Unrealistic pessimism about risk of coronary heart disease and stroke in patients with type 2 diabetes

Expecting Relocation to a Nursing Home: Longitudinal Links with Functional Limitations, Self-Rated Health, and Life Satisfaction

INTRODUCTION

Developing realistic expectations of future old age constitutes an adaptational process which facilitates the anticipation of and adjustment to challenges, such as relocation to a nursing home. Developing such expectations might minimize the negative impacts of relocation. This pre-registered study examined (1) to which extent lower levels and declines in health (i.e., functional limitations and self-rated health) and life satisfaction before relocation were associated with higher levels and increases in expectations to relocate and (2) to which extent higher expectations to relocate were associated with more positive changes in health and life satisfaction after relocation.

METHODS

Using data from the Health and Retirement Study (HRS; 2006-2018), we selected older adults (aged 65 years and older) who relocated to a nursing home. We used latent growth curve models to assess the longitudinal links between self-reported measures of health, life satisfaction, and expectations to relocate to a nursing home from up to 7 years before (n = 1,048) until up to 5 years after relocation (n = 307).

RESULTS

As hypothesized, more functional limitations and lower self-rated health were related to higher expectations of relocation. Surprisingly, changes in expectations to relocate were not related to changes in health and life satisfaction before relocation. Moreover, expectations to relocate were not associated with changes in health and life satisfaction after relocation.

CONCLUSION

The absence of a link between expectations to relocate to a nursing home with changes in health and well-being suggests that these expectations did not constitute adaptational processes before or after this transition.

Research progress in stroke risk perception assessment tool

BACKGROUND

One of the main illnesses in the globe that causes impairment and death in people is stroke. In the globe today, it ranks as the second leading cause of death and the leading cause of death in China.

OBJECTIVE

This paper analyses into the critical role of risk perception in developing individual awareness of stroke risk and encouraging proactive preventive health behaviors, essential for effective primary stroke prevention strategies and reduced stroke incidence. It discusses the concept of risk perception, the content and dimensions of global stroke assessment tools, and their application status, aiming to provide insights for their development and intervention research.

METHODS

Risk perception encompasses subjective assessments of stroke likelihood and severity, influenced by personal experiences, knowledge of risk factors, beliefs about prevention effectiveness, and emotional responses. Global stroke assessment tools, like the Framingham Stroke Risk Score and CHA2DS2-VASc Score, evaluate stroke risk based on factors such as age, gender, blood pressure, and cholesterol levels. In order to improve risk perception and proactive health management and lower the burden of strokes, the paper assesses the advantages and disadvantages of these tools and makes recommendations for improving accessibility, customizing interventions, running educational campaigns, promoting multidisciplinary collaboration, and integrating technology.

RESULTS

By combining the research tools of stroke risk perception, it is found that the evaluation tools are mostly single-dimensional evaluation tools centered on the two dimensions of onset possibility and susceptibility.

CONCLUSION

Some scholars have developed multi-dimensional evaluation tools, but the evaluation population is relatively limited, and the evaluation system lacks comprehensiveness and systematization.

Effects of negative emotions and information perceived value on residents' risk perception during the COVID-19 pandemic: An empirical survey from China

Background

The COVID-19 pandemic has spread rapidly and heavily hit the globe, and the mutation and transmission speed of the coronavirus have accelerated so that the world is still in danger. Thus, this study aims to investigate the participants' risk perception and explore the associations of risk perception of COVID-19 with negative emotions, information value perception and other related dimensions.

Methods

A cross-sectional, population-based online survey was conducted from April 4 to 15, 2020, in China. A total of 3,552 participants were included in this study. A descriptive measure of demographic information was used in this study. Multiple regression models and moderating effect analysis were used to estimate the effect of potential associations of risk perceptions.

Results

Those who showed negative emotions (depressed, helplessness, loneliness) and perceived video information in social media to be useful were positively correlated with risk perception, whereas individuals who perceived experts' advice to be useful, shared risk information with friends and thought that their community made adequate emergency preparation reported lower risk perception. The moderating effect of information perceived value (β = 0.020, p < 0.001) on the relationship between negative emotion and perception of risk was significant.

