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Rodríguez-Muñoz A, Picón-César MJ, Tinahones FJ, Martínez-Montoro JI. Type 1 diabetes-related distress: Current implications in care. Eur J Intern Med 2024; 125:19-27. [PMID: 38609810 DOI: 10.1016/j.ejim.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024]
Abstract
Type 1 diabetes (T1D) is a complex chronic disease associated with major health and economic consequences, also involving important issues in the psychosocial sphere. In this regard, T1D-related distress, defined as the emotional burden of living with T1D, has emerged as a specific entity related to the disease. Diabetes distress (DD) is an overlooked but prevalent condition in people living with T1D, and has significant implications in both glycemic control and mental health in this population. Although overlapping symptoms may be found between DD and mental health disorders, specific approaches should be performed for the diagnosis of this problem. In recent years, different DD-targeted interventions have been postulated, including behavioral and psychosocial strategies. Moreover, new technologies in this field may be helpful to address DD in people living with T1D. In this article, we summarize the current knowledge on T1D-related distress, and we also discuss the current approaches and future perspectives in its management.
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Affiliation(s)
- Alba Rodríguez-Muñoz
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
| | - María José Picón-César
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain; Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco J Tinahones
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain; Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Faculty of Medicine, University of Málaga, Málaga, Spain
| | - José Ignacio Martínez-Montoro
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain; Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Faculty of Medicine, University of Málaga, Málaga, Spain.
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Fayyaz F, Mardi P, Sobhani S, Sokoty L, Aghamahdi F, Qorbani M. Association of quality of life with medication adherence and glycemic control in patients with type 1 diabetes. J Diabetes Metab Disord 2024; 23:783-788. [PMID: 38932841 PMCID: PMC11196443 DOI: 10.1007/s40200-023-01351-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/09/2023] [Indexed: 06/28/2024]
Abstract
Background and objectives Psychological factors and patients' health-related quality of life (HRQOL) affect the outcome of patients with type 1 diabetes mellitus (T1DM). In this study, we aimed to determine the HRQOL status in patients with T1DM and its association with glycemic control and medication adherence. Methods In this cross-sectional study, 227 T1DM patients were selected from the diabetes clinic, Imam Ali Hospital, Alborz University of Medical Sciences, and the Gabric database registry from 2020 to 2022. Demographic and diabetes characteristic checklist, medication adherence questionnaire (8-item Morisky Medication Adherence Scale (MMAS)), and QOL questionnaires (Short-Form-12 and PedsQL) were filled. Independent sample T-test was used to assess mean of QOL subscales with glycemic control and medication adherence. A logistic regression model was used to evaluate the association between glycemic control and medication adherence with QOl. Results Overall QOL scores in adults and children were 33.4 ± 7.1 based on Short-Form-12 and 76.2 ± 17.8 based on PedsQL, respectively. It was demonstrated that adults with Moderate/High adherence had higher QOL (p-value = 0.007). Likewise, Children with good glycemic control had higher psychosocial health scores (0.048). Logistic regression analysis did not reveal a significant association between adherence and QOL or Glycemic control and QOL in both adjusted and crude models. Conclusion Better glycemic control and medication adherence in children and adults, respectively, are related to the psychological aspects of QOL. We suggest that emotional intelligence, which is replaced by other predictors during adulthood, may contribute to glycemic control in children in the early years following diagnosis.
