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Narcisse MR, McElfish PA, Schootman M, Selig JP, Kirkland T, McFarlane SI, Felix HC, Seixas A, Jean-Louis G. Type 2 diabetes and health-related quality of life among older Medicare beneficiaries: The mediating role of sleep. Sleep Med 2024; 117:209-215. [PMID: 38593616 PMCID: PMC11081429 DOI: 10.1016/j.sleep.2024.03.015] [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: 11/01/2023] [Revised: 02/21/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To examine mediating effects of sleep quality and duration on the association between T2D and QoL among Medicare beneficiaries 65+. METHODS Data from the Medicare Health Outcome Survey (2015-2020) were used. The outcome was QoL (physical and mental health component-summary scores [PCS and MCS]) measured by the Veterans-Rand-12. The main predictor was diagnosed T2D. Mediators were sleep duration and sleep quality. The effect modifier was race/ethnicity. Structural Equation Modeling was used to estimate moderated-mediating effects of sleep quality and duration across race/ethnicity. RESULTS Of the 746,400 Medicare beneficiaries, 26.7% had T2D, and mean age was 76 years (SD ± 6.9). Mean PCS score was 40 (SD ± 12.2), and mean MCS score was 54.0 (SD ± 10.2). Associations of T2D with PCS and MCS were negative and significant. For all racial/ethnic groups, those with T2D reported lower PCS. For White, Black, Asian, and Hispanic beneficiaries only, those with T2D reported lower MCS. The negative impact of T2D on PCS and MCS was mediated through sleep quality, especially very bad sleep quality. CONCLUSION Improving sleep may lead to improvement in QoL in elderly adults with T2D.
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Affiliation(s)
- Marie-Rachelle Narcisse
- Department of Psychiatry and Human Behavior, Brown University, 222 Richmond St., Providence, RI, 02903, USA.
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Mario Schootman
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR, 72762, USA
| | - Tracie Kirkland
- Department of Nursing, University of Southern California, Los Angeles, CA, 90033, USA
| | - Samy I McFarlane
- Department of Medicine, State University of New York-Downstate Health Sciences University, 450 Clarkson Avenue, MSC 50, Brooklyn, NY, 11203, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Azizi Seixas
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Girardin Jean-Louis
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
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Guerra KMP, Corrêa ÁCDP, Oliveira JCAXD, Alvarenga EC, Rosa ITM. Self-care of informal male workers during the COVID-19 pandemic in the light of Orem's theory. Rev Gaucha Enferm 2023; 44:e20220351. [PMID: 37909518 DOI: 10.1590/1983-1447.2023.20220351.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/10/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE To understand the self-care requirements of informal male workers in carrying out their activities during the COVID-19 pandemic, in the light of Orem's theory. METHOD Qualitative approach, with an exploratory descriptive nature. Data collection was conducted through a closed questionnaire, with questions that refer to the self-care requirements and semi-structured interviews, both conducted in a virtual environment. Ten men working as delivery workers and app drivers participated. Data analysis was performed using thematic content analysis. RESULTS The diagnosis of the self-care requirements performed by each of the interviewees was presented. FINAL CONSIDERATIONS The work performed by the participants influences the self-care requirements of the population studied, and it is possible to infer that as specializations of these requirements occur, they are no longer performed or are practiced superficially.
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Affiliation(s)
| | | | | | - Eric Campos Alvarenga
- Universidade Federal do Pará (UFPA), Departamento de Psicologia. Belém, Pará, Brasil
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3
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Basinger ED, Hartsell H. Communal Coping and Self-Care in Black and White Individuals Living with Type 2 Diabetes. HEALTH COMMUNICATION 2021; 36:1961-1969. [PMID: 32844697 DOI: 10.1080/10410236.2020.1808408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Type 2 diabetes mellitus is both prevalent and profoundly impactful, and how people cope with the illness is related to a variety of individual and relational outcomes. The goal of this investigation was to test the logic of the recently extended Theoretical Model of Communal Coping (TMCC), a communication theory that argues that race (in this study, Black and White) moderates the relationship between communal coping and disease-related outcomes (i.e., glucose, diet, and exercise self-care). In general, survey data from 348 participants (n = 224 Black participants, n = 124 White participants) revealed that although communal coping was directly and positively related to self-care, the relationship between communal coping and self-care was stronger for Black participants than White participants. The results of the study have implications for the TMCC and for researchers, families managing type 2 diabetes, and healthcare practitioners.
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Affiliation(s)
- Erin D Basinger
- Department of Communication Studies, University of North Carolina at Charlotte
| | - Haley Hartsell
- Department of Communication Studies, University of North Carolina at Charlotte
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4
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Helgeson VS, Naqvi JB, Korytkowski MT, Gary-Webb TL. A Closer Look at Racial Differences in Diabetes Outcomes Among a Community Sample: Diabetes Distress, Self-care, and HbA 1c. Diabetes Care 2021; 44:2487-2492. [PMID: 34475029 PMCID: PMC8546284 DOI: 10.2337/dc21-0734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 08/16/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Approximately 34 million people in the U.S. have diabetes. With this illness come substantial changes to psychological and physical health. However, type 2 diabetes disproportionately affects non-Hispanic Black compared with non-Hispanic White populations. The purpose of this study was to examine racial differences in psychological, behavioral, and physical health over time among individuals recently diagnosed with type 2 diabetes. RESEARCH DESIGN AND METHODS Data were collected from a community sample of 193 adults recently diagnosed with type 2 diabetes (44% female; 45% Black). Measures of distress, self-care behaviors, and HbA1c were taken at an initial interview (time 1) and 6 months later (time 2). Individuals wore an Actical accelerometer to assess physical activity and participated in three 24-h dietary recall interviews to assess dietary intake within 2 weeks of the initial interview. RESULTS From time 1 to time 2, Black women showed the highest increase in depressive symptoms. There was a greater increase in regimen and physician distress among White compared with Black participants. White men and Black women reported a decline in medication adherence over time. There were no racial differences in changes in physical activity across 6 months. However, Black individuals had higher overall calorie consumption with greater protein, saturated fat, and cholesterol intake than White individuals. There were no race or sex differences in changes in glycemic stability. CONCLUSIONS Initial adjustment to a diagnosis of type 2 diabetes differentially influences Black and White men and women in terms of depressive symptoms, diabetes distress, and self-care.
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Olukotun O, Akinboboye O, Williams JS, Ozieh M, Egede LE. Influences of Demographic, Social Determinants, Clinical, Knowledge, and Self-Care Factors on Quality of Life in Adults With Type 2 Diabetes: Black-White Differences. J Racial Ethn Health Disparities 2021; 9:1172-1183. [PMID: 34009560 PMCID: PMC8602439 DOI: 10.1007/s40615-021-01058-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study evaluated racial differences in the contribution of demographic, social determinants, clinical, and self-care factors on quality of life (QOL) in adults with type 2 diabetes mellitus (T2DM). METHODS A total of 615 adults with T2DM in Southeastern United States were recruited. Linear regression models were used to assess the contribution of demographic, social determinants, clinical, and self-care factors on the mental (MCS) and physical components (PCS) of QOL, after stratifying by race. RESULTS For the entire sample, there were significant relationships between PCS and psychological distress (β = 0.02, p < 0.01), neighborhood aesthetics (β = 0.05, p < 0.01), neighborhood walking environment (β = -0.02, p < 0.05), access to healthy food (β = 0.01, p < 0.05), neighborhood crime (β = -0.15, p < 0.05), and neighborhood comparison (β = 0.13, p < 0.05); and MCS and depression (β = -0.06, p < 0.05), psychological distress (β = -0.09, p < 0.001), perceived stress (β = -0.12, p < 0.01), and perceived health status (β = -0.33, p < 0.01). In the regression models stratified by race, notable differences existed in the association between PCS, MCS, and demographic, psychosocial, built environment, and clinical factors among Whites and Blacks, respectively. CONCLUSION In this sample, there were racial differences in demographic, social determinants, built environment, and clinical factors associated with PCS and MCS components of QOL. Interventions may need to be tailored by race or ethnicity to improve quality of life in adults with T2DM.
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Affiliation(s)
| | - Olaitan Akinboboye
- Institute of Health and Equity, Department of Public and Community Health, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joni S Williams
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226-3596, USA
| | - Mukoso Ozieh
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
| | - Leonard E Egede
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA.
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226-3596, USA.
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6
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Campbell JA, Yan A, Walker RE, Weinhardt L, Wang Y, Walker RJ, Egede LE. Quantifying the Influence of Individual, Community, and Health System Factors on Quality of Life Among Inner-City African Americans With Type 2 Diabetes. Sci Diabetes Self Manag Care 2021; 47:124-143. [PMID: 34078179 DOI: 10.1177/0145721721996287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study is to examine the association of individual, community, and health system factors on quality of life among inner-city African Americans with type 2 diabetes. METHODS Primary data from a cross-sectional study with a community sample of 241 inner-city African Americans with type 2 diabetes were analyzed. Paper-based surveys were administered in which the SF-12 was used to capture the physical component (PCS) and mental component (MCS) of quality of life. Four regression approaches (sequential, stepwise with backward and forward selection, and all possible subsets regression) were used to examine the influence of individual, community, and health system factors on PCS and MCS after adjusting for relevant covariates using a conceptual framework. RESULTS In fully adjusted models, having less than a high school education and having major depression were associated with lower quality-of-life scores for MCS across all 4 regression approaches. Being employed was positively associated with better quality-of-life scores for PCS across all 4 regression approaches. PCS was higher across all 4 regression approaches for those reporting a history of trauma. At the health systems level, usual source of care was associated with better PCS across 3 regression approaches. CONCLUSIONS These results highlight key factors that influence quality of life among inner-city African Americans with type 2 diabetes that could be targets for interventions in this population. However, additional research is needed to understand existing pathways that may be driving many of these relationships.
