster analysis revealed four distinct clusters: (1) "comprehensively exhausted profile"; (2) "strained profile"; (3) "high internal anguish profile"; (4) "unperturbed profile". The measures of fasting blood glucose (FBG), glycated hemoglobin (HbA1c), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, sleep quality, depression, anxiety, positive and negative affect and self-efficacy differ between clusters. CONCLUSIONS This study identified important differences that existed in patterns of diabetes distress among people with T2DM and overweight/obesity, and this variation can be utilized to tailor intervention strategies to the particular needs of different subgroups within individuals with T2DM.
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Affiliation(s)
- Yiyun Zhang
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing 100191, China; School of Nursing, Peking University, Beijing, China
| | - Dan Zhang
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing 100191, China; School of Nursing, Peking University, Beijing, China
| | - Tianxue Long
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing 100191, China; School of Nursing, Peking University, Beijing, China
| | - Yi Wu
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing 100191, China; School of Nursing, Peking University, Beijing, China
| | - Jing Huang
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing 100191, China; School of Nursing, Peking University, Beijing, China
| | - Yating Zhang
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing 100191, China; School of Nursing, Peking University, Beijing, China
| | - Mingzi Li
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing 100191, China; School of Nursing, Peking University, Beijing, China.
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Saudelli E, Moscatiello S, Baldari M, Bongiorno C, Zucchini S, Maltoni G, Agostini A, Paccapelo A, Nardi E, Ribichini D, Bruco A, Lo Preiato V, Laffi G, Pagotto U, Di Dalmazi G. Sex-driven factors associated with anxiety and depression in autoimmune diabetes. Acta Diabetol 2024; 61:1231-1240. [PMID: 38743078 PMCID: PMC11486797 DOI: 10.1007/s00592-024-02275-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/11/2024] [Indexed: 05/16/2024]
Abstract
AIM To analyze the prevalence of anxiety and depression in a large cohort of adults with autoimmune diabetes, identifying sex-driven associated factors. MATERIALS AND METHODS In this cross-sectional study, we enrolled 553 consecutive adults with Type 1 diabetes mellitus or latent autoimmune diabetes in adults who came to the Division of Endocrinology of the S.Orsola-Malpighi Polyclinic, Bologna (Italy), to receive their second dose of SARS-CoV-2 vaccine. We administered the questionnaires: Hospital Anxiety and Depression Scale, Diabetes Distress Scale, Diabetes-related Quality of Life, Diabetes Treatment Satisfaction Questionnaire. We collected clinical and biochemical data and 14 days glucose metrics in patients with sensor use > 70% in a time span of ± 4 months from the questionnaires' administration. We excluded 119 patients from our analyses with missing data (final cohort n = 434: 79% of those enrolled). RESULTS Anxiety and depression prevalence was respectively 30.4% and 10.8%. According to the multivariate analysis, higher diabete-related emotional burden, lower treatment satisfaction, but not physician-related distress, were risk factors for anxiety and depression; female sex was associated with anxiety (OR 0.51, 95% 0.31-0.81; p = 0.005); in women, depression was associated with increasing age (males vs. females OR 0.96 per 1 year increase, 95% CI 0.92-1.00; p = 0.036), whilst in men with HbA1c (OR 1.08 per 1 mmol/mol increase, 95% CI 1.03-1.13; p = 0.002). CONCLUSION Nearly 1/3 of patients with autoimmune diabetes suffers from anxiety and 1/10 from depression. These conditions are associated with independent modifiable and non-modifiable characteristics. For depression, these characteristics differ between males and females.
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Affiliation(s)
- Enrico Saudelli
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Simona Moscatiello
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Michele Baldari
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Claudio Bongiorno
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Stefano Zucchini
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giulio Maltoni
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Agostini
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alexandro Paccapelo
- Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elena Nardi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Danilo Ribichini
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessia Bruco
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Valentina Lo Preiato
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gilberto Laffi
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Uberto Pagotto
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Guido Di Dalmazi
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy.
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Hessler DM, Fisher L, Guzman S, Strycker L, Polonsky WH, Ahmann A, Aleppo G, Argento NB, Henske J, Kim S, Stephens E, Greenberg K, Masharani U. EMBARK: A Randomized, Controlled Trial Comparing Three Approaches to Reducing Diabetes Distress and Improving HbA1c in Adults With Type 1 Diabetes. Diabetes Care 2024; 47:1370-1378. [PMID: 38809903 PMCID: PMC11272976 DOI: 10.2337/dc23-2452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/30/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To compare the effectiveness of three interventions to reduce diabetes distress (DD) and improve HbA1c among adults with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS Individuals with T1D (n = 276) with elevated DD (a score >2 on the total Type 1 Diabetes Distress Scale) and HbA1c (>7.5%) were recruited from multiple settings and randomly assigned to one of three virtual group-based programs: 1) Streamline, an educator-led education and diabetes self-management program; 2) TunedIn, a psychologist-led program focused exclusively on emotional-focused DD reduction; or 3) FixIt, an integration of Streamline and TunedIn. Assessments of the primary outcomes of DD and HbA1c occurred at baseline and at 3, 6, and 12 months. RESULTS All three programs demonstrated substantive and sustained reductions in DD (Cohen's d = 0.58-1.14) and HbA1c (range, -0.4 to -0.72) at 12-month follow-up. TunedIn and FixIt participants reported significantly greater DD reductions compared with Streamline participants (P = 0.007). Streamline and TunedIn participants achieved significantly greater HbA1c reductions than did FixIt participants (P = 0.006). CONCLUSIONS DD can be successfully reduced among individuals with T1D with elevated HbA1c using both the educational/behavioral and emotion-focused approaches included in the study. Although both approaches are associated with significant and clinically meaningful reductions in DD and HbA1c, TunedIn, the emotion-focused program, had the most consistent benefits across both DD and HbA1c. The study findings suggest the overall value of group-based, fully virtual, and time-limited emotion-focused strategies, like those used in TunedIn, for adults with T1D.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Joseph Henske
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Sarah Kim
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
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Tschirhart H, Landeen J, Yost J, Nerenberg KA, Sherifali D. The Examination and Exploration of Diabetes Distress in Pre-existing Diabetes in Pregnancy: A Mixed-methods Study. Can J Diabetes 2024; 48:281-289.e2. [PMID: 38492737 DOI: 10.1016/j.jcjd.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/15/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES Diabetes distress (DD) has been understudied in the pregnancy population. Pregnancy is known to be a complex, highly stressful time for women with diabetes because of medical risks and the high burden of diabetes management. Our aim in this study was to explain and understand DD in women with pre-existing diabetes in pregnancy. METHODS An explanatory, sequential mixed-methods study was undertaken. The first strand consisted of a cross-sectional study of 76 women with type 1 and type 2 diabetes. A nested sampling approach was used to re-recruit 18 women back into the second strand for qualitative interviews using an interpretive description approach. RESULTS DD was measured by the validated Problem Area in Diabetes (PAID) scale. A PAID score of ≥40 was positive for distress. DD prevalence was 22.4% in the cross-sectional cohort and the average PAID score was 27.75 (standard deviation 16.08). In the qualitative strand, women with a range of PAID scores (10.0 to 60.0) were sampled for interviews. The majority of these participants described themes of DD in their interviews. Of the 15 women who described DD thematically, only 6 had positive PAID scores. CONCLUSIONS Integration of the mixed-methods data underscores important meta-inferences about DD in pregnancy, namely that DD was present to a greater degree than the PAID tool is sensitive to. DD was present qualitatively in most of the qualitative sample, despite interviewing women with a range of PAID scores. Future research on a pregnancy-specific DD scale is needed.
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Affiliation(s)
- Holly Tschirhart
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Janet Landeen
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Yost
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, United States
| | - Kara A Nerenberg
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Lamaro BD, Greenfield JR, Snaith JR. Can Unmet Needs Be Addressed by Adjunctive Therapies? Findings from a Patient Perspectives Survey in Adults with Type 1 Diabetes. J Patient Exp 2024; 11:23743735241257811. [PMID: 38799027 PMCID: PMC11128168 DOI: 10.1177/23743735241257811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Many individuals with type 1 diabetes (T1D) do not achieve their management goals. The patient perspective on unmet needs in T1D may guide the role of adjunctive therapies, including glucagon like peptide-1 receptor agonists (GLP-1RAs). A quantitative online survey (n = 133) assessed (1) self-reported demographic and management data, (2) management priorities, satisfaction, and willingness to use adjunctive therapies and (3) conducted a risk-benefit analysis using three masked drug profiles (1.8 mg vs 0.6 mg liraglutide vs placebo). A subgroup of respondents (n = 20) participated in semi-structured interviews to extend upon survey insights. Needs were unmet by current treatment in 28% of surveyed individuals. The greatest unmet needs included (1) glycemia, (2) management-related fatigue, and (3) weight management. Most respondents (94%) indicated that they would use adjunctive therapies. The preferred administration route was daily tablets (66%) followed by weekly injections (32%). Metabolic improvements were most valued (reduction in hypoglycemia, hyperglycemia). Most respondents (94%) preferred the liraglutide risk-benefit profile (1.8 mg, then 0.6 mg) over placebo. Individuals with T1D self-report many unmet needs. While not currently approved in T1D, GLP-1RA properties align with many management priorities reported by individuals with T1D.
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Affiliation(s)
- Bella D. Lamaro
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jerry R. Greenfield
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Diabetes and Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Diabetes and Metabolism, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Jennifer R. Snaith
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Diabetes and Endocrinology, St Vincent's Hospital, Sydney, New South Wales, Australia
- Diabetes and Metabolism, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
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Tschirhart H, Landeen J, Yost J, Nerenberg KA, Sherifali D. Perceptions of diabetes distress during pregnancy in women with type 1 and type 2 diabetes: a qualitative interpretive description study. BMC Pregnancy Childbirth 2024; 24:232. [PMID: 38570742 PMCID: PMC10988880 DOI: 10.1186/s12884-024-06370-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 02/25/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Diabetes distress is commonly seen in adults with pre-existing diabetes and is associated with worsened glycemic management and self-management practices. While a majority of women report increased stress during pregnancy, it is unknown how women with type 1 or type 2 diabetes experience diabetes distress during this unique and transitional time. PURPOSE This study aimed to understand the experiences and perceptions of diabetes distress in women with pre-existing diabetes during pregnancy. METHODS A qualitative study using an interpretive description approach was conducted. In-depth, one to one interviewing was used to capture rich descriptions of the pregnancy experience. Nested, stratified, and theoretical sampling was used to recruit 18 participants with type 1 and type 2 diabetes from the quantitative strand of this mixed methods study. Constant comparative analysis was used to inductively analyze the data and develop themes. FINDINGS Four themes, each with several subthemes, emerged under the main finding of "Diabetes Distress": 1) Worry for Baby's Health - "What's this going to do to the baby?"' 2) Feeling Overwhelmed with Diabetes Management-"It just seemed unattainable"; 3) Living with Diabetes - "There's no way out" and 4) Cycle of Diabetes Distress. CONCLUSIONS The findings from this study identify the sources and experiences of diabetes distress during pregnancy in women with pre-existing diabetes. Diabetes distress often presents as cyclical and multifaceted during pregnancy, with elements of fear for the unborn baby, difficulties with diabetes management, and having negative lived experiences of diabetes. Further work is needed to develop appropriate screening tools for pregnancy and interventions to mitigate diabetes distress. Diabetes educators are well-positioned provide emotional support and person-centred self-management education to individuals with diabetes.
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Affiliation(s)
- Holly Tschirhart
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
| | - Janet Landeen
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Jennifer Yost
- M. Louise Fitzpatrick College of Nursing, Villanova University, Pennsylvania, USA
| | - Kara A Nerenberg
- Departments of Medicine, Obstetrics & Gynecology, and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
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Zhang M, Zhang X, Yang Y, Weng Y, Chen X, Chen Y, Shi Y. Diabetes Distress Among Patients Undergoing Surgery for Diabetic Retinopathy and Associated Factors: A Cross-Sectional Survey. Psychol Res Behav Manag 2024; 17:1451-1461. [PMID: 38590759 PMCID: PMC10999732 DOI: 10.2147/prbm.s455535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/14/2024] [Indexed: 04/10/2024] Open
Abstract
Background Diabetes distress (DD) is a negative emotion related to diabetes management and a predictor of depression; it affects diabetic retinopathy (DR) patients' quality of life and disease outcomes. The prevalence of DD was higher in patients undergoing surgery for DR. However, few studies have been conducted on DD in DR surgery patients. The present study aims to investigate the status of DD in DR surgery patients and identify factors associated with DD. Methods Using a convenience sampling method, 210 DR surgery patients who were admitted to 2 tertiary-level hospitals in Wenzhou City (Zhejiang Province) and Zhengzhou City (Henan Province) from February to June 2023 were selected as research subjects. A questionnaire collecting demographic and disease-related information, the Diabetes Distress Scale, the Summary of Diabetes Self-Management Activities, the Family Care Index Scale, and the Social Support Rating Scale were used to collect data. Statistical analyses included descriptive statistics, t tests, ANOVAs, Pearson's correlation analyses and stepwise multiple linear regression. This study is reported according to the STROBE guidelines. Results In total, 156 out of 210 (74.29%) DR surgery patients experienced DD, with an average score of 2.13±0.63. The results of the stepwise multiple regression analysis showed that residential location, employment status, self-management level, family support, and social support were significantly associated with DD. These variables accounted for 30.6% of the total variation in DD. Conclusions DR surgery patients exhibit moderate levels of distress. Health care professionals should pay attention to DD in DR surgery patients and develop targeted interventions to improve the self-management ability of these patients, increase their family support and social support to reduce their DD levels.
