Depression, anxiety, stress and socio-demographic factors for poor glycaemic control in patients with type II diabetes

"Failure to control blood sugar" experiences of persons with type 2 diabetes mellitus

Objectives

This study aimed to explore the experiences of persons with type 2 diabetes mellitus having poor glycemic control.

Methods

A narrative qualitative study was conducted. Eight participants were recruited at a hospital's primary care unit (PCU) in northeastern Thailand from October to December 2021. The data was collected using in-depth interviews, field notes, and non-participatory observation. It was then analyzed based on the thematic analysis guide of Braun & Clarke (2006).

Results

The results revealed four main themes and eight sub-themes: lifestyle practice (inappropriate eating behaviors, taking diabetes drugs irregularly, exercising irregularly); perception of self-care (misperceptions about self-care practices, diabetes was a genetic disease and therefore had to be accepted); awareness regarding complications (not being aware of glycemic control, issues with social gatherings); stress from socioeconomic issues (feeling stressed in daily life).

Conclusions

It is the role of healthcare professionals to stress the importance of healthy behaviors to improve glycemic control in terms of diet, exercise, medication use, perception, awareness, culture, and beliefs. The study results could aid healthcare providers in developing innovations in nursing care or interventions to change unhealthy behaviors.

Diabetes Mellitus Family Assessment Instruments: A Systematic Review of Measurement Properties

Although many instruments are used to assess the families of people with diabetes, their measurement properties have not been systematically reviewed. We aimed to identify and evaluate the psychometric properties of the instruments used to assess family functioning in adults with diabetes.

METHODS

A systematic literature review, according to the JBI systematic reviews of measurement properties, was conducted using different databases, including gray literature. PROSPERO registration number: CRD42021239733. Two independent reviewers searched, screened, and assessed the risk of bias among the articles according to the COSMIN methodology. The quality of each included instrument was assessed using the updated criteria for good measurement properties.

RESULTS

Eighty-one studies were included, and thirty-one eligible instruments were identified. The psychometric properties frequently assessed were structural validity, internal consistency, and construct validity.

CONCLUSIONS

Although 31 instruments were included, none of their psychometric properties were scored as "very good". From the instruments scored as adequate on development and content validity, five stood out for their quality appraisal.. The development of new instruments is not recommended. More studies should be conducted on the existing instruments to assess the less commonly evaluated psychometric properties. Using valid instruments to develop and evaluate interventions is essential to promote health literacy and the effectiveness of diabetes management.

Medication Adherence of Persons with Type 2 Diabetes in Malaysia: A Scoping Review and Meta-Analysis

Objective

This is a scoping review of Malaysian scientific studies on medication adherence among persons with type 2 diabetes mellitus (T2DM).

Methodology

We conducted a bibliographic search of PubMed, Scopus and Google Scholar using the following keywords: "medication adherence," "drug compliance," "DMTAC" and "Malaysia." The search covered all publications up to 31 December 2021. Eligible articles were original studies conducted in Malaysia that measured or quantified medication adherence among persons with T2DM.

Results

We identified 64 eligible studies published between 2008 to 2021. Most studies included patients with T2DM in ambulatory facilities. Five studies were qualitative research. The quantitative research publications included clinical trials, and cross-sectional, validation, retrospective and prospective cohort studies. Thirty-eight studies used medication adherence scales. The Morisky Medication Adherence Scale (MMAS-8, used in 20 studies) and Malaysian Medication Adherence Scale (MALMAS, used in 6 studies) were the most commonly used tools. There were 6 validation studies with 4 medication adherence scales. A meta-analysis of 10 studies using MMAS-8 or MALMAS revealed that the pooled prevalence of low medication adherence is 34.2% (95% CI: 27.4 to 41.2, random effects model). Eighteen publications evaluated various aspects of the Diabetes Medication Therapy Adherence Clinics (DMTAC).

Conclusion

This scoping review documented extensive research on medication adherence among persons with diabetes in Malaysia. The quantitative meta-analysis showed a pooled low medication adherence rate.

Effectiveness of Self-concept Management of Patients with Depression in Diabetic Ulcer

BACKGROUND

This study explores the management of self-concept in improving the quality of life of diabetic ulcer patients. Low confidence in the quality of life is a factor causing patients with long-term diabetes to believe they cannot be cured properly. Ulcers result from diabetes mellitus complications due to the nervous system and blood vessel damage. Patients with diabetic ulcers experience depression and feel acute stress when the disease has been categorized as a chronic condition.

METHODS

This study uses quantitative methods with a cross-sectional study design approach. The data collection techniques used purposive sampling and had 82 diabetic ulcer sufferers as respondents in the study.