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Affiliation(s)
- Jennifer A Campbell
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alice Yan
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Renee E Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lance Weinhardt
- Joseph Zilber School of Public Health, University of Wisconsin, Milwaukee, Milwaukee, Wisconsin
| | - Yang Wang
- Joseph Zilber School of Public Health, University of Wisconsin, Milwaukee, Milwaukee, Wisconsin
| | - Rebekah J Walker
- Joseph Zilber School of Public Health, University of Wisconsin, Milwaukee, Milwaukee, Wisconsin
| | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
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7
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Campbell JA, Egede LE. Individual-, Community-, and Health System-Level Barriers to Optimal Type 2 Diabetes Care for Inner-City African Americans: An Integrative Review and Model Development. DIABETES EDUCATOR 2019; 46:11-27. [PMID: 31802703 DOI: 10.1177/0145721719889338] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this integrative review is (1) to elucidate the unique barriers faced by inner-city African Americans for type 2 diabetes (T2DM) care; (2) to identify effective interventions/programs for optimal T2DM care at the individual, community, and health systems levels; and (3) to integrate 2 behavioral models and 1 social ecological model for framing interventions for inner-city African American to optimize T2DM care. METHODS PRISMA guidelines were followed to systematically search PubMed, PsychInfo, and CINAHL. Integration of models was based on underlying principles of social ecological models. RESULTS The search returned 1183 articles. Forty-six articles were synthesized after applying inclusion criteria. Multiple barriers for the individual level, community level, and health system level were identified. Major barriers include lack of knowledge, lack of social support, and self-management support. Interventions identified in this review show that among inner-city African Americans with T2DM, the focus is placed at the health systems level, with very limited focus toward addressing individual- and community-level barriers. Final synthesis includes development of a new integrated model that explains barriers to care across multiple levels. CONCLUSIONS These findings highlight the fragmentation that may be occurring between policy, research, and practice for achieving health equity and addressing health disparities for T2DM care among inner-city African Americans. The new model is an important step in the pursuit of equity in T2DM by specifying the complex barriers that occur across multiple levels. The application of this model using the 2017 National Standards for Diabetes-Self Management Education and Support are discussed.
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Affiliation(s)
- Jennifer A Campbell
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Center for Advancing Population Science, Milwaukee, Wisconsin.,Joseph Zilber School of Public Health University of Wisconsin Milwaukee Community and Behavioral Health Promotion PhD Program, Milwaukee, Wisconsin
| | - Leonard E Egede
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Center for Advancing Population Science, Milwaukee, Wisconsin.,Joseph Zilber School of Public Health University of Wisconsin Milwaukee Community and Behavioral Health Promotion PhD Program, Milwaukee, Wisconsin
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8
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Rwegerera GM, Moshomo T, Gaenamong M, Oyewo TA, Gollakota S, Rivera YP, Masaka A, Godman B, Shimwela M, Habte D. Health-related quality of life and associated factors among patients with diabetes mellitus in Botswana. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2017.05.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Godfrey Mutashambara Rwegerera
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, BotswanaFaculty of Medicine, Department of Internal Medicine, University of Botswana, Botswana
- Department of Medicine, Princess Marina Hospital, Gaborone, BotswanaDepartment of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Thato Moshomo
- Scottish Livingstone Hospital, Molepolole, BotswanaScottish Livingstone Hospital, Molepolole, Botswana
| | - Marea Gaenamong
- Department of Accident and Emergency, Princess Marina Hospital, Gaborone, BotswanaDepartment of Accident and Emergency, Princess Marina Hospital, Gaborone, Botswana
| | - Taibat Aderonke Oyewo
- Department of Medicine, Princess Marina Hospital, Gaborone, BotswanaDepartment of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Sivasomnath Gollakota
- Department of Medicine, Princess Marina Hospital, Gaborone, BotswanaDepartment of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Yordanka Piña Rivera
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, BotswanaFaculty of Medicine, Department of Internal Medicine, University of Botswana, Botswana
- Department of Medicine, Princess Marina Hospital, Gaborone, BotswanaDepartment of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Anthony Masaka
- Botho University, Gaborone, BotswanaBotho University, Gaborone, Botswana
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, SwedenDepartment of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United KingdomStrathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Meshack Shimwela
- Amana Municipal Hospital, Dar-es-Salaam, TanzaniaAmana Municipal Hospital, Dar-es-Salaam, Tanzania
| | - Dereje Habte
- Management Sciences for Health (MSH), Addis Ababa, EthiopiaManagement Sciences for Health (MSH), Addis Ababa, Ethiopia
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9
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Choi SA, Hastings JF. Religion, spirituality, coping, and resilience among African Americans with diabetes. JOURNAL OF RELIGION & SPIRITUALITY IN SOCIAL WORK 2018; 38:93-114. [PMID: 31607831 PMCID: PMC6788765 DOI: 10.1080/15426432.2018.1524735] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/13/2018] [Indexed: 05/28/2023]
Abstract
Study aims were to explore how religion and spirituality impacted attitudes about self-management practices among African Americans with homelessness histories and to understand resilience in diabetes care practices. Qualitative semi-structured face-to-face interviews were conducted with 42 African Americans older than 18 years. All audio-taped interviews lasted between 1-1.5 hr, transcribed verbatim, and analyzed using ATLAS.ti (version 7.0). Five resilience themes emerged. While participants recognized diabetes as an illness requiring professional treatment, the context of balancing treatment with religion and spiritual practices mattered. The study findings highlight the importance of spirituality, religious beliefs, and coping strategies in diabetes self-care activities.
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Affiliation(s)
- Sung Ah Choi
- School of Social Welfare, University at Albany, SUNY, Albany, New York, USA
| | - Julia F. Hastings
- School of Social Welfare, University at Albany, SUNY, Albany, New York, USA
- School of Public Health, Health Policy, Management, & Behavior University at Albany, SUNY, Rensselaer, New York, USA
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Ahammed A, Pathan F, Afsana F, Ahammed I, Mir AS, Yusuf A. The Burden of Severe Hypoglycemia on Quality of Life among Diabetes Mellitus Patients in a Tertiary Level Hospital of Bangladesh. Indian J Endocrinol Metab 2018; 22:499-504. [PMID: 30148097 PMCID: PMC6085957 DOI: 10.4103/ijem.ijem_338_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to determine the impact of hypoglycemia on health-related quality of life from a patient perspective. MATERIALS AND METHODS A cross-sectional study was conducted in 164 type 2 diabetes patients admitted due to severe hypoglycemia from August 2015 to October 2016 at Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, in Dhaka. Impact of severe hypoglycemia on health-related quality of life in diabetic patients was evaluated using the disease-specific questionnaire audit of diabetes-dependent quality of life-19 (ADDQOL-19). RESULTS The median ADDQOL score was calculated at -3.31. Totally, 88 (53.7%) patients reported an ADDQOL score of - 3.31 or more, and 76 (46.3%) patients had an ADDQOL score of less than -3.31 (lower quality of life [QoL]). After considering weighting, "Freedom to eat" (mean Weighted Impact Score-6.32 ± 1.94) was the most and "Holidays" (mean Weighted Impact Score-0.96 ± 0.19) was the least affected QoL domains, respectively. In multivariate logistic regression analysis, severe hypoglycemia impact on ADDQOL was related with age (odds ratio [OR] 0.932, 95% confidence intervals [CIs] 0.897-0.969, P < 0.001), sex (OR 0.088, 95% CIs 0.023-0.338, P < 0.001), glycated hemoglobin (%) (OR 0.613, 95% CIs 0.422-0.890, P = 0.010), and marital status (OR 9.264, 95% CIs 2.467-34.790, P = 0.001). CONCLUSIONS The results of this analysis suggest hypoglycemia impacts heavily on the well-being and quality of life of people with diabetes, and every effort should be made to minimize hypoglycemia while aiming for good glycemic control.
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Affiliation(s)
- Afsar Ahammed
- Department of Physiotherapy, National Institute of Traumatology and Orthopedic Rehabilitation, Dhaka, Bangladesh
| | - Faruque Pathan
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Faria Afsana
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Imran Ahammed
- Officer on Special Duty, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Ahmed Salam Mir
- Department of Endocrinology, Dhaka Central International Medical College and Hospital, Dhaka, Bangladesh
| | - Abdullah Yusuf
- Department of Microbiology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
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11
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Awotidebe TO, Adedoyin RA, Oke KI, Ativie RN, Opiyo R, Ikujeyisi EO, Ikem RT, Afolabi MA. Relationship between functional capacity and health-related quality of life of patients with type-2 diabetes. Diabetes Metab Syndr 2017; 11:1-5. [PMID: 27389077 DOI: 10.1016/j.dsx.2016.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/06/2016] [Indexed: 11/28/2022]
Abstract
AIMS Physical function is a determinant of survival in chronic diseases, however, little is known about functional capacity (FC) and self-reported health status of patients with type-2 diabetes (T2D). This study investigated the relationship between FC and health related quality of life (HRQoL) of patients with T2D. MATERIALS AND METHODS This cross-sectional survey recruited 150 patients with T2D from a Nigerian university teaching hospital using purposive sampling technique. Socio-demographic and physical characteristics were assessed. FC and HRQoL including physical and mental health component summary (PCS and MCS) were assessed using the six minute walk test (6MWT) and Short-Form (SF-12) questionnaire respectively. Maximum oxygen consumption (VO2 max) was estimated, pre and post 6MWT cardiovascular parameters and fasting blood glucose (FBG) were assessed. Data were analyzed using descriptive and inferential statistics. Alpha level was set at p<0.05. RESULTS There were 83(55.3%) women, means of age and FBG of participants were 64.2±8.7years and 7.4±2.4mmol/L respectively. The means of 6-min walk distance (6-MWD) and estimated VO2 max were 341.55±41.82m and 9.2±0.7mL/kg/min respectively. Significant differences were found between pre and post HR (t=-44.71; p=0.001), SBP (t=-38.38; p=0.001) and DBP (t=-38.58; p=0.001) following 6MWT. The means of PCS and MCS of HRQoL were 48.67±5.51 and 58.39±2.86 respectively. There were significant correlations between FC and each of PCS (r=0.678; p=0.001) and MCS (r=0.211; p=0.009). CONCLUSION Patients with T2D demonstrated low functional capacity and reduced HRQoL. Significant relationship exists between FC and physical and mental component summary of HRQoL. Exercise intervention to improve FC and HRQoL were recommended.