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Affiliation(s)
- Farimah Fayyaz
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Parham Mardi
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Sahar Sobhani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Leily Sokoty
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Fatemeh Aghamahdi
- Department of Pediatric Endocrinology and Metabolism, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
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Stephen DA, Nordin A, Johansson UB, Nilsson J. Psychosocial Self-efficacy and its Association with Selected Potential Factors Among Adults with Type 1 Diabetes: A Cross-Sectional Survey Study. Diabetes Ther 2024; 15:1361-1373. [PMID: 38642262 PMCID: PMC11096132 DOI: 10.1007/s13300-024-01581-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/27/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION The management of type 1 diabetes, a non-preventable chronic disease, leads to a high physical and psychological burden on the individual. Digital health technology can improve a person's psychosocial self-efficacy and thereby contribute to improved diabetes self-care. The aim of this study was to explore associations between psychosocial self-efficacy and demographic-, disease specific-, well-being as well as digital health technology (DHT) related factors among adults with type 1 diabetes. METHODS A primarily web-based cross sectional survey was conducted among adults with type 1 diabetes in Sweden (n = 301). Psychosocial self-efficacy was assessed using the Swedish version of the Diabetes Empowerment Scale, Swe-DES-23. The survey also contained questions related to demographic-, disease specific-, well-being as well as digital health technology related variables. RESULTS Higher well-being scores and lower HbA1c levels were associated with higher psychosocial self-efficacy in multiple linear regression analysis. In multivariate analysis, gender, body mass index, well-being scores, and HbA1c levels showed association with psychosocial self-efficacy. None of the DHT factors were found associated with psychosocial self-efficacy. CONCLUSIONS In this study, higher well-being score and lower self-reported HbA1c levels were associated with higher psychosocial self-efficacy in both univariate- and multivariate analysis and accounted for 30% of the variation in psychosocial self-efficacy in the regression model. Thus, measures to improve psychosocial self-efficacy in adults with type 1 diabetes may help maintain their psychological well-being and blood glucose control.
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Affiliation(s)
- Divya Anna Stephen
- Department of Health Science, Faculty for Health, Nature and Technology, Karlstad University, 65188, Karlstad, Sweden.
| | - Anna Nordin
- Department of Health Science, Faculty for Health, Nature and Technology, Karlstad University, 65188, Karlstad, Sweden
| | - Unn-Britt Johansson
- Department of Health Promoting Science, Sophiahemmet University, 11486, Stockholm, Sweden
| | - Jan Nilsson
- Department of Health Science, Faculty for Health, Nature and Technology, Karlstad University, 65188, Karlstad, Sweden
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, 2418, Elverum, Norway
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Pugh A, Ritholz MD, Beverly EA. Similarities and Differences in Diabetes Diagnosis Stories Among Adults With Type 1 or Type 2 Diabetes in Appalachian Ohio. Clin Diabetes 2024; 42:408-418. [PMID: 39015170 PMCID: PMC11247034 DOI: 10.2337/cd23-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
This qualitative study examined adults' recollections of their reactions to their diabetes diagnosis and explored the similarities and differences among those diagnosed with type 1 versus type 2 diabetes. Based on semistructured interviews, the authors identified three themes: 1) shared emotional reactions of fear, sadness, confusion, and worry; 2) perceived differences in expressing concerns for diabetes complications; and 3) differences in perceiving the diagnosis as a surprise versus an inevitability. How health care professionals (HCPs) deliver diabetes diagnoses may be crucial to individuals' acceptance of the condition and coping strategies. HCPs should consider assessing people's emotional reactions to their diagnosis.
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Affiliation(s)
- Andrew Pugh
- Ohio University, Athens, OH
- Ohio University Diabetes Institute, Athens, OH
| | - Marilyn D. Ritholz
- Behavioral Health, Joslin Diabetes Center, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Elizabeth A. Beverly
- Ohio University Diabetes Institute, Athens, OH
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
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Pecoli PFG, Rosa ADS, Gabbay MAL, Dib SA. Psycho-Behavioral Characteristics Perceived as Facilitators by Brazilian Adults with Type 1 Diabetes Mellitus in a Public Health Service. Healthcare (Basel) 2023; 11:2300. [PMID: 37628498 PMCID: PMC10454162 DOI: 10.3390/healthcare11162300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Type 1 diabetes imposes a complex and challenging routine on patients and caregivers. Therefore, considering individual experiences and personal facilitators to promote assertive interventions is crucial. However, no studies have addressed these perspectives in the Brazilian adult population. We aimed to identify psycho-behavioral characteristics perceived as facilitators for coping with the condition. We used a biographical method to conduct semi-structured, face-to-face, in-depth interviews for each participant. Transcripts were analyzed using inductive thematic analysis. Participants (n = 22) were aged 18-57 years (mean: 30.2; standard deviation (SD): 8.7), and the duration since diagnosis was approximately 20.6 years (SD: 4.6). A total of 12 (54.4%) were women, 13 (59.1%) used insulin pumps, 14 (63.6%) had at least a college degree, and 13 (59.1%) had HbA1C (glycated hemoglobin) levels above 58 mmol/mol (7.5%). Five major themes emerged: (1) peer learning, (2) ownership, (3) welcoming experiences, (4) equity, and (5) reframing the path (P.O.W.E.R.). All themes appeared in the lived experiences shared by participants with HbA1C levels below 58 mmol/mol (7.5%). Improved glycemic control can be achieved, and the challenges encountered in diabetes care within similar socioeconomic contexts can be addressed by an interdisciplinary care team that takes P.O.W.E.R. into consideration when providing person-centered care strategies.
