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Pang J, Zhang L, Li X, Sun F, Qiu J, Zhao Y, Wang J, Liu L, Wan X, Zhang Y. Identification of factors associated with fear of hypoglycemia using the capability, opportunity, motivation and behavior model in people with type 2 diabetes mellitus: a cross-sectional study. Acta Diabetol 2023; 60:1405-1415. [PMID: 37380727 DOI: 10.1007/s00592-023-02132-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Abstract
AIMS To examined the relationship between fear of hypoglycemia and certain variables in people with type 2 diabetes mellitus (T2DM) based on the Capability, Opportunity, Motivation, and Behavior model, combined with the context unique to people with diabetes to provide a basis for developing targeted nursing interventions. METHODS In this cross-sectional study, 212 people with T2DM were recruited from February 2021 to July 2021. Data were collected using the Hypoglycaemia Fear Survey, Gold score, Patient Assessment of Chronic Illness Care (PACIC) scale and Diabetic Self-Management Attitudes Scale. Multiple linear regression analysis was performed to determine the predictors of fear of hypoglycemia using SPSS 26.0. RESULTS The mean fear of hypoglycemia score was 74.88 ± 18.28 (range: 37.00-132.00). In people with T2DM, the frequency of blood glucose monitoring, the frequency of hypoglycemia in the past half-year, degree of understanding of hypoglycemia, impaired awareness of hypoglycemia, PACIC, and self-management attitude of diabetes were the influencing factors of fear of hypoglycemia (adjusted R2 = 0.560, F[21,190] = 13.800, P < 0.001). These variables explained 56.0% of the variance in the fear of hypoglycemia. CONCLUSIONS The level of fear of hypoglycemia in people with T2DM was relatively high. In addition to paying attention to the disease characteristics of people with T2DM, medical staff should also pay attention to patients' own perception and handling ability of disease and hypoglycemia, attitude toward self-management behavior and external environment support, all of which have a positive effect on improving the fear of hypoglycemia in people with T2DM, optimizing the self-management level and improving quality of life.
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Affiliation(s)
- Juan Pang
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Lu Zhang
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Xiangning Li
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Fenfen Sun
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Jiahui Qiu
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Yueqi Zhao
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Jinping Wang
- Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou, China
| | - Lin Liu
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Xiaojuan Wan
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China
| | - Yu Zhang
- School of Nursing School of Public Health, Yangzhou University, 136 Jiangyang Middle Road, Yangzhou, 225009, Jiangsu Province, China.
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Alosaimi AM, Alsulaimani NH, Alotaibi WA. Potential mechanisms for poor glycaemic control in patients with type two diabetes and fear of hypoglycaemia. J Diabetes Metab Disord 2022; 21:1689-1697. [PMID: 36404853 PMCID: PMC9672273 DOI: 10.1007/s40200-022-01123-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022]
Abstract
Purpose The current study aimed to explore the potential effect of diabetes-related distress on the association between fear of hypoglycaemia and poor glycaemic control. We evaluated the specific aspects of fear of hypoglycaemia that affect glycaemic control among Saudi patients with type 2 diabetes (T2D). Methods Descriptive cross-sectional survey of patients with T2D attending a specialist diabetes clinic in Taif, Saudi Arabia. We used the Hypoglycaemia Attitudes and Behaviour Scale (HABS) for assessing fear of hypoglycaemia among our sample. We used Structural Equation Modelling to evaluate the moderators and correlates of fear of hypoglycaemia. Results We surveyed 365 patients with T2D. Cronbach's alpha for the HABS assessment was 0.84, an indication of excellent internal consistency. The composite reliability for hypoglycaemic anxiety was 86.8%; hypoglycaemic avoidance was 85.2%; and hypoglycaemic confidence was 92.6%. The mean HABS score was 32.7 points (out of 70 points; SD = 9.8 points). Fear of hypoglycaemia was associated with increased levels of glycated haemoglobin (HbA1c), presence of eye disease, heart disease, and stroke. Fear of hypoglycaemia was associated with poor glycaemic control. No significant moderating effect of diabetes-related distress was observed. However, only hypoglycaemic anxiety and avoidance were associated with poor glycaemic control. Confidence in the ability to control low glucose levels was not associated with elevated HbA1c levels. Conclusion A significant finding of this study highlighted the considerable and direct effect of fear of hypoglycaemia on poor glycaemic control among patients with T2D. However, only fear-related anxiety and avoidance-and not confidence in the ability to control low glucose levels-had an effect on poor glycaemic control.