Conclusions

Individual differences in risk cognition during the COVID-19 pandemic were observed in subgroups of age level. Furthermore, the role of negative emotional states, the perceived usefulness of risk information and the sense of security also contributed to improving the public's risk perception. It is crucial for authorities to focus on residents' negative emotions and to clarify misinformation in accessible and effective ways in a timely manner.

The Association of Dispositional Optimism and Pessimism With Cardiovascular Disease Events in Older Adults: A Prospective Cohort Study

Objective: Positive psychosocial factors may protect against cardiovascular disease (CVD). We aimed to determine the association of optimism and pessimism with CVD events in community-dwelling older adults. Methods: 11,651 adults aged 70 years and over, participants of the ASPREE Longitudinal Study of Older Persons (ALSOP), were followed-up for 4.7 years (median). The association of optimism and pessimism (assessed as separate constructs by revised Life Orientation Test) and incident CVD events (composite and components) was assessed by Cox regression adjusted for demographic, socioeconomic and health factors. Results: No association was observed between optimism and pessimism with composite CVD events. Being more pessimistic was associated with a greater risk of fatal coronary heart disease, while being more optimistic was associated with a lower risk of non-fatal myocardial infarction. Conclusions: Optimism and pessimism may shape cardiovascular health of older adults; and we argue these psychosocial factors should be researched as separate constructs.

Comparative optimism about infection and recovery from COVID-19; Implications for adherence with lockdown advice

Background

Comparative optimism, the belief that negative events are more likely to happen to others rather than to oneself, is well established in health risk research. It is unknown, however, whether comparative optimism also permeates people’s health expectations and potentially behaviour during the COVID‐19 pandemic.

Objectives

Data were collected through an international survey (N = 6485) exploring people’s thoughts and psychosocial behaviours relating to COVID‐19. This paper reports UK data on comparative optimism. In particular, we examine the belief that negative events surrounding risk and recovery from COVID‐19 are perceived as more likely to happen to others rather than to oneself.

Methods

Using online snowball sampling through social media, anonymous UK survey data were collected from N = 645 adults during weeks 5‐8 of the UK COVID‐19 lockdown. The sample was normally distributed in terms of age and reflected the UK ethnic and disability profile.

Findings

Respondents demonstrated comparative optimism where they believed that as compared to others of the same age and gender, they were unlikely to experience a range of controllable (eg accidentally infect/ be infected) and uncontrollable (eg need hospitalization/ intensive care treatment if infected) COVID‐19‐related risks in the short term (P < .001). They were comparatively pessimistic (ie thinking they were more at risk than others for developing COVID‐19‐related infection or symptoms) when thinking about the next year.

Discussion

This is one of the first ever studies to report compelling comparative biases in UK adults’ thinking about COVID‐19.

Optimism Bias during the Covid-19 Pandemic: Empirical Evidence from Romania and Italy

Given the importance of perceived susceptibility to a disease in adopting preventive behaviors, and the negative impact of optimism bias on prevention, this paper aimed to explore to what extent comparative optimism bias (understood as the tendency to assess a lower probability for oneself to experience negative health events compared to others) is present in the specific context of the Covid-19 pandemic, in two countries with different profiles in terms of the spread of the disease: Italy and Romania. After identifying optimism bias in both countries, we tested whether it depends on respondents’ characteristics like gender, age, education, health status and whether or not they have the opportunity to work from home. We surveyed 1126 Romanians and 742 Italians, and found that optimism bias depends on self-reported health status, and that optimism bias increases with age. Inconclusive evidences were found regarding gender and education level, as well as the option to work from home.

