A consultation dialogue tool helps address psychological aspects of diabetes

Deficiencies in postgraduate training for healthcare professionals who provide diabetes education and support: results from the Diabetes Attitudes, Wishes and Needs (DAWN2) study

AIMS

To consider the global provision of self-management diabetes education and training for healthcare professionals using data from the second Diabetes Attitudes, Wishes and Needs (DAWN2) study.

METHODS

A total of 4785 healthcare professionals caring for people with diabetes were surveyed in 17 countries to assess diabetes healthcare provision, self-management support and training.

RESULTS

Of the healthcare professionals surveyed, 33.5% received formal postgraduate training in self-management (19.3-51.4% across countries) and 62.9% received training for medical management of diabetes (47.6-70.6% variation). Training in psychological management was low (19.1%), ranging from 3.6 to 36.5%, while 20.4% (a range of 3.6-36.4% across countries) had received no postgraduate training. Overall, the greatest training need was in the management of psychological aspects of diabetes (59.5%). For some, training in a domain was positively associated with a perceived need for further training. Communication skills, for example, listening (76.9%) and encouraging questions (76.1%), were the skills most widely used. Discussion of emotional issues was limited; 31-60% of healthcare professionals across the different countries reported that this only occurred if initiated by patients. Approximately two-thirds of participants reported a need for major improvements in emotional/psychological support, but few had received training in this area, with consistent findings across professional affiliations.

CONCLUSIONS

The present study shows that healthcare professionals report being insufficiently equipped to provide diabetes self-management education, including emotional and psychological aspects of diabetes, and many are not receiving postgraduate training in any part (including medical care) of the management of diabetes. It is paramount that those responsible for the continuing professional development of healthcare professionals address this skills gap.

Clinical and sociodemographic variables associated with diabetes-related distress in patients with type 2 diabetes mellitus

Objective:

To evaluate the relation between diabetes-related distress and the clinical and sociodemographic characteristics of type 2 diabetes mellitus patients.

Methods:

A cross-sectional study based on a secondary analysis of data collected at a specialized care outpatient center in Brazil. Participants completed a questionnaire on sociodemographic and clinical characteristics and the Brazilian version of the Diabetes Distress Scale (B-DDS).

Results:

About 31% of the 130 eligible patients reported diabetes distress, and the mean B-DDS score was 2.6. Multiple regression analysis showed the B-DDS score was positively correlated with marital status (p=0.0230), use of diet and physical activities for diabetes management (p=0.0180), and use of insulin therapy (p=0.0030). The "emotional burden", "regimen-related distress", and "interpersonal distress" domains from B-DDS were associated with the use of insulin therapy (p=0.0010), marital status (p=0.0110), and the presence of three or more comorbidities (p=0.0175).

Conclusion:

These findings suggest the clinical and sociodemographic variables are relatively weak predictors of diabetes-related distress. The highest scores in the B-DDS were observed in the emotional burden domain, indicating the presence of diabetes distress among the participants of the study.

Objetivo:

Avaliar a relação entre o estresse relacionado ao diabetes e as características clínicas e sociodemográficas de pacientes com diabetes mellitus do tipo 2.

Métodos:

Estudo transversal com base na análise secundária de dados coletados em um ambulatório de atendimento terciário no Brasil. Os participantes preencheram um questionário sobre as características sociodemográficas e clínicas, e a versão brasileira da Diabetes Distress Scale (B-DDS).

Resultados:

Aproximadamente 31% dos 130 pacientes elegíveis relataram estresse relacionado ao diabetes, e a média do escore da B-DDS foi de 2,6. O modelo de regressão múltipla mostrou que a pontuação B-DDS foi positivamente correlacionada com o estado civil (p=0,0230), realização de dieta e atividades físicas (p=0,0180), e uso de insulina (p=0,0030). Os domínios da B-DDS "carga emocional", "estresse relacionado ao regime terapêutico" e "estresse nas relações interpessoais" foram associados a uso de insulina (p=0,0010), estado civil (p=0,0110) e presença de três ou mais comorbidades (p=0,0175).

Conclusão:

Estes resultados sugerem que as variáveis clínicas e sociodemográficas são preditores relativamente fracos para o estresse relacionado ao diabetes. No domínio "carga emocional", foi observada a maior pontuação da B-DDS, indicando a presença do estresse relacionado ao diabetes entre os pacientes deste estudo.

Longitudinal relationship between diabetes-specific emotional distress and follow-up HbA1c in adults with Type 1 diabetes mellitus

AIM

To examine whether diabetes-specific emotional distress was related to follow-up glycaemic control in adults with Type 1 diabetes mellitus.

METHODS

Adults with Type 1 diabetes mellitus completed the Diabetes Distress Scale and reported sociodemographic information when attending a clinical consultation at a university endocrinology unit. Blood samples to determine baseline HbA1c were taken during consultations. All respondents' HbA1c measurements registered from January 2009 to December 2011 were collected from medical records. The relationship between baseline diabetes-specific emotional distress and HbA1c was examined with linear mixed-effects models in 175 patients with complete data.

RESULTS

After controlling for confounders, baseline diabetes-specific emotional distress and glycaemic control were significantly associated (fixed-effect coefficient 0.40, P < 0.001) and the regimen-related distress subscale had the strongest association with glycaemic control (fixed-effect coefficient 0.47, P < 0.001). The two-item measure of diabetes-specific distress had a weaker but still significant association with glycaemic control (fixed-effect coefficient 0.31, P < 0.001). None of these relationships was significant after adjusting for the baseline HbA1c .

CONCLUSIONS

People with elevated baseline diabetes-specific emotional distress are at risk of prolonged suboptimum glycaemic control; therefore, elevated diabetes-specific emotional distress, especially regimen-related distress, might be an important marker for prolonged suboptimum glycaemic control, and might indicate a need for special attention regarding patient self-management.