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Wijk I, Amsberg S, Johansson UB, Toft E, Hagquist C, Anderbro T. Psychometric Evaluation of the Swedish Acceptance and Action Diabetes Questionnaire: A Rasch Analysis. J Nurs Meas 2024; 32:227-240. [PMID: 37553160 DOI: 10.1891/jnm-2022-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Background and Purpose: The Acceptance and Action Diabetes Questionnaire (AADQ) is a tool for assessing the acceptance of thoughts and emotions related to diabetes in people living with the disease. This study aimed to examine the psychometric properties of the Swedish version of AADQ (Swe-AADQ) in a sample of adults with type 1 diabetes. Methods: To examine the psychometric properties of the Swe-AADQ, the Rasch model was used. Data for 120 individuals were included. Results: The Swe-AADQ showed an acceptable fit to the Rasch model. A sufficiently high value of the separation index indicated a capacity to distinguish between different levels of acceptance in the sample. The 7-point Likert scale was reduced to three categories suggesting an improvement in the ordering of the item thresholds. Conclusions: The Swe-AADQ possesses reasonable quality in terms of reliability and validity. However, there are some deficiencies regarding the categorization of the response rating that should be addressed.
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Affiliation(s)
- Ingrid Wijk
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Susanne Amsberg
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Unn-Britt Johansson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Eva Toft
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Ersta Hospital, Stockholm, Sweden
| | - Curt Hagquist
- Department of Education and Special Education, University of Gothenburg, Gothenburg, Sweden
| | - Therese Anderbro
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Li Y, Wang D, Fang J, Zu S, Hu Y. Association between depressive symptoms and prediabetes: NHANES 2007-2016 findings. J Affect Disord 2024; 355:426-431. [PMID: 38537755 DOI: 10.1016/j.jad.2024.03.122] [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: 05/27/2023] [Revised: 02/04/2024] [Accepted: 03/23/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION The association between diabetes and depressive symptoms is well recognized. However, the impact of depressive symptoms on prediabetes remains unclear. This study aims to explore the specific correlation between depressive symptoms and prediabetes. METHODS A total of 7467 participants from the National Health and Nutrition Examination Survey (NHANES) were included in this study, spanning five rounds of surveys conducted between 2007 and 2016. Weighted logistic regression was utilized to assess the relationship between depressive symptoms and prediabetes. RESULTS Compared with the normoglycemic population, individuals with prediabetes had a significantly higher probability of experiencing trouble sleeping (P = 0.020). After adjusting for non-glucose factors, there was no significant correlation between PHQ-9 and prediabetes; however, severe depressive symptoms were positively associated with abnormal fasting plasma glucose (FPG) levels (OR = 1.093 [95 % CI 1.002, 1.192]). There was a positive correlation between trouble concentrating and FPG abnormalities (OR = 1.065 [95 % CI 1.004, 1.129]). LIMITATIONS The cross-sectional design limits causal inference. CONCLUSION Individuals with depressive symptoms, especially severe cases, should be targeted for prediabetes prevention and management efforts. The diverse symptom presentations may have distinct impacts on glucose, necessitating personalized prevention and management strategies.
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Affiliation(s)
- Yuwei Li
- Department of Clinical Psychology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Dong Wang
- Department of Clinical Psychology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiexin Fang
- Department of Clinical Psychology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Si Zu
- Department of Clinical Psychology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yongdong Hu
- Department of Clinical Psychology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Snoek FJ, Anarte-Ortiz MT, Anderbro T, Cyranka K, Hendrieckx C, Hermanns N, Indelicato L, McGuire BE, Mocan A, Nefs G, Polonsky WH, Stewart R, Vallis M. Roles and competencies of the clinical psychologist in adult diabetes care-A consensus report. Diabet Med 2024; 41:e15312. [PMID: 38385984 DOI: 10.1111/dme.15312] [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: 09/14/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 02/23/2024]
Abstract
AIMS Psychological care is recognised as an integral part of quality diabetes care. We set out to describe the roles and competencies of the clinical psychologist as a member of the multidisciplinary adult diabetes care team, focused on secondary care. METHODS The authors are clinically experienced psychologists involved in adult diabetes care, from Australia, Europe and North America, and active members of the international psychosocial aspects of diabetes study group. Consensus was reached as a group on the roles and competencies of the clinical psychologist working in adult diabetes secondary care, building both on expert opinion and a selective review and discussion of the literature on psychological care in diabetes, clinical guidelines and competency frameworks. RESULTS The clinical psychologist fulfils multiple roles: (1) as a clinician (psychological assessment and therapy), (2) as advisor to the healthcare team (training, consulting), (3) as a communicator and promotor of person-centred care initiatives and (4) as a researcher. Four competencies that are key to successfully fulfilling the above-mentioned roles in a diabetes setting are as follows: (a) specialised knowledge, (b) teamwork and advice, (c) assessment, (d) psychotherapy (referred to as STAP framework). CONCLUSIONS The roles and competencies of clinical psychologists working in diabetes extend beyond the requirements of most university and post-graduate curricula. There is a need for a comprehensive, accredited specialist post-graduate training for clinical psychologists working in diabetes care, building on the proposed STAP framework. This calls for a collaborative effort involving diabetes organisations, clinical psychology societies and diabetes psychology interest groups.
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Affiliation(s)
- Frank J Snoek
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Maria Teresa Anarte-Ortiz
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Málaga, Málaga, Spain
- Departamento de Personalidad, Evaluacion y Tratamiento Psicologico, Instituto de Investigación Biomedica de Málaga (IBIMA), Málaga, Spain
| | - Therese Anderbro
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Katarzyna Cyranka
- Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Carlton, Victoria, Australia
- School of Psychology, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Norbert Hermanns
- Forschungsinstitut Diabetes-Akademie Bad Mergentheim (FIDAM GmbH), Bad Mergentheim, Germany
- Department of Clinical Psychology, Psychotherapy of the University of Bamberg, Bamberg, Germany
| | - Liliana Indelicato
- Divission od Endocrinology, Diabetes and Metabolic Diseases, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Brian E McGuire
- School of Psychology, University of Galway and Centre for Diabetes, Endocrinology & Metabolism, Galway University Hospital, Galway, Ireland
| | - Andreia Mocan
- Center for Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Giesje Nefs
- Department of Medical Psychology, Radboud UMC, Nijmegen, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, The Netherlands
| | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, California, USA
- Department of Medicine, University of California, San Diego, California, USA
| | - Rose Stewart
- Betsi Cadwaladr University Health Board, Hospitals and Health Care, North Wales, UK
| | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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ElSayed NA, Aleppo G, Bannuru RR, Beverly EA, Bruemmer D, Collins BS, Darville A, Ekhlaspour L, Hassanein M, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S77-S110. [PMID: 38078584 PMCID: PMC10725816 DOI: 10.2337/dc24-s005] [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] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Wicaksana AL, Apriliyasari RW, Tsai PS. Effect of self-help interventions on psychological, glycemic, and behavioral outcomes in patients with diabetes: A meta-analysis of randomized controlled trials. Int J Nurs Stud 2024; 149:104626. [PMID: 37979371 DOI: 10.1016/j.ijnurstu.2023.104626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 10/06/2023] [Accepted: 10/19/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Self-help interventions are beneficial for patients with diabetes; however, related studies have reported conflicting results. To date, no review has examined the effect of self-help interventions on diabetes outcomes. OBJECTIVES To systematically evaluate the effects of self-help interventions on psychological, glycemic, and behavioral outcomes in patients with diabetes. DESIGN A systematic review and meta-analysis of randomized controlled trials. METHODS Five databases-PubMed, CINAHL, Embase, PsycINFO, and ClinicalTrials.gov-were searched from 1996, 1937, 1947, 1887, and 2000, respectively, to 2 June 2023. Studies that employed a randomized controlled trial design, enrolled adults with diabetes, implemented a self-help intervention as the main or an additional intervention, and reported the outcomes of interest were included. Studies providing self-help interventions to patients with gestational diabetes or pregnant women were excluded. The primary outcomes were diabetes distress, depression, and anxiety, and the secondary outcomes were glycemic and behavioral outcomes (self-management behavior, self-efficacy, and quality of life). Hedges' g and the associated 95 % confidence interval (CI) were calculated using a random-effects model to obtain the pooled estimates of short-, mid-, and long-term effects of self-help interventions. Heterogeneity was explored using I2 and Q statistics, and moderator analysis was performed to identify the sources of heterogeneity. RESULTS Of 17 eligible studies, 16 provided data for meta-analysis. We included 3083 patients with diabetes; the majority were women (61.95 %), and their average age was 55.13 years. Self-help interventions exerted significant short-term effects on diabetes distress (g = -0.363; 95 % CI = -0.554, -0.173), depression (g = -0.465; 95 % CI = -0.773, -0.156), anxiety (g = -0.295; 95 % CI = -0.523, -0.068), glycosylated hemoglobin level (g = -0.497; 95 % CI = -0.791, -0.167), self-efficacy (g = 0.629; 95 % CI = 0.060, 1.197), and quality of life (g = 0.413; 95 % CI = 0.104, 0.721; g = 0.182; 95 % CI = 0.031, 0.333; and g = 0.469; 95 % CI = 0.156, 0.783 for overall, physical, and mental domains, respectively). We also noted significant mid-term effects of self-help interventions on diabetes distress (g = -0.195; 95 % CI = -0.374, -0.016), self-management behavior (g = 0.305; 95 % CI = 0.155, 0.454), and overall quality of life (g = 0.562; 95 % CI = 0.315, 0.810). The certainty of evidence ranged from high to very low certainty for the measured outcomes. CONCLUSIONS Self-help interventions may have some positive effects on diabetes distress, anxiety, self-management behavior, and quality of life. REGISTRATION This review was registered in PROSPERO (CRD42022329905). TWEETABLE ABSTRACT This meta-analysis demonstrated that self-help interventions might improve psychological and behavioral outcomes in patients with diabetes.