Emotional Dysregulation as a Factor of Psychosomatic Disturbances in Depression and Cardiovascular Pathology (Analytical Review of Foreign Literature)

The review presents data on cognitive processes of emotional regulation, which are the result of the interaction of the activity of the prefrontal cortex and emotional centers, as the most important pathogenetic link in the psychosomatic relations of depressive and cardiovascular diseases. The neuroanatomical substrate of emotional regulation is the connection between emotional and cognitive processes, which are carried out through bidirectional neuronal interactions between the neocortex and emotional centers. This connection allows emotional centers to modulate cortical activity, and cognitive centers, through descending cortical influences, to modulate the processing of emotions. At present, direct and indirect connections of the frontal cortex with the centers of the autonomic nervous system and its stimulating sympathetic and inhibitory parasympathetic influences have been confirmed. Pathogenetic links of emotional dysregulation include neurobiological and cognitive (rumination, fixation on negative information) processes. The pathophysiological mechanisms of depression and cardiovascular diseases have common links - the dysregulation of the metabolic, immunological and hypothalamus-pituitary-adrenal systems. The tendency to negative emotional response, the prevalence of negative emotions and alexithymia (low awareness of emotions) stand out as predictors of the development of both cardiovascular diseases and depression. Studies aimed at studying the typology and meaning of emotional dysregulation in various forms of psychopathological disorders in the aspect of comorbidity and psychosomatic relationships with somatic diseases can be fruitful in terms of finding new approaches to diagnosis and therapy.

The Language of Diabetes Complications: Communication and Framing of Risk Messages in North American and Australasian Diabetes-Specific Media

IN BRIEF Reducing the risk of diabetes complications requires the delivery of accurate and constructive information for people with diabetes to make informed self-management choices. This article reports on a study assessing the language and framing of risk messages about long-term complications featured in publications produced by North American and Australasian diabetes organizations. Findings highlight problems with the language, content, and framing of messages about risk of long-term diabetes complications presented by diabetes-specific media. These poorly communicated messages may be contributing to distorted perceptions of complications risk and diabetes distress and may interfere with optimal self-management.

The Detrimental Consequences of Overestimating Future Health in Late Life

OBJECTIVES

Although forecasting a positive future can be adaptive, it may not be when expectations are unmet. Our study examined whether such inaccurate expectations about future health status (overestimation) were maladaptive for older adults who commonly experience late life declines in physical functioning.

METHOD

We analyzed data from the nationally representative German Aging Survey (DEAS; 1996-2011; n = 2,539; age range 60-85 years) using multilevel growth models that assessed the influence of inaccurate health expectations on older adults' physical functioning over a 9-year period.

RESULTS

Overestimating future health status predicted reduced day-to-day physical functioning when age, gender, and self-rated health were controlled. A Time × Overestimation interaction indicated that the negative effects of overestimation on physical functioning became more pronounced over the 9-year period.

DISCUSSION

Results suggest that repeatedly unmet health expectations may undermine motivational resources and accelerate late life declines in physical functioning.

Measurement and Outcomes of the Perceived Risk of Stroke: A Review

Stroke continues to be a public health problem, and risk perceptions are key to understanding people's thoughts about stroke risk and their preventive health behaviors. This review identifies how the perceived risk of stroke has been measured and outcomes in terms of levels, predictors, accuracy, and intervention results. Sixteen studies were included. The perceived risk of stroke has primarily been assessed with single-item measures; no multi-item surveys were found. In general, people tend to perceive a low-moderate risk of stroke; the most common predictors of higher stroke risk perceptions were having risk factors for stroke (hypertension, diabetes) and a higher number of risk factors. However, inaccuracies were common; at least half of respondents underestimated/overestimated their risk. Few studies have examined whether interventions can improve the perceived risk of stroke. Strategies to improve stroke risk perceptions should be explored to determine whether accuracy can promote healthy lifestyles to reduce stroke risk.

A healthy dose of realism: The role of optimistic and pessimistic expectations when facing a downward spiral in health

RATIONALE AND OBJECTIVES

Whether expectations about future health are adaptive or maladaptive in late life likely depends on the extent to which they conform to or defy a future reality of declining health. Our premise was that, when adults face a downward spiral in health, it can be adaptive to realistically expect poorer future health and maladaptive to unrealistically expect good health.

METHOD

This 18-year-long study of community-dwelling older Canadians (n = 132, 72-98 years) involved a baseline interview to identify those who anticipated heath would decline (pessimistic expectation) or improve/remain stable (optimistic expectation). We determined initial (baseline) health status by assessing the severity of chronic conditions. An objective within-person measure of actual health change was derived by documenting hospital admissions (HAs) over time to capture a continuum that ranged from no declines (HAs remained stable) to greater declines in health (increasing numbers of HAs). Our a priori hypotheses examined the effects of health expectations (pessimistic, optimistic) and actual health change on the outcomes of depressive symptoms and mortality.