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Affiliation(s)
- Mengyue Zhang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Xiaoxian Zhang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Yingrui Yang
- Department of Nursing, Henan Provincial People’s Hospital, Zhengzhou, People’s Republic of China
| | - Yu Weng
- Department of Nursing, The Eye Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Xiaojun Chen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Yanyan Chen
- Department of Nursing, The Eye Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Yinghui Shi
- Department of Nursing, The Eye Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China
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10
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AlOzairi A, Irshad M, AlKandari J, AlSaraf H, Al-Ozairi E. Prevalence and predictors of diabetes distress and depression in people with type 1 diabetes. Front Psychiatry 2024; 15:1367876. [PMID: 38585475 PMCID: PMC10995252 DOI: 10.3389/fpsyt.2024.1367876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Background People living with diabetes often encounter psychosocial challenges, including diabetes distress and depression. Despite this, little research has focused on the co-occurrence of these conditions. This study aimed to explore the prevalence of depressive symptoms and diabetes distress in people with type 1 diabetes in Kuwait and to identify clinical and demographic factors associated with these conditions. Methods A total of 832 people with type 1 diabetes (females: 54.1%, mean age: 29 ± 8.5 years), were invited to participate in Dose Adjustment for Normal Eating (DAFNE) course. Diabetes distress was measured using the Problem Areas in Diabetes (PAID) scale and depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Depressive symptoms were defined as PHQ-9 scores ≥10. Data on biomedical outcomes, lifestyle factors, and sociodemographic information were collected. Results The prevalence rates of diabetes distress and depressive symptoms were 27.8% and 38.3%, respectively. Notably, 19.6% of people experienced both conditions. In the regression analysis, PAID scale and PHQ-9 scores were significantly associated, patients with higher score on depressive symptoms scale were more likely to suffer diabetes distress (B= 2.65, p < 0.001). Female sex (odds ratio [OR]= 2.2, 95% CI= 1.5, 3.2), higher hemoglobin A1c levels (OR= 1.6, 95% CI= 1.0, 2.5), obesity (OR= 1.7, 95% CI= 1.1, 2.8), inactivity (OR= 2.4, 95% CI= 1.6, 3.6), microvascular complications (OR= 2.8, 95% CI= 1.5, 5.4), and lipohypertrophy (OR= 1.7, 95% CI= 1.1, 2.5) were associated with greater odds for the co-occurrence of diabetes distress and depressive symptoms (p< 0.05 for all). Conclusion The majority of people with type 1 diabetes in Kuwait experience both diabetes distress and depressive symptoms. The strong correlation between diabetes distress and depressive symptoms suggests mutual predictability. The co-occurrence of both symptoms is associated with many sociodemographic and clinical factors.
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Affiliation(s)
- Abdullah AlOzairi
- Department of Psychological Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
- Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | | | - Jumana AlKandari
- Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
- DAFNE Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Husain AlSaraf
- Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
- DAFNE Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Ebaa Al-Ozairi
- DAFNE Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
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Tang TS, Seddigh S, Halbe E, Vesco AT. Testing 3 Digital Health Platforms to Improve Mental Health Outcomes in Adults With Type 1 Diabetes: A Pilot Trial. Can J Diabetes 2024; 48:18-25.e2. [PMID: 37625504 DOI: 10.1016/j.jcjd.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/23/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Our aim in this study was to examine the potential impact of a 3-pronged digital health pilot intervention (TRIFECTA) on diabetes distress and depressive symptoms among adults with type 1 diabetes (T1D) in British Columbia. METHODS We recruited 60 adults with T1D (mean age 38.9±15.1 years, 75% female, 77% Caucasian) who participated in the 6-month pilot intervention involving 3 digital health platforms: monthly, provider-led, group-based sessions over Zoom (virtual huddles); a WhatsApp peer texting group; and a web-based "Ask-the-expert" portal. Assessments were conducted at baseline and 6 months and measured diabetes distress (T1D Diabetes Distress Scale), depressive symptoms (9-item Personal Health Questionnaire), and TRIFECTA engagement metrics. RESULTS Participation in TRIFECTA was associated with significant reductions in Overall Distress (p=0.011) and 4 distress subscales: Powerlessness (p=0.006), Management Distress (p=0.001), Hypoglycemia Distress (p=0.029), and Eating Distress (p<0.001). A higher number of virtual huddles attended predicted lower Overall Distress (p=0.019) and Family/Friends Distress (p=0.023). A higher number of "Ask-the-expert" posts viewed predicted lower Overall Distress (p=0.046), whereas a higher number of WhatsApp messages posted predicted lower Management Distress (p=0.006). Furthermore, engagement in all 3 metrics was a predictor for lower Negative Social Perceptions Distress (p<0.05). No associations were seen in other distress subscales or for depressive symptoms. CONCLUSIONS Participation in TRIFECTA was linked to reduced diabetes distress levels, but not depressive symptoms, in a platform-dependent manner. This study provides promising pilot data for a subsequent large-scale and fully powered randomized controlled trial.
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Affiliation(s)
- Tricia S Tang
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Sorayya Seddigh
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eashan Halbe
- APEL, Division of Respiratory Medicine, Department of Medicine, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; Experimental Medicine Program, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony T Vesco
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States; Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
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12
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Hernar I, Cooper JG, Nilsen RM, Skinner TC, Strandberg RB, Iversen MM, Graue M, Ernes T, Løvaas KF, Madsen TV, Lie SS, Richards DA, Ueland GÅ, Haugstvedt A. Diabetes Distress and Associations With Demographic and Clinical Variables: A Nationwide Population-Based Registry Study of 10,186 Adults With Type 1 Diabetes in Norway. Diabetes Care 2024; 47:126-131. [PMID: 37922320 PMCID: PMC10733651 DOI: 10.2337/dc23-1001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/16/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVE To estimate diabetes distress prevalence and associations with demographic and clinical variables among adults with type 1 diabetes in Norway. RESEARCH DESIGN AND METHODS In this nationwide population-based registry study, the 20-item Problem Areas in Diabetes (PAID-20) questionnaire was sent to 16,255 adults with type 1 diabetes. Linear regression models examined associations of demographic and clinical variables with distress. RESULTS In total, 10,186 individuals (62.7%) completed the PAID-20, with a mean score of 25.4 (SD 18.4) and 21.7% reporting high distress. Respondents endorsed worrying about the future and complications as the most problematic item (23.0%). Female sex, younger age, non-European origin, primary education only, unemployment, smoking, continuous glucose monitoring use, more symptomatic hypoglycemia, reduced foot sensitivity, treated retinopathy, and higher HbA1c were associated with higher distress. CONCLUSIONS Diabetes distress is common among adults with type 1 diabetes and associated with clinically relevant factors, underlining that regular care should include efforts to identify and address distress.
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Affiliation(s)
- Ingvild Hernar
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - John G. Cooper
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Roy M. Nilsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Timothy C. Skinner
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
| | - Ragnhild B. Strandberg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Marjolein M. Iversen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Centre on Patient-Reported Outcomes Data, Haukeland University Hospital, Bergen, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tony Ernes
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Karianne F. Løvaas
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tone V. Madsen
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Silje S. Lie
- Department of Health, VID Specialized University, Stavanger, Norway
| | - David A. Richards
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Grethe Å. Ueland
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
- Norwegian Diabetes Register for Adults, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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13
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Poos S, Faerovitch M, Pinto C, Jamalkhani N, Chaudhri F, Khan S, Lo DF, McGowan K, Martin A. The role of diabetes distress in Diabulimia. J Eat Disord 2023; 11:213. [PMID: 38041170 PMCID: PMC10691075 DOI: 10.1186/s40337-023-00924-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/31/2023] [Indexed: 12/03/2023] Open
Abstract
IMPORTANCE Diabulimia is a disordered eating behavior in which a person with type 1 diabetes withholds insulin injections to lose weight. It is thought that the psychosocial stress of managing this chronic disease, which is termed diabetes distress, may contribute to developing diabulimia. OBJECTIVE This paper explores links between diabetes distress and diabulimia and their relevance to the diagnosis and treatment of diabulimia by assessing whether people with diabulimia report measurable evidence of diabetes distress. EVIDENCE REVIEW We evaluated studies examining the qualitative experiences of people with disordered eating behaviors in the setting of type 1 diabetes for themes of diabetes distress by identifying aspects of the patients' stories that matched the criteria in the Diabetes Distress Scale. Selected studies recorded primary data, analyzed qualitative data, examined lived experiences of individuals with diabulimia, and were made available in English-language peer-reviewed journals between January 1, 2000 and August 31, 2022. Exclusion criteria included partial articles, editorials, reviews, and abstracts along with studies of patients with type 2 diabetes. FINDINGS Over forty individual participants across twelve studies were found to have aspects of their experiences that met one or more criteria from the Diabetes Distress Scale. Participants reported experiences that matched criteria items from each of the seven subscales of the Diabetes Distress Scale. Participants in the twelve studies included 185 individuals with type 1 diabetes experiencing diabulimia, including 164 females (88.6%), 20 males (10.8%), and 1 non-reported gender (0.54%). CONCLUSION We believe this discovery warrants further research probing the prevalence of diabetes distress among people with diabulimia as well as other links between the two conditions. We advocate for a diabetes distress-informed approach to diabulimia treatment and for diabetes distress screening in every patient with type 1 diabetes.
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Affiliation(s)
- Stephen Poos
- Stony Brook Southampton Hospital, 240 Meeting House Ln, Southampton, NY, USA
| | - Misha Faerovitch
- School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Rochester, NY, USA
| | - Celeste Pinto
- Rowan-Virtua School of Osteopathic Medicine, 1 Medical Center Dr, Stratford, NJ, USA
| | - Nima Jamalkhani
- Rowan-Virtua School of Osteopathic Medicine, 1 Medical Center Dr, Stratford, NJ, USA
| | - Fahad Chaudhri
- Rowan-Virtua School of Osteopathic Medicine, 1 Medical Center Dr, Stratford, NJ, USA
| | - Satara Khan
- Touro University, 3 Times Sq, New York, NY, USA
| | - David F Lo
- Rowan-Virtua School of Osteopathic Medicine, 1 Medical Center Dr, Stratford, NJ, USA.
| | - Kaitlin McGowan
- Dartmouth Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, USA
| | - Ashaki Martin
- Ocean University Medical Center, 425 Jack Martin Blvd, Brick, NJ, USA
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14
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Hamilton K, Forde R, Due-Christensen M, Eeg-Olofson K, Nathanson D, Rossner S, Vikstrom-Greve S, Porth AK, Seidler Y, Kautzky-Willer A, Delbecque L, Ozdemir Saltik AZ, Hasler Y, Flores V, Stamm T, Hopkins D, Forbes A. Which diabetes specific patient reported outcomes should be measured in routine care? A systematic review to inform a core outcome set for adults with Type 1 and 2 diabetes mellitus: The European Health Outcomes Observatory (H2O) programme. PATIENT EDUCATION AND COUNSELING 2023; 116:107933. [PMID: 37672919 DOI: 10.1016/j.pec.2023.107933] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/21/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES The objective was to identify candidate patient reported outcomes with potential to inform individual patient care and service development for inclusion in a digital outcome set to be collected in routine care, as part of an international project to enhance care outcomes for people with diabetes. METHODS PubMed, COSMIN and COMET databases were searched. Published studies were included if they recommended patient reported outcomes that were clinically useful and/or important to people with diabetes. To aid selection decisions, recommended outcomes were considered in terms of the evidence endorsing them and their importance to people with diabetes. RESULTS Twenty-seven studies recommending 53 diabetes specific outcomes, and patient reported outcome measures, were included. The outcomes reflected the experience of living with diabetes (e.g. psychological well-being, symptom experience, health beliefs and stigma) and behaviours (e.g. self-management). Diabetes distress and self-management behaviours were most endorsed by the evidence. CONCLUSIONS The review provides a comprehensive list of candidate outcomes endorsed by international evidence and informed by existing outcome sets, and suggestions for measures. PRACTICE IMPLICATIONS The review offers evidence to guide clinical application. Integrated measurement of these outcomes in care settings holds enormous potential to improve provision of care and outcomes in diabetes.