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Affiliation(s)
| | | | - Mônica Andrade Lima Gabbay
- Diabetes and Endocrinology Center, Internal Medicine Department, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
| | - Sérgio Atala Dib
- Diabetes and Endocrinology Center, Internal Medicine Department, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
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Due-Christensen M, Bruun LD, Joensen LE, Norgaard O, Andersen TH. Psychosocial aspects and perspectives of adult-onset type 1 diabetes: A systematic scoping review. Diabet Med 2023; 40:e15073. [PMID: 36807612 DOI: 10.1111/dme.15073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/21/2022] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
AIM To map existing research on psychosocial aspects of adult-onset type 1 diabetes (T1D), including psychosocial health status, ways psychosocial aspects may affect management of T1D in everyday life, and interventions targeting management of adult-onset T1D. METHODS We conducted a systematic search in MEDLINE, EMBASE, CINAHL and PsycInfo. Search results were screened with predefined eligibility criteria, followed by data extraction of the included studies. Charted data were summarized in narrative and tabular form. RESULTS We included 10 reports describing nine studies from the 7302 identified in the search. All studies were conducted in Europe. Participant characteristics were missing in several studies. Five of the nine studies incorporated psychosocial aspects as the main aim of the study. Limited information on psychosocial aspects was available in the remaining studies. We identified three overarching themes related to psychosocial aspects: (1) the impact of the diagnosis on everyday life, (2) the influence of psychosocial health on metabolic levels and adaptation, and (3) provision of self-management support. CONCLUSIONS Research focussing on psychosocial aspects of the adult-onset population is scarce. Future research should involve participants across the adult life age span and from a wider geographical area. Sociodemographic information should be collected to explore different perspectives. Further exploration of suitable outcome measures considering adults' limited experience of living with the condition is needed. This would help to better understand how psychosocial aspects may affect management of T1D in everyday life and thus enable healthcare professionals to provide appropriate support to adults with new-onset T1D.
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Affiliation(s)
- Mette Due-Christensen
- Department of Health Promotion, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, Denmark
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - L D Bruun
- Danish Diabetes Knowledge Center, Department of Education, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - L E Joensen
- Department of Health Promotion, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - O Norgaard
- Danish Diabetes Knowledge Center, Department of Education, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - T H Andersen
- Danish Diabetes Knowledge Center, Department of Education, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
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Wang RH, Chen SY, Lee CM, Lu CH, Hsu HC. Resilience, self-efficacy and diabetes distress on self-management behaviours in patients newly diagnosed with type 2 diabetes: A moderated mediation analysis. J Adv Nurs 2023; 79:215-222. [PMID: 36317455 DOI: 10.1111/jan.15483] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/24/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
AIM To examine (1) the mediating role of self-efficacy between resilience and self-management behaviours and (2) the moderating role of diabetes distress on the relationship between self-efficacy and self-management behaviours in patients newly diagnosed with type 2 diabetes. DESIGN Cross-sectional design. METHODS Totally, 195 patients newly diagnosed with type 2 diabetes for more than 5 months but less than 18 months were recruited from three endocrine clinics in Taiwan through convenience sampling. Self-reported questionnaires including demographic and disease characteristics, resilience, self-efficacy and self-management behaviours were used to collect data from October 2020 to May 2021. Moderated mediation analysis was performed by Hayes's PROCESS macro. RESULT According to bootstrapping results, the indirect effect of resilience on self-management was significant, although the direct effect of resilience on self-management was not. Participants were categorized into with and without diabetes distress groups. The results of moderated mediation analysis indicated self-efficacy significantly correlated with self-management behaviours in participants without diabetes distress, although self-efficacy did not significantly correlate with self-management in participants with diabetes distress. CONCLUSION The association of resilience with self-management behaviours was fully mediated through self-efficacy with diabetes distress moderating the relationship between self-efficacy and self-management behaviours in patients newly diagnosed with type 2 diabetes. IMPACT Improving resilience could enhance self-efficacy leading to possible improvement in self-management behaviour, although improving self-efficacy might not benefit self-management behaviours for those with high levels of diabetes distress. Healthcare providers need to first assess and address the diabetes distress before intervening to improve self-efficacy to enhance self-management behaviours in patients newly diagnosed with type 2 diabetes. PATIENT OR PUBLIC CONTRIBUTION When designing this study, two patients newly diagnosed with diabetes were consulted about the importance of self-management behaviours for them personally.