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Due-Christensen M, Willaing I, Ismail K, Forbes A. Learning about Type 1 diabetes and learning to live with it when diagnosed in adulthood: two distinct but inter-related psychological processes of adaptation A qualitative longitudinal study. Diabet Med 2019; 36:742-752. [PMID: 30329176 DOI: 10.1111/dme.13838] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2018] [Indexed: 11/27/2022]
Abstract
AIM To explore the experiences of adults with newly diagnosed Type 1 diabetes in order to understand the adaptive processes that occur in the early phase of the condition. METHODS We conducted longitudinal semi-structured interviews with 30 adults newly diagnosed with Type 1 diabetes (age range 20-67 years; 16 men; median diabetes duration 23.5 months), recruited from hospitals in Denmark and the UK. The data were analysed using a narrative approach. RESULTS The narratives could be grouped into three thematic areas: the diagnosis; learning about diabetes; and learning to live with diabetes. Diabetes was characterized as a major disruptor to the established and future life plans of participants, causing significant emotional distress. The narratives showed how early experiences triggered the development of ongoing psychological problems (fear of complications or hypoglycaemia) and diabetes distress, and that navigating different social scenarios (relationships and employment) could be challenging, leading to suboptimal self-management behaviours. The narratives also showed that health professionals often did not attend effectively to participants' emotional needs after diagnosis, and that the language used frequently triggered negative feelings, such as fear or a sense of failure. CONCLUSIONS Many of the common psychosocial problems associated with Type 1 diabetes seem to gestate in the early phase of life with the condition. There appear to be opportunities to enhance the support provided in this phase to minimize these problems.
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Affiliation(s)
- M Due-Christensen
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - I Willaing
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - K Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - A Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Saidi S, Milnes LJ, Griffiths J. Fatalism, faith and fear: A case study of self-care practice among adults with Type 2 diabetes in urban Malaysia. J Clin Nurs 2018; 27:3758-3767. [DOI: 10.1111/jocn.14559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Sanisah Saidi
- Kulliyyah of Nursing; International Islamic University Malaysia; Kuantan Pahang Malaysia
| | | | - Jane Griffiths
- Division of Nursing; Midwifery and Social Work; School of Health Sciences; University of Manchester; Manchester UK
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Grammes J, Stock W, Mann CG, Flynn EM, Kubiak T. Focus group study to identify the central facets of fear of hypoglycaemia in people with Type 2 diabetes mellitus. Diabet Med 2017; 34:1765-1772. [PMID: 28856721 DOI: 10.1111/dme.13506] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2017] [Indexed: 12/20/2022]
Abstract
AIMS To determine key worries about hypoglycaemia among insulin-using adults with Type 2 diabetes using a focus group approach. METHODS Thirteen focus groups were conducted in three diabetes outpatient care units and one peer support group was set up, in Germany. A total of 64 insulin-dependent adults with Type 2 diabetes (36.5% women, mean age 65.2 ± 11.0 years) discussed their worries about hypoglycaemia. The qualitative results were assigned into thematic categories using a bottom-up coding procedure. Participants completed the Hypoglycaemia Fear Survey and demographic measures were recorded. The results of the Hypoglycaemia Fear Survey were contrasted with the focus group findings to evaluate how accurately the Hypoglycaemia Fear Survey comprehensively captures features of fear of hypoglycaemia in Type 2 diabetes. RESULTS Eight themes were identified: 'unconsciousness/death'; 'aloneness/ helplessness', 'fear of hurting somebody'; 'shame'; 'loss of physical control'; 'long-term complications'; 'diabetes self-management issues'; and 'impaired awareness'. A total of 30 participants (46.9%) scored ≥3 on at least one item of the Hypoglycaemia Fear Survey worry subscale, indicating elevated worries. The Hypoglycaemia Fear Survey comprehensively captured all identified themes. Self-efficacy with regard to diabetes self-management seemed to play an important role in fear of hypoglycaemia in Type 2 diabetes. CONCLUSIONS Given that even subclinical worries can have negative effects on quality of life and diabetes self-management, emphasis should be placed on diabetes education; in particular, to help patients to develop self-efficacy concerning diabetes self-management. The Hypoglycaemia Fear Survey comprehensively captures hypoglycaemia worries in Type 2 diabetes. Additional assessment of self-efficacy might be beneficial to identify people at risk of developing hypoglycaemia worries.