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Affiliation(s)
- Kathryn Hamilton
- Kings College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK.
| | - Rita Forde
- Kings College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Mette Due-Christensen
- Kings College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Katarina Eeg-Olofson
- University of Gothenburg, Institute of Medicine, Department of Molecular and Clinical Medicine, Gothenburg, Sweden
| | - David Nathanson
- Karolinska Institutet, Department of Medicine, Huddinge, Sweden; Karolinska University Hospital, Medical Unit Endocrinology, Huddinge, Sweden
| | - Sophia Rossner
- Karolinska Institutet, Department of Medicine, Huddinge, Sweden
| | - Sara Vikstrom-Greve
- Karolinska Institutet, Department of Medicine, Huddinge, Sweden; Karolinska University Hospital, Medical Unit Endocrinology, Huddinge, Sweden
| | - Ann-Kristin Porth
- Medical University of Vienna, Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Vienna, Austria
| | - Yuki Seidler
- Medical University of Vienna, Institute of Outcomes Research, Center for Medical Statistics and Informatics, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Medical University of Vienna, Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Vienna, Austria
| | | | | | - Yvonne Hasler
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Vanesa Flores
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Tanja Stamm
- Medical University of Vienna, Institute of Outcomes Research, Center for Medical Statistics and Informatics, Vienna, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - David Hopkins
- King's Health Partners Institute for Diabetes, Endocrinology and Obesity, London, UK
| | - Angus Forbes
- Kings College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
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15
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Titoria R, Fung A, Tang TS, Amed S. Systematic review of technology-mediated peer support interventions in paediatric type 1 diabetes care. Diabet Med 2023; 40:e15172. [PMID: 37428650 DOI: 10.1111/dme.15172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/12/2023]
Abstract
AIMS There is increasing interest in the role of peer support in diabetes care. However, technology-mediated peer support in paediatric type 1 diabetes remains understudied.We aimed todescribe technology-mediated peer support interventions for children living with type 1 diabetes, their caregivers and healthcare providers. METHODS CINAHL, Embase and MEDLINE (Ovid) were searched from Jan 2007 to June 2022. We included randomised and non-randomised trials with peer support interventions for children living with diabetes, their caregivers and/or healthcare providers. Studies examining clinical, behavioural or psychosocial outcomes were included. Quality was assessed with the Cochrane risk of bias tool. RESULTS Twelve of 308 retrieved studies were included, with a study duration range of 3 weeks to 24 months and most were randomised trials (n = 8, 66.67%). Four technology-based interventions were identified: phone-based text messages, video, web portal and social media, or a hybrid peer support model. Most (58.6%, n = 7) studies exclusively targeted children with diabetes. No significant improvement was observed in psychosocial outcomes (quality of life, n = 4; stress and coping, n = 4; social support, n = 2). Mixed findings were observed in HbA1c (n = 7) and 28.5% studies (n = 2/7) reported reduced incidence of hypoglycaemia. CONCLUSIONS Technology-mediated peer support interventions may have the potential to improve diabetes care and outcomes. However, further well-designed studies are necessary that address the needs of diverse populations and settings, and the sustainability of intervention effects.
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Affiliation(s)
- Reena Titoria
- Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Andrea Fung
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Tricia S Tang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shazhan Amed
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Franken K, ten Klooster P, Bohlmeijer E, Westerhof G, Kraiss J. Predicting non-improvement of symptoms in daily mental healthcare practice using routinely collected patient-level data: a machine learning approach. Front Psychiatry 2023; 14:1236551. [PMID: 37817829 PMCID: PMC10560743 DOI: 10.3389/fpsyt.2023.1236551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
Objectives Anxiety and mood disorders greatly affect the quality of life for individuals worldwide. A substantial proportion of patients do not sufficiently improve during evidence-based treatments in mental healthcare. It remains challenging to predict which patients will or will not benefit. Moreover, the limited research available on predictors of treatment outcomes comes from efficacy RCTs with strict selection criteria which may limit generalizability to a real-world context. The current study evaluates the performance of different machine learning (ML) models in predicting non-improvement in an observational sample of patients treated in routine specialized mental healthcare. Methods In the current longitudinal exploratory prediction study diagnosis-related, sociodemographic, clinical and routinely collected patient-reported quantitative outcome measures were acquired during treatment as usual of 755 patients with a primary anxiety, depressive, obsessive compulsive or trauma-related disorder in a specialized outpatient mental healthcare center. ML algorithms were trained to predict non-response (< 0.5 standard deviation improvement) in symptomatic distress 6 months after baseline. Different models were trained, including models with and without early change scores in psychopathology and well-being and models with a trimmed set of predictor variables. Performance of trained models was evaluated in a hold-out sample (30%) as a proxy for unseen data. Results ML models without early change scores performed poorly in predicting six-month non-response in the hold-out sample with Area Under the Curves (AUCs) < 0.63. Including early change scores slightly improved the models' performance (AUC range: 0.68-0.73). Computationally-intensive ML models did not significantly outperform logistic regression (AUC: 0.69). Reduced prediction models performed similar to the full prediction models in both the models without (AUC: 0.58-0.62 vs. 0.58-0.63) and models with early change scores (AUC: 0.69-0.73 vs. 0.68-0.71). Across different ML algorithms, early change scores in psychopathology and well-being consistently emerged as important predictors for non-improvement. Conclusion Accurately predicting treatment outcomes in a mental healthcare context remains challenging. While advanced ML algorithms offer flexibility, they showed limited additional value compared to traditional logistic regression in this study. The current study confirmed the importance of taking early change scores in both psychopathology and well-being into account for predicting longer-term outcomes in symptomatic distress.
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Affiliation(s)
- Katinka Franken
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
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17
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Ranjan R, Rajput M, Sachdeva A, Saha A, Jyotsana, Yadav K. Prevalence of diabetes distress and cross-cultural reliability of DDS-17 scale in rural Haryana. J Family Med Prim Care 2023; 12:2064-2069. [PMID: 38024882 PMCID: PMC10657097 DOI: 10.4103/jfmpc.jfmpc_496_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 12/01/2023] Open
Abstract
Background Diabetes distress associated with diabetes is an important under-appreciated domain of diabetes management. The aim of the study is to assess the prevalence of diabetes distress among T2DM patients in Jhajjar district of Haryana, using widely accepted DDS-17 scale along with testing the scale's reliability through Cronbach's α. Material and Methods This observational study with cross-sectional design was carried out among 503 T2DM patients in district, Jhajjar, Haryana. DDS-17 scale was used for diabetes distress assessment. Data entry and analysis were performed using appropriate software. Results 37.97% subjects had diabetes distress either in moderate (DDS-17 Score ≥2) or severe (DDS-17 Score ≥3) form. English version of DDS-17 scale showed good internal consistency reliability (α = 0.79). Conclusions This study conclusively showed that diabetes distress is very common among T2DM patients as more than one third of the T2DM patients had diabetes distress and diabetes distress scale (DDS-17) is an easy, well-accepted questionnaire with good reliability.
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Affiliation(s)
- Ravish Ranjan
- Department of Community Medicine, SNMIH Saharsa, Bihar, India
| | - Meena Rajput
- Department of Community Medicine, Pt B D Sharma PGIMS Rohtak, Haryana, India
| | | | - Arup Saha
- Department of Community Medicine, Pt B D Sharma PGIMS Rohtak, Haryana, India
| | - Jyotsana
- Department of Community Medicine, Pt B D Sharma PGIMS Rohtak, Haryana, India
| | - Kapil Yadav
- Department of Community Medicine, Pt B D Sharma PGIMS Rohtak, Haryana, India
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18
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Shearrer GE. The Interaction of Glycemia with Anxiety and Depression Is Related to Altered Cerebellar and Cerebral Functional Correlations. Brain Sci 2023; 13:1086. [PMID: 37509016 PMCID: PMC10377615 DOI: 10.3390/brainsci13071086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/06/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Depression, type 2 diabetes (T2D), and obesity are comorbid, and prevention and treatment of all three diseases are needed. We hypothesized an inverse relationship between the connectivity of the cingulo-opercular task control network with the somatosensory mouth network and the interaction between HbA1c and depression. Three-hundred and twenty-five participants (BMI: 26.11 ± 0.29; Achenbach adult self-report (ASR) DSM depressive problems T-score (depression): 54.60 ± 6.77; Age: 28.26 ± 3.90 y; adult self-report anxiety and depression scale (anxiety and depression): 54.69 ± 7.27; HbA1c: 5.26 ± 0.29; 68% white) were sampled from the Human Connectome Project 1200 subjects PTN release. Inclusion criteria were: four (15 min) resting state fMRI scans; BMI; hemoglobin A1c (HbA1c); and complete adult self-report data. The following models were run to assess the connectivity between 15 independent fMRI components: the interaction of depression with HbA1c; anxiety and depression with HbA1c; depression with BMI; and anxiety and depression with BMI. All models were corrected for a reported number of depressive symptoms, head motion in the scanner, age, and race. Functional connectivity was modeled in FSLNets. Corrected significance was set at pFWE < 0.05. The interaction HbA1c and anxiety and depression was positively related to the connectivity of the cerebellum with the visual network (t = 3.76, pFWE = 0.008), frontoparietal network (t = 3.45, pFWE = 0.02), and somatosensory mouth network (t = 4.29, pFWE = 0.0004). Although our hypotheses were not supported, similar increases in cerebellar connectivity are seen in patients with T2D and overall suggest that the increased cerebellar connectivity may be compensatory for an increasingly poor glycemic control.
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Affiliation(s)
- Grace E Shearrer
- Department of Family and Consumer Sciences, Neuroscience Program, School of Computing, College of Agriculture, Life Sciences and Natural Resources, University of Wyoming, Laramie, WY 82070, USA
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19
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Gibson B, Rosser BA, Schneider J, Forshaw MJ. The role of uncertainty intolerance in adjusting to long-term physical health conditions: A systematic review. PLoS One 2023; 18:e0286198. [PMID: 37267292 DOI: 10.1371/journal.pone.0286198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 05/10/2023] [Indexed: 06/04/2023] Open
Abstract
Long-term physical health conditions (LTPHCs) are associated with poorer psychological well-being, quality of life, and longevity. Additionally, individuals with LTPHCs report uncertainty in terms of condition aetiology, course, treatment, and ability to engage in life. An individual's dispositional ability to tolerate uncertainty-or difficulty to endure the unknown-is termed intolerance of uncertainty (IU), and may play a pivotal role in their adjustment to a LTPHC. Consequently, the current review sought to investigate the relationship between IU and health-related outcomes, including physical symptoms, psychological ramifications, self-management, and treatment adherence in individuals with LTPHCs. A systematic search was conducted for papers published from inception until 27 May 2022 using the databases PsycINFO, PubMed (MEDLINE), CINAHL Plus, PsycARTICLES, and Web of Science. Thirty-one studies (N = 6,201) met the inclusion criteria. Results indicated that higher levels of IU were associated with worse psychological well-being outcomes and poorer quality of life, though impacts on self-management were less clear. With the exception of one study (which looked at IU in children), no differences in IU were observed between patients and healthy controls. Although findings highlight the importance of investigating IU related to LTPHCs, the heterogeneity and limitations of the existing literature preclude definite conclusions. Future longitudinal and experimental research is required to investigate how IU interacts with additional psychological constructs and disease variables to predict individuals' adjustment to living with a LTPHC.
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Affiliation(s)
- Benjamin Gibson
- School of Applied Social Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Benjamin A Rosser
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Jekaterina Schneider
- Centre for Appearance Research, School of Social Sciences, College of Health, Science and, University of the West of England, Bristol, United Kingdom
| | - Mark J Forshaw
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
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20
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Robinson DJ, Hanson K, Jain AB, Kichler JC, Mehta G, Melamed OC, Vallis M, Bajaj HS, Barnes T, Gilbert J, Honshorst K, Houlden R, Kim J, Lewis J, MacDonald B, MacKay D, Mansell K, Rabi D, Sherifali D, Senior P. Diabetes and Mental Health. Can J Diabetes 2023; 47:308-344. [PMID: 37321702 DOI: 10.1016/j.jcjd.2023.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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21
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Zeitoun MH, Abdel Reheem AA, Kharboush IF, Sheshtawy H, Assad DH, El Feky AY. Relationship between depressive and anxiety symptoms and fear of hypoglycemia among adolescents and adults with type 1 diabetes mellitus. Prim Care Diabetes 2023; 17:255-259. [PMID: 36925404 DOI: 10.1016/j.pcd.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/22/2023] [Accepted: 03/05/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND AND AIMS Emotional problems including anxiety, depression and fear of hypoglycemia (FOH) are common in patients with type 1 diabetes mellitus (T1DM). The aim of this study was to determine the prevalence of depressive and anxiety symptoms among patients with T1DM and their relation to glycemic control, diabetes complications and to FOH. METHODS This study included 325 patients with T1DM. Anxiety and depressive symptoms were assessed by Hospital Anxiety and Depression Scale (HADS) and FOH was assessed by Hypoglycemia Fear Survey II (HFS-II). Glycemic control was assessed by both fasting plasma glucose and HbA1c. A subsample of 75 patients was screened for diabetes complications. RESULTS The prevalence of anxiety symptoms, depressive symptoms and FOH was 76.3%, 61.8% and 20% respectively. Female sex was related to depressive symptoms but not to anxiety symptoms. Logistic regression analysis showed that both HbA1c and HFS-II total score were independently correlated with both anxiety symptoms and depressive symptoms. Age showed independent correlation with both HFS-II (total score) and with Hypoglycemia Fear Survey-worry (HFS-W) while HbA1c showed independent correlation with Hypoglycemia Fear Survey-behavior (HFS-B). Both anxiety and depressive symptoms were positively correlated to HFS-B score, HFS-W score and HFS-II total score. CONCLUSIONS FOH is not uncommon among Egyptian patients with T1DM and it seems to be one of the factors contributing to the increased prevalence of anxiety and depressive symptoms among those individuals. Addressing and managing the different psychological aspects of diabetes should be integrated within the routine diabetes care services for people with T1DM.