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Affiliation(s)
- Ruey-Hsia Wang
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan.,National Pingtung University of Science and Technology, Kaohsiung City, Taiwan
| | - Shi-Yu Chen
- Tri-Service General Hospital, Taipei City, Taiwan
| | | | - Chieh-Hua Lu
- Tri-Service General Hospital, Taipei City, Taiwan
| | - Hui-Chun Hsu
- Lee's Endocrinology Clinic, Pingtung City, Taiwan
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Challenges of Caregivers Regarding Homecare to Type 1 Diabetic Children in Vhembe District, South Africa: A Qualitative Study Report. NURSING REPORTS 2022; 12:884-893. [PMID: 36412804 PMCID: PMC9680399 DOI: 10.3390/nursrep12040085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Worldwide, type 1 diabetes mellitus disease is a devastating health condition for both the diagnosed children and caregivers taking care of them. These challenges were drastically affecting caregivers in rendering the required homecare service for their patients. Caring for a child with diabetes mellitus often hurts the caregivers and other family members. Aim: This study aimed to explore the challenges experienced by caregivers during the provision of care to type 1 diabetic children. Setting: The study was conducted in selected health facility of Vhembe District, South Africa. Methods: A qualitative design that was both descriptive and exploratory was used. Non-probability purposive sampling was used to select the caregivers who were taking care of children with type 1 diabetes mellitus at their homes. Semi-structured interviews were conducted with 15 participants from the Vhembe district of Limpopo province. Results: Caregivers experienced various challenges related to re-admission, poor understanding of medication, low level of literacy, committed mistakes, poor adherence, and fear of giving an injection. Conclusion: It is imperative to educate the caregivers on the care of children with type 1 diabetes mellitus for them to be competent and knowledgeable in assisting their diabetic children at home.
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Pecoli PFG, Dib SA. Psychology at the heart of every diabetes care intervention. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:780-781. [PMID: 36394482 PMCID: PMC10118770 DOI: 10.20945/2359-3997000000575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Orben K, Ritholz MD, McCalla M, Beverly EA. Differences and similarities in the experience of living with diabetes distress: A qualitative study of adults with type 1 and type 2 diabetes. Diabet Med 2022; 39:e14919. [PMID: 35842933 DOI: 10.1111/dme.14919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/30/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Abstract
AIMS To explore the lived experiences of diabetes distress (DD) in adults with type 1 and type 2 diabetes, and to identify similarities and differences in these experiences. METHODS We conducted in-depth interviews with people with type 1 (n = 19) and type 2 diabetes (n = 29). We conducted thematic analysis using NVivo 12 software. RESULTS We identified three themes: (1) Experiencing Diabetes Distress as a Lack of Control - Similarities: All participants voiced a perceived lack of control with their glucose levels and other peoples' misconceptions about diabetes. Differences: Nearly all type 1 participants described a "lack of control" over emotional reactions to hypo- and hyperglycaemia as opposed to only one type 2 participant. (2) Experiencing Diabetes Distress as a Burden of Constant Management - Similarities: All participants emphasized the nonstop, relentless nature of diabetes management. Differences: type 1 participants described self-care as vital, with life-threatening consequences if not performed, while type 2 participants did not perceive such dangerous consequences. (3) Understanding the Value of Social Support in Diabetes Distress - Similarities: All participants acknowledged the importance of having others recognize the difficulties of living with diabetes. Differences: type 1 participants noted actual experiences where peers and health care professionals acknowledged that burden, whereas type 2 participants expressed a desire for this support that was not present in their lives. CONCLUSIONS Findings revealed subtle differences in perceptions of DD among adults with type 1 and type 2 diabetes, which suggest a need to tailor treatment for people with each type of diabetes.