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Affiliation(s)
- Anggi Lukman Wicaksana
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Medical Surgical Nursing, Universitas Gadjah Mada, Indonesia; The Sleman Health and Demographic Surveillance System, Universitas Gadjah Mada, Indonesia
| | - Renny Wulan Apriliyasari
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Institut Teknologi Kesehatan Cendekia Utama Kudus, Kudus, Indonesia
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing and Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
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Wijk I, Amsberg S, Johansson UB, Livheim F, Toft E, Anderbro T. Impact of an Acceptance and Commitment Therapy programme on HbA1c, self-management and psychosocial factors in adults with type 1 diabetes and elevated HbA1c levels: a randomised controlled trial. BMJ Open 2023; 13:e072061. [PMID: 38101850 PMCID: PMC10729111 DOI: 10.1136/bmjopen-2023-072061] [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: 01/21/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE To evaluate the impact of an Acceptance and Commitment Therapy (ACT) programme, tailored for people living with type 1 diabetes, on glycated haemoglobin (HbA1c), self-management and psychosocial factors among individuals with HbA1c>60 mmol/mol compared with treatment as usual (TAU). SETTING An endocrinologic clinic in Sweden. PARTICIPANTS In this randomised controlled trial, 81 individuals with type 1 diabetes, aged 18-70 years with HbA1c>60 mmol/mol, were randomly assigned to either an ACT group intervention or TAU. Exclusion criteria were: unable to speak Swedish, untreated or severe psychiatric disease, cortisone treatment, untreated thyroid disease and newly started insulin pump therapy. At the 2-year follow-up, HbA1c was measured in 26 individuals. INTERVENTION The ACT programme comprised seven 2-hour sessions held over 14 weeks and focused on acceptance of stressful thoughts and emotions, and to promote value-based committed action. OUTCOMES The primary outcome was HbA1c, and the secondary outcomes were measures of depression, anxiety, general stress, fear of hypoglycaemia, diabetes distress, self-care activities, psychological flexibility (general and related to diabetes) and quality of life. The primary endpoint was HbA1c 2 years after the intervention programme. Linear mixed models were used to test for an interaction effect between measurement time and group. RESULTS Likelihood ratio test of nested models demonstrated no statistically significant interaction effect (χ2=0.49, p=0.485) between measurement time and group regarding HbA1c. However, a statistically significant interaction effect (likelihood ratio test χ2=12.63, p<0.001) was observed with improved scores on The Acceptance and Action Questionnaire in the intervention group after 1 and 2 years. CONCLUSIONS No statistically significant difference was found between the groups regarding the primary outcome measure, HbA1c. However, the ACT programme showed a persistent beneficial impact on psychological flexibility in the intervention group. The dropout rate was higher than expected, which may indicate a challenge in this type of study. TRIAL REGISTRATION NUMBER NCT02914496.
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Affiliation(s)
- Ingrid Wijk
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Susanne Amsberg
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Unn-Britt Johansson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Livheim
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eva Toft
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Ersta Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Therese Anderbro
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Han B, Wang L, Zhang Y, Gu L, Yuan W, Cao W. Baseline anxiety disorders are associated with progression of diabetic kidney disease in type 2 diabetes. Ren Fail 2023; 45:2159431. [PMID: 36632821 PMCID: PMC9848365 DOI: 10.1080/0886022x.2022.2159431] [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: 01/13/2023] Open
Abstract
BACKGROUND Diabetic kidney disease (DKD) is a leading cause of kidney failure worldwide. Anxiety has been associated with disease progression in non-diabetes patients. We aimed to examine the prospective association between anxiety and progression of DKD in type 2 diabetes. METHODS We conducted a prospective cohort study of 2040 participants with type 2 diabetes at the Diabetes Center of Shanghai General Hospital between May 2017 and June 2020. Anxiety disorders at baseline were diagnosed by a structured clinical interview based on the 10th Revision of International Classification of Disease (ICD). Progression of DKD was identified as the transition from one urinary albumin excretion rate (AER) stage to the next or the development of kidney failure during the follow-up period. RESULTS At baseline, 403 (19.8%) had a diagnosis of anxiety disorders, of whom 107 (26.6%) also received a depression diagnosis. During a median follow-up time of 3.2 years, deterioration of the kidney status occurred in 340 (16.7%) individuals. After adjustment for potential confounders including depression or an anxiety × depression interaction term, anxiety disorders were independently related to an increased risk of progression of DKD (HR 1.539, 95% CI 1.130-2.095, p = 0.006; HR 1.536, 95% CI 1.111-2.122, p = 0.009, respectively). CONCLUSIONS Anxiety disorders at baseline, independent of possible confounders, were associated with the progression of DKD in type 2 diabetes. Whether therapeutic interventions for anxiety reduce the risk needs to be investigated.
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Affiliation(s)
- Bin Han
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ling Wang
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yueyue Zhang
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lijie Gu
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weijie Yuan
- Department of Nephrology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China,Weijie Yuan Department of Nephrology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200080, China
| | - Wei Cao
- Department of Emergency Medicine, Affiliated Hospital of Jiaxing University, Jiaxing, China,CONTACT Wei Cao Department of Emergency Medicine, Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China
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Maun A, Björkelund C, Arvidsson E. Primary care utilisation, adherence to guideline-based pharmacotherapy and continuity of care in primary care patients with chronic diseases and multimorbidity - a cross-sectional study. BMC PRIMARY CARE 2023; 24:237. [PMID: 37957554 PMCID: PMC10644564 DOI: 10.1186/s12875-023-02191-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND To understand how to improve care for patients with chronic diseases and multimorbidity we wanted to describe the prevalence of different chronic diseases and the pattern of multimorbidity and to analyse the associations between occurrence of diseases and primary care utilization, adherence to guideline-based pharmacotherapy, and continuity of care. METHODS Retrospective cross-sectional study of routine care data of the general population in region Jönköping in Sweden (345 916 inhabitants using primary care services) covering 4.3 years. PARTICIPANTS Patients fulfilling the inclusion criteria of having ≥ 1 of 10 common chronic diseases and ≥ 3 visits to primary care between 2011 and 2015. PRIMARY OUTCOME MEASURES In order to determine diseases and multimorbidity, primary care utilisation, adherence to guideline-based pharmacotherapy, frequencies and percentages, interval and ratio scaled variables were described using means, standard deviations, and various percentiles in the population. Two continuity indices were used (MMCI, COC) to describe continuity. RESULTS Of the general population, 25 829 patients fulfilled the inclusion criteria (7.5% of the population). Number of diseases increased with increasing age, and multimorbidity was much more common than single diseases (mean 2.0 per patient). There was a slight positive correlation (0.29) between number of diseases and visits, but visits did not increase proportionally to the number of diseases. Patients with physical diseases combined with anxiety and/or depression made more visits than others. The number of diseases per patient was negatively associated with the adherence to pharmacotherapy guidelines. There was no association between continuity and healthcare utilisation or adherence to pharmacotherapy guidelines. CONCLUSIONS Multimorbid patients are common in primary care and for many chronic diseases it is more common to have other simultaneous diseases than having only one disease. This can make adherence to pharmacotherapy guidelines a questionable measure for aged multimorbid patients. Existing continuity indices also revealed limitations. Holistic and patient-centred measures should be used for quality assessment of care for multimorbid patients in primary care.
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Affiliation(s)
- Andy Maun
- Institute of General Practice / Primary Care, Faculty of Medicine and Medical Center, University of Freiburg, Elsässer Str 2m, Freiburg, DE-79110, Germany.
| | - Cecilia Björkelund
- Primary Health Care, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 454, Göteborg, SE-405 30, Sweden
| | - Eva Arvidsson
- Research and Development Unit for Primary Care, Futurum, Hus B4, Länssjukhuset Ryhov, Jönköping, SE-551 85, Sweden
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Hamasaki H, Yanai H. Association of the use of psychotropic drugs with hospitalization, cardiovascular events, and mortality in patients with type 2 diabetes: a propensity score-matched cohort study. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1181998. [PMID: 37476651 PMCID: PMC10354430 DOI: 10.3389/fcdhc.2023.1181998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/16/2023] [Indexed: 07/22/2023]
Abstract
Background Use of psychotropic drugs (PD) may be associated with impairment of physical function. However, few studies have assessed the impact of PD on health outcomes in patients with type 2 diabetes. This study aimed to examine the associations between psychotropic drug use and handgrip strength (HGS) and between the use of PD and hospitalization in patients with type 2 diabetes. Methods From April 2013 to December 2015, we conducted a retrospective cohort study in patients with type 2 diabetes at the National Center for Global Health and Medicine Kohnodai Hospital. Patients aged 20 years and over who can measure HGS were included. All participants received nutritional guidance regarding diet therapy for type 2 diabetes at baseline. Nonpsychotropic drug users were matched one-to-one with the PD users using propensity score matching method with respect to their baseline covariates. The differences in HGS and the number of patients who had hospitalizations during the study period were examined. By Cox proportional hazard regression analysis, the association between the use of PD and repeated hospitalizations was estimated. Results A total of 1,282 patients were enrolled and followed up for 2.36 ± 0.73 years. In the propensity score matching cohort, HGS was significantly lower (p = 0.006) in PD users than non-PD users. PD users had more hospitalizations than non-PD users. Cox proportional hazard regression analysis confirmed the association of repeated hospitalizations with the use of PD (hazard ratio = 2.138; 95% confidence interval, 1.144-3.995, p = 0.017)). In addition, HGS was significantly and inversely correlated with the number of hospitalizations (r = -0.143, p = 0.013). Conclusions The use of PD could increase the risk of repeated hospitalizations. Skeletal muscle may play a role in reducing the risk of hospitalization in patients who are treated with PD.
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Affiliation(s)
| | - Hidekatsu Yanai
- Department of Diabetes and Endocrinology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Japan
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Gallo LC, Fortmann AL, Clark TL, Roesch SC, Bravin JI, Spierling Bagsic SR, Sandoval H, Savin KL, Gilmer T, Talavera GA, Philis-Tsimikas A. Mi Puente (My Bridge) Care Transitions Program for Hispanic/Latino Adults with Multimorbidity: Results of a Randomized Controlled Trial. J Gen Intern Med 2023; 38:2098-2106. [PMID: 36697929 PMCID: PMC9876654 DOI: 10.1007/s11606-022-08006-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/23/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Multimorbidity frequently co-occurs with behavioral health concerns and leads to increased healthcare costs and reduced quality and quantity of life. Unplanned readmissions are a primary driver of high healthcare costs. OBJECTIVE We tested the effectiveness of a culturally appropriate care transitions program for Latino adults with multiple cardiometabolic conditions and behavioral health concerns in reducing hospital utilization and improving patient-reported outcomes. DESIGN Randomized, controlled, single-blind parallel-groups. PARTICIPANTS Hispanic/Latino adults (N=536; 75% of those screened and eligible; M=62.3 years (SD=13.9); 48% women; 73% born in Mexico) with multiple chronic cardiometabolic conditions and at least one behavioral health concern (e.g., depression symptoms, alcohol misuse) hospitalized at a hospital that serves a large, mostly Hispanic/Latino, low-income population. INTERVENTIONS Usual care (UC) involved best-practice discharge processes (e.g., discharge instructions, assistance with appointments). Mi Puente ("My Bridge"; MP) was a culturally appropriate program of UC plus inpatient and telephone encounters with a behavioral health nurse and community mentor team who addressed participants' social, medical, and behavioral health needs. MAIN MEASURES The primary outcome was 30- and 180-day readmissions (inpatient, emergency, and observation visits). Patient-reported outcomes (quality of life, patient activation) and healthcare use were also examined. KEY RESULTS In intention-to-treat models, the MP group evidenced a higher rate of recurrent hospitalization (15.9%) versus UC (9.4%) (OR=1.91 (95% CI 1.09, 3.33)), and a greater number of recurrent hospitalizations (M=0.20 (SD=0.49) MP versus 0.12 (SD=0.45) UC; P=0.02) at 30 days. Similar trends were observed at 180 days. Both groups showed improved patient-reported outcomes, with no advantage in the Mi Puente group. Results were similar in per protocol analyses. CONCLUSIONS In this at-risk population, the MP group experienced increased hospital utilization and did not demonstrate an advantage in improved patient-reported outcomes, relative to UC. Possible reasons for these unexpected findings are discussed. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02723019. Registered on 30 March 2016.