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Affiliation(s)
| | | | - Ibrahim F Kharboush
- Department of Maternal and Child Health, High Institute of Public Health, Alexandria University, Egypt
| | - Hesham Sheshtawy
- Department of Neurology and Psychiatry, Alexandria University, Egypt
| | - Dalia H Assad
- Department of Internal Medicine, Abu Qir general hospital, Alexandria, Egypt
| | - Amr Y El Feky
- Department of Internal Medicine, Alexandria University, Egypt.
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22
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Baruffaldi I. Perceived stress can negatively affect blood glucose control and fear of hypoglycaemia in people with type 1 diabetes. Evid Based Nurs 2023; 26:52. [PMID: 36180201 DOI: 10.1136/ebnurs-2022-103555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Ilaria Baruffaldi
- Paula Carr Diabetes Centre, Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, UK
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23
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Stahl-Pehe A, Bächle C, Bódis K, Zaharia OP, Lange K, Holl RW, Roden M, Rosenbauer J. Comparison of diabetes distress and depression screening results of emerging adults with type 1 diabetes onset at different ages: findings from the German early-onset T1D study and the German Diabetes Study (GDS). Diabetol Metab Syndr 2023; 15:24. [PMID: 36803876 PMCID: PMC9940340 DOI: 10.1186/s13098-023-00994-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/08/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Diabetes distress is increasingly considered one of the most important psychosocial issues in the care of people with type 1 diabetes (T1D). We analyse whether diabetes distress and depression screening results of emerging adults are associated with the age at T1D onset. METHODS Data were taken from two cohort studies conducted at the German Diabetes Center, Düsseldorf, Germany. The 18-30-year-old participants had an age at onset either before the age of 5 years (childhood-onset long-term T1D study group, N = 749) or during adulthood (adult-onset short-term T1D study group from the German Diabetes Study (GDS), N = 163). Diabetes distress and depression screening were analysed by means of the 20-item Problem Areas in Diabetes (PAID-20) scale and the nine-item depression module from the Patient Health Questionnaire (PHQ-9). The average causal effect of age at onset was estimated by a doubly robust causal inference method. RESULTS The PAID-20 total scores were increased in the adult-onset study group [potential outcome mean (POM) 32.1 (95% confidence interval 28.0; 36.1) points] compared to the childhood-onset study group [POM 21.0 (19.6; 22.4) points, difference 11.1 (6.9; 15.3) points, p<0.001] adjusted for age, sex and haemoglobin A1c (HbA1c) levels. Moreover, more participants in the adult-onset group [POM 34.5 (24.9; 44.2) %] than in the childhood-onset group [POM 16.3 (13.3; 19.2) %] screened positive for diabetes distress [adjusted difference 18.3 (8.3; 28.2) %, p<0.001]. The PHQ-9 total score [difference 0.3 (-1.1; 1.7) points, p=0.660] and the proportion of participants with a positive screening result for depression [difference 0.0 (-12.7; 12.8) %, p=0.994] did not differ between the groups in the adjusted analyses. CONCLUSIONS Emerging adults with short-term type 1 diabetes screened positive for diabetes distress more often than adults with type 1 diabetes onset during early childhood when age, sex and HbA1c values were considered confounding factors. Accounting for age at onset or the duration of diabetes may help explain the heterogeneity in the data when psychological factors are examined.
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Affiliation(s)
- Anna Stahl-Pehe
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Christina Bächle
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Kálmán Bódis
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Oana-Patricia Zaharia
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Karin Lange
- Medical Psychology Unit, Hannover Medical School, Hannover, Germany
| | - Reinhard W Holl
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Institute for Clinical Diabetology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Joachim Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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24
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Lunkenheimer F, Eckert AJ, Hilgard D, Köth D, Kulzer B, Lück U, Lüdecke B, Müller A, Baumeister H, Holl RW. Posttraumatic stress disorder and diabetes-related outcomes in patients with type 1 diabetes. Sci Rep 2023; 13:1556. [PMID: 36707607 PMCID: PMC9883226 DOI: 10.1038/s41598-023-28373-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023] Open
Abstract
Mental comorbidities in patients with type 1 diabetes mellitus (T1D) are common, and can have a negative impact on acute blood glucose levels and long-term metabolic control. Information on the association of T1D and comorbid posttraumatic stress disorder (PTSD) with diabetes-related outcomes is limited. The aim was to examine the associations between a clinical diagnosis of PTSD and diabetes-related outcomes in patients with T1D. Patients with T1D and comorbid documented PTSD from the DPV database (n = 179) were compared to a group with T1D without PTSD (n = 895), and compared to a group with T1D without comorbid mental disorder (n = 895) by matching demographics (age, gender, duration of diabetes, therapy and migration background) 1:5. Clinical diabetes-related outcomes {body mass index (BMI), hemoglobin A1c (hbA1c), daily insulin dose, diabetic ketoacidosis (DKA), hypoglycemia, number of hospital admissions, number of hospital days} were analyzed, stratified by age groups (≤ 25 years vs. > 25 years). Patients with comorbid PTSD aged ≤ 25 years compared with patients without PTSD or patients without mental disorders had significantly higher HbA1c (8.71 vs. 8.30 or 8.24%), higher number of hospital admissions (0.94 vs. 0.44 or 0.32 per year) and higher rates of DKA (0.10 vs. 0.02 or 0.01 events/year). Patients with comorbid PTSD aged ≤ 25 years compared with patients without PTSD had significantly higher BMI (0.85 vs. 0.59) and longer hospital stays (15.89 vs.11.58 days) than patients without PTSD. Patients with PTSD > 25 years compared with patients without PTSD or without any mental comorbidities had significantly fewer hospital admissions (0.49 vs. 0.77 or 0.69), but a longer hospital length of stay (20.35 vs. 11.58 or 1.09 days). We found that PTSD in younger patients with T1D is significantly related to diabetes outcome. In adult patients with T1D, comorbid PTSD is associated with fewer, but longer hospitalizations. Awareness of PTSD in the care of patients with T1D should be raised and psychological intervention should be provided when necessary.
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Affiliation(s)
- Frederike Lunkenheimer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany.
| | - Alexander J Eckert
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, Ulm, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, Munich-Neuherberg, Germany
| | - Dörte Hilgard
- Pediatric Endocrinology and Diabetology, Primary Psychosomatic Care, Bahnhofstraße 54, Witten, Germany
| | - Daniel Köth
- Department of Endocrinology and Diabetology, Hospital Sachsenhausen, Schulstraße 31, Frankfurt, Germany
| | - Bernhard Kulzer
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, Munich-Neuherberg, Germany
- Research Institute of the Diabetes-Academy Mergentheim (FIDAM), Theodor-Klotzbücher-Straße 12, Bad Mergentheim, Germany
| | - Ursula Lück
- Department of Pediatrics and Adolescent Medicine, Regional Hospital Mödling, Sr. M. Restituta-Gasse 12, Mödling, Austria
| | - Blanca Lüdecke
- Diabetes Centre, Alexianer St. Hedwig Hospital, Große Hambuger Straße 5-11, Berlin, Germany
| | - Antonia Müller
- Clinic Group Dr. Guth GmbH & Co. KG, Clinical Center Karlsburg, Greifswalder Straße 11, Karlsburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, 89081, Ulm, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, Ulm, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, Munich-Neuherberg, Germany
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25
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Fishman SR, Fernandez Galvis MA, Linnell J, Iribarren P, Jonas VH, Gittleman JM, Tanenbaum M, Scherer M, Weiss L, Walker EA, Crespo-Ramos G, Hoogendoorn CJ, Pham-Singer H, Wu WY, Gonzalez JS. Diabetes-Related Quality of Life: Learning From Individuals Making Lifestyle Changes to Improve Type 2 Diabetes Control. DIABETES EDUCATOR 2023; 49:136-149. [PMID: 36700517 DOI: 10.1177/26350106221149665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose of this study was to explore how treatment adherence and lifestyle changes required for glycemic control in type 2 diabetes (T2D) are related to quality of life (QoL) among predominantly ethnic minority and socioeconomically disadvantaged adults engaged in making changes to improve T2D self-management. METHODS Adults with T2D in New York City were recruited for the parent study based on recent A1C (≥7.5%) and randomly assigned to 1 of 2 arms, receiving educational materials and additional self-management support calls, respectively. Substudy participants were recruited from both arms after study completion. Participants (N = 50; 62% Spanish speaking) were interviewed by phone using a semistructured guide and were asked to define QoL and share ways that T2D, treatment, self-management, and study participation influenced their QoL. Interviews were analyzed using thematic analysis. RESULTS QoL was described as a multidimensional health-related construct with detracting and enhancing factors related to T2D. Detracting factors included financial strain, symptom progression and burden, perceived necessity to change cultural and lifestyle traditions, and dietary and medical limitations. Enhancing factors included social support, diabetes education, health behavior change, sociocultural connection. CONCLUSION QoL for diverse and socioeconomically disadvantaged adults with T2D is multifaceted and includes aspects of health, independence, social support, culture, and lifestyle, which may not be captured by existing QoL measures. Findings may inform the development of a novel QoL measure for T2D.
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Affiliation(s)
- Sarah R Fishman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Maria A Fernandez Galvis
- New York City Department of Health & Mental Hygiene, Queens, New York, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Jill Linnell
- New York City Department of Health & Mental Hygiene, Queens, New York, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Pia Iribarren
- New York City Department of Health & Mental Hygiene, Queens, New York, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Victoria H Jonas
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Jennifer M Gittleman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Molly Tanenbaum
- Stanford University School of Medicine, Stanford, California, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Maya Scherer
- New York Academy of Medicine, New York, New York, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Linda Weiss
- New York Academy of Medicine, New York, New York, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Elizabeth A Walker
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Gladys Crespo-Ramos
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Claire J Hoogendoorn
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, Miller School of Medicine, University of Miami Health System, Miami, Florida.,Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Hang Pham-Singer
- New York City Department of Health & Mental Hygiene, Queens, New York, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Winfred Y Wu
- New York City Department of Health & Mental Hygiene, Queens, New York, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, Miller School of Medicine, University of Miami Health System, Miami, Florida.,Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, Miller School of Medicine, University of Miami Health System, Miami, Florida
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26
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Grau-Del Valle C, Marco-Expósito JF, Bosch-Sierra N, Zaragoza-Villena B, Solá E, Montoya-Castilla I, Morillas C, Bañuls C. Effect of perceived stress, concern about hypoglycaemia and level of knowledge of management of the disease on glycaemic control in type 1 diabetes mellitus. J Clin Nurs 2023; 32:264-272. [PMID: 35224806 DOI: 10.1111/jocn.16270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/10/2021] [Accepted: 01/10/2022] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES To evaluate perceived stress, concern about hypoglycaemia and the level of knowledge of management of the disease in patients with type 1 diabetes mellitus and their relationship with glycaemic control, gender and age. BACKGROUND Perceived stress and concern about hypoglycaemia are significant obstacles to achieving adequate glycaemic control in patients with type 1 diabetes mellitus, and notably influence management of the disease itself. MATERIAL AND METHODS A cross-sectional study was carried out in 193 adult patients with type 1 diabetes mellitus. Study quality was scored using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cohort studies. Glycaemic control was evaluated by number and type of hypoglycaemic event and glycosylated haemoglobin. Questionnaires about hypoglycaemia concern (HFS II), perceived stress (PSS), unrecognised hypoglycaemia (Clarke Test) and level of knowledge of the disease were completed. RESULTS Perceived stress was significantly associated with glycosylated haemoglobin (p < 0.001) and concern about hypoglycaemia (p < 0.037). With respect to level of knowledge, we observed that an advanced level was associated with lower glycosylated haemoglobin (p < 0.001), number (p < 0.001) and type (p < 0.001) of hypoglycaemic episode, and less perceived stress (p = 0.006). In addition, age was negatively correlated with perceived stress (p < 0.030) and positively correlated with the number of unrecognised hypoglycaemic episodes (p < 0.002), which was associated, in turn, with a higher number of daily glycaemia tests (p < 0.037) and concern about hypoglycaemia (p < 0.006). CONCLUSION In type 1 diabetes mellitus, perceived stress can negatively influence glycaemic control and concern about hypoglycaemia, and level of knowledge about the condition has a bearing on glycosylated haemoglobin levels, perceived stress and number and type of hypoglycaemic events. In addition, higher age is associated with more frequent unrecognised hypoglycaemic events. RELEVANCE TO CLINICAL PRACTICE It is essential to identify and address the psychological needs of patients with type 1 diabetes mellitus with the aim of achieving an adequate management of the disease itself and generating a change in future intervention strategies.