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Affiliation(s)
- Kimberlee Orben
- School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Dublin, Ohio, USA
- The Graduate College, Translational Biomedical Sciences Program, Ohio University, Athens, Ohio, USA
| | - Marilyn D Ritholz
- Behavioral Health, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Monet McCalla
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
| | - Elizabeth A Beverly
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
- The Diabetes Institute, Ohio University, Athens, Ohio, USA
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11
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Nettleton JA, Burton AE, Povey RC. "No-one realises what we go through as Type 1s": A qualitative photo-elicitation study on coping with diabetes. Diabetes Res Clin Pract 2022; 187:109876. [PMID: 35439539 DOI: 10.1016/j.diabres.2022.109876] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/22/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022]
Abstract
AIMS Type 1 diabetes (T1D) has physical, emotional, and social consequences and little is known how adults cope with the condition long term. This research aimed to use a novel photo-elicitation technique to gain in-depth insight into the personal coping experiences of adults living with T1D. METHODS In-depth photo elicitation interviews were employed to collect data and transcripts were analysed using thematic analysis. RESULTS Participant-led data revealed an overarching theme of the relentlessness of the condition. Continuous self-management tasks infiltrated participants' lives and had a significant impact on coping experiences. A range of techniques and resources were used to cope including using alarms and reminders, diabetes technology, interpersonal relationships, supportive healthcare services and seeking a mind-body balance. CONCLUSIONS Technology shows promise for easing the burden of the condition, expert-led online support would be of benefit, and peer support should be prioritised within interventions for adults with T1D.
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Affiliation(s)
- J A Nettleton
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University
| | - A E Burton
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University.
| | - R C Povey
- Staffordshire Centre for Psychological Research, School of Health, Science and Wellbeing, Staffordshire University
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12
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Sharpe L, Michalowski M, Richmond B, Menzies RE, Shaw J. Fear of Progression in chronic illnesses other than cancer: A systematic review and meta-analysis of a transdiagnostic construct. Health Psychol Rev 2022; 17:301-320. [PMID: 35132937 DOI: 10.1080/17437199.2022.2039744] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fear of cancer recurrence (FCR) is the most common psychosocial issue amongst cancer survivors. However, fear of progression (FoP) has been studied outside of the cancer context. This review aimed to: (1) meta-synthesize qualitative studies of FoP in illnesses other than cancer; and (2) quantify the relationship between FoP and anxiety, depression, and quality of life (QoL) in non-cancer chronic illnesses. We identified 25 qualitative and 11 quantitative studies in a range of chronic illnesses. Participants described fears of progression and recurrence of their illness, including fears of dying, and fears of becoming a burden to family. Fears were often triggered by downward comparison (i.e. seeing people worse off than themselves). Participants coped in different ways, including by accepting the illness or seeking knowledge. Those for whom these fears caused distress reported hypervigilance to physical symptoms and avoidance. Distress, and seeking information, were associated with adherence. In quantitative analyses, FoP was moderately associated with QoL, and strongly associated with anxiety and depression. These results suggest that FoP in illnesses other than cancer is similar to FCR. FoP appears to be an important transdiagnostic construct associated with distress. Evidence-based FCR interventions could be adapted to better manage FoP in other illnesses.