RESULTS

Support was found for our premise that it is adaptive to be realistic when forecasting future health, at least at low levels of initial chronic condition severity. Regression analyses showed that realistically pessimistic (vs. unrealistically optimistic) expectations predicted significantly fewer depressive symptoms and a lower risk of death. The results also supported our premise that it is maladaptive to be unrealistically optimistic when health subsequently declines in reality: The risk of death was 313% higher for those with optimistic expectations that were unrealistic (vs. realistic).

CONCLUSION

These findings provide insights for health care professionals regarding the messages they communicate to their patients. Together, they imply that, when good health is slipping away, it seems optimal to encourage a healthy dose of realism.

Effect of Stress, Depression and Type D Personality on Immune System in the Incidence of Coronary Artery Disease

BACKGROUND:

Psychoneuroimmunology (PNI) is the study of the interaction between psychological processes and the nervous and immune systems of the human body. The impact of psychological factors on the immune system and the role of this system in Coronary Artery Disease (CAD) are confirmed. Coronary Heart Disease (CHD) is arisen due to the failure of blood and oxygen to the heart tissues.

AIM:

The present study aimed to describe psychoneuroimmunological processes which contribute to CAD and CHD progression.

METHOD:

Such psychological risk factors like stress, depression and type D personality were investigated here. Psychoneuroimmunological pathways of all three mentioned risk factors were described for CAD.

RESULTS:

The studies review indicated that stress could be accompanied with myocardial ischemia and help to rupture. The depression involves in the transfer of stable atherosclerotic plaque to unstable, and type D personality is effective in the initial stages of a CAD.

CONCLUSION:

As more information on cardiovascular immunity becomes available, this will provide a better understanding and thus act as the foundation for the potential development of new treatment strategies for treatment of cardiovascular disorders.

Perceptions of risks for diabetes-related complications in Type 2 diabetes populations: a systematic review

AIM

In Type 2 diabetes, there is no clear understanding of how people perceive their risk of experiencing diabetes-related complications. To address this issue, we undertook an evidence-based synthesis of how people with Type 2 diabetes perceive their risk of complications.

METHODS

We performed a systematic search of nine electronic databases for peer-reviewed articles published on or before 1 March 2016. Data from 18 studies reporting lay perceptions of risks for complications in Type 2 diabetes populations were included. Publication year ranged between 2002 and 2014.

RESULTS

Methods used to assess risk perceptions were heterogeneous, ranging from questionnaires measuring the accuracy of perceived risks to semi-structured and focus group interviews. We found evidence of low risk awareness in most dimensions of risk perceptions measured and the existence of optimistic bias.

CONCLUSIONS

Perceptions were generally biased and varied according to the dimension of risk measured, the subpopulation concerned and the type of complications considered. Future work is needed to identify the best practical ways of correcting for biased risk perceptions so as to encourage self-care behaviours and treatment adherence.

Experiences of diabetes self-management: a focus group study among Australians with type 2 diabetes

AIMS AND OBJECTIVES

The aim of this study was to explore the experiences and concerns of individuals with type 2 diabetes mellitus, in a predominantly low socio-economic setting.

BACKGROUND

Currently, approximately 1 million Australians have diabetes and rates have more than doubled since 1989. Type 2 diabetes mellitus accounts for approximately 85% of diabetes cases. Risk factors include obesity, older age, low socio-economic status, sedentary lifestyle and ethnicity. Older individuals from low socio-economic backgrounds are particularly at risk of both developing and of mismanaging their condition.

DESIGN

Exploratory qualitative design.

METHODS

Focus groups were used to collect data from 22 individuals, aged 40 to more than 70 years, with type 2 diabetes mellitus, who were attending local health services for their diabetes care. Focus groups ranged in size from four to eight individuals and all were recorded, transcribed and analysed. Data were analysed using a thematic analysis approach.