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Affiliation(s)
- Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA.
- South Bay Latino Research Center, San Diego State University, 780 Bay Blvd. Suite 200, Chula Vista, CA, 91910, USA.
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | - Taylor L Clark
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Scott C Roesch
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Julia I Bravin
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | | | - Haley Sandoval
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | - Kimberly L Savin
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Todd Gilmer
- Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, CA, USA
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11
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Zhou J, Sherrill CH, Hwang AY, Lee S. Association between mental health and self-care behavior among older adults with diabetes according to Behavioral Risk Factor Surveillance System 2019. Prim Care Diabetes 2023; 17:250-254. [PMID: 36898951 DOI: 10.1016/j.pcd.2023.02.005] [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: 06/30/2022] [Revised: 02/09/2023] [Accepted: 02/26/2023] [Indexed: 03/11/2023]
Abstract
AIM To assess the association of mental health burden with diabetes-related self-care behaviors and healthcare utilization among older adults. METHOD This cross-sectional 2019 Behavioral Risk Factor Surveillance System (BRFSS) study included ≥ 65 years old adults with self-reported diabetes. Three groups were used based on the number of days in the past month affected by mental health: 0 days (no burden), 1-13 days (occasional burden), and 14-30 days (frequent burden). Primary outcome was performing ≥ 3 of 5 diabetes-related self-care behaviors. Secondary outcome was performing ≥ 3 of 5 healthcare utilization behaviors. Multivariable logistic regression was used in Stata/SE 15.1. RESULTS Of 14,217 included individuals, 10.2 % reported frequent mental health burden. Compared to 'no burden', 'occasional' and 'frequent burden' groups included more female, obese, not married persons with younger age of diabetes diagnosis, and reported more comorbidities, insulin use, cost-related barriers to see doctors, and diabetes-related eye issues (p < 0.05). 'Occasional/frequent burden' groups reported less self-care and healthcare utilization behaviors, except 30 % higher healthcare utilization was observed in the 'occasional burden' group compared to no burden (aOR 1.30, 95 %CI 1.08-1.58, p = 0.006). CONCLUSIONS Overall, mental health burden was associated with reduced participation in diabetes-related self-care and healthcare utilization behaviors in a stepwise manner, except occasional burden was associated with higher healthcare utilization.
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Affiliation(s)
- Jenny Zhou
- University of North Carolina Eshelman School of Pharmacy, 301 Pharmacy Ln, Chapel Hill, NC 27599, United States
| | - Christina H Sherrill
- High Point University Fred Wilson School of Pharmacy, 602 International Ave, High Point, NC 27262, United States
| | - Andrew Y Hwang
- High Point University Fred Wilson School of Pharmacy, 602 International Ave, High Point, NC 27262, United States; MCPHS University School of Pharmacy, 179 Longwood Ave, Boston, MA 02115, United States.
| | - Sun Lee
- High Point University Fred Wilson School of Pharmacy, 602 International Ave, High Point, NC 27262, United States; Analysis Group, 111 Huntington Ave, Boston, MA 02199, United States
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12
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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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Benari O, Ravona Springer R, Almog G, Yore I, Zadok M, Lin HM, Ouyang Y, Sano M, Bendlin BB, Livny A, Heymann A, Schnaider Beeri M. Behavioral and Brain Correlates of Emotional Distress in Older Adults During COVID-19 Quarantine. Alzheimer Dis Assoc Disord 2023; 37:156-159. [PMID: 37027496 PMCID: PMC10219644 DOI: 10.1097/wad.0000000000000540] [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: 06/08/2022] [Accepted: 10/31/2022] [Indexed: 04/09/2023]
Abstract
COVID-19 led to unprecedented lockdowns and changes in older adults' lives, especially those with type 2 diabetes who have high risk of complications and mortality. We investigated the associations of cognitive and motor function and gray matter volumes (GMVs) with COVID-19 lockdown-related emotional distress of type 2 diabetes older adults, participating in the Israel Diabetes and Cognitive Decline Study. We administered a questionnaire to obtain information about anxiety, depression, general well-being, and optimism during a mandated lockdown. Lower grip strength before lockdown was associated with increased sadness, anxiety, and less optimism. Slower gait speed was associated with greater sadness. Lower GMV was related to greater anxiety during the lockdown when compared with anxiety levels before the COVID-19 outbreak. Yet, global cognition was not associated with any emotional distress measure. These results support the role of good motor function on emotional well-being during acute stress and GMV as a potential underlying mechanism.
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Affiliation(s)
- Ori Benari
- The Joseph Sagol Neuroscience Center
- Sackler Faculty of Medicine, Tel Aviv University
| | - Ramit Ravona Springer
- The Joseph Sagol Neuroscience Center
- Memory Clinic, Sheba Medical Center
- Sackler Faculty of Medicine, Tel Aviv University
| | | | | | | | - Hung-Mo Lin
- Departments of Population Health Science and Policy
| | - Yuxia Ouyang
- Departments of Population Health Science and Policy
| | - Mary Sano
- Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Barbara B. Bendlin
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Abigail Livny
- The Joseph Sagol Neuroscience Center
- Department of Diagnostic imaging, Sheba Medical Center, Tel Hashomer
- Sackler Faculty of Medicine, Tel Aviv University
| | - Anthony Heymann
- Sackler Faculty of Medicine, Tel Aviv University
- Maccabi Healthcare Services, Tel Aviv, Israel
| | - Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center
- Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY
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14
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Claro AE, Palanza C, Mazza M, Corsello A, Rizzi A, Tartaglione L, de Waure C, Marano G, Piciollo S, Muti Schuenemann GEU, Rigoni M, Muti P, Pontecorvi A, Janiri L, Sani G, Pitocco D. Evaluation of the prevalence of the most common psychiatric disorders in patients with type 2 diabetes mellitus using the patient health questionnaire: results of the cross-sectional "DIA2PSI" study. Acta Diabetol 2023; 60:247-255. [PMID: 36342534 PMCID: PMC9640892 DOI: 10.1007/s00592-022-01993-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/07/2022] [Indexed: 11/09/2022]
Abstract
AIMS Common Psychiatric Disorders (CPDs) are associated with the development of overweight and obesity, the strongest risk factors for the onset and maintenance of Type 2 Diabetes mellitus (T2D). To the best of our knowledge, this is the first study to assess the prevalence of CPDs in patients with T2D in Italy. METHODS This is a monocentric cross-sectional study; n = 184 T2D patients were screened for CPDs using the Patient Health Questionnaire (PHQ). Primary outcome was to evaluate the prevalence of CPDs. To assess association between CPDs and risk factors, we have utilized univariable logistic regression models. RESULTS 64.1% were men, median age was 67 (59-64) and median BMI 27 (25-30) kg/m2. The 42.9% tested positive for one or more mental disorders, 25.6% for depression. Patients with higher BMI (p = 0.04) had an increased likelihood of testing positive to the PHQ. Patients who had implemented lifestyle changes (p < 0.01) and were aware that mental health is linked to body health (p = 0.07) had a reduction in the likelihood of testing positive. CONCLUSIONS Prevalence of CPDs in T2D patients is higher than in the general population. Since CPDs favor the onset and subsistence of T2D, integrated diabetic-psychiatric therapy is required for improvement or remission of T2D in patients with comorbid CPDs.
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Affiliation(s)
- Angelo Emilio Claro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8-CAP 00168 Rome, Italy
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8-CAP 00168 Rome, Italy
| | - Clelia Palanza
- Istituto Italiano Di Antropologia-ISItA, Piazzale Aldo Moro, 5-00185 Rome, Italy
| | - Marianna Mazza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8-CAP 00168 Rome, Italy
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8-CAP 00168 Rome, Italy
| | - Andrea Corsello
- Diabetes Care Unit, Department of Endocrinology and Diabetes, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8-CAP 00168 Rome, Italy
| | - Alessandro Rizzi
- Diabetes Care Unit, Department of Endocrinology and Diabetes, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8-CAP 00168 Rome, Italy
| | - Linda Tartaglione
- Diabetes Care Unit, Department of Endocrinology and Diabetes, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8-CAP 00168 Rome, Italy
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, Piazza dell’ Università, 1, 06123 Perugia, Italy
| | - Giuseppe Marano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8-CAP 00168 Rome, Italy
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8-CAP 00168 Rome, Italy
| | - Simone Piciollo
- Associazione Italiana di Psicologia Giuridica–AIPG, Via Bisagno, 15, 00199 Rome, Italy
| | - Giovanna Elsa Ute Muti Schuenemann
- Health Research Methods, Evidence and Impact Department, McMaster University, McMaster University Medical Centre, 1280 Main Street West 2C Area, Hamilton, ON L8S 4K1 Canada
| | - Marta Rigoni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Paola Muti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology, Department of Endocrine-Metabolic and Dermo-Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8-CAP 00168 Rome, Italy
| | - Luigi Janiri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8-CAP 00168 Rome, Italy
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8-CAP 00168 Rome, Italy
| | - Gabriele Sani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8-CAP 00168 Rome, Italy
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8-CAP 00168 Rome, Italy
| | - Dario Pitocco
- Diabetes Care Unit, Department of Endocrinology and Diabetes, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8-CAP 00168 Rome, Italy
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Xin M, Chan VWY, Kong APS, Lau JTF, Cameron LD, Mak WWS, Mo PKH. Using the common-sense model to explicate the role of illness representation in self-care behaviours and anxiety symptoms among patients with Type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2023; 107:107581. [PMID: 36470126 DOI: 10.1016/j.pec.2022.107581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/29/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Based on the common-sense model of self-regulation, this study aimed to explicate the mechanism underlying the effect of illness representations on self-care behaviours and anxiety symptoms among patients with type 2 diabetes. METHODS A telephone survey was administered to 473 patients in Hong Kong. Structural equation modelling was used to test if threat and control perceptions regarding diabetes would be associated with self-reported self-care behaviours and anxiety symptoms through adoption of adaptive/maladaptive coping strategies and diabetes-related self-efficacy. RESULTS Control perceptions but not threat perceptions were positively associated with self-care behaviours. Control perceptions had a positive indirect association with self-care behaviours through more problem-focused coping and diabetes-related self-efficacy. Threat perceptions simultaneously had a positive indirect association through more problem-focused coping and a negative indirect association through more avoidant coping and lower diabetes-related self-efficacy. In contrast, threat and control perceptions were positively and negatively, respectively, associated with anxiety symptoms. Problem-focused and avoidant coping consistently mediated the indirect association between threat perceptions and anxiety symptoms. CONCLUSION Threat and control perceptions were associated with diabetes self-care behaviours and anxiety symptoms through different self-regulation pathways. PRACTICE IMPLICATIONS Our findings inform possible targets for self-management interventions to simultaneously enhance self-care behaviours and alleviate diabetes-associated anxiety.