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Affiliation(s)
- Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - M Michalowski
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - B Richmond
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - R E Menzies
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006
| | - J Shaw
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006.,Psycho-Oncology Co-operative Group (POCOG), The University of Sydney, NSW 2006
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Chatwin H, Broadley M, Hendrieckx C, Carlton J, Heller S, Amiel SA, de Galan BE, Hermanns N, Finke‐Groene K, Speight J, Pouwer F. Unmet support needs relating to hypoglycaemia among adults with type 1 diabetes: Results of a multi-country web-based qualitative study. Diabet Med 2022; 39:e14727. [PMID: 34668230 PMCID: PMC9298379 DOI: 10.1111/dme.14727] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Hypoglycaemic episodes and fear of hypoglycaemia can be burdensome for adults with type 1 diabetes. This study explored support needs relating to hypoglycaemia among adults with type 1 diabetes living in Denmark, Germany, the Netherlands and the United Kingdom. RESEARCH DESIGN AND METHODS Respondents participated in a web-based qualitative study involving four open-ended questions that asked what they wished other people understood about hypoglycaemia and what other people could do differently to support them with hypoglycaemia. Responses were analyzed using reflexive thematic analysis. RESULTS Participants were 219 adults with type 1 diabetes (mean ± SD age 39 ± 13 years; mean ± SD diabetes duration 20 ± 14 years). They described unmet needs relating to: (1) Clinical support, involving access to new diabetes technologies, training on hypoglycaemia prevention, personalised care and psychological support; (2) Practical support, involving family and friends better supporting them with hypoglycaemia management and prevention; (3) Education for other people, involving others becoming more informed about hypoglycaemia; and (4) An appreciation of the burden, involving others recognizing the experience and impact of episodes, and the burden of living with the risk of hypoglycaemia. CONCLUSIONS Adults with type 1 diabetes report several unmet support needs relating to hypoglycaemia. Service delivery should be person-centred and prioritise the individual's support needs. Clinical conversations are needed to identify the individual's support needs and develop tailored support plans. People with diabetes and their family members should be offered hypoglycaemia-specific education and training.
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Affiliation(s)
- Hannah Chatwin
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
| | - Melanie Broadley
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
| | - Christel Hendrieckx
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes VictoriaMelbourneVictoriaAustralia
| | - Jill Carlton
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Simon Heller
- Department of Oncology and MetabolismUniversity of SheffieldSheffieldUK
| | | | - Bastiaan E. de Galan
- Department of Internal MedicineRadboud University Medical CentreNijmegenThe Netherlands
- Department of Internal MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Norbert Hermanns
- Research Institute Diabetes Academy MergentheimBad MergentheimGermany
| | | | - Jane Speight
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes VictoriaMelbourneVictoriaAustralia
| | - Frans Pouwer
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- Steno Diabetes Center OdenseOdenseDenmark
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Due-Christensen M, Joensen LE, Sarre S, Romanczuk E, Wad JL, Forde R, Robert G, Willaing I, Forbes A. A co-design study to develop supportive interventions to improve psychological and social adaptation among adults with new-onset type 1 diabetes in Denmark and the UK. BMJ Open 2021; 11:e051430. [PMID: 34728449 PMCID: PMC8565545 DOI: 10.1136/bmjopen-2021-051430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To develop supportive interventions for adults with new-onset type 1 diabetes (T1D) to facilitate positive adaptive strategies during their transition into a life with diabetes. DESIGN The study used a co-design approach informed by Design Thinking to stimulate participants' reflections on their experiences of current care and generate ideas for new supportive interventions. Visual illustrations were used to depict support needs and challenges. Initial discussions of these needs and challenges were facilitated by researchers and people with diabetes in workshops. Data comprising transcribed audio recordings of the workshop discussions and materials generated during the workshops were analysed thematically. SETTINGS Specialised diabetes centres in Denmark and the United Kingdom. PARTICIPANTS Adults with new-onset T1D (n=24) and healthcare professionals (HCPs) (n=56) participated in six parallel workshops followed by four joint workshops with adults (n=29) and HCPs (n=24) together. RESULTS The common solution prioritised by both adults with new-onset T1D and HCP participants was the development of an integrated model of care addressing the psychological and social elements of the diagnosis, alongside information on diabetes self-management. Participants also indicated a need to develop the organisation, provision and content of care, along with the skills HCPs need to optimally deliver that care. The co-designed interventions included three visual conversation tools that could be used flexibly in the care of adults with new-onset T1D to support physical, psychological and social adaptation to T1D. CONCLUSION This co-design study has identified the care priorities for adults who develop T1D, along with some practical conversational tools that may help guide HCPs in attending to the disruptive experience of the diagnosis and support adults in adjusting into a life with diabetes.