RESULTS

This study empirically proves that (p-value ≤ α=0.05) where there is effective management of the concept of self-health applied by diabetic ulcer patients in reducing the level of depression and sufferers can increase their confidence in better health factors.

CONCLUSION

The effectiveness of self-care management is an important indicator in overcoming diabetic ulcer disease. The low management of self-concept for people with diabetes will certainly impact increasing depression and acute stress, decreasing the quality of life for sufferers.

How Much Do We Know about the Biopsychosocial Predictors of Glycaemic Control? Age and Clinical Factors Predict Glycaemic Control, but Psychological Factors Do Not

OBJECTIVE

Diabetes mellitus is one of the most common noncommunicable diseases in Malaysia. It is associated with significant complications and a high cost of treatment, especially when glycaemic control is poor. Despite its negative impact on health, data is still lacking on the possible biopsychosocial predictors of poor glycaemic control among the diabetic population. This study is aimed at determining the prevalence of poor glycaemic control as well as its association with biopsychosocial factors such as personality traits, psychiatric factors, and quality of life (QOL) among Malaysian patients with diabetes.

METHODS

A cross-sectional study was conducted at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) using outpatient population diabetic patients. Demographic data on social and clinical characteristics were collected from participants. Several questionnaires were administered, including the Beck Depression Inventory-II (BDI-II) to measure depressive symptoms, the Generalized Anxiety Disorder-7 (GAD-7) to assess anxiety symptoms, the Big Five Inventory (BFI) to evaluate personality traits, and the WHO Quality of Life-BREF (WHOQOL-BREF) to assess QOL. Multivariate binary logistic regression was performed to determine the predictors of poor glycaemic control.

RESULTS

300 patients with diabetes mellitus were recruited, with the majority (90%) having type 2 diabetes. In this population, the prevalence of poor glycaemic control (HbA_1C ≥ 7.0%) was 69%, with a median HbA_1C of 7.6% (IQR = 2.7). Longer duration of diabetes mellitus and a greater number of days of missed medications predicted poor glycaemic control, while older age and overall self-perception of QOL protected against poor glycaemic control. No psychological factors were associated with poor glycaemic control.

CONCLUSION

This study emphasizes the importance of considering the various factors that contribute to poor glycaemic control, such as duration of diabetes, medication adherence, age, and QOL. These findings should be used by clinicians, particularly when planning a multidisciplinary approach to the management of diabetes.

The Effect of Cognitive Behavioral Therapy on Depression, Anxiety, and Stress in Patients With COVID-19: A Randomized Controlled Trial

Background: As a public health emergency of international concern, the COVID-19 outbreak has had a tremendous impact on patients' psychological health. However, studies on psychological interventions in patients with COVID-19 are relatively rare. Objectives: This study examined the effectiveness of Cognitive Behavioral Therapy (CBT) in relieving patients' psychological distress during the COVID-19 epidemic. Methods: Ninety-three eligible participants selected by cluster sampling were randomized to an intervention group (N = 47) and a control group (N = 46). Participants in the control group received routine treatment according to the Chinese Management Guidelines for COVID-19, while participants in the intervention group received routine treatment with additional CBT. The Chinese Version of Depression Anxiety and Stress Scale-21 (DASS-21) was used to evaluate depression, anxiety, and stress for all participants at baseline and post-intervention. Two-sided t-test, and proportion tests were used to examine the differences between the intervention and control group for each DASS-21 indicator. Univariate linear regression was used to examine the association between chronic disease status and change in each DASS-21 indicator after intervention. Two-way scatter plots were generated to show the association of the length of hospital stay and the changes of each DASS-21 indicator by intervention and control groups. Results: Significant decreases in means were found for scales of depression, anxiety, stress and total DASS-21 in both intervention (p < 0.001) and control group (p = 0.001), with participants in the intervention group having a bigger reduction in means. After the intervention, more participants in the intervention group had no depression or anxiety symptoms than in the control group, but no statistical differences were found (p > 0.05). Compared with participants with chronic disease, participants with no chronic disease had a significantly larger reduction of total DASS-21 scale (coefficient = -4.74, 95% CI: -9.31; -0.17).The length of hospital stay was significantly associated with a greater increase in anxiety scale in the intervention group (p = 0.005), whilst no significant association was found in the control group (p = 0.29). Conclusions: The patients with COVID-19 experienced high levels of anxiety, depression and stress. Our study result highlights the effectiveness of CBT in improving the psychological health among patients with COVID-19, also suggests that CBT should be focused on patients with chronic disease and those who have longer hospital stays. These results have important implications in clinical practice in improving psychological health in the context of COVID-19 pandemic. Trial Registration: ISRCTN68675756. Available at: http://www.isrctn.com/ISRCTN68675756.