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Affiliation(s)
- Carmen Grau-Del Valle
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - José Francisco Marco-Expósito
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - Neus Bosch-Sierra
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - Begoña Zaragoza-Villena
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - Eva Solá
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain.,Departament of Medicine, University of Valencia, Valencia, Spain
| | | | - Carlos Morillas
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain.,Departament of Medicine, University of Valencia, Valencia, Spain
| | - Celia Bañuls
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
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27
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Ferrey A, Ashworth G, Cabling M, Rundblad G, Ismail K. A thematic analysis of YouTube comments on a television documentary titled 'Diabulimia: The World's most dangerous eating disorder'. Diabet Med 2022; 40:e15025. [PMID: 36508358 DOI: 10.1111/dme.15025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
AIM Omitting insulin for fear of weight gain is a type of disordered eating (also labelled as diabulimia) common in type 1 diabetes (T1D) and is associated with a worse biomedical prognosis but is not a formally recognised condition. This research explored the public's opinion of diabulimia as a condition as presented in a television documentary. METHODS We conducted a coding reliability thematic analysis using NVivo software of the original comments to a YouTube documentary 'Diabulimia: The World's Most Dangerous Eating Disorder' between 24 September 2017 and 16 June 2020. RESULTS Of 1424 original comments, 1264 were eligible and uploaded into NVivo 12. The commenters were people with T1D, family and friends, health care professionals, and the wider public who collectively had questions, personal stories and/or opinions. Three main themes were discerned: lack of awareness of diabulimia as a condition; the importance of support; diabulimia as a psychiatric condition in the diabetes setting. CONCLUSION This analysis of social media comments found that there is a lack of awareness of diabulimia amongst patients, their families and friends, and healthcare professionals and that there were many commenters who had the experience of disordered eating with T1D. This study has reported on themes that suggest there may be an eating disorder specifically in people with T1D and that further work is needed to understand the diagnostic criteria for diabulimia in order to develop effective treatments.
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Affiliation(s)
- Amy Ferrey
- James Paget University Hospital, Great Yarmouth, United Kingdom
| | - Georgia Ashworth
- Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mark Cabling
- School of Education, Communication & Society, King's College London, London, United Kingdom
| | | | - Khalida Ismail
- Weston Education Centre, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
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28
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Kurza D, Kobos E. Diabetes distress in adult patients with type 1 and type 2 diabetes. MEDICAL SCIENCE PULSE 2022. [DOI: 10.5604/01.3001.0016.1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Diabetes is a chronic and demanding condition, exposing patients to complex physical and mental challenges, and making them particularly vulnerable to distress. Diabetes distress related to disease in diabetic patients is a term encompassing challenges associated with the psychosocial adaptation required of these individuals. Aim of the study: To assess distress in patients with diabetes mellitus. Material and methods: This study was conducted among 107 patients with type 1 and 2 diabetes mellitus reporting for follow-up at a diabetes clinic. The Diabetes Distress Scale (DDS) was used for data collection. Results: Moderate and severe diabetes distress was found in 36.4% and 15% of respondents in the study group, respectively. The total mean score for the DDS was 2.19. The largest percentages of respondents with high levels of distress were observed in patients with a financial situation rated lower than good (30.6%), those having less than secondary education (28.0%), and those under 30 years of age (27.8%). Patients with type 1 diabetes (26.9%), a disease duration > 30 years (30.8%), those using insulin pump therapy (30%) or CGM (Continuous Glucose Monitoring) and FGM (Flash Glucose Monitoring) systems (50%), and those showing ≥ 3 chronic diabetic complications (37.5%) experienced severe distress. Conclusions: Overall, diabetic patients showed a moderate level of distress. The greatest inconveniences caused by the disorder were associated with regimen-related distress and emotional burden. Rural patients with a lower level of education and a lower financial status showed higher levels of distress. Patients experiencing chronic complications from diabetes and those with higher levels of glycated hemoglobin also presented with more severe distress.
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Affiliation(s)
- Dominika Kurza
- Department of Development of Nursing, Social and Medical Sciences, Faculty of Health Sciences, Medical University of Warsaw, Poland
| | - Ewa Kobos
- Department of Development of Nursing, Social and Medical Sciences, Faculty of Health Sciences, Medical University of Warsaw, Poland
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29
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Hapunda G. Coping strategies and their association with diabetes specific distress, depression and diabetes self-care among people living with diabetes in Zambia. BMC Endocr Disord 2022; 22:215. [PMID: 36031626 PMCID: PMC9420272 DOI: 10.1186/s12902-022-01131-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 08/16/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Utilising coping strategies to reduce and manage the intensity of negative and distressing emotions caused by diabetes is essential. However, little is known about the use of coping strategies among people living with diabetes in Sub-Saharan African countries like Zambia. This study investigates coping strategies used by people with diabetes in Zambia and how these are associated with diabetes-specific emotional distress, depression and diabetes self-care. METHODS Cross-sectional data from 157 people with diabetes aged between 12 and 68 years were collected. Of the 157, 59% were people with type 1 diabetes and 37% with type 2 diabetes. About 4% had missing information in their record but had either type 1 or type 2 diabetes. Coping styles were measured using the Brief Version of the Coping Orientation to Problems Experienced (Brief COPE), diabetes specific-distress using the Problem Areas in Diabetes, depression using the Major Depression Inventory and self-care using the Diabetes Self-Care scale. RESULTS Data showed that adaptive coping strategies such as religious coping, acceptance among others, were the most frequently used coping strategies among Zambian individuals with diabetes. Maladaptive coping strategies e.g., self-blame and self-distraction were related to increased diabetes specific-distress and depression. Emotional support was related to better diabetes self-care, while self-blame was related to poor diabetes self-care. CONCLUSION There is need to help individuals with diabetes identify adaptive strategies that work best for them in order to improve their quality of life.
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Affiliation(s)
- Given Hapunda
- Department of Psychology, School of Humanities and Social Sciences, University of Zambia, P.O Box 32379, Lusaka, Zambia.
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30
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Martyn-Nemeth P, Duffecy J, Quinn L, Reutrakul S, Steffen AD, Burke L, Clark Withington MH, Irsheed GA, Perez R, Park M, Saleh A, Mihailescu D, Baron KG. Sleep optimization to improve glycemic control in adults with type 1 diabetes: study protocol for a randomized controlled parallel intervention trial. Trials 2022; 23:686. [PMID: 35986415 PMCID: PMC9389486 DOI: 10.1186/s13063-022-06565-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/18/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Despite improvements in treatment regimens and technology, less than 20% of adults with type 1 diabetes (T1D) achieve glycemic targets. Sleep is increasingly recognized as a potentially modifiable target for improving glycemic control. Diabetes distress, poor self-management behaviors, and reduced quality of life have also been linked to sleep variability and insufficient sleep duration. A significant gap of knowledge exists regarding interventions to improve sleep and the effects of sleep optimization on glycemic control in T1D. The purpose of this study is to determine the efficacy of a T1D-specific sleep optimization intervention (Sleep-Opt) on the primary outcomes of sleep variability, sleep duration, and glycemic control (A1C); other glycemic parameters (glycemic variability, time-in-range [TIR]); diabetes distress; self-management behaviors; quality of life; and other patient-reported outcomes in adults with T1D and habitual increased sleep variability or short sleep duration. METHODS A randomized controlled parallel-arm study will be employed in 120 adults (aged 18 to 65 years) with T1D. Participants will be screened for habitual sleep variability (> 1 h/week) or insufficient sleep duration (< 6.5 h per night). Eligible subjects will be randomized to the Sleep-Opt intervention group or healthy living attention control group for 12 weeks. A 1-week run-in period is planned, with baseline measures of sleep by actigraphy (sleep variability and duration), glycemia (A1C and related glycemic measures: glycemic variability and TIR using continuous glucose monitoring), and other secondary outcomes: diabetes distress, self-management behaviors, quality of life, and additional patient-reported outcomes. Sleep-Opt is a technology-assisted behavioral sleep intervention that we recently developed that leverages the rapidly increasing public interest in sleep tracking. Our behavioral intervention employs four elements: a wearable sleep tracker, didactic content, an interactive smartphone application, and brief telephone counseling. The attention control group will participate in a healthy living information program. Baseline measures will be repeated at midpoint, program completion, and post-program (weeks 6, 12, and 24, respectively) to determine differences between the two groups and sustainability of the intervention. DISCUSSION A better understanding of strategies to improve sleep in persons with T1D has the potential to be an important component of diabetes. TRIAL REGISTRATION Clinical Trial Registration: NCT04506151 .
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Affiliation(s)
- Pamela Martyn-Nemeth
- grid.185648.60000 0001 2175 0319Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Jennifer Duffecy
- grid.185648.60000 0001 2175 0319Department of Psychiatry, College of Medicine, University of Illinois Chicago, Chicago, IL USA
| | - Laurie Quinn
- grid.185648.60000 0001 2175 0319Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Sirimon Reutrakul
- grid.185648.60000 0001 2175 0319Department of Endocrinology, College of Medicine, University of Illinois Chicago, Chicago, IL USA
| | - Alana D. Steffen
- grid.185648.60000 0001 2175 0319Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Larisa Burke
- grid.185648.60000 0001 2175 0319Office of Research Facilitation, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Margaret H. Clark Withington
- grid.185648.60000 0001 2175 0319Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Ghada Abu Irsheed
- grid.185648.60000 0001 2175 0319Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Rose Perez
- grid.185648.60000 0001 2175 0319Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Minsun Park
- grid.185648.60000 0001 2175 0319Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Adam Saleh
- grid.185648.60000 0001 2175 0319Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL USA
| | - Dan Mihailescu
- Department of Endocrinology, Cook County Health, Chicago, IL USA
| | - Kelly Glazer Baron
- grid.223827.e0000 0001 2193 0096Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT USA
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Rikos N, Mpalaskas A, Fragiadaki M, Frantzeskaki C, Kassotaki A, Linardakis M. Quality of Life and Psychological Burden of Parents of Children, Adolescents, and Young Adults with Type 1 Diabetes: A Cross-Sectional Study during the Lockdown Period of COVID-19. NURSING REPORTS 2022; 12:564-573. [PMID: 35997463 PMCID: PMC9397070 DOI: 10.3390/nursrep12030055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 01/09/2023] Open
Abstract
The current study aimed to investigate how parents of children, adolescents, and young adults with DM1 perceived quality of life and psychological burden during the lockdown period of COVID-19. A cross-sectional study was carried out on 110 parents in Greece in spring 2021. Perceived quality of life was measured using the Parent Diabetes Distress Scale, and psychological burden was measured using the Spielberger State/Trait Anxiety Inventory, and both were assessed with correlational analysis. Overall, 79.1% of the parents were females ,while the mean age of all was 44.4 years (±5.8). PDDS was found to be moderate (mean 2.42 ± 0.76): 63.6% of respondents had moderate/high distress. The highest mean score was for Teen Management Distress and the lowest for Healthcare Team (3.02 vs. 1.49, p < 0.001). STAI was found to be moderate to high, with a higher mean score for state versus trait anxiety (49.8 vs. 48.0, p = 0.006). Increased distress or poorer parents’ quality of life was related with the highest number of hyperglycemic episodes (β = 0.25, p = 0.002), the fewest hypoglycemic episodes (β = −0.18, p = 0.024), and the highest parental trait anxiety (β = 0.04, p < 0.001). Parents were found with moderate-to-high distress and anxiety, and their correlation also shows that there is an urgent need for suitable education of parents on managing the disease to improve quality of life and eliminate health risks to all involved.