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Affiliation(s)
- Mette Due-Christensen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Lene Eide Joensen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Sophie Sarre
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Ewa Romanczuk
- Steno Diabetes Center Odense, Odense Universitetshospital, Odense, Denmark
| | - Julie Lindberg Wad
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Rita Forde
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Ingrid Willaing
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Clever SN, Baulig S, Benecke A. Psychologische Herausforderungen bei Erwachsenen mit Typ-1-Diabetes. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1338-4332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungMenschen mit Typ-1-Diabetes müssen immer wieder verschiedene Anpassungsleistungen erbringen, um ihre Erkrankung und deren Therapie in den Alltag integrieren zu können. Gelingt dies nicht, können daraus Probleme beim Selbstmanagement der Krankheit resultieren. Doch trotz strukturierter Schulungsprogramme und leitliniengerechter, individuell zugeschnittener Therapieempfehlungen leben einige Menschen mit Typ-1-Diabetes mit chronisch erhöhten Blutzuckerwerten. Dabei scheint der Diabetes-Distress als Reaktion auf die erlebten Herausforderungen eine wichtige Rolle zu spielen und im Zusammenhang mit Problemen bei der glykämischen Kontrolle wie auch einer Therapievermeidung zu stehen. Um eine Chronifizierung des Diabetes-Distress zu verhindern, empfiehlt es sich daher, ein Screening auf diabetesbezogene Belastungen in der Versorgung von Menschen mit Typ-1-Diabetes zu etablieren. Dies kann mittels Fragebogen oder der Thematisierung im persönlichen Gespräch geschehen. Diabetesspezifische psychologische Interventionen können sowohl die diabetesbezogene emotionale Belastung als auch die glykämische Kontrolle verbessern, sind jedoch in Deutschland noch nicht in der Regelversorgung verfügbar.
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Affiliation(s)
- Susan Norah Clever
- Psychotherapiepraxis, Diabetespraxis Blankenese, Hamburg, Germany
- CEO, Medical Psychology Consultancy, Hamburg, Germany
| | - Susanne Baulig
- Poliklinische Institutsambulanz für Psychotherapie, Johannes-Gutenberg-Universität Mainz, Germany
| | - Andrea Benecke
- Poliklinische Institutsambulanz für Psychotherapie, Johannes-Gutenberg-Universität Mainz, Germany
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16
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Chatwin H, Broadley M, Valdersdorf Jensen M, Hendrieckx C, Carlton J, Heller S, Amiel S, de Galan B, Hermanns N, Finke-Groene K, Speight J, Pouwer F. 'Never again will I be carefree': a qualitative study of the impact of hypoglycemia on quality of life among adults with type 1 diabetes. BMJ Open Diabetes Res Care 2021; 9:e002322. [PMID: 34400465 PMCID: PMC8370551 DOI: 10.1136/bmjdrc-2021-002322] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/17/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Achieving glycemic targets and optimizing quality of life (QoL) are important goals of type 1 diabetes care. Hypoglycemia is a common barrier to achieving targets and can be associated with significant distress. However, the impact of hypoglycemia on QoL is not fully understood. The aim of this study was to explore how adults with type 1 diabetes are impacted by hypoglycemia in areas of life that are important to their overall QoL. RESEARCH DESIGN AND METHODS Participants responded to a web-based qualitative survey involving a novel 'Wheel of Life' activity. Responses were analyzed using reflexive thematic analysis. RESULTS The final sample included 219 adults with type 1 diabetes from Denmark, Germany, the Netherlands, and the UK. They had a mean±SD age of 39±13 years and diabetes duration of 20±14 years. Participants identified eight areas of life important to their overall QoL, including relationships and social life, work and studies, leisure and physical activity, everyday life, sleep, sex life, physical health, and mental health. Participants reported emotional, behavioral, cognitive, and social impacts of hypoglycemia within domains. Across domains, participants described interruptions, limited participation in activities, exhaustion, fear of hypoglycemia, compensatory strategies to prevent hypoglycemia, and reduced spontaneity. CONCLUSIONS The findings emphasize the profound impact of hypoglycemia on QoL and diabetes self-care behaviors. Diabetes services should be aware of and address the burden of hypoglycemia to provide person-centered care. Clinicians could ask individuals how hypoglycemia affects important areas of their lives to better understand the personal impact and develop tailored management plans.