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Affiliation(s)
- Taofeek O Awotidebe
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - Rufus A Adedoyin
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Kayode I Oke
- Department of Physiotherapy, College of Medical Sciences, University of Benin, Benin City, Edo State, Nigeria
| | - Rita N Ativie
- Department of Physiotherapy, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria
| | - Rose Opiyo
- Department of Nutrition, School of Public Health, University of Nairobi, Nairobi, Kenya
| | - Ebenezer O Ikujeyisi
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Rosemary T Ikem
- Department of Medicine, Endocrine and Metabolism Unit, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Mubaraq A Afolabi
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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12
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Lontchi-Yimagou E, Mapa-Tassou C, Dehayem MY, Essi MJ, Saji J, Takogue R, Sobngwi E, Mbanya JC. The effect of free diabetes care on metabolic control and on health-related quality of life among youths with type 1 diabetes in Cameroon. BMJ Open Diabetes Res Care 2017; 5:e000397. [PMID: 28761659 PMCID: PMC5530241 DOI: 10.1136/bmjdrc-2017-000397] [Citation(s) in RCA: 9] [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: 02/01/2017] [Revised: 04/19/2017] [Accepted: 05/10/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To assess the effect of free diabetes care on metabolic control and on health-related quality of life (HRQoL) of youths living with type 1 diabetes in Cameroon. RESEARCH DESIGN AND METHODS We conducted a clinical audit of a multicenter prospective cohort, performed in three of the nine clinics of the 'Changing Diabetes in Children' (CDiC) project in Cameroon. We collected data on demography, glycemic control, diabetes acute complications, and patients' HRQoL at baseline and after 1 year of follow-up. RESULTS One hundred and four patients (51 female) were included. The mean age was 16±2 years (min-max: 9-18), the mean duration of diabetes was 5±3 years, and the mean HbA1C level was 11.4%±2.7%. A significant reduction in HbA1c (11.4%±2.7% vs 8.7±2.4%), episodes of severe hypoglycemia (27/104 vs 15/104), and episodes of ketoacidosis (31/104 vs 7/104) were observed after 1 year (p<0.05). We did not observe any significant difference in the total HRQoL score (p=0.66). However, we observed a significant decrease in diabetes-associated symptoms (p<0.05). Age, level of education, duration of diabetes, glycemic control, and the presence or absence of diabetes complications did not significantly affect the total HRQoL score. CONCLUSIONS One year after free diabetes care offered through the CDiC project, a significant improvement was observed in glycemic control and acute complications of diabetes, but not in the total score of HRQoL of youths living with type 1 diabetes enrolled in the project.
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Affiliation(s)
- Eric Lontchi-Yimagou
- Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, The University of Yaoundé I, Yaoundé, Cameroon
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
| | - Clarisse Mapa-Tassou
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
| | - Mesmin Y Dehayem
- Endocrine and Diabetology Service, National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Marie-José Essi
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
| | - Jude Saji
- Public Health Research Institute, University of Montreal, Montreal, Canada
| | - Remy Takogue
- Endocrine and Diabetology Service, National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Eugène Sobngwi
- Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, The University of Yaoundé I, Yaoundé, Cameroon
- Endocrine and Diabetology Service, National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
| | - Jean Claude Mbanya
- Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, The University of Yaoundé I, Yaoundé, Cameroon
- Endocrine and Diabetology Service, National Obesity Centre, Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
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Wan EYF, Fung CSC, Choi EPH, Wong CKH, Chan AKC, Chan KHY, Lam CLK. Main predictors in health-related quality of life in Chinese patients with type 2 diabetes mellitus. Qual Life Res 2016; 25:2957-2965. [DOI: 10.1007/s11136-016-1324-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 11/24/2022]
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Shi M, Xu MY, Liu ZL, Duan XY, Zhu YB, Shi HM, Jiang B, Zhang XM, Yu XH. Effectiveness of family involvement in newly diagnosed type 2 diabetes patients: a follow-up study. PATIENT EDUCATION AND COUNSELING 2016; 99:776-782. [PMID: 26763869 DOI: 10.1016/j.pec.2015.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 12/22/2015] [Accepted: 12/26/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the effects of family-involvement on health education for T2DM from the aspects of knowledge, attitude and practice (KAP), health-related quality of life (HRQoL), body mass index (BMI) and glucose control. METHODS A follow-up study was performed and patients with newly diagnosed T2DM were divided into family-involved group (FIG, n=60) and single-involved group (SIG, n=60). Hierarchical linear models were used to assess within-group changes and between-group differences in the glycosylated hemoglobin A1c (HbA1c), KAP, SF-36 and BMI. RESULTS Significant improvements in FIG along with significant differences between-group were seen for HbA1c levels (9.73, 8.92, 5.55, 5.79, 5.30 vs. 10.05, 9.53, 6.36, 8.41, 6.58) in baseline, M3, M6, M12, M24 compared with SIG, respectively (all P≤0.001). Significant improvements in FIG along with significant differences between-group were seen for KAP (16.23, 46.98, 48.93 vs. 16.65, 29.07, 37.62), SF-36 (78.04, 92.68, 92.34 vs. 74.96, 77.03, 78.25), and BMI (24.74, 23.46, 22.96 vs. 24.00, 23.45, 23.50) in baseline, M12 and M24, respectively (all P≤0.05). CONCLUSION Family involvement is beneficial to the control of T2DM and should be suggested for T2DM newly diagnosed. PRACTICE IMPLICATIONS Health education should encourage the family to participate in the whole process to improve the efficacy of education.
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Affiliation(s)
- Mai Shi
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China; Department of Clinical Nutrition, China-Japan Friendship Hospital, Beijing 100029, China
| | - Mei-Yan Xu
- Department of Clinical Nutrition, The Central Hospital of China Aerospace Corporation, Beijing 100049, China
| | - Zhao-Lan Liu
- Centre for Evidence-based Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xue-Ying Duan
- Department of Clinical Nutrition, Yan-Hua Hospital, Beijing 100250, China
| | - Yan-Bo Zhu
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China.
| | - Hui-Mei Shi
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Bo Jiang
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xiao-Mei Zhang
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xiao-Han Yu
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
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Shi M, Liu ZL, Zhu YB, Xu MY, Duan XY, Shi HM, Jiang B, Zhang XM, Yu XH. Effect of Health Education Based on Integrative Therapy of Chinese and Western Medicine for Adult Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Study. Chin J Integr Med 2015; 24:94-102. [DOI: 10.1007/s11655-015-2113-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Indexed: 10/22/2022]
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Sepúlveda E, Poínhos R, Constante M, Pais-Ribeiro J, Freitas P, Carvalho D. Health-related quality of life in type 1 and type 2 diabetic patients in a Portuguese central public hospital. Diabetes Metab Syndr Obes 2015; 8:219-26. [PMID: 25995647 PMCID: PMC4425233 DOI: 10.2147/dmso.s80472] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a chronic metabolic disease, the prevalence of which has registered a considerable increase, mainly in adults and elderly. The purpose of this study was to assess the relationship between health-related quality of life in patients with diabetes and sex, body mass index, type of diabetes and treatment regimens (type 1 diabetes: intensive versus conventional treatment; type 2 diabetes: insulin use versus non-insulin use), and duration of diabetes. METHODS One hundred and twenty-four patients with diabetes were interviewed. Health-related quality of life was evaluated using the age-adjusted Short-Form 36 dimensions (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health), and related to demographic and clinical variables. Independent samples t-tests and One-Way Analysis of Variance were used to compare means of independent samples. The degree of association between pairs of variables was measured by Pearson's (r) or Spearman's (rs ) correlation coefficients. RESULTS The mean age of the study population was 55.7±16.4 years; 54.8% were male, and 77.4% had type 2 diabetes. Females reported worse quality of life than males in all dimensions of the Short-Form 36, except for role-physical and bodily pain. Obese patients had worse physical functioning than normal weight and overweight patients, and worse vitality than their normal weight counterparts. Type 2 diabetic patients taking insulin had lower physical functioning and vitality than those without insulin therapy. Longer duration of diabetes was associated with lower physical functioning, role-physical, general health, vitality, role-emotional, and mental health. CONCLUSION Being female, obese, having type 2 diabetes and taking insulin, and having a longer disease duration are characteristics associated with worse age-adjusted quality of life in patients with diabetes.
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Affiliation(s)
- Eduardo Sepúlveda
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
- Associação de Prevenção e Apoio à Diabetes, Porto, Portugal
| | - Rui Poínhos
- Associação de Prevenção e Apoio à Diabetes, Porto, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Miguel Constante
- Institute of Psychiatry, King’s College London, London, UK
- Department of Psychiatry, Hospital Beatriz Ângelo, Loures, Portugal
| | - José Pais-Ribeiro
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
- Associação de Prevenção e Apoio à Diabetes, Porto, Portugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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Sepúlveda E, Poínhos R, Constante M, Pais-Ribeiro J, Freitas P, Carvalho D. Relationship between chronic complications, hypertension, and health-related quality of life in Portuguese patients with type 2 diabetes. Diabetes Metab Syndr Obes 2015; 8:535-42. [PMID: 26586958 PMCID: PMC4634825 DOI: 10.2147/dmso.s88489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the relationship between health-related quality of life (HRQoL) and the presence or absence of hypertension and diabetes-related chronic complications in type 2 diabetes, and also the association between HRQoL and the number of chronic complications. METHODS One hundred patients with type 2 diabetes were interviewed. HRQoL was evaluated using the age-adjusted Short-Form 36 dimensions (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health). RESULTS The mean age of the study population was 62.7±8.7 years; 54.0% were male, and 51.0% were receiving only oral hypoglycemic agents. Chronic complications were related to worse HRQoL in different dimensions: peripheral neuropathy and cardiovascular disease (all, except bodily pain), retinopathy (physical functioning, general health, vitality, and mental health), peripheral arterial disease (physical functioning, role-physical, and general health), and nephropathy (general health and vitality). Hypertension was related to worse general health and vitality. An increased number of chronic complications was associated with worse HRQoL in all dimensions of Short-Form 36 except for the bodily pain dimension. CONCLUSION The presence and increased number of diabetes-related chronic complications, and the presence of hypertension were related to worse age-adjusted HRQoL. Peripheral neuropathy and cardiovascular disease were more strongly related to age-adjusted HRQoL.