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Affiliation(s)
- Nikolaos Rikos
- School of Health Science, Department of Nursing, Hellenic Mediterranean University, Heraklion 71410, Greece
| | - Andreas Mpalaskas
- School of Health Science, Department of Nursing, Hellenic Mediterranean University, Heraklion 71410, Greece
| | - Maria Fragiadaki
- School of Health Science, Department of Nursing, Hellenic Mediterranean University, Heraklion 71410, Greece
| | - Chara Frantzeskaki
- School of Health Science, Department of Nursing, Hellenic Mediterranean University, Heraklion 71410, Greece
| | - Anna Kassotaki
- School of Health Science, Department of Nursing, Hellenic Mediterranean University, Heraklion 71410, Greece
| | - Manolis Linardakis
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion 70013, Greece
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Zara S, Kruse J, Leveling AM, Schmitz J, Hempler I, Kampling H. Capturing Diabetes-Related Distress and Burden From the Perspective of Patients With Type 1 or Type 2 Diabetes: Protocol for an Explorative Mixed Methods Study. JMIR Res Protoc 2022; 11:e38477. [PMID: 35916703 PMCID: PMC9379798 DOI: 10.2196/38477] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diabetes is one of the most common diseases worldwide and is associated with increased morbidity, mortality, and reduced quality of life. Many patients experience high diabetes-related distress as well as depression and anxiety symptoms, which are associated with poor diabetes self-management. As disease management is a central component in diabetes treatment, poor management enhances the occurrence of micro- and macrovascular complications. This emphasizes the relevance of reducing diabetes-related distress and providing adequate treatment options addressing the individual psychosocial burden of patients with diabetes. Since patients' perspectives diverge significantly from those of practitioners in terms of relevant treatment aspects, the patient perspective on, for example, barriers to and facilitators of diabetes treatment is crucial for adequate and effective treatment as well as improvements to self-management and therefore, needs to be further explored. OBJECTIVE This study aims to examine diabetes-related distress, the course of distress throughout diabetes management, as well as barriers and facilitating factors in dealing with diabetes from the individual perspective of patients with type 1 and type 2 diabetes. METHODS The study employs a mixed methods design combining qualitative and quantitative data. Semistructured interviews (N=40) will be conducted with patients with type 1 diabetes (n=20) and patients with type 2 diabetes (n=20). The primary outcomes comprise (1) diabetes-related distress, (2) the severity of distress, (3) the course of distress throughout diabetes management, (4) barriers, and (5) facilitating factors. Questionnaires will provide data on the following secondary outcomes: diabetes-related emotional distress (the Problem Areas in Diabetes scale), symptoms of depression and anxiety (Patient Health Questionnaire, German version), personality functioning (Operationalized Psychodynamic Diagnosis-Structure Questionnaire), mentalizing capacities (Mentalization Questionnaire), epistemic trust (Epistemic Trust, Mistrust and Credulity Questionnaire) and experiences of child maltreatment (Childhood Trauma Questionnaire), and the overall health status of the patient (routine medical data). RESULTS As of April 2022, the conceptualization phase of the study was finalized. Ethics approval was received in January 2022 from the local ethics committee of the Justus Liebig University Giessen - Faculty of Medicine (AZ 161/21). CONCLUSIONS This study will provide insights into the individual perspective of patients with type 1 and type 2 diabetes regarding their experiences with diabetes management and what they perceive to be relevant, obstructive, or beneficial. The insights gained could help further tailor diabetes treatment to the individual needs of patients with diabetes and therefore optimize diabetes self-management. TRIAL REGISTRATION German Clinical Trial Register DRKS00024999; https://tinyurl.com/2wb4xdh8. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/38477.
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Affiliation(s)
- Sandra Zara
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany.,Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
| | - Anna Maria Leveling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Jana Schmitz
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Isabelle Hempler
- Institute of General Practice / Family Medicine, Medical Center - University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
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Masharani U, Strycker LA, Fisher L. The ubiquity of diabetes distress among adults with type 1 diabetes in an urban, academic practice: A template for intervention. Diabet Med 2022; 39:e14832. [PMID: 35322466 DOI: 10.1111/dme.14832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study was to assess the patterns of diabetes distress within an urban, technology-oriented academic clinical practice to inform staff training and intervention. METHODS Adults with type 1 diabetes completed the Type 1 Diabetes Distress Scale at their regular clinic visit. Descriptive statistics were generated to document the prevalence of diabetes distress overall, and from seven primary sources of distress: powerlessness, disease management, hypoglycaemia, negative social perceptions, eating, physician and family/friends. Additional analyses explored relations between diabetes distress, demographic characteristics and disease status. RESULTS The prevalence of elevated diabetes distress was 30% overall, with 88% of the sample reporting elevated distress from at least one primary source. Women reported more elevated distress overall, and from the primary sources. There was an inverse relationship between diabetes duration with total diabetes distress (r = -0.19) and with the powerlessness subscale (r = -0.28). Also, those without micro- and/or macrovascular complications more frequently reported elevated distress from powerlessness (85%) compared to those having complications (61%). Use of technology (continuous glucose monitoring, insulin pumps) was not significantly related to diabetes distress. Diabetes distress was positively correlated with HbA1c. About 22% of individuals with HbA1c <53 mmol/mol (<7%) had elevated total distress. About a third of the sample (34%-39%) reported elevated distress from powerlessness, hypoglycaemia, negative social perceptions, eating, or family/friends. CONCLUSIONS It is critical to understand clinic-specific patterns of diabetes distress in order to customise staff training and intervention programmes, and thereby reduce distress among unique populations of adults with type 1 diabetes in different settings.
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Affiliation(s)
- Umesh Masharani
- Department of Medicine, University of California, San Francisco, California, USA
| | | | - Lawrence Fisher
- Department of Family Medicine, University of California, San Francisco, California, USA
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Abdoli S, Odoi E, Doosti-Irani M, Fanti P, Beebe LH. Regional Comparison of Diabetes Psychosocial Comorbidities Among Americans With Type 1 Diabetes During the COVID-19 Pandemic. Sci Diabetes Self Manag Care 2022; 48:213-234. [PMID: 35642136 DOI: 10.1177/26350106221102863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to compare diabetes psychosocial comorbidities among adults with type 1 diabetes (T1D) across the United States during the onset of COVID-19 pandemic. METHODS Adults with T1D from 4 main US geographic regions including South (n = 367), West (n = 234), Northeast (n = 250), and Midwest (n = 247) completed a cross-sectional online survey between April and June 2020. Data collection was done on psychosocial measures, glycemic variability, sociodemographic characteristics, and various challenges related to the COVID-19 pandemic. Chi-square, Fisher's exact, Kruskal-Wallis tests, ordinary least squares, proportional odds, and ordinal logistic regression methods were used for data analysis. RESULTS In the South, 51.2% of participants had moderate to high levels of diabetes distress, and this was significantly (P = .03) higher than other regions. Northeast region had the lowest prevalence of moderate to severe diabetes burnout (19.8%), but this was not significantly different compared to the other regions. Participants in the South had also the highest mean score on the 8-item Patient Health Questionnaire, with 30.3% of them reporting moderate to severe depressive symptoms. However, there were no significant differences in depressive symptoms among the regions. Glycemic control, demographic characteristics, and COVID-19-related challenges were associated with different psychosocial comorbidities in different regions. CONCLUSIONS When providing information and support to individuals with diabetes in time of crisis like the COVID pandemic, providers should consider psychosocial aspects of diabetes care. Diabetes disparities and contextual factors vary geographically in the United States; these factors may impact the psychosocial comorbidities of diabetes in each region.
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Affiliation(s)
- Samereh Abdoli
- College of Nursing, University of Tennessee, Knoxville, Tennesse
| | - Evah Odoi
- Department of Public Health, The University of Tennessee, Knoxville, Tennessee
| | - Mehri Doosti-Irani
- Shehr-e-Kourd University of Medical Sciences, Shahre-e-Kourd, Chahar Mahaal and Bakhtia, Iran
| | - Paulo Fanti
- Faculty of Medical Sciences - University of Campinas, Campinas, São Paulo, Brazil
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Déniz-García A, Díaz-Artiles A, Saavedra P, Alvarado-Martel D, Wägner AM, Boronat M. Impact of anxiety, depression and disease-related distress on long-term glycaemic variability among subjects with Type 1 diabetes mellitus. BMC Endocr Disord 2022; 22:122. [PMID: 35546667 PMCID: PMC9092877 DOI: 10.1186/s12902-022-01013-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety, depression, and disease-related distress are linked to worse overall glycaemic control, in terms of HbA1c. This study was aimed to evaluate whether traits of these emotional disorders are associated with long-term glycaemic variability in subjects with Type 1 diabetes. METHODS Longitudinal retrospective study. Six-year HbA1c data (2014-2019) from 411 subjects with Type 1 diabetes who had participated in a previous study to design a diabetes-specific quality of life questionnaire in the year 2014 were included. Scores for Spanish versions of the Hospital Anxiety and Depression Scale (HADS) and Problem Areas in Diabetes (PAID) scale were obtained at baseline, along with sociodemographic and clinical data. Long-term glycaemic variability was measured as the coefficient of variation of HbA1c (HbA1c-CV). The association between HADS and PAID scores and HbA1c-CV was analysed with Spearman correlations and multiple regression models, both linear and additive, including other covariates (age, sex, diabetes duration time, type of treatment, baseline HbA1c, use of anxiolytic or antidepressant drugs, education level and employment status). RESULTS Scores of depression, anxiety and distress were positively and significantly correlated to HbA1c-CV in univariate analyses. Multiple regression study demonstrated an independent association only for diabetes distress score (p < 0.001). Age, diabetes duration time, baseline HbA1c, education level and employment status were also significantly associated with HbA1c-CV. However, when subjects were analyzed separately in two age groups, distress scores were associated with HbA1c-CV only among those aged 25 years or older, while anxiety scores, but not distress, were associated with HbA1c-CV among those younger than 25 years. CONCLUSIONS Psychological factors, particularly disease-related distress and anxiety, are associated with long-term glycaemic variability in subjects with Type 1 diabetes.
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Affiliation(s)
- Alejandro Déniz-García
- Section of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular Materno-Infantil, Avenida Marítima del Sur, s/n. 35016, Las Palmas de Gran Canaria, Spain
- Institute of Biomedical and Health Research, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Alba Díaz-Artiles
- Section of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular Materno-Infantil, Avenida Marítima del Sur, s/n. 35016, Las Palmas de Gran Canaria, Spain
| | - Pedro Saavedra
- Mathematics Department, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Dácil Alvarado-Martel
- Institute of Biomedical and Health Research, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Ana M Wägner
- Section of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular Materno-Infantil, Avenida Marítima del Sur, s/n. 35016, Las Palmas de Gran Canaria, Spain
- Institute of Biomedical and Health Research, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Mauro Boronat
- Section of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular Materno-Infantil, Avenida Marítima del Sur, s/n. 35016, Las Palmas de Gran Canaria, Spain.
- Institute of Biomedical and Health Research, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
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Loseby P, Schache K, Cavadino A, Young S, Hofman PL, Serlachius A. The role of protective psychological factors, self-care behaviors, and HbA1c in young adults with type 1 diabetes. Pediatr Diabetes 2022; 23:380-389. [PMID: 34967089 DOI: 10.1111/pedi.13306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate whether protective psychological factors in young adults with type 1 diabetes are associated with more optimal self-care behaviors and HbA1c, and to explore possible mediators between protective psychological factors and HbA1c. RESEARCH DESIGN AND METHODS This cross-sectional study examined the associations between protective psychological factors (optimism, positive efficacy expectancies, and self-compassion), maladaptive psychological factors (depression, anxiety, and stress), self-care behaviors, and HbA1c in 113 young adults (17-25 years) with type 1 diabetes in Auckland, New Zealand. Pearson's correlations, multiple linear regressions, and multiple mediation analyses were used to examine associations and mediators. RESULTS Higher positive efficacy expectancies (beliefs about coping with difficulties) were associated with more optimal HbA1c (β = -0.26, 95% CI: -1.99 to -0.45) and more optimal self-care behaviors (β = 0.33, 95% CI: 0.28 to 0.92) in the adjusted models. Higher levels of self-compassion were associated with more optimal self-care behaviors (β = 0.27, 95% CI: 0.09 to 0.43). Depression was associated with less optimal self-care behaviors (β = -0.35, 95% CI: -1.33 to -0.43) and stress was associated with less optimal HbA1c (β = 0.26, 95% CI: 0.27 to 1.21). Mediation results suggested that self-care behaviors mediated the relationship between all three of the protective psychological factors and more optimal HbA1c, and that lower stress also mediated the relationship between higher self-compassion and more optimal HbA1c. CONCLUSIONS This study adds to the emerging literature that protective psychological factors may play an adaptive role in improving health outcomes in young adults with type 1 diabetes. Interventions targeting protective psychological factors present a promising approach to optimizing wellbeing and self-care in youth with type 1 diabetes.
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Affiliation(s)
- Philippa Loseby
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Kiralee Schache
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand.,Psychological Medicine, Counties Manukau Health, Auckland, New Zealand
| | - Alana Cavadino
- Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Simon Young
- North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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Savel C, Fayet F, Abdi D, Marty L, Soubrier M, Malochet-Guinamand S. Results from a preliminary study on the theme of sexuality for therapeutic patient education for people with inflammatory arthritis. SEXOLOGIES 2022. [DOI: 10.1016/j.sexol.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Silveira MSVM, Pavin EJ, Cardoso EB, Fanti P, Abdoli S. Emotional burden and care of adults with type 1 diabetes during the COVID-19 pandemic in Brazilian regions. J Diabetes Complications 2021; 35:108053. [PMID: 34620557 PMCID: PMC8597042 DOI: 10.1016/j.jdiacomp.2021.108053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 09/10/2021] [Accepted: 09/23/2021] [Indexed: 11/27/2022]
Abstract
AIMS This study investigated the emotional burden in persons with type 1 diabetes (PWT1D) during the COVID-19 pandemic in Brazilian regions and evaluated which COVID-19, sociodemographic/clinical characteristics are related to it. METHODS In a cross-sectional study, T1D adults completed a web-based survey from May to July 2020. We collected sociodemographic/clinical data, and participants answered COVID-19 related questions. Diabetes burnout was evaluated by Diabetes burnout scale. Type 1 Diabetes scale assessed Diabetes Distress and PHQ-8 measured depressive symptoms. RESULTS DD and DS levels were similar in all Brazilian regions. DB was higher in Central-West/North/Northeast. Higher DB was associated with females, lower-income, higher HbA1c, and shorter time since T1D diagnosis. Predictors of experiencing higher levels of DD included: difficulty access to safe places to exercise, participants without a partner, male gender, young age, and higher HbA1c. Higher depressive symptoms were associated with difficulty to access diabetes supplies, and higher HbA1c (p < 0.05). CONCLUSIONS The mean levels of DB, DD, and DS were high in all Brazilian regions. A great number of PWT1D had their diabetes care impaired and relied on family as their main support during the pandemic. The subgroups identified at risk should be prioritized in mental health support.