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Affiliation(s)
- Meiqi Xin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
| | | | - Alice P S Kong
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Joseph T F Lau
- School of Mental Health, Wenzhou Medical University, Wenzhou, China; Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, China; School of Public Health, Zhejiang University, Hangzhou, China; Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Linda D Cameron
- School of Social Science, Humanities, and the Arts, University of California, Merced, USA.
| | - Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Phoenix K H Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
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16
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Young-Hyman D, Gabbay RA, on behalf of the American Diabetes Association. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S68-S96. [PMID: 36507648 PMCID: PMC9810478 DOI: 10.2337/dc23-s005] [Citation(s) in RCA: 136] [Impact Index Per Article: 136.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Validation and Cross-Cultural Adaptation of the Diabetes Self-Management Questionnaire (DSMQ) and the Social Phobia Inventory (SPIN) in Romanian Patients with Diabetes Mellitus. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121823. [PMID: 36557025 PMCID: PMC9783180 DOI: 10.3390/medicina58121823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
Background and Objectives: Anxiety disorders are common in individuals with diabetes mellitus (DM) and have a negative impact on diabetes-related self-management and, therefore, on patients’ evolution and prognosis. In this context, it becomes necessary to accurately and easily assess anxiety and self-management behaviours. Thus, the aim of this research was translation and cultural adaptation for Romanian patients and validation of two instruments used for assessing diabetes self-management and anxiety, namely the Diabetes Self-Management Questionnaire (DSMQ) and the Social Phobia Inventory (SPIN). Materials and Methods: The Summary of Diabetes Self-Care Activities Questionnaire (SDSCA) and the DSMQ instruments for assessing diabetes self-management, as well as the Generalised Anxiety Disorder Scale (GAD-7) and the SPIN instruments for assessing anxiety, have been administered to 117 patients from Timisoara, Romania, previously diagnosed with DM. Results: The SPIN has proven to have good internal consistency, excellent acceptability of its questions without non-responders and a median completion time of 3 min and 10 s, an excellent test−retest performance (Spearman’s rho = 0.971, p < 0.001 between two administrations of the test) and good validity in comparison with the GAD-7, a previously validated and comprehensive instrument. The DSMQ has also proven to have acceptable internal consistency, excellent acceptability of its questions without non-responders and a median completion time of 2 min and 28 s; however, it has shown a weak, positive correlation without statistical significance in comparison with the SDSCA, a previously validated questionnaire. Conclusions: The SPIN, translated in Romanian and culturally adapted, is a valid tool for the screening of social phobias in individuals with DM. The DSMQ requires additional data for its validation in DM patients from Romania.
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Mphasha MH, Mothiba TM, Skaal L. Lived experiences of diabetic outpatients attending clinics in rural areas of Limpopo province in South Africa. Health SA 2022. [DOI: 10.4102/hsag.v27i0.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lara-Cinisomo S, Loret de Mola JR, Flores-Carter K, Tabb KM, Roloff K. Prenatal Depressive Symptoms, Self-Rated Health, and Diabetes Self-Efficacy: A Moderated Mediation Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013603. [PMID: 36294181 PMCID: PMC9602843 DOI: 10.3390/ijerph192013603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Diabetes leads to risk for pregnant persons and their fetuses and requires behavioral changes that can be compromised by poor mental health. Poor self-rated health (SRH), a reliable predictor of morbidity and mortality, has been associated with depressive symptoms and lower self-efficacy in patients with diabetes. However, it is unclear whether SRH mediates the association between depressive symptoms and self-efficacy in pregnant patients with diabetes and whether the healthcare site moderates the mediation. Thus, we sought to test these associations in a racially and ethnically diverse sample of pregnant individuals diagnosed with diabetes from two clinical settings. MATERIALS AND METHODS This was an observational, cross-sectional study of 137 pregnant individuals diagnosed with diabetes at two clinical study sites. Participants self-administered a demographic questionnaire and measures designed to assess depressive symptoms, SRH in pregnancy, and diabetes self-efficacy. A moderated mediation model tested whether these indirect effects were moderated by the site. RESULTS The results show that SRH mediated the association between depressive symptoms and diabetes self-efficacy. The results also showed the site moderated the mediating effect of SRH on depressive symptoms and diabetes self-efficacy. CONCLUSIONS Understanding the role of clinical care settings can help inform when and how SRH mediates that association between prenatal depressive symptoms and self-efficacy in diabetic patients.
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Affiliation(s)
- Sandraluz Lara-Cinisomo
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, 1206 S. Fourth Street, Champaign, IL 61820, USA
| | - Julio Ricardo Loret de Mola
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, 415 N. 9th St. Suite 6W100, Springfield, IL 62794, USA
| | - Kendra Flores-Carter
- Department of Social Work, College of Behavioral and Social Sciences, California Baptist University, 8432 Magnolia Avenue, Riverside, CA 92504, USA
| | - Karen M. Tabb
- School of Social Work, University of Illinois Urbana-Champaign, 1010 W. Nevada St., Urbana, IL 61801, USA
| | - Kristina Roloff
- Department of Women’s Health, Arrowhead Regional Medical Center, 400 N. Pepper Avenue, Colton, CA 92324, USA
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MacGregor KL, DeMartini KS, Barry-Menkhaus SA, Derr AG, Thompson MJ. The Impact of Integrated Behavioral Healthcare on Glycemic Control. J Clin Psychol Med Settings 2022; 29:636-644. [PMID: 34436717 DOI: 10.1007/s10880-021-09817-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
Integrated behavioral healthcare (IBH) is the "standard of care" to address psychosocial factors impacting diabetes outcomes; it is not standard in practice. This longitudinal, retrospective, chart-review examines IBH impact on glycemic control in an adult diabetes clinic. Adults (n = 374) with ≥ 1 behavioral health encounter, ≥ 2 hemoglobin A1c (HbA1c) values, and HbA1c value > 8% at initial IBH visit were included. Mixed effects linear piecewise models examined differences in slope trajectories for 365 days pre- and post-IBH intervention. Pre-intervention slope was not significant (z = - 1.09, p = 0.28). The post-intervention slope was significant (z = - 6.44, p < 0.001), indicating a significant linear decrease in HbA1c values. Results demonstrated that prior to engaging with behavioral health, there was no change in HbA1c. After initial IBH visit, there was a predicted reduction of > 1% in HbA1c over the following year. These results suggest that IBH significantly improves patients' metabolic status. Next steps for IBH research are offered.
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Affiliation(s)
- Kristin L MacGregor
- Department of Psychiatry/Diabetes Center of Excellence, UMass Memorial Medical Center/UMass Medical School, Worcester, MA, 01655, USA.
| | - Kelly S DeMartini
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | | | - Alan G Derr
- Diabetes Center of Excellence, UMass Medical School, Worcester, MA, 01655, USA
| | - Michael J Thompson
- Diabetes Center of Excellence, UMass Medical School, Worcester, MA, 01655, USA
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McInerney AM, Lindekilde N, Nouwen A, Schmitz N, Deschênes SS. Diabetes Distress, Depressive Symptoms, and Anxiety Symptoms in People With Type 2 Diabetes: A Network Analysis Approach to Understanding Comorbidity. Diabetes Care 2022; 45:1715-1723. [PMID: 35704532 DOI: 10.2337/dc21-2297] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/17/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In this study, we aimed to explore interactions between individual items that assess diabetes distress, depressive symptoms, and anxiety symptoms in a cohort of adults with type 2 diabetes using network analysis. RESEARCH DESIGN AND METHODS Participants (N = 1,796) were from the Montreal Evaluation of Diabetes Treatment (EDIT) study from Quebec, Canada. A network of diabetes distress was estimated using the 17 items of the Diabetes Distress Scale (DDS-17). A second network was estimated using the DDS-17 items, the nine items of the Patient Health Questionnaire (PHQ-9), and the seven items of the Generalized Anxiety Disorder Assessment (GAD-7). Network analysis was used to identify central items, clusters of items, and items that may act as bridges between diabetes distress, depressive symptoms, and anxiety symptoms. RESULTS Regimen-related and physician-related problems were among the most central (highly connected) and influential (most positive connections) in the diabetes distress network. The depressive symptom of failure was found to be a potential bridge between depression and diabetes distress, being highly connected to diabetes distress items. The anxiety symptoms of worrying too much, uncontrollable worry, and trouble relaxing were identified as bridges linking both anxiety and depressive items and anxiety and diabetes distress items, respectively. CONCLUSIONS Regimen-related and physician-related diabetes-specific problems may be important in contributing to the development and maintenance of diabetes distress. Feelings of failure and worry are potentially strong candidates for explaining comorbidity. These individual diabetes-specific problems and mental health symptoms could hold promise for targeted interventions for people with type 2 diabetes.
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Affiliation(s)
- Amy M McInerney
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Nanna Lindekilde
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Arie Nouwen
- Department of Psychology, Middlesex University, London, U.K
| | - Norbert Schmitz
- Population-Based Medicine Department, University of Tübingen, Tübingen, Germany.,Douglas Research Centre, McGill University, Montreal, Canada
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Exploring the lived experience of diabetes through an intersectional lens: A qualitative study of adults with type 1 and type 2 diabetes. Can J Diabetes 2022; 46:620-627. [DOI: 10.1016/j.jcjd.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/23/2022] [Accepted: 06/08/2022] [Indexed: 11/24/2022]
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Kintzoglanakis K, Gkousiou A, Vonta P, Sagmatopoulos A, Copanitsanou P. Depression, anxiety, and diabetes-related distress in type 2 diabetes in primary care in Greece: Different roles for glycemic control and self-care. SAGE Open Med 2022; 10:20503121221096605. [PMID: 35600704 PMCID: PMC9118887 DOI: 10.1177/20503121221096605] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/05/2022] [Indexed: 12/28/2022] Open
Abstract
Objectives: The psychological distress of people living with diabetes is increased and associated with poorer glycemic outcomes and self-care. We aimed to examine the frequency of depression, anxiety, and diabetes-related distress (DRD) of individuals with type 2 diabetes (T2D) in primary care (PC) and their comparative associations with clinical, self-care, and socio-demographic characteristics, testing for possible different roles on glycemic control and self-care. Methods: This is a cross-sectional study of 182 adults with a T2D diagnosis of at least six months, recruited between August 2019-March 2020 and May-October 2020, from an urban PC unit. Participants were screened for symptoms of depression (Patient Health Questionnaire-9 (PHQ-9)), anxiety (Generalized Anxiety Disorder-7 (GAD-7)), and DRD (Diabetes Distress Scale (DDS)). Clinical, self-care, and socio-demographic parameters were recorded. Results: The frequency of clinically significant symptoms of depression was 16.6%, (PHQ-9 score ⩾10), anxiety 17.7% (GAD-7 score ⩾10), and DRD 22.6% (DDS score ⩾2). All PHQ-9, GAD-7, and DDS scores intercorrelated, and higher scores were found to be associated with female gender, lower income, and prior diagnosis of depression. Higher PHQ-9 and GAD-7 scores were found to be associated with lower education, more hypoglycemia episodes, more blood glucose self-tests and antidepressant or benzodiazepine use. The retired/housewives scored significantly lower in GAD-7 and DDS compared to the unemployed participants. Higher DDS scores were associated with higher glycated hemoglobin, higher fasting plasma glucose, and insulin use. It was also noted that higher PHQ-9 scores were associated with lower uric acid levels and were significantly higher in the sedentary lifestyle group. Conclusion: DRD was associated with poorer glycemic outcomes while depressive symptoms were associated with lower physical activity perhaps sharing different roles for glycemic control and self-care. The psychological burden of individuals with T2D may be considered in PC.