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Affiliation(s)
- Eduardo Sepúlveda
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
- Associação de Prevenção e Apoio à Diabetes, Porto, Portugal
- Correspondence: Eduardo Sepúlveda, Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal, Rua Alfredo Allen, s/n, 4200-135 Porto, Portugal, Tel +351 916 714 084, Email
| | - Rui Poínhos
- Associação de Prevenção e Apoio à Diabetes, Porto, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Miguel Constante
- Institute of Psychiatry, King’s College London, London, UK
- Department of Psychiatry, Hospital Beatriz Ângelo, Loures, Portugal
| | - José Pais-Ribeiro
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
- Associação de Prevenção e Apoio à Diabetes, Porto, Portugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Jhita T, Petrou S, Gumber A, Szczepura A, Raymond NT, Bellary S. Ethnic differences in health related quality of life for patients with type 2 diabetes. Health Qual Life Outcomes 2014; 12:83. [PMID: 24902492 PMCID: PMC4060842 DOI: 10.1186/1477-7525-12-83] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 05/30/2014] [Indexed: 12/29/2022] Open
Abstract
Background The objective of this study was to investigate the association between ethnicity and health related quality of life (HRQoL) in patients with type 2 diabetes. Methods The EuroQol EQ-5D measure was administered to 1,978 patients with type 2 diabetes in the UK Asian Diabetes Study (UKADS): 1,486 of south Asian origin (Indian, Pakistani, Bangladeshi or other south Asian) and 492 of white European origin. Multivariate regression using ordinary least square (OLS), Tobit, fractional logit and Censored Least Absolutes Deviations estimators was used to estimate the impact of ethnicity on both visual analogue scale (VAS) and utility scores for the EuroQol EQ-5D. Results Mean EQ-5D VAS and utility scores were lower among south Asians with diabetes compared to the white European population; the unadjusted effect on the mean EQ-5D VAS score was −7.82 (Standard error [SE] = 1.06, p < 0.01) and on the EQ-5D utility score was −0.06 (SE = 0.02, p < 0.01) (OLS estimator). After controlling for socio-demographic and clinical confounders, the adjusted effect on the EQ-5D VAS score was −9.35 (SE = 2.46, p < 0.01) and on the EQ-5D utility score was 0.06 (SE = 0.04), although the latter was not statistically significant. Conclusions There was a large and statistically significant association between south Asian ethnicity and lower EQ-5D VAS scores. In contrast, there was no significant difference in EQ-5D utility scores between the south Asian and white European sub-groups. Further research is needed to explain the differences in effects on subjective EQ-5D VAS scores and population-weighted EQ-5D utility scores in this context.
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Affiliation(s)
- Tracey Jhita
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry CV4 7AL, UK.
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Jain V, Shivkumar S, Gupta O. Health-related quality of life (hr-qol) in patients with type 2 diabetes mellitus. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:96-101. [PMID: 24696831 PMCID: PMC3968572 DOI: 10.4103/1947-2714.127752] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Quality of life is an important aspect in diabetes because poor quality of life leads to diminished self-care, which in turn leads to worsened glycemic control, increased risks for complications, and exacerbation of diabetes overwhelming in both the short run and the long run. AIMS The aim of our study is to examine the health-related quality of life of diabetic patients in rural India. MATERIALS AND METHODS This case-control study was done among type 2 diabetes mellitus patients attending Medicine Outpatient department of a 780-bedded rural medical college located in central India. We used the World Health Organization Quality of Life Questionnaire - short version (WHOQOL-BREF) to assess quality of life. RESULTS The HRQOL among diabetics and non-diabetic controls is comparable to each other with bad physical health, bad psychological health, deteriorating social relationships, and bad environmental conditions affecting the HRQOL of both the groups equally. The overall HRQOL of the total study population (cases and controls) was poor. CONCLUSION The finding of this study will help in health promotion in rural medical practice in India. It would beckon the much awaited avenue of holistic care of a diabetic patient with equal importance to the mental wellbeing and quality of life, as compared to physical well being.
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Affiliation(s)
- Vishakha Jain
- Department of Medicine, Mahatma Gandhi Institute of medical sciences, Sevagram, Wardha, Maharashtra, India
| | - Saumya Shivkumar
- Department of Medicine, Mahatma Gandhi Institute of medical sciences, Sevagram, Wardha, Maharashtra, India
| | - Omprakash Gupta
- Department of Medicine, Mahatma Gandhi Institute of medical sciences, Sevagram, Wardha, Maharashtra, India
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Naranjo D, Hessler DM, Deol R, Chesla CA. Health and psychosocial outcomes in U.S. adult patients with diabetes from diverse ethnicities. Curr Diab Rep 2012; 12:729-38. [PMID: 22961116 DOI: 10.1007/s11892-012-0319-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Within the United States, diabetes is a serious public health concern and patients with diabetes are more likely to experience clinical depression, psychological distress, and depressive symptoms than those without. Negative psychosocial factors are associated with poorer diabetes management and glycemic control. Overall, both the rates of diabetes and related psychological distress are greater for persons of diverse ethnicities than for non-Latino whites, and have reached epidemic proportions in certain groups. The following article will provide an overview across ethnicities of the rates of diabetes, health outcomes, psychosocial outcomes, and unique cultural and linguistic challenges that contribute to disparities within US diabetes patients of diverse ethnicities. Using this information, our hope is that health care practitioners and researchers alike can better respond to the psychosocial needs of ethnically diverse patients.
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Affiliation(s)
- Diana Naranjo
- Department of Pediatrics, University of California San Francisco, 400 Parnassus Avenue, 4th Floor, UCSF, MailBox 0318, San Francisco, CA 94143-0318, USA.
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Chung SW, Park JS, Kim SH, Shin SH, Oh JH. Quality of life after arthroscopic rotator cuff repair: evaluation using SF-36 and an analysis of affecting clinical factors. Am J Sports Med 2012; 40:631-9. [PMID: 22190415 DOI: 10.1177/0363546511430309] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite its importance, few studies regarding health-related quality of life (HRQOL) after rotator cuff repair have been reported. PURPOSE To evaluate the outcomes of rotator cuff repair in terms of HRQOL using SF-36 and to analyze factors affecting postoperative HRQOL. STUDY DESIGN Case series; Level of evidence, 4. METHODS We included 309 patients who were followed-up for a mean 26.3 months (range, 12-48 months) after arthroscopic rotator cuff repair, between November 2004 and August 2008, and who underwent periodic measurement of HRQOL using SF-36 preoperatively, 1 year postoperatively, and at the final follow-up. The correlation between SF-36 and shoulder-specific functional outcome measures (American Shoulder and Elbow Surgeons [ASES], Simple Shoulder Test [SST], and Constant score) was evaluated using correlation analysis, and the relationship between various clinical factors, including rotator cuff healing and HRQOL, was assessed using univariate and multivariate analyses. RESULTS The SF-36 scores for physical HRQOL and mental HRQOL showed significant improvement, from 40.40 to 47.53 and from 44.45 to 50.55 at 12 months after surgery, respectively (all P < .001), and improvement was maintained with 48.24 and 50.45, respectively, at the final follow-up (all P < .001). Scores also showed improvement according to all clinical variables, even after stratification of each variable. The correlation between SF-36 and shoulder-specific functional outcome measures was fair to moderate (Pearson correlation coefficients, 0.199-0.528). Various factors had significant effects on preoperative physical and mental HRQOL; however, postoperatively (at 12 months and final follow-up, respectively), only older age (P = .008 and .013), female sex (P = .036 and .043), presence of diabetes (P = .026 and .027), and low level of sports activity (P = .049 at final follow-up) had a negative effect on postoperative physical HRQOL in multivariate analysis, and female sex (P = .010 and .001) was the only factor leading to worse postoperative mental HRQOL. CONCLUSION Arthroscopic rotator cuff repair significantly improved the patients' HRQOL both physically and mentally. Older age, female sex, diabetes, and low level of sports activity were related to low postoperative physical HRQOL, and female sex was also related to low postoperative mental HRQOL.
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Affiliation(s)
- Seok Won Chung
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Goomi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea
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Vieta A, Badia X, Sacristán JA. A systematic review of patient-reported and economic outcomes: value to stakeholders in the decision-making process in patients with type 2 diabetes mellitus. Clin Ther 2012; 33:1225-45. [PMID: 21856000 DOI: 10.1016/j.clinthera.2011.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2011] [Indexed: 12/26/2022]
Abstract
BACKGROUND The need for an approach to measuring health results that incorporates patients' and payers' perspectives has generated a wide range of health care outcomes (HCOs), but it is yet unknown whether these HCOs are appropriate or valid for the health care decision-making process. OBJECTIVE The goal of this study was to assess HCOs, patient-reported outcomes (PROs), and economic outcomes in terms of validity and appropriateness to health care decision making in type 2 diabetes mellitus (T2DM). METHODS This systematic review of studies published between January 1, 1996, and November 1, 2010, comprised an electronic literature search of MEDLINE and Centre for Reviews and Dissemination databases. Studies included were clinical trials, observational studies, economic analyses, and studies on the development and validation of HCOs in T2DM in the adult population. HCOs were assessed and classified according to their relevance for decision makers in terms of feasibility for routine use, validity, sensitivity, reliability, understanding, and scope. RESULTS Two independent reviewers screened 4497 citations. Of these, 281 potentially eligible full articles were retrieved, and 185 met the inclusion criteria. A total of 121 HCOs in T2DM were identified: 80 (66.1%) PROs and 41 (33.9%) economic outcomes. Only 44.6% of the outcomes assessed were appropriate and valid for health care decision making. Greater deficiencies in evidence were found for PROs (61.3%), followed by economic outcomes (43.9%). CONCLUSIONS A large number of HCOs are being used in the health care decision-making process, but a significant proportion of these new outcomes have not been properly validated. Despite the fact that appropriate measures will depend on the specific needs of the decision makers, researchers need to use HCOs for which evidence of quality and appropriateness is available.
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Affiliation(s)
- Ana Vieta
- IMS, Health Economics and Outcomes Research, Barcelona, Spain.
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Abstract
BACKGROUND With improved combination antiretroviral therapy-related survival, diabetes and hypertension increasingly contribute to morbidity and mortality among individuals with HIV. However, there is limited data on diabetes and blood pressure control in this population. We examined whether virologic control is associated with control of diabetes and hypertension. METHODS We examined HIV viral load, hemoglobin A1c (HbA1c), and blood pressure measurements from 70 diabetics and 291 hypertensives in the Johns Hopkins HIV Clinical Cohort, an urban, university-based cohort. All patients were treated for HIV and diabetes or hypertension. HbA1c and HIV-1 RNA were captured electronically from laboratory data, and blood pressure was collected electronically from vital signs taken at clinic visits. We used HIV-1 RNA values within 30 days of the HbA1c measurement or blood pressure measurement. The relationships between HIV-1 RNA and HbA1c and HIV-1 RNA and blood pressure were examined using separate random effects generalized least squares linear regression models. RESULTS The study sample was predominantly male and black, with a high prevalence of comorbid hepatitis C virus infection and psychiatric illness. In multivariable analysis, each log(10) increase in HIV-1 RNA was associated with higher HbA1c (β = 0.47 units, P < 0.001) among diabetics and higher mean arterial pressure among hypertensive patients (β = 1.95 mmHg, P < 0.001). CONCLUSIONS Suboptimal control of HIV, indicated by detectable viral load, correlates with suboptimal control of diabetes and hypertension, indicated by higher HbA1c and mean arterial pressure. Achieving control of multiple medical comorbidities and HIV simultaneously may require expansion of current adherence interventions focused primarily on antiretroviral therapy.