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Affiliation(s)
- Mônica S V M Silveira
- Faculty of Medical Sciences- University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil.
| | - Elizabeth João Pavin
- Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences- University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil.
| | - Edimariz Buin Cardoso
- Faculty of Medical Sciences- University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil
| | - Paulo Fanti
- Faculty of Medical Sciences- University of Campinas, Rua Tessália Vieira de Camargo, 126, Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil.
| | - Samereh Abdoli
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd Rm 155, Knoxville, TN, USA.
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Martin-Delgado J, Guilabert M, Mira-Solves J. Patient-Reported Experience and Outcome Measures in People Living with Diabetes: A Scoping Review of Instruments. THE PATIENT 2021; 14:759-773. [PMID: 34043215 PMCID: PMC8563512 DOI: 10.1007/s40271-021-00526-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 11/25/2022]
Abstract
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."
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Affiliation(s)
- Jimmy Martin-Delgado
- Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, Health District Alicante-Sant Joan, Carretera Nacional 332, Av. de Benidorm, Sant Joan d´Alacant, 03550, Alicante, Spain.
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK.
- Department of Public Health, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.
| | - Mercedes Guilabert
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
| | - José Mira-Solves
- Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, Health District Alicante-Sant Joan, Carretera Nacional 332, Av. de Benidorm, Sant Joan d´Alacant, 03550, Alicante, Spain
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Alicante, Spain
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Uygun SD, Şakar M, Erdeve ŞS, Çetinkaya S. Effects of subclinical emotional and behavioral problems on metabolic control in adolescents with type 1 diabetes: Role of maternal and adolescent personality traits. Arch Pediatr 2021; 28:626-631. [PMID: 34690026 DOI: 10.1016/j.arcped.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/08/2021] [Accepted: 10/03/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Personality traits of adolescents with type 1 diabetes mellitus (T1DM) and those of their mothers may lead to poor glycemic control through psychiatric comorbidity. However, it is not yet known how the personality traits of adolescents with T1DM and those of their mothers affect metabolic control in the absence of or before the development of psychiatric disorders. We aimed to determine the effects of subclinical emotional and behavioral problems, as well as maternal and own personality traits, on metabolic control in adolescents with T1DM. METHODS A total of 48 adolescents with diabetes (19 females and 29 males), with a median age of 14 years, who did not meet diagnostic criteria for a psychiatric condition, and their mothers completed the Junior Temperament and Character Inventory (J-TCI) as well as the adolescent and parent forms of the Strengths and Difficulties Questionnaire (SDQ) and the TCI for adults. The mean HbA1c levels measured in the past year were obtained from medical records. RESULTS Personality traits and the emotional and behavioral difficulties in adolescents with poor metabolic control were similar to those with good metabolic control (p>.05). However, the self-directedness and cooperativeness subscale scores of the TCI completed by the mothers of those in the poor metabolic control group were significantly lower than the others: 25.5 vs. 30.4; t(39)= 3.737, p= .001, and 27.3 vs. 31.5; t(46)= 2.759, p= .008; respectively. CONCLUSION Our study showed that adolescents' personality and subclinical symptoms were not related to HbA1c levels in the absence of psychiatric comorbidity, while some maternal personality traits were associated with metabolic control. Management of T1DM should be tailored to adolescents and their needs with the proper involvement of mothers.
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Affiliation(s)
- Sabide Duygu Uygun
- Department of Child and Adolescent Psychiatry, Ankara University School of Medicine, Ankara, Turkey.
| | - Merve Şakar
- Department of Pediatric Endocrinology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Şenay Savaş Erdeve
- Department of Pediatric Endocrinology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Semra Çetinkaya
- Department of Pediatric Endocrinology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
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Wisting L, Haugvik S, Wennersberg AL, Hage TW, Stice E, Olmsted MP, Ghaderi A, Brunborg C, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. Feasibility of a virtually delivered eating disorder prevention program for young females with type 1 diabetes. Int J Eat Disord 2021; 54:1696-1706. [PMID: 34245038 DOI: 10.1002/eat.23578] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study aimed to develop a virtual diabetes-specific version of the eating disorder (ED) prevention program the Body Project, and to assess feasibility and preliminary efficacy of this program for young females with type 1 diabetes. METHOD Young females with type 1 diabetes aged 16-35 years were invited to participate in the study. A total of 35 participants were allocated to five Diabetes Body Project groups (six meetings over 6 weeks) and completed pretest assessments; 26 participants completed all sessions and posttest assessments (<7 days after last meeting). Primary measures included ED risk factors and symptoms, and secondary outcomes included diabetes-specific constructs previously found to be associated with ED psychopathology (e.g., diabetes distress and illness perceptions). RESULTS The ease of recruitment, timely conduct of five groups, moderate drop-out rate and appreciation of the intervention by participants indicated that the Diabetes Body Project is feasible. Meaningful reductions occurred on the primary outcomes (i.e., ED psychopathology, body dissatisfaction, and thin ideal internalization) and on internalization of appearance ideals and appearance pressures at posttest (Cohen's d ranging from .63 to .83, which are medium to large effects). Small to medium effect sizes were found for diabetes illness perceptions and distress (.41 and .48, respectively). DISCUSSION The virtual Diabetes Body Project is a promising and much-needed intervention, worthy of more rigorous evaluation. A randomized controlled trial is warranted to determine its effectiveness compared with a control condition.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Oslo Diabetes Research Centre, Oslo, Norway
| | - Severina Haugvik
- Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,The Norwegian Diabetes Centre, Oslo, Norway
| | - Anne Louise Wennersberg
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Trine Wiig Hage
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Eric Stice
- Department of Psychiatry and Behavioral Science, Stanford University, Stanford, California, USA
| | - Marion P Olmsted
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Cathrine Brunborg
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, Oslo, Norway.,Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,The Norwegian Diabetes Centre, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Knut Dahl-Jørgensen
- Oslo Diabetes Research Centre, Oslo, Norway.,Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,The Norwegian Diabetes Centre, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Mental Health and Addiction, University of Oslo, Oslo, Norway
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Papadakis JL, Shapiro JB, Evans M, Feldman MA, Weil LEG, Vesco AT, Thompson LG, Garza K, Weissberg-Benchell J. Psychometric properties of the diabetes skills checklist for adolescents with type 1 diabetes and their parents. Pediatr Diabetes 2021; 22:924-932. [PMID: 34173308 DOI: 10.1111/pedi.13241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/14/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Among adolescents with type 1 diabetes, research has found that their perception of their diabetes management is an important predictor of actual diabetes management. There is a need for measures that assess adolescents' perception of their ability to independently complete daily diabetes self-care tasks. The current study examined the psychometric properties of the Diabetes Skills Checklist Teen-Report (DSC-T) and DSC Parent of Teen-Report (DSC-PT), which assess perceived independence in diabetes self-care skills. RESEARCH DESIGN AND METHODS Data were from 1450 adolescents aged 12 to 18 years and their parents who participated in the Diabetes Camp Matters Study. Families completed the DSC as well as other questionnaires online assessing demographic and diabetes-related information, diabetes strengths, and diabetes-specific emotional distress. RESULTS Exploratory factor analysis revealed a 14-item DSC-T and 12-item DSC-PT, both with excellent internal consistency and concurrent validity. Both the DSC-T and DSC-PT were found to be positively correlated with diabetes strengths and negatively correlated with HbA1c, and the DSC-PT was significantly correlated with parent-reported diabetes distress. Adolescents who used insulin pumps and continuous glucose monitoring reported higher perceived independence in diabetes self-care skills compared to adolescents who used insulin pens/syringes or blood glucose meters. No differences were found based on demographic characteristics. CONCLUSIONS The DSC-T and DSC-PT have strong potential to be used during diabetes clinic visits to spark discussion regarding adolescents' self-care, which would allow for a more successful transfer of diabetes care from parent to adolescent, and eventually, the transition from pediatric to adult healthcare.
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Affiliation(s)
- Jaclyn Lennon Papadakis
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jenna B Shapiro
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Meredyth Evans
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Marissa A Feldman
- Child Development and Rehabilitation Center, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
| | - Lindsey E G Weil
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anthony T Vesco
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laurie Gayes Thompson
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kimberly Garza
- Department of Anthropology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jill Weissberg-Benchell
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Blanchette JE, Toly VB, Wood JR. Financial stress in emerging adults with type 1 diabetes in the United States. Pediatr Diabetes 2021; 22:807-815. [PMID: 33887095 DOI: 10.1111/pedi.13216] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 03/11/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the relationships among financial stress factors (perceived stress, financial stress, and financial independence) and psychological factors (depressive symptoms, trait anxiety, and diabetes distress) on self-management outcomes (HbA1c and diabetes-related quality of life) in emerging adults with type 1 diabetes. RESEARCH DESIGN AND METHODS A descriptive, correlational, cross-sectional study examined 413 emerging adults, ages 18-25, from the Type 1 Diabetes Exchange Clinic Registry. Data were collected via REDCap surveys using the Personal Financial Well-Being Scale, Willingness to Pay Scale, Financial Independence Visual Analog Scale, Center for Epidemiological Studies-Depression Inventory, State-Trait Anxiety Inventory, The Type 1 Diabetes Distress Scale, and Diabetes Quality of Life Measure. Hierarchical Multiple Regression analyses explored significant barriers to self-management outcomes. RESULTS Hierarchical Multiple Regression analyses revealed that 20.6% of variance in HbA1c (F = 15.555, p < 0.001) was explained by greater financial stress (β = -0.197, p < 0.001), willingness to pay (β = -0.220, p < 0.001), disease duration (β = 0.119, p = 0.014), and diabetes distress (β = 0.181, p < 0.001); 64.5% of the variance in diabetes-related quality of life (F = 148.469, p < 0.001) was significantly explained by greater financial stress (β = -0.112, p = 0.002), diabetes distress (β = 0.512, p < 0.001), trait anxiety (β = 0.183, p = 0.001) and depressive symptoms (β = 0.162, p = 0.001). CONCLUSIONS Greater financial stress and psychological factors have detrimental impacts on self-management outcomes during emerging adulthood. Diabetes providers need to identify and address these factors in routine care and advocate for policy changes to support improved self-management outcomes.
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Affiliation(s)
- Julia E Blanchette
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Valerie B Toly
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jamie R Wood
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Division of Pediatric Endocrinology, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
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Mirahmadizadeh A, Mahizadeh H, Seif M, Sharifi MH. Factors related to psychological well-being amongst patients with type 2 diabetes. Diabetes Res Clin Pract 2021; 178:108982. [PMID: 34311021 DOI: 10.1016/j.diabres.2021.108982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/26/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The effect of diabetes on psychological well-being (PWB) is a concern for the development of medical care in diabetes management. There are few studies have simultaneously evaluated the impacts of related factors in PWB among patients with type 2 diabetes. METHOD This cross-sectional study was conducted on 183 male and 317 female patients with diabetes who had been registered in healthcare centers in Behbahan from November 2018 until April 2019. The patients' well-being status, medications, diet, and physical activity (PA) adherances were measured using validated questionnaires. RESULT The mean age of the participants was 52.18 ± 10.29 years. The total mean (SD) score of PWB was 87.40 ± 9.945. In addition, the results of univariate and multivariate analyses showed that the level of adherence to medication had a significant or close-to-significant relationship with PWB score (p < 0.001 and p = 0.082, respectively). The results of univariate and multivariate analyses also indicated that adherence to diet was significantly associated with PWB score (p < 0.001 and p < 0.001, respectively). However, there were no significant differences among PA levels regarding the PWB score (p = 0.087). The results showed that glycemic control was significantly correlated to PWB score (p < 0.001). CONCLUSION Despite the wide variety of relating factors to PWB, adherence to the diet and medication could be added to diabetic guidelines to improve glycemic management and well-being.