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Affiliation(s)
| | | | | | | | - Panagiota Copanitsanou
- General Hospital of Piraeus “Tzaneio,” Piraeus, Greece
- Department of Nursing Science, National and Kapodistrian University of Athens, Athens, Greece
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A parallel randomised controlled trial of the Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes and problematic hypoglycaemia despite optimised self-care (HARPdoc). Nat Commun 2022; 13:2229. [PMID: 35484106 PMCID: PMC9050729 DOI: 10.1038/s41467-022-29488-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/18/2022] [Indexed: 02/02/2023] Open
Abstract
Impaired awareness of hypoglycaemia (IAH) is a major risk for severe hypoglycaemia in insulin treatment of type 1 diabetes (T1D). To explore the hypothesis that unhelpful health beliefs create barriers to regaining awareness, we conducted a multi-centre, randomised, parallel, two-arm trial (ClinicalTrials.gov NCT02940873) in adults with T1D and treatment-resistant IAH and severe hypoglycaemia, with blinded analysis of 12-month recall of severe hypoglycaemia at 12 and/or 24 months the primary outcome. Secondary outcomes included cognitive and emotional measures. Adults with T1D, IAH and severe hypoglycaemia despite structured education in insulin adjustment, +/- diabetes technologies, were randomised to the "Hypoglycaemia Awareness Restoration Programme despite optimised self-care" (HARPdoc, n = 49), a psychoeducation programme uniquely focussing on changing cognitive barriers to avoiding hypoglycaemia, or the evidence-based "Blood Glucose Awareness Training" (BGAT, n = 50), both delivered over six weeks. Median [IQR] severe hypoglycaemia at baseline was 5[2-12] per patient/year, 1[0-5] at 12 months and 0[0-2] at 24 months, with no superiority for HARPdoc (HARPdoc vs BGAT incident rate ratios [95% CI] 1.25[0.51, 3.09], p = 0.62 and 1.26[0.48, 3.35], p = 0.64 respectively), nor for changes in hypoglycaemia awareness scores or fear. Compared to BGAT, HARPdoc significantly reduced endorsement of unhelpful cognitions (Estimated Mean Difference for Attitudes to Awareness scores at 24 months, -2.07 [-3.37,-0.560], p = 0.01) and reduced scores for diabetes distress (-6.70[-12.50,-0.89], p = 0.02); depression (-1.86[-3.30, -0.43], p = 0.01) and anxiety (-1.89[-3.32, -0.47], p = 0.01). Despite positive impact on cognitive barriers around hypoglycaemia avoidance and on diabetes-related and general emotional distress scores, HARPdoc was not more effective than BGAT at reducing severe hypoglycaemia.
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Mehta G, Lo B, Memarpour M, Chan A. Impact of Diabetes on Inpatient Length of Stay in Adult Mental Health Services in a Community Hospital Setting: A Retrospective Cohort Study. Can J Diabetes 2022; 46:S1499-2671(22)00075-2. [PMID: 35933315 DOI: 10.1016/j.jcjd.2022.03.012] [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: 11/20/2021] [Revised: 03/05/2022] [Accepted: 03/29/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Our aim in this study was to characterise the relationship between comorbid mental health diagnosis and diabetes type on inpatient length of stay (LOS). METHODS This retrospective, chart review study was conducted at a community hospital in Ontario, Canada. Individuals admitted to the inpatient mental health unit with a reported diagnosis of type 1 or type 2 diabetes were included in the analysis. Relevant data related to mental health conditions at admission and LOS were collected from the electronic health record. Analyses of variance and coviariance were used to determine the impact on LOS. RESULTS A total of 249 encounters were included in the analyses. Overall, individuals with type 2 diabetes (mean, 14.70 days; standard deviation, 15.75 days) had a significantly longer LOS than individuals with type 1 diabetes (mean, 8.01 days; standard deviation, 7.27 days). Upon including sociodemographic factors, individuals older in age and with a most recent admission of <1 year also had a longer LOS. There was no significant relationship between the most responsible mental health diagnosis and LOS. CONCLUSIONS Individuals with type 2 diabetes may be more likely to have a longer LOS in inpatient mental health settings than those with type 1 diabetes. More dedicated support would be beneficial for this population. Future work should focus on in-depth exploration of the challenges that lead to the observed LOS.
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Affiliation(s)
- Gaurav Mehta
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Brian Lo
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Mahdi Memarpour
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Angela Chan
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
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Longitudinal Association of Depressive Symptoms, Binge Eating, and Quality of Life With Cardiovascular Risk Factors in Young Adults With Youth-Onset Type 2 Diabetes: The TODAY2 Study. Diabetes Care 2022; 45:dc211995. [PMID: 35290434 PMCID: PMC9174973 DOI: 10.2337/dc21-1995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/16/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To report the prevalence of depression, eating disorder symptoms, and impaired health-related quality of life (HRQOL) and examine their longitudinal associations with glycemia and diabetes complications in young adults with youth-onset type 2 diabetes. RESEARCH DESIGN AND METHODS Participants recruited over a 4-year period were enrolled at 15 clinical diabetes centers in the follow-up observational Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) study. From 2014-2020, prevalence of symptoms of depression, eating disorders, and HRQOL by sex, race/ethnicity, and baseline family income were assessed annually. Longitudinal relationships between assessments of glycemia and complications with psychiatric symptoms and HRQOL were evaluated in adjusted models. RESULTS Participants (n = 514) were 21.7 ± 2.5 years old with a diabetes duration of 8.6 ± 1.5 years in year 1 of TODAY 2 (2014). Symptoms of depression and impaired HRQOL were common and increased significantly over 6 years (14.0% to 19.2%, P = 0.003; and 13.1% to 16.7%, P = 0.009, respectively). Depression and impaired HRQOL were more common in women and those with lower baseline family income but did not differ by race/ethnicity. Rates of binge eating were stable over time; self-reported purging increased. Over time, symptoms of depression were associated with higher HbA1c, hypertension, and retinopathy progression; impaired HRQOL was associated with higher BMI, systolic blood pressure, hypertension, and retinopathy progression; and symptoms of eating disorders were associated with higher BMI. CONCLUSIONS Significant psychiatric symptoms and impaired HRQOL are common among emerging adults with youth-onset type 2 diabetes and are positively associated with glycemia, hypertension, and retinopathy progression in this group that is at ongoing risk for medical morbidity.
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Relating sociodemographic factors and glycemic control among inpatients with type 2 diabetes. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01303-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Comer-HaGans D, Austin S, Ramamonjiarivelo Z, Sherman LD. Preventative diabetes self-care management practices among individuals with diabetes and mental health stress. J Affect Disord 2022; 298:24-34. [PMID: 34780862 DOI: 10.1016/j.jad.2021.11.020] [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: 08/23/2020] [Revised: 09/09/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The study purpose examines diabetes self-care management practices among individuals diagnosed with diabetes with and without mental health stress. METHODS Pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey (HC-MEPS) were used. The sample consisted of individuals ages 25-85 years (n = 13,193; weighted n = 23,559,975). Dependent variables were engagement in moderate/vigorous physical exercise five times weekly, receiving dilated eye exams, foot checks, treating diabetes with diet modification or insulin injections, and eating fewer high fat/cholesterol foods. The independent variable was diabetes with and without mental health stress. The study controlled for predisposing, enabling, and need factors. RESULTS Compared with individuals with diabetes without mental health stress, findings indicate individuals with diabetes and low or mild/moderate mental health stress were more likely to treat diabetes with diet modification and to restrict high fat/cholesterol food. Individuals with diabetes and severe mental health stress were more likely to restrict high fat/cholesterol. Additionally, individuals with mild/moderate to severe mental health stress were less likely to engage in diabetes care behavior. LIMITATIONS Mental health stress is represented as a non-specific psychological distress index summary during the past 30 days and may not be an actual representation of overall distress in a person's life. There were no variables distinguishing diabetes type or severity. The study uses self-reported data and is cross-sectional. CONCLUSIONS Mental health stress may contribute to individuals not engaging in self-management practices. It would be beneficial to incorporate psychosocial services for individuals with diabetes and mental health stress.
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Affiliation(s)
- DeLawnia Comer-HaGans
- Governors State University, Health Administration, 1 University Parkway, University Park, IL 60484-0975, United States.
| | - Shamly Austin
- Gateway Health, Four Gateway Center, Research Development and Analytics, 444 Liberty Avenue -1222, Pittsburgh, PA 15222, United States.
| | - Zo Ramamonjiarivelo
- Texas State University, School of Health Administration, University Drive, Encino Hall, Suite 250, Office 254, 601, San Marcos, TX 78666, United States.
| | - Ledric D Sherman
- Department of Health and Kinesiology, Texas A&M University, 4243 TAMU, College Station, TX 77843, United States.
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Myers BA, Klingensmith R, de Groot M. Emotional Correlates of the COVID-19 Pandemic in Individuals With and Without Diabetes. Diabetes Care 2022; 45:42-58. [PMID: 34740911 DOI: 10.2337/dc21-0769] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/30/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the mental health experiences associated with coronavirus disease 2019 (COVID-19) in adults with and without diabetes. RESEARCH DESIGN AND METHODS Between 29 May 2020 and 30 June 2020, 2,176 U.S. adults completed an online survey including demographics, COVID-19 experiences, depression (eight-item Patient Health Questionnaire) and anxiety (seven-item Generalized Anxiety Disorder) symptoms, perceived stress (10-item Perceived Stress Scale), resilience (Brief Resilience Scale), and diabetes-related distress (in participants with diabetes) (17-item Diabetes Distress Scale). RESULTS Mean age was 49.6 years (SD 16.9); participants were primarily women (80.0%) and White (88.3%), with an annual household income of ≥$60,000 (57.6%). One hundred reported a diagnosis of type 1 diabetes (4.6%), 304 type 2 diabetes (13.9%), and 145 prediabetes (6.6%). Nearly one-third (29.7%) indicated decreases in income attributable to the pandemic. Participants with type 1 diabetes had higher levels of diabetes distress than participants with type 2 diabetes (P < 0.05), with moderate severity in both groups. Participants with type 2 diabetes had significantly more comorbidities and COVID-19 risk factors than all other groups (all P < 0.01). After controlling for covariates, participants with type 2 diabetes reported significantly more depressive symptoms than those without diabetes (P < 0.05) and lower levels of resilience (P < 0.05). Subgroup analyses by sex and age indicated that women and younger adults, particularly those age 18-34 years, reported significantly more depression and anxiety symptoms, stress, and diabetes-related distress and lower levels of resilience than men and adults age ≥51 years. CONCLUSIONS In this naturalistic observational study, participants with type 2 diabetes reported more depression, lower resilience, and significantly more COVID-19 risk factors and medical comorbidities than participants without diabetes. Overall, our participants demonstrated worse depression and anxiety symptoms during compared with before the pandemic.