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Affiliation(s)
- J Grammes
- Health Psychology, Institute of Psychology, Johannes Gutenberg University Mainz, Germany
| | - W Stock
- Health Psychology, Institute of Psychology, Johannes Gutenberg University Mainz, Germany
| | - C G Mann
- Health Psychology, Institute of Psychology, Johannes Gutenberg University Mainz, Germany
| | - E M Flynn
- Health Psychology, Institute of Psychology, Johannes Gutenberg University Mainz, Germany
| | - T Kubiak
- Health Psychology, Institute of Psychology, Johannes Gutenberg University Mainz, Germany
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Strandberg RB, Graue M, Wentzel-Larsen T, Peyrot M, Wahl AK, Rokne B. The relationships among fear of hypoglycaemia, diabetes-related quality of life and psychological well-being in Norwegian adults with Type 1 diabetes. Diabetes Res Clin Pract 2017; 124:11-19. [PMID: 28081448 DOI: 10.1016/j.diabres.2016.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/08/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Abstract
AIMS To examine the associations among fear of hypoglycaemia, diabetes-related quality of life and psychological well-being, and determine whether diabetes-related quality of life is a mediator of the relationship between fear of hypoglycaemia and psychological well-being in adults with Type 1 diabetes. METHODS A total of 235 of 319 invited adults (18-69years) with Type 1 diabetes agreed to participate. Hierarchical linear regression was applied to 188 individuals with complete data. Mediation analysis was used to determine whether diabetes-related quality of life mediated the relationship between fear of hypoglycaemia and psychological well-being. RESULTS Fear of hypoglycaemia was significantly associated with diabetes-related quality of life and psychological well-being. The behaviour and worry components of fear of hypoglycaemia were significantly associated with diabetes-related quality of life (behaviour component: unstandardised coefficient=-0.04, p<0.001, standardised coefficient=-0.40; worry component: unstandardised coefficient=-0.01, p=0.041, standardised coefficient=-0.18). Fear of hypoglycaemia worry had a significant independent association with psychological well-being (unstandardised coefficient=-0.28, p=0.009, standardised coefficient=-0.25), whereas fear of hypoglycaemia behaviour did not. Diabetes-related quality of life mediated approximately half of the association between fear of hypoglycaemia worry and psychological well-being. CONCLUSIONS Hypoglycaemic episodes can have serious consequences, and assessing fear of hypoglycaemia might help health care providers offer suitable care strategies to individuals with Type 1 diabetes.
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Affiliation(s)
- Ragnhild B Strandberg
- Centre for Evidence Based Practice, Bergen University College, Bergen, Norway; Department of Global Public Health and Primary Care, the Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
| | - Marit Graue
- Centre for Evidence Based Practice, Bergen University College, Bergen, Norway; Department of Paediatrics, Haukeland University Hospital, Bergen, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway; Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway; Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Mark Peyrot
- Centre for Evidence Based Practice, Bergen University College, Bergen, Norway; Department of Sociology, Loyola University Maryland, USA
| | - Astrid K Wahl
- Institute of Health and Society, the Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Berit Rokne
- Department of Global Public Health and Primary Care, the Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway; Department for Research and Development, Haukeland University Hospital, Bergen, Norway
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Shiu ATY, Thompson DR, Wong RYM. Quality of life and its predictors among Hong Kong Chinese patients with diabetes. J Clin Nurs 2016; 17:125-32. [PMID: 18298763 DOI: 10.1111/j.1365-2702.2007.02036.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To adapt, cross-culturally, an established quality of life (QoL) scale for Hong Kong Chinese patients with diabetes; to measure their QoL and to identify the predictors of QoL in this population. BACKGROUND Healthcare providers are called on to assess and enhance the QoL of patients with diabetes. However, there is a lack of empirical QoL data pertaining to such individuals in China. METHODS The diabetes-specific QoL scale (DQoL) developed by Jacobson and the Diabetes Control and Complications Trial research group was cross-culturally adapted for use in a sample of 206 Hong Kong Chinese patients recruited from a diabetes specialist outpatient clinic. Demographic and clinical data were also collected. RESULTS The cross-cultural adaptation process produced a Hong Kong Chinese version of the DQoL scale with 37 items (HKC-DQoL-37) that demonstrated good internal consistency (alpha = 0.87) and acceptable test-retest validity (ICC 0.70, 95% CI 0.36-0.87). Discriminant validity was confirmed by comparing QoL scores between patients with and without insulin treatment. The QoL status of this sample (Mean = 2.2, SD = 0.5) is similar to that of Chinese immigrants and Caucasians in North America. Multiple regression analyses identified four predictors of poor QoL: (i) younger age, (ii) with diabetes complications, (iii) with admission due to hypoglycaemia, (iv) on insulin treatment. CONCLUSIONS Findings provide preliminary evidence on the validity and reliability of the HKC-DQoL-37. The four predictors of poor DQoL in Hong Kong Chinese patients are consistent with those identified in the West. RELEVANCE TO CLINICAL PRACTICE Understanding these predictors of poor QoL could help nurses and others to design and deliver appropriate interventions to these patients.