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Affiliation(s)
- Anne K Monroe
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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Hill-Briggs F, Lazo M, Peyrot M, Doswell A, Chang YT, Hill MN, Levine D, Wang NY, Brancati FL. Effect of problem-solving-based diabetes self-management training on diabetes control in a low income patient sample. J Gen Intern Med 2011; 26:972-8. [PMID: 21445680 PMCID: PMC3157525 DOI: 10.1007/s11606-011-1689-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 01/27/2011] [Accepted: 03/01/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lower socioeconomic status is associated with excess disease burden from diabetes. Diabetes self-management support interventions are needed that are effective in engaging lower income patients, addressing competing life priorities and barriers to self-care, and facilitating behavior change. OBJECTIVE To pilot test feasibility, acceptability, and effect on disease control of a problem-based diabetes self-management training adapted for low literacy and accessibility. DESIGN Two-arm randomized controlled trial powered to detect a 0.50% change in A1C at follow-up with a 2-sided alpha of 0.05 in a pooled analysis. PARTICIPANTS Fifty-six urban African-American patients with type 2 diabetes and suboptimal blood sugar, blood pressure, or cholesterol control recruited from a diabetes registry within a university-affiliated managed care organization. INTERVENTIONS A group, problem-based diabetes self-management training designed for delivery in an intensive and a condensed program format. Three intensive and three condensed program groups were conducted during the trial. MAIN MEASURES Clinical (A1C, systolic blood pressure [SBP], diastolic blood pressure [DBP], LDL and HDL cholesterol) and behavioral (knowledge, problem solving, self-management behavior) data were measured at baseline, post-intervention, and 3 months post-intervention (corresponding with 6-9 months following baseline). RESULTS Adoption of both programs was high (>85% attendance rates, 95% retention). At 3 months post-intervention, the between-group difference in A1C change was -0.72% (p = 0.02), in favor of the intensive program. A1C reduction was partially mediated by problem-solving skill at follow-up (ß = -0.13, p = 0.04). Intensive program patients demonstrated within-group improvements in knowledge (p < 0.001), problem-solving (p = 0.01), and self-management behaviors (p = 0.04). Among the subsets of patients with suboptimal blood pressure or lipids at baseline, the intensive program yielded clinically significant individual improvements in SBP, DBP, and LDL cholesterol. Patient satisfaction and usability ratings were high for both programs. CONCLUSIONS A literacy-adapted, intensive, problem-solving-based diabetes self-management training was effective for key clinical and behavioral outcomes in a lower income patient sample.
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Affiliation(s)
- Felicia Hill-Briggs
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Goldfinger JZ, Arniella G, Wylie-Rosett J, Horowitz CR. Project HEAL: peer education leads to weight loss in Harlem. J Health Care Poor Underserved 2011; 19:180-92. [PMID: 18263994 DOI: 10.1353/hpu.2008.0016] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Obesity and diabetes are epidemic in the predominantly minority Harlem community. To address them, a coalition of community and academic leaders tested the effectiveness of a peer-led weight loss course. METHODS The coalition developed Project HEAL: Healthy Eating, Active Lifestyles through extensive collaboration with community members and experts in nutrition, exercise, and peer education. We piloted the course in a local church and assessed its impact through pre and post course weights, self-reported behaviors and quality of life. RESULTS Twenty-six overweight and obese African American adults lost a mean of 4.4 pounds at 10 weeks, 8.4 pounds at 22 weeks, and 9.8 pounds at 1 year. Participants reported decreased fat consumption and sedentary hours, and improved health related quality of life. CONCLUSIONS A peer-led, community-based course can lead to weight loss and behavior change. The minority communities most affected by obesity and diabetes may benefit from this low-cost, culturally appropriate intervention.
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Affiliation(s)
- Judith Z Goldfinger
- Department of Health Policy and Medicine, Mt Sinai School of Medicine, New York, NY 10029, USA
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Gary-Webb TL, Baptiste-Roberts K, Pham L, Wesche-Thobaben J, Patricio J, Pi-Sunyer FX, Brown AF, Jones-Corneille L, Brancati FL. Neighborhood socioeconomic status, depression, and health status in the Look AHEAD (Action for Health in Diabetes) study. BMC Public Health 2011; 11:349. [PMID: 22182286 PMCID: PMC3111582 DOI: 10.1186/1471-2458-11-349] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 05/19/2011] [Indexed: 11/25/2022] Open
Abstract
Background Depression and diminished health status are common in adults with diabetes, but few studies have investigated associations with socio-economic environment. The objective of this manuscript was to evaluate the relationship between neighborhood-level SES and health status and depression. Methods Individual-level data on 1010 participants at baseline in Look AHEAD (Action for Health in Diabetes), a trial of long-term weight loss among adults with type 2 diabetes, were linked to neighborhood-level SES (% living below poverty) from the 2000 US Census (tracts). Dependent variables included depression (Beck Inventory), and health status (Medical Outcomes Study (SF-36) scale). Multi-level regression models were used to account simultaneously for individual-level age, sex, race, education, personal yearly income and neighborhood-level SES. Results Overall, the % living in poverty in the participants' neighborhoods varied, mean = 11% (range 0-67%). Compared to their counterparts in the lowest tertile of neighborhood poverty (least poverty), those in the highest tertile (most poverty) had significantly lower scores on the role-limitations(physical), role limitations(emotional), physical functioning, social functioning, mental health, and vitality sub-scales of the SF-36 scale. When evaluating SF-36 composite scores, those living in neighborhoods with more poverty had significantly lower scores on the physical health (β-coefficient [β] = -1.90 units, 95% CI: -3.40,-0.039), mental health (β = -2.92 units, -4.31,-1.53) and global health (β = -2.77 units, -4.21,-1.33) composite scores. Conclusion In this selected group of weight loss trial participants, lower neighborhood SES was significantly associated with poorer health status. Whether these associations might influence response to the Look AHEAD weight loss intervention requires further investigation.
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Affiliation(s)
- Tiffany L Gary-Webb
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA.
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In the Shadow of Academic Medical Centers: A Systematic Review of Urban Health Research in Baltimore City. J Community Health 2010; 35:433-52. [PMID: 20422444 DOI: 10.1007/s10900-010-9258-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Thomas SB, Sansing VV, Davis A, Magee M, Massaro E, Srinivas VS, Helmy T, Desvigne-Nickens P, Brooks MM. Racial differences in the association between self-rated health status and objective clinical measures among participants in the BARI 2D trial. Am J Public Health 2010; 100 Suppl 1:S269-76. [PMID: 20147671 DOI: 10.2105/ajph.2009.176180] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We explored whether and how race shapes perceived health status in patients with type 2 diabetes mellitus and coronary artery disease. METHODS We analyzed self-rated health (fair or poor versus good, very good, or excellent) and associated clinical risk factors among 866 White and 333 Black participants in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial. RESULTS Michigan Neuropathy Screening Instrument scores, regular exercise, and employment were associated with higher self-rated health (P < .05). Blacks were more likely than were Whites to rate their health as fair or poor (adjusted odds ratio [OR] = 1.88; 95% confidence interval [CI] = 1.38, 2.57; P < .001). Among Whites but not Blacks, a clinical history of myocardial infarction (OR = 1.61; 95% CI = 1.12, 2.31; P < .001) and insulin use (OR = 1.62; 95% CI = 1.10, 2.38; P = .01) was associated with a fair or poor rating. A post-high school education was related to poorer self-rated health among Blacks (OR = 1.86; 95% CI = 1.07, 3.24; P < .001). CONCLUSIONS Symptomatic clinical factors played a proportionally larger role in self-assessment of health among Whites with diabetes and coronary artery disease than among Blacks with the same conditions.
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Affiliation(s)
- Stephen B Thomas
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
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Kogan SM, Brody GH, Chen YF. Depressive symptomatology mediates the effect of socioeconomic disadvantage on HbA(1c) among rural African Americans with type 2 diabetes. J Psychosom Res 2009; 67:289-96. [PMID: 19773021 DOI: 10.1016/j.jpsychores.2009.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 11/12/2008] [Accepted: 01/29/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Rural African Americans with diabetes mellitus type 2 (T2D) represent a disadvantaged and understudied group who experience difficulties with maintaining glycemic control. Although mounting evidence has linked socioeconomic disadvantage to chronic disease morbidity, few studies have examined the mediating mechanisms that account for this effect. We hypothesized that rural African Americans' financial distress, community disadvantage, and educational attainment would predict glycemic control, indirectly, via effects on depressive symptoms. METHODS Predictions were tested using data from 192 rural African American adults with T2D and data from community support persons the participants nominated. Participants completed an in-home interview and provided a blood sample at a local laboratory. Levels of glycosylated hemoglobin (HbA(1c)) constituted the criterion variable. RESULTS Structural equation modeling analyses confirmed our hypotheses: financial distress, community disadvantage, and educational attainment demonstrated significant indirect effects on HbA(1c) via their influence on depressive symptoms. CONCLUSIONS The findings underscore the importance of targeting mental health in interventions to support glycemic control as well as tailoring interventions for individuals in difficult socioeconomic circumstances.