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5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022; 45:S60-S82. [PMID: 34964866 DOI: 10.2337/dc22-s005] [Citation(s) in RCA: 127] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Sallay V, Klinovszky A, Csuka SI, Buzás N, Papp-Zipernovszky O. Striving for autonomy in everyday diabetes self-management-qualitative exploration via grounded theory approach. BMJ Open 2021; 11:e058885. [PMID: 34952888 PMCID: PMC9066350 DOI: 10.1136/bmjopen-2021-058885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The rapid worldwide increase in the incidence of diabetes significantly influences the lives of individuals, families and communities. Diabetes self-management requires personal autonomy and the presence of a supportive social environment. These attributes can considerably ameliorate the outcomes of the chronic condition. However, little is known about individual variations in overcoming the illness-related challenges and in the achievement of autonomy in daily activities. This paper seeks to bridge this knowledge gap. DESIGN This qualitative study used the grounded theory approach. Semi-structured interviews were conducted, and the data collection and data analysis probed participant experiences of autonomy through the self-management of their daily socio-physical environments. SETTING Participants were recruited from the outpatient ward of a university clinic in Hungary. PARTICIPANTS The study was conducted with 26 adult patients with type 2 diabetes mellitus (15 females and 11 males aged between 26 and 80 years; M=62.6 years; SD=13.1). The inclusion criteria were: T2D diagnosis at least 1 year before the beginning of the study; prescribed insulin injection therapy; aged over 18 years; native Hungarian speaker and not diagnosed with dementia or any form of cognitive impairment. RESULTS The study established three principal aspects of the active construction of personal autonomy in diabetes self-management: coping strategies vis-à-vis threats posed by the symptoms and the treatment of the disease; autonomous ways of creating protective space and time and relationship processes that support everyday experiences of self-directedness. CONCLUSIONS The results of this study confirm the validity of the self-determination theory in diabetes self-management. They also imply that pathways towards constructing everyday experiences of self-directedness in participants lead through self-acceptance, supporting family relationships and a doctor-patient relationship characterised by partnership. The tentative empirical model of pathways towards patients' experience of self-directedness can serve as a framework for future research, patient-centred clinical practice, and education.
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Affiliation(s)
- Viola Sallay
- Institute of Psychology, University of Szeged, Szeged, Hungary
| | - Andrea Klinovszky
- Department of Health Economics, University of Szeged, Szeged, Hungary
| | - Sára Imola Csuka
- Károly Rácz Doctoral School, Semmelweis University, Budapest, Hungary
- Institute for the Psychology of Special Needs, Eötvös Loránd University, Budapest, Hungary
| | - Norbert Buzás
- Department of Health Economics, University of Szeged, Szeged, Hungary
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Tasya Z, Amiruddin R, Syam A, Thamrin Y. Psychotherapy intervention diabetes distress in diabetes patients: A systematic review. ENFERMERIA CLINICA 2021. [DOI: 10.1016/j.enfcli.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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33
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Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL. The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2021; 64:2609-2652. [PMID: 34590174 PMCID: PMC8481000 DOI: 10.1007/s00125-021-05568-3] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycaemia, behavioural considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that healthcare professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors. Graphical abstract.
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Affiliation(s)
- Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - J Hans DeVries
- Amsterdam UMC, Internal Medicine, University of Amsterdam, Amsterdam, the Netherlands
- Profil Institute for Metabolic Research, Neuss, Germany
| | - Amy Hess-Fischl
- Kovler Diabetes Center, University of Chicago, Chicago, IL, USA
| | - Irl B Hirsch
- UW Medicine Diabetes Institute, Seattle, WA, USA
| | - M Sue Kirkman
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Tomasz Klupa
- Department of Metabolic Diseases, Center for Advanced Technologies in Diabetes, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Ludwig
- University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | | | - Eric Renard
- Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, Inserm, Montpellier, France
| | - Jay S Skyler
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Frank J Snoek
- Amsterdam UMC, Medical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | | | - Anne L Peters
- Keck School of Medicine of USC, Los Angeles, CA, USA
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Holt RIG, DeVries JH, Hess-Fischl A, Hirsch IB, Kirkman MS, Klupa T, Ludwig B, Nørgaard K, Pettus J, Renard E, Skyler JS, Snoek FJ, Weinstock RS, Peters AL. The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2021; 44:2589-2625. [PMID: 34593612 DOI: 10.2337/dci21-0043] [Citation(s) in RCA: 202] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycemia, behavioral considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management, and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that health care professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors.
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Affiliation(s)
- Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, U.K. .,Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, U.K
| | - J Hans DeVries
- Amsterdam UMC, Internal Medicine, University of Amsterdam, Amsterdam, the Netherlands.,Profil Institute for Metabolic Research, Neuss, Germany
| | | | | | - M Sue Kirkman
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Tomasz Klupa
- Department of Metabolic Diseases, Center for Advanced Technologies in Diabetes, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Ludwig
- University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | | | - Eric Renard
- Montpellier University Hospital, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, Inserm, Montpellier, France
| | - Jay S Skyler
- University of Miami Miller School of Medicine, Miami, FL
| | - Frank J Snoek
- Amsterdam UMC, Medical Psychology, Vrije Universiteit, Amsterdam, the Netherlands
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Muller AE, Berg RC, Jardim PSJ, Johansen TB, Ormstad SS. Can Remote Patient Monitoring Be the New Standard in Primary Care of Chronic Diseases, Post-COVID-19? Telemed J E Health 2021; 28:942-969. [PMID: 34665645 DOI: 10.1089/tmj.2021.0399] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: One lesson from the current COVID-19 pandemic is the need to optimize health care provision outside of traditional settings, and potentially over longer periods of time. An important strategy is remote patient monitoring (RPM), allowing patients to remain at home, while they transmit health data and receive follow-up services. Materials and Methods: We conducted an overview of the latest systematic reviews that had included randomized controlled trials with adult patients with chronic diseases. We summarized results and displayed these in forest plots, and used GRADE (Grading of Recommendations Assessment, Development, and Evaluation) to assess our certainty of the evidence. Results: We included 4 systematic reviews that together reported on 11 trials that met our definition of RPM, each including patients with diabetes and/or hypertension. RPM probably makes little to no difference on HbA1c levels. RPM probably leads to a slight reduction in systolic blood pressure, with questionable clinical meaningfulness. RPM probably has a small negative effect on the physical component of health-related quality of life, but the clinical significance of this reduction is uncertain. We have low confidence in the finding that RPM makes no difference to the remaining five primary outcomes. Conclusion: Most of our findings are consistent with reviews of other, broader definitions of RPM. The type of RPM examined in this review is as effective as standard treatment for patients with diabetes/hypertension. If this or other types of RPM are to be used for "long covid" patients or for other chronic disease groups post-pandemic, we need to understand why RPM may negatively affect quality of life.
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Affiliation(s)
- Ashley Elizabeth Muller
- Department of Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
| | - Rigmor C Berg
- Department of Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway.,Department of Community Medicine, The Arctic University of Norway, University of Tromsø, Tromsø, Norway
| | | | - Trine Bjerke Johansen
- Department of Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
| | - Sari Susanna Ormstad
- Department of Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
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Vrany EA, Jennings A, Hossain MB, Hill-Briggs F. Mental Health History and DECIDE (Decision-Making Education for Choices in Diabetes Everyday) Diabetes Support Program Outcomes Among African Americans With Type 2 Diabetes. Sci Diabetes Self Manag Care 2021; 47:425-435. [PMID: 34617828 DOI: 10.1177/26350106211048782] [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: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to determine behavioral and clinical outcomes of the DECIDE (Decision-Making Education for Choices in Diabetes Everyday) diabetes support program trial participants with and without a mental health (MH) history by treatment arm. METHODS A secondary analysis was conducted of data from the DECIDE trial sample of urban African American adults with type 2 diabetes (T2DM; N = 137) who received the DECIDE diabetes support program in 1 of 3 delivery formats: self-study (n = 46), individual (n = 45), and group (n = 46). Positive screen on the Patient Health Questionnaire-2 and/or reported MH diagnosis were coded as MH history. Self-management, knowledge, problem-solving, and A1C data at baseline and 1 week and 6 months postintervention were analyzed for participants with and without MH history. RESULTS Prevalence of MH history was 37% in the sample. Among those with no MH history, knowledge and problem-solving improved at 6 months postintervention in all intervention arms. For those with MH history, knowledge and problem-solving improved in the self-study and individual arms but not in the group arm. Clinically but not statistically significant changes in A1C were observed at 6 months. CONCLUSIONS In an urban minority T2DM sample, those with an MH history benefited from the intervention, but delivery format mattered, with robust improvements when participants with an MH history received self-directed or one-on-one formats rather than group.
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Affiliation(s)
- Elizabeth A Vrany
- From Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Arianne Jennings
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, Maryland
| | - Mian B Hossain
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, Maryland
| | - Felicia Hill-Briggs
- From Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Bojanić I, Sund ER, Sletvold H, Bjerkeset O. Prevalence trends of depression and anxiety symptoms in adults with cardiovascular diseases and diabetes 1995-2019: The HUNT studies, Norway. BMC Psychol 2021; 9:130. [PMID: 34465377 PMCID: PMC8406588 DOI: 10.1186/s40359-021-00636-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Symptoms of depression and anxiety are common in adults with cardiovascular diseases (CVDs) and diabetes mellitus (DM). The literature on depression and anxiety in CVDs and DM populations is extensive; however, studies examining these relationships over time, directly compared to adults without these conditions, are still lacking. This study aimed to investigate trends in depression and anxiety symptom prevalence over more than 20 years in adults with CVDs and DM compared to the general population. Methods We used data from the population-based Trøndelag Health Study (HUNT), Norway, including adults (≥ 20 years) from three waves; the HUNT2 (1995–97; n = 65,228), HUNT3 (2006–08; n = 50,800) and HUNT4 (2017–19; n = 56,042). Depressive and anxiety symptom prevalence was measured independently by the Hospital Anxiety and Depressions scale (HADS) in sex-stratified samples. We analyzed associations of these common psychological symptoms with CVDs and DM over time using multi-level random-effects models, accounting for repeated measurements and individual variation. Results Overall, the CVDs groups reported higher levels of depression than those free of CVDs in all waves of the study. Further, depressive and anxiety symptom prevalence in adults with and without CVDs and DM declined from HUNT2 to HUNT4, whereas women reported more anxiety than men. Positive associations of depression and anxiety symptoms with CVDs and DM in HUNT2 declined over time. However, associations of CVDs with depression symptoms remained over time in men. Moreover, in women, DM was associated with increased depression symptom risk in HUNT2 and HUNT4. Conclusions Depression and anxiety symptoms are frequent in adults with CVDs. Further, our time trend analysis indicates that anxiety and depression are differentially related to CVDs and DM and sex. This study highlights the importance of awareness and management of psychological symptoms in CVDs and DM populations. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00636-0.