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Affiliation(s)
- Ann T Y Shiu
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Nafees B, Lloyd A, Kennedy-Martin T, Hynd S. How diabetes and insulin therapy affects the lives of people with type 1 diabetes. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.50] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Singh H, Gonder-Frederick L, Schmidt K, Ford D, Vajda KA, Hawley J, Cox DJ. Assessing hyperglycemia avoidance in people with Type 1 diabetes. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/dmt.14.3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Olsen M, Anderbro T, Amsberg S, Leksell J, Moberg E, Lisspers J, Gudbjörnsdottir S, Johansson UB. Psychometric Properties of the Swedish Version of the Fear of Complications Questionnaire. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojemd.2014.44008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Shen H, Edwards H, Courtney M, McDowell J, Wei J. Barriers and facilitators to diabetes self-management: perspectives of older community dwellers and health professionals in China. Int J Nurs Pract 2013; 19:627-35. [PMID: 24330214 DOI: 10.1111/ijn.12114] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Little is known about self-management among people with Type 2 diabetes living in mainland China. Understanding the experiences of this target population is needed to provide socioculturally relevant education to effectively promote self-management. The aim of this study was to explore perceived barriers and facilitators to diabetes self-management for both older community dwellers and health professionals in China. Four focus groups, two for older people with diabetes and two for health professionals, were conducted. All participants were purposively sampled from two communities in Shanghai, China. Six barriers were identified: overdependence on but dislike of western medicine, family role expectations, cuisine culture, lack of trustworthy information sources, deficits in communication between clients and health professionals, and restriction of reimbursement regulations. Facilitators included family and peer support, good relationships with health professionals, simple and practical instruction and a favourable community environment. The findings provide valuable information for diabetes self-management intervention development in China, and have implications for programmes tailored to populations in similar sociocultural circumstances.
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Affiliation(s)
- Huixia Shen
- Department of Nursing, School of Medicine, Tongji University, Shanghai, China
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Sabourin BC, Pursley S. Psychosocial Issues in Diabetes Self-Management: Strategies for Healthcare Providers. Can J Diabetes 2013; 37:36-40. [DOI: 10.1016/j.jcjd.2013.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 12/19/2012] [Accepted: 01/02/2013] [Indexed: 01/18/2023]
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Böhme P, Bertin E, Cosson E, Chevalier N. Fear of hypoglycaemia in patients with type 1 diabetes: do patients and diabetologists feel the same way? DIABETES & METABOLISM 2012; 39:63-70. [PMID: 23266467 DOI: 10.1016/j.diabet.2012.10.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/26/2012] [Accepted: 10/27/2012] [Indexed: 10/27/2022]
Abstract
AIM This study described and compared the perception of hypoglycaemia in both patients with type 1 diabetes and diabetologists. METHODS This was an observational cross-sectional study undertaken in France in 2011. Data for what hypoglycaemia represents and practices related to it were collected using a questionnaire completed by patients with type 1 diabetes (all>12 years of age) and their diabetologists. Agreement between patients and physicians was evaluated by the intraclass correlation coefficient (ICC) and Gwet's coefficient (GC). RESULTS A total of 485 patients were enrolled by 118 diabetologists. Half the patients thought that hypoglycaemia was always symptomatic. According to both patients and diabetologists, hypoglycaemia impaired quality of life, caused anxiety and was disturbing, especially at night. Clinical symptoms of hypoglycaemia (sweating, shakiness, anxiety) were linked to patient's age and diabetes duration. Regarding hypoglycaemia frequency, agreement was good for severe hypoglycaemia (GC: 0.61 and 0.72 for diurnal and nocturnal hypoglycaemia, respectively) and poor for mild hypoglycaemia (ICC: 0.44 and 0.40, respectively). Diabetologists correctly evaluated the impact of hypoglycaemia on quality of life, but overestimated the hypoglycaemia-induced burden and anxiety. Counteractive behaviours were frequent: 23% of patients decreased their insulin dose, 20% increased their sugar intake and 12% ate extra snacks. Diabetologists were generally aware of these measures, but not of how often patients used them. CONCLUSION Diabetologists and patients do not share enough information about hypoglycaemia. Fear of hypoglycaemia and counteractive behaviours should be looked for by diabetologists. Systematic advice and specially adapted education should also be provided to increase patients' awareness of hypoglycaemia.