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Aguiar CCT, Vieira APGF, Carvalho AF, Montenegro-Junior RM. [Assessment instruments for a Health-Related Quality of Life in diabetes mellitus]. ACTA ACUST UNITED AC 2009; 52:931-9. [PMID: 18820804 DOI: 10.1590/s0004-27302008000600004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Accepted: 05/18/2008] [Indexed: 12/14/2022]
Abstract
The assessment of Health-Related Quality of Life (HRQoL) has been increasingly used to measure the overall impact of diseases in people's life. Diabetes mellitus (DM) is a chronic disease associated with high morbidity, mortality, and HRQoL impairment in patients. In longitudinal studies, the psychosocial impact of DM predicts mortality. The objective of this review is to describe and to analyze the main instruments used for the HRQoL evaluation in patients with DM. Generic instruments such, as the Quality of Well-Being Scale (QWB), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), EuroQol (EQ-5D) and specific instruments as the Diabetes Care Profile (DCP), Diabetes Quality of Life Measure (DQOL), Diabetes Impact Measurement Scales (DIMS), Appraisal of Diabetes Scale (ADS), Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Health Profile (DHP-1 and DHP-18), Questionnaire on Stress in Patients with Diabetes-Revised (QSD-R), Well-Being Enquiry goes Diabetics (WED), Diabetes-Specific Quality-of-life Scale (DSQOLS), Diabetes 39 (D-39) Problems Areas in Diabetes (PAID) were analyzed. PAID is the only translated and validated instrument available in Brazil. The generic and specific instruments have their stregths and shortcomings for evaluation of HRQL in patients with DM. The combined use of both generic (such as the SF-36) and specific (such as the PAID) appears to be a consistent way to evaluate HRQoL as a construct in Brazilian patients with DM. The present article reviews a variety of instruments and emphasizes the urgent need for validation studies of such instruments to be used in Brazilian subjects with DM.
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Affiliation(s)
- Carlos Clayton Torres Aguiar
- Programa de Pós-graduação em Saúde Coletiva da Universidade de Fortaleza Serviço de Endocrinologia e Diabetes do Hospital Universitário Walter Cantídio da Faculdade de Medicina da Universidade Federal do Ceará, CE, Brasil
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Misra R, Lager J. Ethnic and gender differences in psychosocial factors, glycemic control, and quality of life among adult type 2 diabetic patients. J Diabetes Complications 2009; 23:54-64. [PMID: 18413181 DOI: 10.1016/j.jdiacomp.2007.11.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 07/18/2007] [Accepted: 11/09/2007] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To examine ethnic and gender differences in psychosocial factors, e.g., social support and acceptance of the disease, knowledge levels, perceived difficulty in adherence behaviors, and diabetes outcome (glycemic control and quality of life) in Type 2 diabetic patients. METHODS Data were collected via telephone interviews from 180 diabetic subjects (34% Hispanics, 27% Non-Hispanic whites, 18% African-Americans, and 20% Asian-Indians; 52% females) from 2 clinics. Hemoglobin A1c levels were obtained from patient charts. RESULTS Significant ethnic and gender differences existed in acceptance of the disease, in receiving social support, disease knowledge, perceived difficulty in self-management behaviors, glycemic control, and quality of life among Type 2 diabetic patients; differences were more pronounced by gender than by ethnicity. In general, social support and acceptance of the disease were high. However, perceived difficulty in self-management behaviors varied by racial/ethnic groups with self-monitoring of blood glucose perceived as most difficult by Hispanic respondents, dietary management was most difficult for non-Hispanic whites, while physical activity was the most difficult for African-Americans. Hispanic respondents had greatest severity of the disease (poorest metabolic control). CONCLUSIONS Ethnic and gender variations exist in social support, acceptance of diabetes, quality of life, and adherence behaviors. The outcomes of diabetes care can be improved if practitioners factor these differences in tailoring diabetes education and supportive care for individuals with Type 2 diabetes.
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Affiliation(s)
- Ranjita Misra
- Health and Kinesiology Department, 4243 TAMU, 158V Read Building, Texas A&M University, College Station, TX 77843-4243, USA.
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Abstract
BACKGROUND AND OBJECTIVES Health-related quality of life (HRQOL) is an important health outcome, representing one of the most important goals of all health interventions. The objectives of this study were to determine HRQOL and the factors affecting it in type 2 diabetic patients. PATIENTS AND METHODS This cross-sectional study was conducted in five primary health care (PHC) centers in the Al-Khobar area. From a random sample of 225 type 2 diabetic patients, 216 patients were included in the study along with 216 age- , sex- and nationality-matched controls. Nine patients refused to participate. Type 2 diabetic patients and controls were interviewed with the translated Arabic SF-12 questionnaire. RESULTS The mean ages were 50.0A+/-10.0 years for cases and of 49.3+/-10.3 years for controls (P=.526). Type 2 diabetic patients had lower socioeconomic status and educational level than controls. Obesity was significantly higher in diabetics than controls. HRQOL in type 2 diabetic patients was significantly lower than controls. The mean physical component score was 41.3+/-8.9 for cases vs. 47.5+/-9.5 for controls (P<.001), and the mean mental component score 47.8+/-9.1 in cases vs. 51.5+/-9.4 in controls (P<.001). HRQOL was significantly lower in females than males (P<.001). HRQOL was impaired in uncontrolled patients (fasting plasma glucose [FPG]>130 mg/dL) in comparison with controlled patients (FPG</=130 mg/dL) (P<.05). CONCLUSIONS HRQOL was lower in type 2 diabetic patients than controls and was affected by many factors. Females had lower HRQOL than males, possibly because of a higher incidence of obesity. Uncontrolled diabetic patients had a lower HRQOL than controlled diabetics. Improving HRQOL in diabetic patients is important.
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Affiliation(s)
- Amer H Al-Shehri
- Ministry of Health, King Faisal University, Dammam, Saudi Arabia.
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Magwood GS, Zapka J, Jenkins C. A review of systematic reviews evaluating diabetes interventions: focus on quality of life and disparities. DIABETES EDUCATOR 2008; 34:242-65. [PMID: 18375775 DOI: 10.1177/0145721708316551] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This article reviews the literature on definitions and issues related to measurement of quality of life in people with diabetes and summarizes reviews of evidence of intervention studies, with a particular focus on interventions targeted for underserved and minority populations. METHODS An integrative literature review of reviews was conducted on adult diabetes interventions and outcomes. Five electronic databases were searched. Eligible publications were those published between 1999 and 2006 that described outcome measures. Twelve review articles are included. RESULTS Review studies were heterogeneous in terms of intervention type, content, participants, setting, and outcome measures. Interventions used variable operational definitions and frequently lacked adequate description; therefore, comparisons of findings proved difficult. A clinical outcome, A1C, was the most frequently assessed, with little inclusion of quality-of-life measures. Several reviews and independent studies did not explicitly consider interventions aimed at the underserved. When quality of life was considered, measures and operational definition of domains were limited. CONCLUSIONS Understanding the relationship between interventions and resulting outcomes, particularly quality of life, will require attention to operational definitions and better conceptual models. There is an evidence base emerging about important characteristics of effective intervention programs. This evidence base can guide public health and clinical program planners to better understand and make prudent decisions about assessment, planning, implementation, and evaluation of interventions for people with complex chronic illnesses such as diabetes.
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Affiliation(s)
- Gayenell S Magwood
- The College of Nursing, Medical University of South Carolina, Charleston (GSM, JZ, CJ)
| | - Jane Zapka
- The College of Nursing, Medical University of South Carolina, Charleston (GSM, JZ, CJ),The Department of Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston (JZ)
| | - Carolyn Jenkins
- The College of Nursing, Medical University of South Carolina, Charleston (GSM, JZ, CJ)
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Fjeldstad C, Fjeldstad AS, Acree LS, Nickel KJ, Gardner AW. The influence of obesity on falls and quality of life. DYNAMIC MEDICINE : DM 2008; 7:4. [PMID: 18304350 PMCID: PMC2288598 DOI: 10.1186/1476-5918-7-4] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Accepted: 02/27/2008] [Indexed: 11/12/2022]
Abstract
Objective To determine (1) whether obese older adults had higher prevalence of falls and ambulatory stumbling, impaired balance and lower health-related quality of life (HRQL) than their normal weight counterparts, and (2) whether the falls and balance measures were associated with HRQL in obese adults. Methods Subjects who had a body mass index (BMI) greater than 30 kg/m2 were classified into an obese group (n = 128) while those with BMI between 18.5 and 24.9 kg/m2 were included into a normal weight group (n = 88). Functional tests were performed to assess balance, and questionnaires were administered to assess history of falls, ambulatory stumbling, and HRQL. Results The obese group reported a higher prevalence of falls (27% vs. 15%), and ambulatory stumbling (32% vs. 14%) than the normal weight group. Furthermore, the obese group had lower HRQL, (p ≤ 0.05) for physical function (63 ± 27 vs. 75 ± 26; mean ± SD), role-physical (59 ± 40 vs. 74 ± 37), vitality (58 ± 23 vs. 66 ± 20), bodily pain (62 ± 25 vs. 74 ± 21) and general health (64 ± 19 vs. 70 ± 18). In the obese group, a history of falls was related (p ≤ 0.05) to lower scores in 4 domains of HRQL, and ambulatory stumbling was related (p ≤ 0.01) to 7 domains. Conclusion In middle-aged and older adults, obesity was associated with a higher prevalence of falls and stumbling during ambulation, as well as lower values in multiple domains of HRQL. Furthermore, a history of falls and ambulatory stumbling were related to lower measures of HRQL in obese adults.
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Affiliation(s)
- Cecilie Fjeldstad
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA.
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Graham JE, Stoebner-May DG, Ostir GV, Al Snih S, Peek MK, Markides K, Ottenbacher KJ. Health related quality of life in older Mexican Americans with diabetes: a cross-sectional study. Health Qual Life Outcomes 2007; 5:39. [PMID: 17626634 PMCID: PMC1947953 DOI: 10.1186/1477-7525-5-39] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Accepted: 07/12/2007] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The older Hispanic population of the U.S. is growing at a tremendous rate. While ethnic-related risk and complications of diabetes are widely-acknowledged for older Hispanics, less is known about how health related quality of life is affected in this population. METHODS Cross-sectional study assessing differences in health related quality of life between older Mexican Americans with and without diabetes. Participants (n = 619) from the Hispanic Established Population for the Epidemiological Study of the Elderly were interviewed in their homes. The primary measure was the Medical Outcomes Study Short Form (SF-36). RESULTS The sample was 59.6% female with a mean age of 78.3 (SD = 5.2) years. 31.2% (n = 193) of the participants were identified with diabetes. Individuals with diabetes had significantly (F = 19.35, p < .001) lower scores on the Physical Composite scale (mean = 37.50, SD = 12.69) of the SF-36 compared to persons without diabetes (mean = 43.04, SD = 12.22). There was no significant difference between persons with and without diabetes on the Mental Composite scale of the SF-36. CONCLUSION Diabetes was associated with lower health related quality of life in older Mexican Americans. The physical components of health related quality of life uniformly differentiated those with diabetes from those without, whereas mental component scores were equivocal.