RESULTS

Participants described their experiences of managing their diabetes as emotionally, physically and socially challenging. Data analysis revealed four main themes including: (1) diabetes the silent disease; (2) a personal journey (3) the work of managing diabetes; and (4) access to resources and services. Throughout, participants highlighted the impact of diabetes on the family, and the importance of family members in providing support and encouragement to assist their self-management efforts.

CONCLUSIONS

Participants in this study were generally satisfied with their diabetes care but identified a need for clear simple instruction immediately post-diagnosis, followed by a need for additional informal information when they had gained some understanding of their condition.

RELEVANCE TO CLINICAL PRACTICE

Findings reveal a number of unmet information and support needs for individuals with type 2 diabetes mellitus. In particular, it is important for healthcare professionals and family members to recognise the significant emotional burden that diabetes imposes, and the type and quantity of information individuals with diabetes prefer. It is also important to consider levels of health literacy in the community when developing diabetes-related information or programmes.

Risk perception, prevention and diagnostic tests

The objective of this paper is to study the impact of risk perception and diagnostic information on medical prevention decisions. The intertemporal preferences of individuals are represented by a model of recursive rank dependent utility, which has the advantage of allowing risk perceptions to vary over time and with health status. The main results of the paper are the following. Concerning the impact of risk perception on prevention, two types of pessimists have to be distinguished: the moderate pessimists and the fatalists. Both types overestimate the probability of disease, but the fatalists underestimate the reduction of the disease probability by prevention. Risk perception modification after the occurrence of the disease influences prevention decisions. Indeed, we show that moderate pessimists often choose a high level of primary and tertiary prevention, but a moderate pessimist who becomes fatalist after the occurrence of the disease may choose a high level of primary prevention and a low level of tertiary prevention.

Comparative optimism among patients with coronary heart disease (CHD) is associated with fewer adverse clinical events 12 months later

The current study evaluates the levels of comparative optimism among patients with coronary heart disease (CHD) and examines its relationship to health outcomes 12 months later. 164 patients completed self-report questionnaires at the end of cardiac rehabilitation and the number of adverse clinical events in the following 12 months were recorded. Comparative optimism was assessed in relation to a typical other who has not had cardiac event, a typical other who has had the same cardiac event as the respondent, and a typical member of the cardiac rehabilitation class. Clinical-demographic details and distress were assessed. Participants were comparatively optimistic in all three ratings. Logistic regression (controlling for age, gender, co-morbidities, and distress) revealed that higher levels of adverse events were associated with older age, being male, and lower levels of overall comparative optimism. Comparative optimism was associated with decreased risk of adverse clinical events in the year following cardiac rehabilitation attendance.

Comparative optimism among patients with coronary heart disease (CHD) is associated with fewer adverse clinical events 12 months later

The current study evaluates the levels of comparative optimism among patients with coronary heart disease (CHD) and examines its relationship to health outcomes 12 months later. 164 patients completed self-report questionnaires at the end of cardiac rehabilitation and the number of adverse clinical events in the following 12 months were recorded. Comparative optimism was assessed in relation to a typical other who has not had cardiac event, a typical other who has had the same cardiac event as the respondent, and a typical member of the cardiac rehabilitation class. Clinical-demographic details and distress were assessed. Participants were comparatively optimistic in all three ratings. Logistic regression (controlling for age, gender, co-morbidities, and distress) revealed that higher levels of adverse events were associated with older age, being male, and lower levels of overall comparative optimism. Comparative optimism was associated with decreased risk of adverse clinical events in the year following cardiac rehabilitation attendance.

Blood pressure and lipid management fall far short in persons with type 2 diabetes: results from the DIAB-CORE Consortium including six German population-based studies

Background

Although most deaths among patients with type 2 diabetes (T2D) are attributable to cardiovascular disease, modifiable cardiovascular risk factors appear to be inadequately treated in medical practice. The aim of this study was to describe hypertension, dyslipidemia and medical treatment of these conditions in a large population-based sample.

Methods

The present analysis was based on the DIAB-CORE project, in which data from five regional population-based studies and one nationwide German study were pooled. All studies were conducted between 1997 and 2006. We assessed the frequencies of risk factors and co-morbidities, especially hypertension and dyslipidemia, in participants with and without T2D. The odds of no or insufficient treatment and the odds of pharmacotherapy were computed using multivariable logistic regression models. Types of medication regimens were described.