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Affiliation(s)
- P Böhme
- Service de Diabétologie, Maladies Métaboliques et Nutrition, Hôpital Brabois, CHU de Nancy, 54511 Vandoeuvre-les-Nancy, France.
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Abstract
AIMS To examine the impact of the threat of hypoglycaemic episodes on people with diabetes in Taiwan. BACKGROUND Intensive diabetes treatment in people with diabetes helps them to achieve better glycaemic control. However, it also causes more frequent hypoglycaemic episodes and has an impact on their overall quality of life. Hypoglycaemia is accompanied by various distressing symptoms which may cause excessive fear, affecting decision making in hypoglycaemic management. DESIGN Purposive sampling and in-depth, face-to-face interviews were used to collect data. METHODS Semi-structured interviews were conducted from July 2008-January 2009 with 17 individuals treated with insulin who had previous hypoglycaemic episodes. Data were analysed using qualitative content analysis. RESULTS Four themes were generated from the analysis, 'inability to control fluctuations in health', 'challenges to interpersonal relationships', 'facing the disease alone' and 'finding a balance between competing symptoms'. CONCLUSIONS Hypoglycaemia is a major health issue for many people with diabetes. Understanding individuals' experiences with hypoglycaemic episodes should help practitioners become more fully involved in promoting self-management. We identified key areas that health care providers should address, including concerns about patient education and professional support for people with diabetes experiencing hypoglycaemia, to enhance problem solving skills for them and their families. RELEVANCE TO CLINICAL PRACTICE We recommend that health care providers make proper use of support groups for family caregivers or other important individuals in the lives of people with diabetes to provide education, clarification, support and guidance. In addition, health care providers also need to provide clients with hypoglycaemia-related emotional support, while enhancing diabetes self-management and problem-solving skills.
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Affiliation(s)
- Fei-Ling Wu
- Department of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan
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Brito-Sanfiel M, Diago-Cabezudo J, Calderon A. Economic impact of hypoglycemia on healthcare in Spain. Expert Rev Pharmacoecon Outcomes Res 2011; 10:649-60. [PMID: 21155698 DOI: 10.1586/erp.10.73] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Diabetes mellitus has a major impact on costs for healthcare and society. The estimation for 2010 is that investment in diabetes will reach 11.6% of public healthcare expenses worldwide. The expected rise in the prevalence of diabetes over the coming decades may create problems for the sustainability of healthcare systems, such as those in Spain. The rise in direct costs is the main issue in diabetes, especially the treatment of acute and chronic complications that often need hospital care. Severe hypoglycemia (SH) is the most frequent acute complication. In Spain, the incidence of SH is estimated at two episodes per patient per year for Type 1 diabetes and one to two episodes for advanced Type 2 diabetes requiring insulin treatment. Although results vary, Spanish national data provide an estimated cost of approximately €3500 per SH episode. It also has a major influence on indirect costs, mainly related to reduced productivity, absenteeism and occasionally early retirement, and affects direct health, such as quality of life. As a result of SH, patients acquire a fear of new hypoglycemic episodes, which makes them modify their behavior and habits and, in the long term, has the potential to negatively impact metabolic control. Educational programs for healthcare professionals and patients with diabetes, increased involvement of patients in the management of their illness and regular self-measurement of blood glucose are all strategies aimed at minimizing the social and economic effects of severe hypoglycemia.