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Affiliation(s)
- James E Graham
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, USA
| | | | - Glenn V Ostir
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, USA
- Department of Internal Medicine, Division of Geriatrics, University of Texas Medical Branch, Galveston, USA
| | - Soham Al Snih
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, USA
| | - M Kristen Peek
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, USA
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, USA
| | - Kyriakos Markides
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, USA
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, USA
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, USA
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Krousel-Wood M, Radosevich DM, Erikson C, Blonde L, Sanderson-Austin J. Quality of care indicators, health behaviors, and physical functioning in adults with diabetes. Ochsner J 2007; 7:158-166. [PMID: 21603538 PMCID: PMC3096410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
PURPOSE Physical functioning is an important and often neglected outcome in patients with diabetes. Identification of quality of care indicators and health behaviors associated with higher physical functioning may lead to improved care and outcomes for adult diabetic patients. METHODS We studied 3,521 adult persons with diabetes mellitus from 13 geographically dispersed, multi-specialty group practices in a cross-sectional survey. The outcome variable was the 10-item physical functioning scale. Independent variables included demographics, health behaviors, diabetes management, use of services, health status, risk for depression, comorbidities, and testing for albuminuria, glycosylated hemoglobin, and low-density lipoprotein. From these data, 10 quality-of-care indicators were constructed. We evaluated relationships between physical functioning and the quality of care indicators. RESULTS Participants had a mean age of 64.2 +/- 12.6 years, and 52% were female, 67% married, 78% had a high school education or higher, and 73% were white. Multivariate analyses revealed several factors independently associated with higher physical functioning score on the 10-item scale (each p < 0.05, R(2) = 0.54): recent test for albuminuria or low-density lipoprotein lipids; no hospitalization or emergency admission in the prior year; being married; younger age; male gender; African American or Asian race; higher formal education; regular physical exercise; fewer comorbidities; better perceived health; not at risk for depression; not more limited in activities and health not worse compared to a year ago; nonsmoker; not being obese; and not taking insulin. CONCLUSIONS We identified quality of care and health behaviors associated with higher physical functioning in adult patients with diabetes mellitus. Interventions to enhance the modifiable risk factors may lead to improved physical functioning and delay the onset of disability in these patients.
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Affiliation(s)
- Marie Krousel-Wood
- Director, Center for Health Research, Ochsner Clinic Foundation, and Clinical Professor, Tulane Health Sciences Center, New Orleans, LA
| | - David M. Radosevich
- Assistant Professor, Deputy Director, Clinical Outcomes Research Center, School of Public Health and Director, Transplant Information Services, Department of Surgery, University of Minnesota, Minneapolis, MN
| | | | - Lawrence Blonde
- Director, Ochsner Diabetes Clinical Research Unit, Ochsner Clinic Foundation, New Orleans, LA
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Samuel-Hodge CD, Keyserling TC, France R, Ingram AF, Johnston LF, Pullen Davis L, Davis G, Cole AS. A church-based diabetes self-management education program for African Americans with type 2 diabetes. Prev Chronic Dis 2006; 3:A93. [PMID: 16776894 PMCID: PMC1637801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Diabetes self-management education interventions in community gathering places have been moderately effective, but very few studies of intervention effectiveness have been conducted among African Americans with type 2 diabetes. This paper describes a church-based diabetes self-management education intervention for African Americans, a randomized controlled trial to evaluate the intervention, and baseline characteristics of study participants. METHODS A New DAWN: Diabetes Awareness & Wellness Network was conducted among 24 churches of varying size in North Carolina. Each church recruited congregants with type 2 diabetes and designated a diabetes advisor, or peer counselor, to be part of the intervention team. Participants were enrolled at each church and randomized as a unit to either the special intervention or the minimal intervention. The special intervention included one individual counseling visit, twelve group sessions, three postcard messages from the participant's diabetes care provider, and twelve monthly telephone calls from a diabetes advisor. Baseline data included measures of weight, hemoglobin A1c, blood pressure, physical activity, dietary and diabetes self-care practices, and psychosocial factors. The study to evaluate the intervention (from enrollment visit to last follow-up) began in February 2001 and ended in August 2003. RESULTS Twenty-four churches (with 201 total participants) were randomized. Sixty-four percent of the participants were women. On average, the participants were aged 59 years and sedentary. They had an average of 12 years of education, had been diagnosed with diabetes for 9 years, had a body mass index of 35, had a hemoglobin A1c level of 7.8%, and had a reported dietary intake of 39% of calories from fat. CONCLUSION A New DAWN is a culturally sensitive, church-based diabetes self-management education program for African Americans with type 2 diabetes that is being evaluated for effectiveness in a randomized controlled trial. The outcomes of A New DAWN will contribute to the literature on community-based interventions for minority populations and help to inform the selection of approaches to improve diabetes care in this population.
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Affiliation(s)
- Carmen D Samuel-Hodge
- University of North Carolina at Chapel Hill, Department of Nutrition, Schools of Medicine and Public Health, CB #7426, 1700 Airport Rd, Room 246, Chapel Hill, NC 27599-8140, USA.
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Wee HL, Li SC, Cheung YB, Fong KY, Thumboo J. The influence of ethnicity on health-related quality of life in diabetes mellitus: a population-based, multiethnic study. J Diabetes Complications 2006; 20:170-8. [PMID: 16632237 DOI: 10.1016/j.jdiacomp.2005.06.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Revised: 06/07/2005] [Accepted: 06/22/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aims of this study were to evaluate the influence of ethnicity on health-related quality of life (HRQoL) in diabetic participants using both profile [the Short-Form 36 (SF-36)] and single-index (the SF-6D) instruments and to evaluate the usefulness of the SF-6D as a summary measure for the SF-36. RESEARCH DESIGN AND METHODS Using data from a cross-sectional, population-based survey of Chinese, Malay, and Indians in Singapore, we analyzed the influence of ethnicity and other variables on each SF-36 scale and SF-6D scores using linear regression models to adjust for the influence of known determinants of HRQoL. RESULTS Data from 309 diabetic respondents were analyzed. Compared with other ethnicities, Indians were most likely to report impaired HRQoL. The unadjusted influence of ethnicity on HRQoL exceeded the minimum clinically important difference (MCID) for all SF-36 scales (MCID: 5 points) and the SF-6D (MCID: 0.033 points). After adjusting for gender, age, and education, the influence of Chinese ethnicity exceeded the MCID for all SF-36 scales, except vitality (VT) and mental health (MH), as well as for the SF-6D. The influence of Malay ethnicity exceeded the MCID only for the SF-36 MH scale and the SF-6D. The influence of ethnicity on HRQoL persisted after adjusting further for other determinants of HRQoL. The SF-6D reflected the ethnic trends for some but not all SF-36 scales. CONCLUSIONS After adjusting for demographic, socioeconomic, and other factors known to influence HRQoL, ethnicity remained an important factor influencing HRQoL in this population-based multiethnic sample of diabetic Asians. Further studies to identify modifiable factors explaining the ethnic disparities in HRQoL among diabetic participants are needed. The SF-6D may be a useful summary measure for the SF-36.
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Affiliation(s)
- Hwee-Lin Wee
- Department of Pharmacy, National University of Singapore, and Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Republic of Singapore
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Hill-Briggs F, Gary TL, Yeh HC, Batts-Turner M, Powe NR, Saudek CD, Brancati FL. Association of social problem solving with glycemic control in a sample of urban African Americans with type 2 diabetes. J Behav Med 2006; 29:69-78. [PMID: 16397820 DOI: 10.1007/s10865-005-9037-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2005] [Indexed: 10/25/2022]
Abstract
The Social Problem-Solving Inventory--Revised, Short Form, was administered to 65 urban African Americans with type 2 diabetes to examine association of generic problem-solving styles and orientation with hemoglobin A1C (A1C). Eighty-five percent of participants had total social problem-solving scores in the Average range or higher. In linear regression models adjusted for education, each interquartile increase in impulsive/careless score was associated with a 0.82 increase in A1C (%) (p = 0.01), and each interquartile increase in avoidant score was associated with a 1.62 increase in A1C (%) (p = 0.004). After adjusting for depressive symptoms, the association of impulsive/careless style with A1C was attenuated, while the association of avoidant problem solving with A1C remained significant (p = 0.01). Associations of rational problem-solving style, positive orientation, and negative orientation with A1C and health behaviors were not statistically significant. Ineffective problem-solving styles may prove to be important targets for intervention to improve glycemic control.
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Affiliation(s)
- Felicia Hill-Briggs
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
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Hill-Briggs F, Gary TL, Bone LR, Hill MN, Levine DM, Brancati FL. Medication adherence and diabetes control in urban African Americans with type 2 diabetes. Health Psychol 2005; 24:349-57. [PMID: 16045370 DOI: 10.1037/0278-6133.24.4.349] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In 181 urban African Americans with Type 2 diabetes, medication adherence was assessed using a measure designed specifically for an urban, impoverished sociodemographic population. Hemoglobin A-sub(1c), blood pressure and cholesterol levels, medication-related beliefs, and depression were assessed. Seventy-four percent of the sample reported adherence to diabetes medication. Adherence, adjusted for age, was associated with lower hemoglobin A-sub(1c). The specific behaviors associated with poorer diabetes control were forgetting to take medications and running out of medications. Knowledge of blood glucose goals differed for adherers and nonadherers. Blood pressure and cholesterol medication adherence rates were not associated with actual levels of blood pressure or lipids, respectively. These data suggest that specific medication-taking behaviors are important to diabetes control and constitute logical targets for interventions. ((c) 2005 APA, all rights reserved).
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Affiliation(s)
- Felicia Hill-Briggs
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA.
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Gary TL, Brancati FL. Commentary: Socioeconomic position and the risk of type 2 diabetes. Int J Epidemiol 2005; 34:1282-3. [PMID: 16303813 DOI: 10.1093/ije/dyi264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tiffany L Gary
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Goodridge D, Trepman E, Embil JM. Health-Related Quality of Life in Diabetic Patients With Foot Ulcers. J Wound Ostomy Continence Nurs 2005; 32:368-77. [PMID: 16301902 DOI: 10.1097/00152192-200511000-00007] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Foot ulcers are a common, serious, and costly complication of diabetes, preceding 84% of lower extremity amputations in diabetic patients and increasing the risk of death by 2.4-fold over diabetic patients without ulcers. Health-related quality of life (HRQOL) is worse among individuals with diabetes than individuals without diabetes, and complications of diabetes, including foot ulcers, have a major negative effect on HRQOL. Diabetic foot ulcers are associated with reduced mobility and deficits related to activities of daily living that adversely affect HRQOL. Qualitative studies have confirmed clinical observations that diabetic foot ulcers have a huge negative psychological and social effect, including reduction in social activities, increased family tensions for patients and their caregivers (spouses or partners), limited employment, and financial hardship. Quantitative studies confirm the findings of qualitative studies that diabetic foot ulcers exert a negative effect on physical functioning, psychological status, and social situation. Recent advances include the development and validation of disease-specific HRQOL surveys for diabetic patients with foot ulcers. Disease-specific surveys may improve the evaluation of HRQOL as a function of ulcer healing, the effect of different treatment methods on HRQOL, and the relationship between treatment-specific HRQOL, patient compliance, and treatment efficacy.