Results

The pooled data set comprised individual data of 15, 071 participants aged 45–74 years, including 1287 (8.5%) participants with T2D. Subjects with T2D were significantly more likely to have untreated or insufficiently treated hypertension, i.e. blood pressure of > = 140/90 mmHg (OR = 1.43, 95% CI 1.26-1.61) and dyslipidemia i.e. a total cholesterol/HDL-cholesterol ratio > = 5 (OR = 1.80, 95% CI 1.59-2.04) than participants without T2D. Untreated or insufficiently treated blood pressure was observed in 48.9% of participants without T2D and in 63.6% of participants with T2D. In this latter group, 28.0% did not receive anti-hypertensive medication and 72.0% were insufficiently treated. In non-T2D participants, 28.8% had untreated or insufficiently treated dyslipidemia. Of all participants with T2D 42.5% had currently elevated lipids, 80.3% of these were untreated and 19.7% were insufficiently treated.

Conclusions

Blood pressure and lipid management fall short especially in persons with T2D across Germany. The importance of sufficient risk factor control besides blood glucose monitoring in diabetes care needs to be emphasized in order to prevent cardiovascular sequelae and premature death.

The impact of hypoglycaemia on quality of life and related patient-reported outcomes in Type 2 diabetes: a narrative review

As a common side effect of insulin treatment for diabetes, hypoglycaemia is a constant threat and can have far-reaching and potentially devastating consequences, including immediate physical injury as well as more pervasive cognitive, behavioural and emotional effects. Moreover, as a significant limiting factor in achieving optimal glycaemic control, exposure to hypoglycaemia can influence diabetes self-management. Although hypoglycaemia is known to occur in Type 2 diabetes, its morbidity and impact on the individual are not well recognized. The aim of the current review is to examine published evidence to achieve a synthesis of the scope and significance of the potential detriment caused by hypoglycaemia to individuals with Type 2 diabetes. The implications of these observations for treatment and research have also been considered. A narrative review was performed of empirical papers published in English since 1966, reporting the effect of hypoglycaemia on quality of life and related outcomes (including generic and diabetes-specific quality of life, emotional well-being and health utilities) in Type 2 diabetes. Research demonstrates the potential impact of hypoglycaemia on the lives of people with Type 2 diabetes, from an association with depressive symptoms and heightened anxiety, to impairment of the ability to drive, work and function in ways that are important for quality of life. Few studies consider hypoglycaemia as an explanatory variable in combination with quality of life or related primary endpoints. As a consequence, there is a pressing need for high-quality research into the overall impact of hypoglycaemia on the lives of people with Type 2 diabetes.

Sources of uncertainty in type 2 diabetes: explication and implications for health communication theory and clinical practice

According to the American Diabetes Association, nearly 24 million Americans live with type 2 diabetes, and clinical data project that this figure will increase 165% from 2000 to 2050. Thus, there is a pressing need to understand not only the physiological and medical needs, but also the psychological demands associated with the illness. Even though uncertainty has been explicated in various other illness contexts and potentially shapes the experience of type 2 diabetes, very little attention has been paid to the nature of uncertainty in this context. The present study examines the nature of uncertainty through qualitative interviews with 49 individuals diagnosed with type 2 diabetes. Using grounded theory methods, various themes emerged relative to the sources of uncertainty. These themes are discussed in light of their potential extension of health communication theory and application to intervention and educational programs for individuals living with type 2 diabetes.

Pacific Islanders' perceived risk of cardiovascular disease and diabetes

PURPOSE

To explore literature on Pacific Islanders' perceived risk of cardiovascular disease (CVD) and diabetes.

METHOD

A search of literature databases for English-language perceived risk research published from 2000 to 2008.

RESULTS

Few studies targeting perceived risk of CVD (n = 6) and diabetes (n = 4) included minority participants. No studies targeted Pacific Islanders exclusively. Overall, Pacific Islanders and other minority groups inaccurately perceive their risk of these conditions. No studies explored cultural relevancy or measurement of perceived risk.