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Affiliation(s)
- M Brito-Sanfiel
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro Majadahonda (Madrid), C/ Manuel de Falla, 1 Majadahonda 28220, Madrid, Spain
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Ho AYK, Berggren I, Dahlborg-Lyckhage E. Diabetes empowerment related to Pender's Health Promotion Model: a meta-synthesis. Nurs Health Sci 2011; 12:259-67. [PMID: 20602700 DOI: 10.1111/j.1442-2018.2010.00517.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Diabetes self-management is a challenge for both clients and health-care professionals. Empowerment plays a vital role in helping clients to achieve successful self-management. This study adopted a meta-ethnographic approach. Nine qualitative studies were synthesized in order to contribute to a deeper understanding of what clients perceive as being important in an effective empowerment strategy for diabetes self-management. Four central metaphors that influenced empowerment were identified: trust in nurses' competence and awareness, striving for control, a desire to share experiences, and nurses' attitudes and ability to personalize. The lines-of-argument synthesis suggested the need for an evaluation system to appraise clients' diabetes knowledge, health beliefs, and negative emotions, as well as the outcome of interventions. Based on Pender's Health Promotion Model, this study emphasizes the fact that health-care professionals need to understand and address modifiable behavior-specific variables. The study suggests that an effective empowerment strategy would be to use activity-related affect, as well as interpersonal and situational influences, as a means of facilitating and enhancing clients' health-promoting behaviors.
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Affiliation(s)
- Agnes Yin Kwan Ho
- Department of Nursing, Health and Culture, University West, Trollhättan, Gothenburg, Sweden.
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Zhang CX, Tse LA, Ye XQ, Lin FY, Chen YM, Chen WQ. Moderating effects of coping styles on anxiety and depressive symptoms caused by psychological stress in Chinese patients with Type 2 diabetes. Diabet Med 2009; 26:1282-8. [PMID: 20002482 DOI: 10.1111/j.1464-5491.2009.02840.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS This study aimed to assess possible interactive effects of coping styles and psychological stress on depression and anxiety symptoms in Chinese patients with Type 2 diabetes. METHODS Three hundred and four patients with Type 2 diabetes underwent a face-to-face interview by trained research staff according to a standardized questionnaire including information on socio-demographic characteristics, psychological stress, coping styles and anxiety and depressive symptoms. The interactive effects of coping styles and psychological stress on depression and anxiety symptoms were assessed by hierarchical multiple regression analyses. RESULTS There were significant associations of the four domains of psychological stress with anxiety and depressive symptoms, except for the relationship between 'reduced economic condition' and depressive symptoms. 'Negative coping style' significantly increased the level of both anxiety and depressive symptoms; whereas, 'active coping style' and 'avoidant coping style' decreased the risk of depressive symptoms. The interactions of 'negative coping style' with 'worrying about decline in body/physical function' and 'reduced economic condition' significantly increased the risk of anxiety and depressive symptoms, and the interaction of 'social/family crisis caused by the disease' with 'avoidance coping style' and 'worrying about decline in body/physical function' with 'active coping style' significantly decreased the risk of depressive symptoms. CONCLUSIONS The results of this study suggest that certain coping styles might moderate the association of psychological stress with anxiety and depressive symptoms in Chinese patients with Type 2 diabetes.
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Affiliation(s)
- C-X Zhang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
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Brod M, Kongsø JH, Lessard S, Christensen TL. Psychological insulin resistance: patient beliefs and implications for diabetes management. Qual Life Res 2008; 18:23-32. [PMID: 19039679 DOI: 10.1007/s11136-008-9419-1] [Citation(s) in RCA: 151] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 11/01/2008] [Indexed: 12/20/2022]
Abstract
PURPOSE To define and understand patient psychological insulin resistance (PIR) and its impact on diabetes management. METHODS Systematic literature review of peer-refereed journals using the MEDLINE database, including all articles in English from 1985 to 2007. The population included patients with type 1 and type 2 diabetes, insulin naïve, and those currently using insulin. A total of 116 articles were reviewed. RESULTS PIR is impacted by patients' beliefs and knowledge about diabetes and insulin, negative self-perceptions and attitudinal barriers, the fear of side effects and complications from insulin use, as well as lifestyle adaptations, restrictions required by insulin use, and social stigma. These etiological influences, both independently and in combination, constitute a patient's PIR and may result in the reluctance of patients to both initiate and intensify treatment, leading to delayed treatment initiation and compromised glucose control. CONCLUSIONS PIR is complex and multifaceted. It plays an important, although often ignored, role in diabetes management. Assisting health care professionals in better understanding PIR from the patient's perspective should result in improved treatment outcomes. By tailoring treatments to patients' PIR, clinicians may be better able to help their patients begin insulin treatment sooner and improve compliance, thus facilitating target glycemic control.