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Affiliation(s)
- Alireza Mirahmadizadeh
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Mozhgan Seif
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Sharifi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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45
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Wilmot EG, Close KL, Jurišić-Eržen D, Bruttomesso D, Ampudia-Blasco FJ, Bosnyak Z, Roborel de Climens A, Bigot G, Peters AL, Renard E, Berard L, Calliari LE, Seufert J. Patient-reported outcomes in adults with type 1 diabetes in global real-world clinical practice: The SAGE study. Diabetes Obes Metab 2021; 23:1892-1901. [PMID: 33914401 DOI: 10.1111/dom.14416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/14/2021] [Accepted: 04/26/2021] [Indexed: 12/22/2022]
Abstract
AIMS To conduct a secondary analysis of the SAGE study to evaluate the association between glycaemic control and patient-reported outcomes (PROs), in adults with type 1 diabetes (T1DM) across different age groups and regions. MATERIALS AND METHODS SAGE was a multinational, cross-sectional, observational study in adults with T1DM. Data were collected at a single visit, analysed according to predefined age groups (26-44, 45-64, and ≥65 years), and reported across different regions. PRO questionnaires were applied to assess hypoglycaemia fear (Hypoglycemia Fear Survey-II), diabetes-related distress (Problem Areas In Diabetes questionnaire), insulin treatment satisfaction (Insulin Treatment Satisfaction Questionnaire), and diabetes-specific quality of life (QoL; Audit of Diabetes-Dependent Quality of Life). Multivariable analysis was performed to evaluate the relationship between glycated haemoglobin (HbA1c) target achievement (<7% and individualised targets) with PRO scores. RESULTS The PRO scores showed relatively low levels of diabetes-related emotional distress and fear of hypoglycaemia, moderate to high treatment satisfaction, and low diabetes-related impact on QoL. Results were generally comparable across age groups with some regional variability. Achievement of the HbA1c <7% target was associated with less worry about hypoglycaemia, lower diabetes-related emotional distress, higher insulin treatment satisfaction, and higher QoL. Achievement of individualised HbA1c targets was associated with lower diabetes-related emotional distress and higher insulin treatment satisfaction. CONCLUSIONS Better glycaemic control was most closely associated with low emotional distress due to diabetes and high patient-reported insulin treatment satisfaction.
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Affiliation(s)
- Emma G Wilmot
- Diabetes Department, Royal Derby Hospital, Derby, UK
- University of Nottingham, Nottingham, UK
| | - Kelly L Close
- The diaTribe Foundation, San Francisco, California, USA
| | | | | | | | | | | | | | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital; INSERM Clinical Investigation Centre 1411; Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Lori Berard
- Nurse Consultant, Winnipeg, Manitoba, Canada
| | | | - Jochen Seufert
- Medical Faculty, University Hospital of Freiburg, Freiburg, Germany
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46
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Beverly EA, Osowik F. Clinically significant depressive symptoms and high diabetes distress in adults with type 1 and type 2 diabetes in Appalachian Ohio. J Osteopath Med 2021; 121:813-824. [PMID: 34265882 DOI: 10.1515/jom-2021-0091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/27/2021] [Indexed: 01/28/2023]
Abstract
CONTEXT In rural southeastern Ohio, the prevalence of diabetes is 19.9%, nearly double the national average of 10.5%. Despite the high rate of diabetes, its impact on the region is understudied; one such understudied topic is psychosocial difficulties. People with diabetes experience disproportionately higher rates of major depressive disorder (MDD), clinically significant depressive symptoms, and diabetes distress. Diabetes distress refers to the negative emotional experience of living with diabetes. It reflects an individual's worries, concerns, and fears about living a chronic and progressive disease. OBJECTIVES To assess the prevalence of diabetes distress as well as comorbid, clinically significant depressive symptoms and diabetes distress among patients in southeastern Ohio; and to assess impact of depressive symptoms and diabetes distress on A1C levels, diabetes self care behaviors, and diabetes quality of life (DQOL). METHODS In this cross sectional survey study, individuals aged 18 years and older, diagnosed with type 1 (T1D) or type 2 (T2D) diabetes, who were able to read and speak English, and living in southeastern Ohio were invited to participate. Participants completed the Diabetes Distress Scale for T2D or T1D, the Patient Health Questionnaire-9, the Self Care Inventory-Revised, and the DQOL Scale as part of the study survey. Participants completed the survey via an online questionnaire service or mailed packets. Chi square tests determined the comorbidity of clinically significant depressive symptoms and high diabetes distress levels by type of diabetes. Multiple regression models examined the relationships among clinically significant depressive symptoms, diabetes distress scores, A1C levels, self care behaviors, and DQOL scores. Statistical significance was defined as a p<0.05. RESULTS A total of 325 adults participated (mean ± standard deviation [SD] age, 41.6 ± 19.2 years; 131 (40.7%) with T1D; 194 (59.7%) with T2D; mean ± SD A1C, 7.5 ± 1.6%; mean ± SD duration, 12.4 ± 9.6 years). Of the 325 participants, 70 (21.5%) indicated clinically significant depressive symptoms, with 29 (22.3%) T1D participants and 41 (21.0%) T2D participants reporting clinically significant depressive symptoms. A total of 92 (28.3%) participants reported high diabetes distress (39 (30.5%) T1D participants and 53 (27.5%) T2D participants). Forty-eight participants (15.0%) screened positive for both clinically significant depressive symptoms and high diabetes distress. Regression models showed that higher diabetes distress scores were associated with fewer self care behaviors (T1D, b=-0.268, p=0.030; T2D, b=-0.312, p<0.001) and lower DQOL (T1D, b=0.726, p<0.001; T2D, b=0.501, p<0.001). Further, more depressive symptoms were associated with lower DQOL in participants with T2D (b=0.363, p<0.001). Higher diabetes distress scores were not associated with higher A1C levels in participants with T1D or T2D; however, increased depressive symptoms were associated with higher A1C levels in participants with T2D (b=0.390, p<0.001). CONCLUSIONS Findings showed that adults in southeastern Ohio experienced high levels of diabetes distress and co-occurring clinically significant depressive symptoms that were within range of data from previous studies. These findings highlight the importance of routine screening for both clinically significant depressive symptoms and diabetes distress. Future longitudinal research is needed to confirm these findings and examine the evolution of these relationships over time.
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Affiliation(s)
- Elizabeth A Beverly
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, The Ohio University Diabetes Institute, Ohio University, Athens, OH, USA
| | - Francis Osowik
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
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47
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Hessler D, Strycker L, Fisher L. Reductions in Management Distress Following a Randomized Distress Intervention Are Associated With Improved Diabetes Behavioral and Glycemic Outcomes Over Time. Diabetes Care 2021; 44:1472-1479. [PMID: 33990376 PMCID: PMC8323176 DOI: 10.2337/dc20-2724] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/28/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To explore associations between reductions in diabetes distress (DD) and improvements in glycemic outcomes among adults with type 1 diabetes (T1D) in the context of a DD randomized clinical trial. RESEARCH DESIGN AND METHODS Adults with T1D (N = 301) participated in a two-arm trial aimed at reducing DD (DD-focused OnTrack group vs. education-oriented KnowIt group). Mean age was 45.1 years; mean baseline HbA1c was 8.8% (73 mmol/mol). Individuals were assessed at baseline and 9 months later on DD, self-care, HbA1c, and frequency of hypoglycemia. Structural equation models evaluated hypothesized pathways among changes in DD, self-care, and glycemic outcomes in the total sample and by intervention group. RESULTS Reductions in DD were significantly and independently associated with better self-care, including fewer missed insulin boluses, more frequent insulin adjustment, improved problem-solving skills, more blood glucose monitoring, and greater adoption of continuous glucose monitoring (all P < 0.05). In turn, better self-care was linked with better glycemic outcomes, including fewer episodes of hypoglycemia and improved HbA1c over time. Fit indices indicated good fit of the model to the data (confirmatory fit index = 0.94, root mean square error of approximation = 0.05), with stronger and more meaningful associations for OnTrack than for KnowIt. CONCLUSIONS In the context of an intervention to reduce DD for adults with T1D, results indicate that reductions in DD do not affect glycemic outcomes directly but through improvements in self-care behavior. Findings support the importance of integrating disease management with DD interventions to maximize improvements in glycemic outcomes.
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Affiliation(s)
- Danielle Hessler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
| | | | - Lawrence Fisher
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
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48
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Wasserman RM, Eshtehardi SS, Anderson BJ, Weissberg-Benchell JA, Hilliard ME. Profiles of Depressive Symptoms and Diabetes Distress in Preadolescents With Type 1 Diabetes. Can J Diabetes 2021; 45:436-443. [PMID: 33771448 PMCID: PMC8238792 DOI: 10.1016/j.jcjd.2021.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/08/2021] [Accepted: 01/24/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Diabetes distress and depressive symptoms are common psychosocial concerns for people with diabetes. These are related, yet distinct, mood states, which have each been related to diabetes management and glycated hemoglobin (A1C) among adolescents and adults with diabetes. However, they have not been examined concurrently in preadolescents with type 1 diabetes. Understanding the overlaps and distinctions between diabetes distress and depressive symptoms in youth would help guide decisions about psychosocial screening in diabetes clinical practice. In this study, we aimed to categorize preadolescents based on clinical cutoffs of concurrently administered measures of depressive symptoms and diabetes distress, and identify clinical and demographic characteristics of each group. METHODS One hundred eighty youth (age range, 9 to 13 years; age [mean ± standard deviation], 11.3±1.3 years; 55% female; 56% Caucasian; mean A1C, 8.4±1.6% [68 mmol/mol]) completed measures of diabetes distress, depressive symptoms and quality of life. Daily blood glucose monitoring frequency was calculated from meter download. A1C values were obtained from electronic medical records. RESULTS Depressive symptoms and diabetes distress each significantly correlated with A1C and quality of life. Although most (69%) participants had no clinically significant elevations in either diabetes distress or depressive symptoms, 14% had elevated depressive symptoms only and 17% had elevated distress without concurrent elevated depressive symptoms. Groups differed based on A1C, quality of life and insurance status. CONCLUSIONS Routine assessment of both depressive symptoms and diabetes distress may help to identify preadolescents with type 1 diabetes who require psychosocial support.
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Affiliation(s)
- Rachel M Wasserman
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Orlando, Florida, United States
| | - Sahar S Eshtehardi
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States; Department of Psychological, Health, & Living Services, University of Houston, Houston, Texas, United States
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States
| | - Jill A Weissberg-Benchell
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States.
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Lu X, Yang D, Liang J, Xie G, Li X, Xu C, Liao H, Zhou H, Xu Z, Ye C, Chen H, Liang M, Shen Q, Sun T, Hu Y, Zhang W, Ning Y. Effectiveness of intervention program on the change of glycaemic control in diabetes with depression patients: A meta-analysis of randomized controlled studies. Prim Care Diabetes 2021; 15:428-434. [PMID: 33551333 DOI: 10.1016/j.pcd.2021.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/16/2021] [Indexed: 12/13/2022]
Abstract
AIM The glycaemic control of diabetes with depression was inconsistent from randomized controlled studies. This meta-analysis aimed to explore the effectiveness of intervention methods in diabetes with depression. METHODS This study systematically searched electronic databases (PubMed, EBSCO, Elsevier, Springer, Wiley, and Cochrane) for studies published up to August 17, 2020. Standardized mean difference (SMD) and 95%CI were used to evaluate the effectiveness of interventions on HbA1c. Heterogeneity was estimated using the I2 statistic. Begg's test was used to assess the possible publication bias among studies. RESULTS Twelve studies of 2444 cases were included in this study. The overall SMD is -0.22 and 95%CI -0.33 to -0.10 in 0-6 months of intervention group. The I2 and P were 18.4% and 0.26. There are no publication bias tested (z = 0.37, P = 0.72). CONCLUSION Cognitive behavioral therapy and mindful self-compassion might be effective method to improve glycaemic control of diabetes with depression in 0-6 months.
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Affiliation(s)
- Xiaobing Lu
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Dongying Yang
- Department of Psychological Behavior, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Jiaquan Liang
- Department of Psychiatric, The Third People's Hospital of Foshan, Foshan, China
| | - Guojun Xie
- Department of Psychiatric, The Third People's Hospital of Foshan, Foshan, China
| | - Xuesong Li
- Department of Psychiatric, The Third People's Hospital of Foshan, Foshan, China
| | - Caixia Xu
- Department of Psychiatric, The Third People's Hospital of Foshan, Foshan, China
| | - Hairong Liao
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Department of Psychiatric, The Third People's Hospital of Foshan, Foshan, China
| | - Hui Zhou
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Department of Psychiatric, The Third People's Hospital of Foshan, Foshan, China
| | - Zhenyu Xu
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chan Ye
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haixia Chen
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Department of Psychiatric, Zhongshan Third People's Hospital, Zhongshan, China
| | - Meihong Liang
- Department of Psychiatry, Guangzhou Medical University, Foshan Third People's Hospital, Foshan, China
| | - Qi Shen
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ting Sun
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yutong Hu
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weizhi Zhang
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
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50
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Egbuonu I, Trief PM, Roe C, Weinstock RS. Glycemic outcomes related to depression in adults with type 1 diabetes. J Health Psychol 2021; 26:786-794. [PMID: 33904320 DOI: 10.1177/1359105319845134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Glycemic outcomes of adults with type 1 diabetes may be affected by depression. Our aim was to compare outcomes of "depressed" (Patient Health Questionnaire-9 ⩾ 10, N = 83) to "not-depressed" matched control (Patient Health Questionnaire-2 < 3, N = 166) adults with type 1 diabetes with objective measures. The depressed group had poorer blood glucose control and, for those with glucose meter downloads, fewer glucose tests/day. The groups did not differ on glucose variability or episodes of hypoglycemia. Depression in adults with type 1 diabetes is associated with poorer glycemic control and less blood glucose monitoring. Future research should examine whether treatment of depression results in better self-care and glycemic outcomes.
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Affiliation(s)
- Ifeoma Egbuonu
- State University of New York Upstate Medical University, USA
| | - Paula M Trief
- State University of New York Upstate Medical University, USA
| | - Cheryl Roe
- State University of New York Upstate Medical University, USA
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