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Affiliation(s)
- Hannah Chatwin
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Jill Carlton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Bastiaan de Galan
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | | | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Research Unit, Steno Diabetes Center Odense, Odense, Denmark
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17
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Akyirem S, Forbes A, Wad JL, Due-Christensen M. Psychosocial interventions for adults with newly diagnosed chronic disease: A systematic review. J Health Psychol 2021; 27:1753-1782. [PMID: 33586486 PMCID: PMC9092922 DOI: 10.1177/1359105321995916] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
While the need for psychosocial interventions in the early formative period of
chronic disease diagnosis is widely acknowledged, little is known about the
currently available interventions and what they entail. This review sought to
collate existing interventions to synthesize their active ingredients. A
systematic search on five electronic databases yielded 2910 records, 12 of which
were eligible for this review. Evidence synthesis revealed three broad
categories of interventions which used at least two out of eight active
techniques. Future studies should adhere to known frameworks for intervention
development, and focus on developing core outcome measures to enhance evidence
synthesis
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Affiliation(s)
- Samuel Akyirem
- King's College London, UK.,SDA Nursing and Midwifery Training College, Asanta, Ghana
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18
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van Duinkerken E, Snoek FJ, de Wit M. The cognitive and psychological effects of living with type 1 diabetes: a narrative review. Diabet Med 2020; 37:555-563. [PMID: 31850538 PMCID: PMC7154747 DOI: 10.1111/dme.14216] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2019] [Indexed: 01/09/2023]
Abstract
Across the lifespan, type 1 diabetes mellitus has a profound (neuro)psychological impact. In young people, type 1 diabetes can interfere with psychosocial development and hamper school performance. In adulthood, it can interfere with work life, relationships and parenting. A substantial minority of adults with type 1 diabetes experience coping difficulties and high diabetes-related distress. In youth and adulthood, type 1 diabetes is related to mild cognitive decrements as well as affective disorders, such as depression and anxiety. There is limited literature available that explores the interaction between cognitive and psychological comorbidity and underlying mechanisms. The aims of the present narrative review were to summarize the current state of the literature regarding both cognitive and psychological comorbidities in type 1 diabetes across the lifespan, and to explore potential links between the two domains of interest to make suggestions for future research and clinical practice.
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Affiliation(s)
- E. van Duinkerken
- Epilepsy CentreInstituto Estadual do Cérebro Paulo NiemeyerRio de JaneiroRJBrazil
- Department of Medical PsychologyAmsterdam University Medical CentresVrije UniveristeitAmsterdamThe Netherlands
- Amsterdam Diabetes Centre/Department of Internal MedicineAmsterdam University Medical CentresVrije UniveristeitAmsterdamThe Netherlands
| | - F. J. Snoek
- Department of Medical PsychologyAmsterdam University Medical CentresVrije UniveristeitAmsterdamThe Netherlands
| | - M. de Wit
- Department of Medical PsychologyAmsterdam University Medical CentresVrije UniveristeitAmsterdamThe Netherlands
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