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Affiliation(s)
- Donna Goodridge
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Gary TL, Hill-Briggs F, Batts-Turner M, Brancati FL. Translational research principles of an effectiveness trial for diabetes care in an urban African American population. THE DIABETES EDUCATOR 2005; 31:880-9. [PMID: 16288095 DOI: 10.1177/0145721705282254] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Large-scale effectiveness trials designed to translate evidence-based diabetes care to community settings are few. Studies describing these methods among high-risk minority populations are particularly limited. METHODS The authors describe Project Sugar, a randomized controlled trial conducted in 2 phases: Project Sugar 1 (1994-1999), which piloted a 4-arm clinic and home-based intervention using nurse case management and community health workers in 186 urban African Americans with type 2 diabetes, and Project Sugar 2 (2000-2005), which examined effectiveness of this intervention among 542 diabetic, urban African Americans. Results and Conclusions Project Sugar had success with regard to recruitment and retention, both in phase 1 (80% rate at 24 months) and phase 2 (>90% at 24 months). Using the RE-AIM framework, planning and research design for Project Sugar 2 is described in detail for elements that contributed to the reach, effectiveness, adoption, implementation, and maintenance of this study within a minority community setting. In addition to successful strategies, challenges to conducting effectiveness trials in an inner-city African American community are identified.
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Affiliation(s)
- Tiffany L Gary
- The Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Gary, Dr Brancati)
| | - Felicia Hill-Briggs
- The Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland (Dr Hill-Briggs, Ms Batts-Turner, Dr Brancati)
| | - Marian Batts-Turner
- The Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland (Dr Hill-Briggs, Ms Batts-Turner, Dr Brancati)
| | - Frederick L Brancati
- The Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Gary, Dr Brancati)
- The Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland (Dr Hill-Briggs, Ms Batts-Turner, Dr Brancati)
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Kirk JK, Bell RA, Bertoni AG, Arcury TA, Quandt SA, Goff DC, Narayan KMV. Ethnic disparities: control of glycemia, blood pressure, and LDL cholesterol among US adults with type 2 diabetes. Ann Pharmacother 2005; 39:1489-501. [PMID: 16076917 DOI: 10.1345/aph.1e685] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To examine ethnic disparities in the quality of diabetes care among adults with diabetes in the US through a systematic qualitative review. DATA SOURCES Material published in the English language was searched from 1993 through June 2003 using PubMed, Web of Science, Cumulative Index to Nursing and Allied Health, the Cochrane Library, Combined Health Information Database, and Education Resources Information Center. STUDY SELECTION AND DATA EXTRACTION Studies of patients with diabetes in which at least 50% of study participants were ethnic minorities and studies that made ethnic group comparisons were eligible. Research on individuals having prediabetes, those <18 years of age, or women with gestational diabetes were excluded. Reviewers used a reproducible search strategy. A standardized abstraction and grading of articles for publication source and content were used. Data on glycemia, blood pressure, and low-density lipoprotein cholesterol (LDL-C) were extracted in patients with diabetes. A total of 390 studies were reviewed, with 78 meeting inclusion criteria. DATA SYNTHESIS Ethnic minorities had poorer outcomes of care than non-Hispanic whites. These disparities were most pronounced for glycemic control and least evident for LDL-C control. Most studies showed blood pressure to be poorly controlled among ethnic minorities. CONCLUSIONS Control of risk factors for diabetes (glycemia, blood pressure, LDL-C) is challenging and requires routine assessment. These findings indicate that additional efforts are needed to promote diabetes quality of care among minority populations.
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Affiliation(s)
- Julienne K Kirk
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1084, USA.
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Baumeister H, Balke K, Härter M. Psychiatric and somatic comorbidities are negatively associated with quality of life in physically ill patients. J Clin Epidemiol 2005; 58:1090-100. [PMID: 16223651 DOI: 10.1016/j.jclinepi.2005.03.011] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Revised: 03/01/2005] [Accepted: 03/07/2005] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The relationship between somatic and psychiatric comorbidity in patients with somatic diseases and diverse outcome variables like mortality, costs, and duration of treatment is often examined and confirmed. In the last years, quality of life (QoL) as another important outcome variable received more attention. METHODS The present review comprises a summary of associations between comorbidity and QoL in patients with somatic diseases. For this reason a search for somatic diseases was performed, including metabolic, respiratory tract, musculoskeletal, cardiovascular, cancer, digestive system, and general somatic diseases. Four hundred eighty-one studies were found, of which 45 fulfilled the inclusion criteria. RESULTS Overall, there are mostly significant negative correlations between comorbidity and QoL. Predominantly, this applies to somatic-psychiatric comorbidity, which accounts for 70.3% (psychosocial aspects of QoL) to 100% (QoL in general) significantly lowered QoL results. Somatic-somatic comorbidities are primarily associated with somatic aspects of QoL (56.5-80.7% significant results), while psychosocial aspects as well as QoL in general are significantly associated in 8.3% to 71.7% of all calculations. CONCLUSION It is of high relevance for life quality research and clinical practice to pay attention to comorbidity. Methodological shortcomings should be taken into account in future research.
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Affiliation(s)
- Harald Baumeister
- Department of Psychiatry and Psychotherapy, Freiburg University Medical Center, Section of Clinical Epidemiology and Health Services Research, Germany.
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Abstract
Diabetes has significant effects on quality of life; however, the interrelationships are complex among the physiologic and psychosocial effects of diabetes, the effects of treatment regimens, and the social and cultural contexts in which we live. These important relationships and effects are being defined, but much additional work is needed to reliably and accurately measure health-related quality of life among subpopulations, and to measure and optimize the effects of increasingly complex and intensive treatments.
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Affiliation(s)
- Susan L Norris
- Center for Outcomes and Effectiveness, Agency for Health Care Research and Quality, 540 Gaither Road, Room 6325, Rockville, MD 20850, USA.
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Hill-Briggs F, Gary TL, Baptiste-Roberts K, Brancati FL. Thirty-six-item short-form outcomes following a randomized controlled trial in type 2 diabetes. Diabetes Care 2005; 28:443-4. [PMID: 15677813 DOI: 10.2337/diacare.28.2.443] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Felicia Hill-Briggs
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, 2024 E. Monument St., Suite 2-600, Baltimore, MD 21205, USA.
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Abstract
OBJECTIVE Residents of East Harlem, an impoverished, non-white community in New York city (NYC), have up to 5 times the mortality and complication rates of diabetes compared with NYC residents overall. To determine potentially remediable problems underlying this condition, a community-based collaboration of health providers, community advocates, and researchers, surveyed East Harlem residents with diabetes to assess their knowledge, behaviors, barriers to care, and actions taken in response to barriers. DESIGN Telephone interviews. SETTING The 3 hospitals and 2 community clinics serving East Harlem. PARTICIPANTS Nine hundred thirty-nine of the 1,423 persons (66%) with diabetes identified from these 5 healthcare sites with 2 or more ambulatory visits for diabetes during 1998 who lived in East Harlem. RESULTS While most respondents (90%) said they know how to take their medicines, between 19% and 39% do not understand other aspects of their diabetes management. Many limit their diabetes care due to concerns about money (16% to 40%), and other barriers, such as language and transportation (19% to 22%). In multivariate analyses, Latinos (relative risk [RR] = 0.77; 95% confidence interval [95% CI] 0.63 to 0.91) and those who do not keep a diabetic diet due to concerns about money (RR = 0.85; 95% CI 0.70 to 0.99) had poorer health status. CONCLUSIONS A community-based coalition was able to come together, identify areas of concern in diabetes care and assess the needs of adults with diabetes residing and obtaining care in East Harlem. The coalition found that even among those with access to care there remain significant financial barriers to good diabetes care, and a need to address and optimize how individuals with diabetes manage their disease.
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Affiliation(s)
- Carol R Horowitz
- Department of Health Policy, Mount Sinai Medical School of Medicine, One Gustave L. Levy Place, Box 1077, New York, NY 10029, USA.
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Bann CM, Fehnel SE, Gagnon DD. Development and validation of the Diabetic Foot Ulcer Scale-short form (DFS-SF). PHARMACOECONOMICS 2003; 21:1277-1290. [PMID: 14986739 DOI: 10.2165/00019053-200321170-00004] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND The Diabetic Foot Ulcer Scale (DFS) provides comprehensive measurement of the impact of diabetic foot ulcers on patients' QOL through self-administration of 64 items comprising 15 subscales. OBJECTIVE To develop and evaluate a short form of the DFS (DFS-SF) to reduce patient burden and the number of outcome measures, and to improve sensitivity to change in clinical condition. METHODS The DFS-SF was created through the analysis of data from a double-blind, placebo-controlled, randomised trial of the efficacy and safety of becaplermin (recombinant human platelet-derived growth factor BB) in the treatment of chronic, full-thickness, neuropathic, diabetic foot ulcers. Using these data, items demonstrating poor psychometric properties were eliminated. Exploratory factor analyses were then conducted to develop a new, more parsimonious scaling algorithm that optimised the internal consistency of the new subscales. Finally, data from two additional clinical trials were used to assess replicability of the DFS-SF subscale structure. RESULTS The DFS-SF contains a total of 29 items comprising six subscales. The results of both confirmatory and exploratory factor analyses provided support for the scaling algorithm. The DFS-SF subscales showed good internal consistency, reliability and construct validity, and demonstrated sensitivity to ulcer healing. CONCLUSIONS The results of this investigation indicate that the DFS-SF has good psychometric properties and replicability.
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Affiliation(s)
- Carla M Bann
- Statistics Research Division, RTI International, Research Triangle Park, North Carolina 27709-2194, USA.
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Affiliation(s)
- JUDYANN BIGBY
- Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
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