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Affiliation(s)
- Ivana Bojanić
- Faculty of Nursing and Health Sciences, Nord University, PB 93, 7601, Levanger, Norway.
| | - Erik R Sund
- Faculty of Nursing and Health Sciences, Nord University, PB 93, 7601, Levanger, Norway.,Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology, NTNU, Levanger, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Hege Sletvold
- Faculty of Nursing and Health Sciences, Nord University, PB 93, 7601, Levanger, Norway
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, PB 93, 7601, Levanger, Norway.,Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
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Efficacy of eHealth Interventions for Adults with Diabetes: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178982. [PMID: 34501572 PMCID: PMC8431552 DOI: 10.3390/ijerph18178982] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/19/2022]
Abstract
The aim is to provide meta-analytical evidence on eHealth interventions’ efficacy in supporting the psychosocial and physical well-being of adults with type 1 or type 2 Diabetes Mellitus (DM), and to investigate differences in interventions primarily targeted at providing glycemic control vs. psychosocial support. A PRISMA-guided systematic search was conducted. Randomized Controlled Trials (RCTs) regarding eHealth interventions for adults (18–65 years) with DM were included. Data were pooled using Standard Mean Difference (SMD); sub-group analysis and meta-regressions were performed when appropriate. Outcomes were Hemoglobin A1c (HbA1c), diabetes distress, quality of life, anxiety, stress, and depression. Intervention acceptability was assessed performing the Odds Ratio (OR) of drop-out rates. Thirteen RCTs comprising 1315 participants were included (52.09% females; Mage = 46.18, SD = 9.98). Analyses showed intervention efficacy on HbA1c (SMD = −0.40; 95% CI = −0.70, −0.12; k = 13) and depressive symptoms (SMD = −0.18; 95% CI = −0.33, −0.02; k = 6) at RCTs endpoint and were well accepted (OR = 1.43; 95% CI = 0.72, 2.81; k = 10). However, efficacy on HbA1c was not maintained at follow-up (SMD = −0.13; 95% CI = −0.31, 0.05; k = 6). eHealth interventions providing medical support were acceptable and effective in fostering glycemic control and decreasing depressive symptoms in the short-term only. Digital solutions should be developed on multiple levels to fully support the psychophysical well-being of people with DM.
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Munda A, Fekonja U, Pongrac Barlovič D. Prevalence of depressive and anxiety symptoms in women with gestational diabetes: a longitudinal cohort study. Acta Diabetol 2021; 58:1091-1100. [PMID: 33772371 DOI: 10.1007/s00592-021-01706-w] [Citation(s) in RCA: 3] [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: 01/11/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
AIMS Prevalence of mental disorders in women with gestational diabetes mellitus (GDM) is not well defined; however, their presence could interfere with effective glucose self-management. Therefore, we aimed to assess the incidence of depression and anxiety symptoms in women with GDM in the 2nd and 3rd trimester of pregnancy and their impact on glycemic control. METHODS We included consecutive women undergoing the GDM screening test at the University Medical Centre Ljubljana. Women with GDM (n = 77) and women without GDM (n = 103) completed questionnaires on depression and anxiety symptomatology, health locus of control and social support. RESULTS The incidence of depression symptoms in the 2nd trimester is higher in women with GDM (23.4%) than in women without GDM (10.7%; p = 0.022; OR = 2.6). The incidence of depression and anxiety symptomatology did not change significantly from 2nd to 3rd trimester within both groups; however, an increase in the average severity of depression symptomatology was observed. Glycemic control was negatively associated with the external health locus of control. CONCLUSIONS Our results highlight the need for depression screening early on during pregnancy, especially in women with GDM. Timely psychological support may contribute to better GDM management and possibly prevent negative pregnancy outcomes.
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Affiliation(s)
- Ana Munda
- Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
- University Medical Center Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia
| | - Urška Fekonja
- Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
| | - Draženka Pongrac Barlovič
- University Medical Center Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia.
- Faculty of Medicine, University Ljubljana, Ljubljana, Slovenia.
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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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Ni Y, Ma L, Li J. Effects of mindfulness-based intervention on glycemic control and psychological outcomes in people with diabetes: A systematic review and meta-analysis. J Diabetes Investig 2021; 12:1092-1103. [PMID: 33064926 PMCID: PMC8169362 DOI: 10.1111/jdi.13439] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 02/05/2023] Open
Abstract
AIMS/INTRODUCTION Psychological therapies have showed benefits for both glycemic control and psychological outcomes in people with diabetes. However, the effects of mindfulness-based intervention (MBI) on glycemic control and psychological outcomes are inconsistent across studies, and the evidence for MBI has not been summarized. We aimed to identify the effects of MBI on glycemic control and psychological outcomes in people with diabetes by carrying out a systematic review and meta-analysis. MATERIALS AND METHODS Six databases (Pubmed, Embase, CINAHL, Cochrane, Web of science and PsycINFO) were searched from inception to October 2019. Randomized controlled trials of MBI for people with type 1 and type 2 diabetes were included. Two authors independently extracted relevant data and assessed the risk of bias, with a third reviewer as arbitrator. Subgroup analyses and sensitivity analyses were also carried out. RESULTS Eight studies with 841 participants met the eligibility criteria. Meta-analysis showed that MBI can slightly improve glycosylated hemoglobin (HbA1c; -0.25%, 95% confidence interval [CI] -0.43 to -0.07) and diabetes-related distress (-5.81, 95% CI -10.10 to -1.52) contribute to a moderate effect size in reducing depression (standardized mean difference -0.56, 95% CI -0.82 to -0.30) and stress (standardized mean difference -0.53, CI -0.75 to -0.31). Subgroup analyses showed greater HbA1c reductions in subgroups with baseline HbA1c levels <8% and follow-up duration >6 months. Mixed effects were observed for anxiety. CONCLUSIONS MBI appears to have benefits on HbA1c, depression, stress and diabetes-related distress in people with diabetes. More rigorous studies with longer follow-up duration are warranted to establish the full potential of MBI.
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Affiliation(s)
- Yun‐xia Ni
- West China School of Nursing/Department of NursingWest China HospitalSichuan UniversityChengduChina
| | - Lin Ma
- West China School of Nursing/Department of EndocrinologyWest China HospitalSichuan UniversityChengduChina
| | - Ji‐ping Li
- West China School of Nursing/Department of NursingWest China HospitalSichuan UniversityChengduChina
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Ferrier L, Ski CF, O'Brien C, Jenkins Z, Thompson DR, Moore G, Ward G, Castle DJ. Bridging the gap between diabetes care and mental health: perspectives of the Mental health IN DiabeteS Optimal Health Program (MINDS OHP). BMC Endocr Disord 2021; 21:96. [PMID: 33964904 PMCID: PMC8105945 DOI: 10.1186/s12902-021-00760-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Mental health problems are highly prevalent in people with type 1 diabetes mellitus (T1DM), which adversely impact physical health and quality of life. This study aimed to explore the experiences of people with T1DM who had completed the Mental health IN DiabeteS Optimal Health Program (MINDS OHP), a novel intervention developed to bridge the gap between physical and mental health care. METHOD Participants with T1DM were invited to take part in a focus group or semi-structured interviews. Participants were recruited from outpatient and community settings. The focus group and interviews were audio-recorded and transcribed verbatim. Thematic content analysis was used and identified themes were cross-validated by researchers and member-checked by participants. RESULTS Ten people with T1DM were included. Two key themes emerged: 'MINDS OHP experiences' and 'lived experiences of diabetes'. MINDS OHP experiences included five sub-themes: program benefits, follow-up and timing, suggested improvements, collaborative partners, and materials suitability. Lived experiences also included five sub-themes: bridging the gap between mental and physical health, support networks, stigma and shame, management intrusiveness, and adolescence and critical life points. CONCLUSIONS The MINDS OHP for people with T1DM was generally well received, though study findings suggest a number of improvements could be made to the program, such as including family members, and consideration being given to its routine early inclusion in diabetes management, ideally in primary care.
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Affiliation(s)
- Lucienne Ferrier
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Chantal F Ski
- Department of Psychiatry, University of Melbourne, Melbourne, Australia.
- Integrated Care Academy, University of Suffolk, Ipswich, UK.
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
| | - Casey O'Brien
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia
| | - Zoe Jenkins
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia
| | - David R Thompson
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Gaye Moore
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia
| | - Glenn Ward
- Department of Endocrinology, St. Vincent's Hospital, Melbourne, Australia
| | - David J Castle
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia
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Jung I, Kwon H, Park SE, Han KD, Park YG, Kim YH, Rhee EJ, Lee WY. Increased Risk of Cardiovascular Disease and Mortality in Patients with Diabetes and Coexisting Depression: A Nationwide Population-Based Cohort Study. Diabetes Metab J 2021; 45:379-389. [PMID: 33297602 PMCID: PMC8164944 DOI: 10.4093/dmj.2020.0008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/02/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Previous studies have suggested that depression in patients with diabetes is associated with worse health outcomes. The aim of this study was to evaluate the risk of cardiovascular disease (CVD) and mortality in patients with diabetes with comorbid depression. METHODS We examined the general health check-up data and claim database of the Korean National Health Insurance Service (NHIS) of 2,668,615 participants with type 2 diabetes mellitus who had examinations between 2009 and 2012. As NHIS database has been established since 2002, those who had been diagnosed with depression or CVD since 2002 were excluded. The 2,228,443 participants were classified into three groups according to the claim history of depression; normal group (n=2,166,979), transient depression group (one episode of depression, n=42,124) and persistent depression group (at least two episodes of depression, n=19,340). The development of CVD and mortality were analyzed from 2009 to 2017. RESULTS Those with depression showed a significantly increased risk for stroke (transient depression group: hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.15 to 1.26) (persistent depression group: HR, 1.54; 95% CI, 1.46 to 1.63). Those with depression had an increased risk for myocardial infarction (transient depression group: HR, 1.25; 95% CI, 1.18 to 1.31) (persistent depression group: HR, 1.38; 95% CI, 1.29 to 1.49). The persistent depression group had an increased risk for all-cause mortality (HR, 1.66; 95% CI, 1.60 to 1.72). CONCLUSION Coexisting depression in patients with diabetes has a deleterious effect on the development of CVD and mortality. We suggest that more attention should be given to patients with diabetes who present with depressive symptoms.