IMPLICATIONS

Perceived risk, an integral part of health behavior change theories, is greatly understudied in Pacific Islanders. Perceived risk research for CVD and diabetes is sparse for any minority group. More research is needed to develop socioculturally appropriate interventions that promote accurate risk perceptions for both diseases and facilitate adoption of health behaviors. Ultimately, these behaviors will reduce the onset and devastating consequences of CVD and diabetes in Pacific Islanders and other minority populations.

The Expanding Spectrum of Health Risks: Public Health or Harm?

Drawing on hydration as an illustrative case in point, this review discusses evidence-based perspectives on the continually expanding spectrum of promulgated health risks, including potential benefits and harms to public health. Future directions for inquiry and practice also are addressed.

The @RISK Study: Risk communication for patients with type 2 diabetes: design of a randomised controlled trial

Background

Patients with type 2 diabetes mellitus (T2DM) have an increased risk to develop severe diabetes related complications, especially cardiovascular disease (CVD). The risk to develop CVD can be estimated by means of risk formulas. However, patients have difficulties to understand the outcomes of these formulas. As a result, they may not recognize the importance of changing lifestyle and taking medication in time. Therefore, it is important to develop risk communication methods, that will improve the patients' understanding of risks associated with having diabetes, which enables them to make informed choices about their diabetes care.

The aim of this study is to investigate the effects of an intervention focussed on the communication of the absolute 10-year risk to develop CVD on risk perception, attitude and intention to change lifestyle behaviour in patients with T2DM. The conceptual framework of the intervention is based on the Theory of Planned Behaviour and the Self-regulation Theory.

Methods

A randomised controlled trial will be performed in the Diabetes Care System West-Friesland (DCS), a managed care system. Newly referred T2DM patients of the DCS, younger than 75 years will be eligible for the study. The intervention group will be exposed to risk communication on CVD, on top of standard managed care of the DCS. This intervention consists of a simple explanation on the causes and consequences of CVD, and possibilities for prevention. The probabilities of CVD in 10 year will be explained in natural frequencies and visualised by a population diagram. The control group will receive standard managed care. The primary outcome is appropriateness of risk perception. Secondary outcomes are attitude and intention to change lifestyle behaviour and illness perception. Differences between baseline and follow-up (2 and 12 weeks) between groups will be analysed according to the intention-to-treat principle. The study was powered on 120 patients in each group.

Discussion

This innovative risk communication method based on two behavioural theories might improve patient's appropriateness of risk perception and attitude concerning lifestyle change. With a better understanding of their CVD risk, patients will be able to make informed choices concerning diabetes care.

Trail registration

The trial is registered as NTR1556 in the Dutch Trial Register.

Life Expectancy in Individuals With Type 2 Diabetes: Implications for Annuities

Background. Insurance companies often offer people with diabetes ‘‘enhanced impaired life annuity’’ at preferential rates, in view of their reduced life expectancy. Objective. To assess the appropriateness of ‘‘enhanced impaired life annuity’’ rates for individuals with type 2 diabetes. Patients. There were 4026 subjects with established type 2 diabetes (but not known cardiovascular or other life-threatening diseases) enrolled into the UK Lipids in Diabetes Study. Measurements. Estimated individual life expectancy using the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model. Results. Subjects were a mean (SD) age of 60.7 (8.6) years, had a blood pressure of 141/83 (17/10) mm Hg, total cholesterol level of 4.5 (0.75) mmol/L, HDL cholesterol level of 1.2 (0.29) mmol/L, with median (interquartile range [IQR]) known diabetes duration of 6 (3—11) years, and HbA1c of 8.0% (7.2—9.0). Sixty-five percent were male, 91% white, 4% Afro-Caribbean, 5% Indian-Asian, and 15% current smokers. The UKPDS Outcomes Model median (IQR) estimated age at death was 76.6 (73.8—79.5) years compared with 81.6 (79.4—83.2) years, estimated using the UK Government Actuary’s Department data for a general population of the same age and gender structure. The median (IQR) difference was 4.3 (2.8—6.1) years, a remaining life expectancy reduction of almost one quarter. The highest value annuity identified, which commences payments immediately for a 60-year-old man with insulin-treated type 2 diabetes investing 100,000, did not reflect this difference, offering 7.4K per year compared with 7.0K per year if not diabetic. Conclusions. The UK Government Actuary’s Department data overestimate likely age at death in individuals with type 2 diabetes, and at present, ‘‘enhanced impaired life annuity’’ rates do not provide equity for people with type 2 diabetes. Using a diabetes-specific model to estimate life expectancy could provide valuable information to the annuity industry and permit more equitable annuity rates for those with type 2 diabetes.