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Affiliation(s)
- Meryl Brod
- The Brod Group, 219 Julia Avenue, Mill Valley, CA 94941, USA.
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Wild D, von Maltzahn R, Brohan E, Christensen T, Clauson P, Gonder-Frederick L. A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education. PATIENT EDUCATION AND COUNSELING 2007; 68:10-5. [PMID: 17582726 DOI: 10.1016/j.pec.2007.05.003] [Citation(s) in RCA: 387] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 05/03/2007] [Accepted: 05/07/2007] [Indexed: 05/15/2023]
Abstract
OBJECTIVE In many individuals with diabetes, the unpleasant symptoms and negative consequences associated with hypoglycemia may result in significant anxiety or even a fear of hypoglycemia (FoH). This fear may have significant clinical implications for diabetes management. The aim of this review is to integrate existing research on FoH (its measurement, predictors, correlates, impact and treatment) and discuss its implications for diabetes management and patient education. METHODS A literature search was conducted using Medline and Embase. The search was limited to journal articles published in English from 1985 to 2007 inclusive. Three hundred and one abstracts were reviewed and 273 were rejected on the basis of non-relevance. In addition to the 28 papers included, six additional papers were identified by further searches and were added to this review. RESULTS FoH appears to be a widespread phenomenon. It is measured primarily through the use of a specific scale, the Hypoglycemic Fear Survey (HFS). There are a number of factors that relate to whether an individual is likely to develop FoH including whether there is a history of hypoglycemia in an individual, length of time since first insulin treatment, and a higher level of variability in blood glucose level. FoH has been linked to both state and trait anxiety although the relationship is complex. CONCLUSIONS There is evidence that FoH may have a significant negative impact on diabetes management, metabolic control and subsequent health outcomes. There is evidence that blood glucose (BG) awareness training and CBT can reduce levels of fear and improve disease management. More research is needed on how FoH arises and the individual variables which predict its development. In addition, well designed research is required to better understand the behavioral and medical impact of FoH, and interventions to reduce it. PRACTICE IMPLICATIONS There is some evidence to suggest that interventions including BG awareness training and cognitive behavioral therapy can reduce levels of fear and improve disease management. While many aspects of FoH require further well-designed research, it is evident that this phenomenon can have a major impact on diabetes management and needs to be specifically addressed in patient education programs.
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Affiliation(s)
- Diane Wild
- Oxford Outcomes Ltd., Seacourt Tower, West Way, Oxford, United Kingdom.
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Chan MF, Zang YL. Nurses? perceived and actual level of diabetes mellitus knowledge: results of a cluster analysis. J Clin Nurs 2007; 16:234-42. [PMID: 17584433 DOI: 10.1111/j.1365-2702.2006.01761.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS Nurses' perceived and actual diabetes knowledge was explored by identifying profiles of nurses working in two hospitals in Hong Kong. Relationships between nurses' perceived and actual diabetes knowledge are explored. BACKGROUND In non-specialist clinical settings in Hong Kong, nurses provide diabetes self-management education to patients, therefore, nurse's knowledge and skill in giving diabetes care is very important. Though patients' perceptions are important, if patients solely select and set their own priorities for learning about and managing diabetes, their care could be compromised by knowledge deficits. METHOD A descriptive correlational survey was conducted during the period September 2004 to July 2005 in two local hospitals in Hong Kong. 245 nurses completed a structured questionnaire. Nurses' demographic data, competence, perceived and actual diabetes mellitus knowledge were collected. RESULTS Two-step cluster analysis yielded three clusters: Cluster 1 nurses were characterized by relatively good competence and high diabetes knowledge than nurses in Clusters 2 and 3. Cluster 3 nurses reported low competence and diabetes knowledge than nurses in Clusters 1 and 2. Cluster 2 was a large group of nurses holding both positive and moderate competence and diabetes knowledge. Statistically significant differences were found between clusters. Overall, nurses' perceived diabetes knowledge was statistically significant correlated with actual knowledge (r(s) = 0.32). CONCLUSIONS Nurses have the responsibility to educate patients with correct and updated information, therefore, knowledge should be provided and maintained to a certain standard. RELEVANCE TO CLINICAL PRACTICE Lack of knowledge among nursing staff has contributed to diabetes patients receiving inadequate health care instruction. As indicated by the results of this study, 'tailor-made' educational programmes should be designed to meet the learning needs of each subgroup. Expertise and nurse education should be recognized when such educational programmes are designed.