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Affiliation(s)
- Inha Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Hyemi Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Se Eun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Kyung-Do Han
- Department of Biostatistics, Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Yong-Gyu Park
- Department of Biostatistics, Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Yang-Hyun Kim
- Department of Family Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Eun-Jung Rhee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Won-Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
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de Groot M. 50 Years of Behavioral Science in Diabetes: A 2020 Vision of the Future. Diabetes Care 2021; 44:633-640. [PMID: 33608324 DOI: 10.2337/dci20-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This article is adapted from a speech Dr. de Groot delivered in June 2020 as President, Health Care & Education, of the American Diabetes Association at the Association's 80th Scientific Sessions, which was held online as a result of coronavirus disease 2019. Dr. de Groot is an Associate Professor of Medicine in the Division of Endocrinology, Diabetes and Metabolism at Indiana University (IU) School of Medicine. She serves as the Acting Director of the IU Diabetes Translational Research Center. Dr. de Groot is the 2020 recipient of the Rachmiel Levine Medal for Leadership from the American Diabetes Association.In the year 2020, we marked the 50th anniversary of the field of behavioral science in diabetes in the modern era. Over this relatively short period of time, this field has charted the psychosocial landscape of prediabetes and diabetes by establishing the prevalence and impact of emotional and behavioral aspects of diabetes. Interventions to address these conditions have been developed that span the T2 to T4 translational research spectrum ranging from the intrapsychic to population-based interventions. Policies ranging from standards of care to Medicare benefits have been implemented. A review of research in the area of diabetes and depression is provided as an example of innovations in this field. Behavior is the foundation of all interventions we make in diabetes and prediabetes. As a mature science, it is critical to stemming the tide of diabetes and its outcomes. To make additional strides, we must rebalance our focus and augment funding for behavioral interventions for individuals, communities, and health care systems in conjunction with other forms of treatment.
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Affiliation(s)
- Mary de Groot
- Division of Endocrinology and Metabolism, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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Rama Chandran S, Zaremba N, Harrison A, Choudhary P, Cheah Y, Allan J, Debong F, Reid F, Treasure J, Hopkins D, Ismail K, Stadler M. Disordered eating in women with type 1 diabetes: Continuous glucose monitoring reveals the complex interactions of glycaemia, self-care behaviour and emotion. Diabet Med 2021; 38:e14446. [PMID: 33141942 DOI: 10.1111/dme.14446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/03/2020] [Accepted: 10/28/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Glycaemia in people with type 1 diabetes and disordered eating is not well characterised. We explored the glycaemia, self-care behaviour and emotional state of women with type 1 diabetes and disordered eating. RESEARCH DESIGN AND METHODS In all, 13 women with and 10 without disordered eating and type 1 diabetes participated in this case-control study. We used a mixed-methods approach with a 7-day blinded continuous glucose monitoring and real-time record of non-prompted capillary glucose (CG), emotion, activity and physical symptoms on a diabetes diary using a smartphone application (mySugr®). We compared groups using Mann-Whitney U test or Fisher's exact test. We conducted thematic analyses of free-text diary entries (NVivo®) and quantitative analysis of emotion/symptom tags. RESULTS People with type 1 diabetes and disordered eating spent longer time above range in level 2 hyperglycaemia (>13.9 mmol/L, Median [interquartile range]: 21% [16,60] vs 5% [2,17], p = 0.015). They had lower time in range and similar time below range compared to those without disordered eating. The standard deviation of CG was significantly higher in the disordered eating group (4.7 mmol/L [4.5, 6.1] vs 3 [2.8, 3.2], p = 0.018). The median of the percentage of rising sensor glucose trends was three times higher in the disordered eating group. They also had higher negative emotional and physical symptoms associated with high blood glucose (>15 mmol/L). CONCLUSIONS Disordered eating has a significant impact on the glycaemia and emotion of a person with type 1 diabetes.
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Affiliation(s)
- Suresh Rama Chandran
- Department of Diabetes, King's College Hospital, London, UK
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Natalie Zaremba
- Diabetes Research Group, King's College London, Weston Education Centre, London, UK
| | - Amy Harrison
- Diabetes Research Group, King's College London, Weston Education Centre, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pratik Choudhary
- Department of Diabetes, King's College Hospital, London, UK
- Diabetes Research Group, King's College London, Weston Education Centre, London, UK
| | - Yee Cheah
- Department of Diabetes, King's College Hospital, London, UK
| | - Jacqueline Allan
- Diabetes Research Group, King's College London, Weston Education Centre, London, UK
| | | | - Fiona Reid
- Faculty of Life Sciences and Medicine, Population Health, King's College London, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David Hopkins
- Institute of Diabetes Endocrinology and Obesity, King's Health Partners, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Marietta Stadler
- Diabetes Research Group, King's College London, Weston Education Centre, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Obo H, Kugbey N, Atefoe E. Social support, depression, anxiety, and quality of life among persons living with type 2 diabetes: a path analysis. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1177/0081246320984285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Co-morbid mental health problems among persons living with type 2 diabetes have a significant influence on diabetic persons’ self-care and, ultimately, quality of life. However, the mechanisms linking the co-morbid mental health problems of type 2 diabetes patients to the decreased quality of life are not fully understood. This study examined the direct and indirect influences of co-morbid depression and anxiety on the quality of life of 115 persons living with type 2 diabetes, using a cross-sectional survey design. Frequencies and percentages were used to summarize the data, and the Pearson correlation was used to determine the bivariate association between the study variables. PROCESS Macro in SPSS was used for mediation analyses. The findings show that depression and anxiety had significant negative correlations with the quality of life of persons living with type 2 diabetes. However, only depression had a significant negative correlation with social support. On the contrary, social support significantly and positively correlated with quality of life. The mediation analysis shows that social support partially mediated the relationship between depression and quality of life after adjusting for the sex of the participants. However, social support did not have a significant mediation effect on the link between anxiety and quality of life after adjusting for the sex of the participants. The availability of social support, especially peer support, could buffer the negative emotional experiences associated with living with type 2 diabetes and improve the quality of life for persons living with this health condition.
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Affiliation(s)
- Henry Obo
- Department of Psychology, Methodist University College, Ghana
| | - Nuworza Kugbey
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ghana
| | - Ethel Atefoe
- Department of Psychological Medicine and Mental Health, School of Medicine, University of Health and Allied Sciences, Ghana
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Bassi G, Gabrielli S, Donisi V, Carbone S, Forti S, Salcuni S. Assessment of Psychological Distress in Adults With Type 2 Diabetes Mellitus Through Technologies: Literature Review. J Med Internet Res 2021; 23:e17740. [PMID: 33410762 PMCID: PMC7819779 DOI: 10.2196/17740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 08/05/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023] Open
Abstract
Background The use of technological devices can support the self-management of individuals with type 2 diabetes mellitus (T2DM), particularly in addressing psychological distress. However, there is poor consistency in the literature regarding the use of psychological instruments for the web-based screening of patients’ psychological distress and subsequent monitoring of their psychological condition during digital interventions. Objective This study aims to review previous literature on the types of psychological instruments delivered in digital interventions for assessing depression, anxiety, and stress in patients with T2DM. Methods The literature review was conducted using the PsycINFO, CINAHL and PubMed databases, in which the following terms were considered: diabetes mellitus, measure, assessment, self-care, self-management, depression, anxiety, stress, technology, eHealth, mobile health, mobile phone, device, and smartphone. Results In most studies, psychological assessments were administered on paper. A few studies deployed self-reporting techniques employing automated telephonic assessment, a call system for screening and monitoring patients’ conditions and preferences, or through telephone interviews via interactive voice response calls, a self-management support program leveraging tailored messages and structured emails. Other studies used simple telephone interviews and included the use of apps for tablets and smartphones to assess the psychological well-being of patients. Finally, some studies deployed mood rating scales delivered through tailored text message–based support systems. Conclusions The deployment of appropriate psychological tools in digital interventions allows researchers and clinicians to make the screening of anxiety, stress, and depression symptoms faster and easier in patients with T2DM. Data from this literature review suggest that mobile health solutions may be preferred tools to use in such digital interventions.
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Affiliation(s)
- Giulia Bassi
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | | | | | | | | | - Silvia Salcuni
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
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5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021; 44:S53-S72. [PMID: 33298416 DOI: 10.2337/dc21-s005] [Citation(s) in RCA: 169] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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de Groot M. 50 Years of Behavioral Science in Diabetes: A 2020 Vision of the Future. Diabetes Spectr 2021; 34:76-84. [PMID: 33627998 PMCID: PMC7887533 DOI: 10.2337/ds20-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Editor's Note: This article is adapted from a speech Dr. de Groot delivered in June 2020 as President, Health Care & Education, of the American Diabetes Association. She delivered her address at the Association's 80th Scientific Sessions, which was held online as a result of the coronavirus disease 2019.
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Albai O, Frandes M, Timar R, Timar B, Anghel T, Avram VF, Sima A. The Mental Status in Patients with Diabetes Mellitus Admitted to a Diabetes Clinic After Presenting in the Emergency Room: The Application of the SCL-90 Scale. Diabetes Metab Syndr Obes 2021; 14:1833-1840. [PMID: 33953583 PMCID: PMC8089080 DOI: 10.2147/dmso.s304904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/19/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is one of the most serious public health problems, involving increasing costs worldwide. The mental state of a person with DM is varied and ever-changing, such as stress, the pressure to always do everything by the book, sadness, anger, and even denial of the disease, all these are feelings patients with DM will experience throughout their life. AIM The aim of our study was to assess the presence of mental and psychiatric disorders (anxiety, depressive states, paranoid ideation, phobia, obsessive-compulsive disorder) in a group of patients with DM after hospitalization in the Clinic for Diabetes, Nutrition, and Metabolic Diseases, for various exacerbations of the underlying condition, looking for possible correlations with other cardiovascular risk factors. PATIENTS AND METHODS Clinical and biological parameters, the presence of acute and chronic complications of the diabetic patients have been evaluated. To assess mental health, the symptom checklist (SCL)-90 questionnaire was conducted for all admitted patients. RESULTS We observed that the number of patients with obsessive-compulsive disorders was relatively high (23.3%), while depression was present in 17.1% of the patients. Also, 10.6% of patients had hostility and 15.6% had delusional ideation. The presence of psychiatric disorders was associated with a higher age (62 vs. 46.5 years; p <0.001), a longer diabetes duration (11 vs. 9 years; p <0.001), higher fasting glycemia (188 vs. 132 mg/dL; p <0.001) and postprandial glycemia (212 vs. 152 mg/dL; p <0.001), and triglycerides (125 vs. 110 mg/dL; p <0.001). Patients with altered mental status have shown statistically significantly more altered clinical and biological parameters compared to those without these mental disorders. CONCLUSION Patients with DM represent a psychologically vulnerable population, which is why they should undergo early and regular screening for both psychological and psychiatric conditions, especially at admission.
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Affiliation(s)
- Oana Albai
- Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Mirela Frandes
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Correspondence: Mirela Frandes Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu, Timisoara, 300041, RomaniaTel +40-731117020Fax +40-256462856 Email
| | - Romulus Timar
- Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Bogdan Timar
- Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Teodora Anghel
- Department of Neuroscience, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Vlad Florian Avram
- Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Alexandra Sima
- Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
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