Advancing the Prevention and Control of Hypertension

Hypertension is on a worrisome public health trajectory. This review discusses some key contributing dynamics as well as considerations for progress toward the prevention and control of hypertension and its comorbidities.

Impact of using a non-diabetes-specific risk calculator on eligibility for statin therapy in type 2 diabetes

AIMS/HYPOTHESIS

The aim of this study was to investigate the impact of using a non-diabetes-specific cardiovascular disease (CVD) risk calculator to determine eligibility for statin therapy according to current UK National Institute for Health and Clinical Excellence (NICE) guidelines for those patients with type 2 diabetes who are at an increased risk of CVD (10 year risk >or=20%).

METHODS

The 10 year CVD risks were estimated using the UK Prospective Diabetes Study (UKPDS) Risk Engine and the Framingham equation for 4,025 patients enrolled in the Lipids in Diabetes Study who had established type 2 diabetes and LDL-cholesterol <4.1 mmol/l.

RESULTS

The mean (SD) age of the patients was 60.7 (8.6) years, blood pressure 141/83 (17/10) mmHg and the total cholesterol:HDL-cholesterol ratio was 3.9 (1.0). The median (interquartile range) diabetes duration was 6 (3-11) years and the HbA(1c) level was 8.0% (7.2-9.0%). The cohort comprised 65% men, 91% whites, 4% Afro-Caribbeans, 5% Asian Indians and 15% current smokers. More patients were classified as being at high risk by the UKPDS Risk Engine (65%) than by the Framingham CVD equation (63%) (p < 0.0001). The Framingham CVD equation classified fewer men and people aged <50 years old as high risk (p < 0.0001). There was no difference between the UKPDS Risk Engine and Framingham classification of women at high risk (p = 0.834).

CONCLUSIONS/INTERPRETATION

These results suggest that the use of Framingham-derived rather than UKPDS Risk Engine-derived CVD risk estimates would deny about one in 25 patients statin therapy when applying current NICE guidelines. Thus, under these guidelines the choice of CVD risk calculator is important when assessing CVD risk in patients with type 2 diabetes, particularly for the identification of the relatively small proportion of younger people who require statin therapy.

The impact of different time frames of risk communication on Type 2 diabetes patients' understanding and memory for risk of coronary heart disease and stroke

AIMS

We examined the impact of communicating risk of coronary heart disease (CHD) and stroke, using three time frames (1, 5 or 10 years), on Type 2 diabetic (T2D) patients' understanding of risk of CHD/stroke and their memory for these risks.

METHODS

Patients (N = 95) estimated their risk of developing CHD/having a stroke as a result of diabetes, in one of three time frames. Using the United Kingdom Prospective Diabetes Study Risk Engine and the same time frame, patients were then given individualized, objective risk estimates of developing CHD/stroke. Following explanation of these risks, patients' risk understanding was examined by asking them to report again their risk of developing CHD/stroke. Six weeks later we assessed patient memory for these risks by asking them to recall their actual risk estimates for CHD/stroke.

RESULTS

In all time frames, we successfully reduced participants' originally inflated risk perceptions of CHD (F(1,92) = 73.01, P < 0.001) and stroke (F(1,91) = 119.05, P < 0.001), although the 10-year risk group was the most resistant to correction for both CHD (F(1,90) = 9.32, P < 0.001) and stroke (F(2,88) = 3.97, P < 0.02). Participants' recall of their stroke risk at 6 weeks regressed towards original, inflated risk perceptions for the 10-year group only (F(4,176) = 4.73, P < 0.001).

CONCLUSION

Patients' inflated perceptions of CHD/stroke risk can be easily corrected using shorter (1- or 5-year) risk communication time frames.