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Affiliation(s)
- Moon Fai Chan
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.
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Lee S, Chiu A, Tsang A, Chow CC, Chan WB. Treatment-related stresses and anxiety-depressive symptoms among Chinese outpatients with type 2 diabetes mellitus in Hong Kong. Diabetes Res Clin Pract 2006; 74:282-8. [PMID: 16701917 DOI: 10.1016/j.diabres.2006.03.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Accepted: 03/29/2006] [Indexed: 11/18/2022]
Abstract
Based on focus group findings, a descriptive instrument was developed to examine the relationship among treatment-related stress, anxiety and depressive symptoms, distress, and impairment of 333 Chinese outpatients with type 2 diabetes mellitus (DM) in Hong Kong. It was found that the main stresses included fears of diabetes complications, work impairment, lifestyle adjustment, stigmatization, and discrimination. Over 1/4 of patients concealed their DM from family members in order not to make the latter worry. 28.3% felt that life was not worth living. 33.6% of patients exhibited four or more anxiety and depressive symptoms accompanied by significant distress and/or impairment. These patients were more likely to be female, of lower educational level, and unemployed. Diabetes complications, concealment of DM, and feeling of being a burden to the family predicted anxious-depressed status. The study showed that treatment-related stresses and anxiety-depressive symptoms were common and associated among Chinese diabetes outpatients in Hong Kong.
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Affiliation(s)
- Sing Lee
- Department of Psychiatry, The Chinese University of Hong Kong, HKSAR, PR China.
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Chan MF, Yee ASW, Leung ELY, Day MC. The effectiveness of a diabetes nurse clinic in treating older patients with type 2 diabetes for their glycaemic control. J Clin Nurs 2006; 15:770-81. [PMID: 16684173 DOI: 10.1111/j.1365-2702.2006.01357.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS The aim of this study is to determine the effectiveness of a diabetes nurse clinic intervention in controlling the poor glycaemia of older patients with type 2 diabetes. RESEARCH METHOD This is a quasi-experimental design with pre- and follow-up tests. The study was conducted in a regional acute hospital in Hong Kong. A total of 150 (75 controls, 75 cases) poor glycaemic control older patients with diabetes were recruited in the study. OUTCOME MEASURES Biomedical and psychological data were collected at pre- and follow-up period and compared between groups. RESULTS The study results show an effective intervention of diabetes nurse clinic in giving consultation and education to the type 2 diabetic patients. Subjects in the nurse follow-up group showed an improvement in the HbA1c, and systolic blood pressure and reduction on healthcare utilization. CONCLUSION The study provided evidence to support the diabetes nurse clinic in treating the older patients with diabetes. This study has provided confidence to the diabetes nurse to treat the unstable older patients with diabetes. RELEVANCE TO CLINICAL PRACTICE Diabetes mellitus is a serious health concern that most commonly affects older people. As indicated by the results of this study, this educational programme can act as an effective nursing intervention to the type 2 diabetic patients.
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Affiliation(s)
- Moon Fai Chan
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
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Chesla CA, Chun KM. Accommodating type 2 diabetes in the Chinese American family. QUALITATIVE HEALTH RESEARCH 2005; 15:240-255. [PMID: 15611206 DOI: 10.1177/1049732304272050] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In this interpretive study, the authors aimed to describe family responses to type 2 diabetes in Chinese Americans as reported by persons with diabetes (PWD) and spouses. Twenty participants representing 16 families completed multiple group interviews. The authors elicited positive and difficult diabetes care narratives and conducted narrative and thematic analysis of transcribed interview texts. Accommodation, the key family response, comprised the enactment of social concerns and practices to balance quality of life for individuals and families with quality of diabetes care. PWDs' accommodation included negotiating disease disclosure, protecting the family's meals, and maintaining ease in family relations despite diabetes symptoms. Accommodation by family members included developing shared diabetes care practices and indirect approaches to disagreements about diabetes management.
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Tak-Ying Shiu A, Kwan JJYM, Wong RYM. Social stigma as a barrier to diabetes self-management: implications for multi-level interventions. J Clin Nurs 2003; 12:149-50. [PMID: 12519263 DOI: 10.1046/j.1365-2702.2003.00735.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ann Tak-Ying Shiu
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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